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Objectives We evaluated the diagnostic contribution and the therapeutic and prognostic implications of 3-dimensional electroanatomic mapping (EAM)-guided endomyocardial biopsy (EMB) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Background ARVC is a frequent cause of life-threatening ventricular arrhythmias and sudden death in young people. The value of current diagnostic criteria and the role of imaging techniques and EMB are still debated. Methods We studied 30 consecutive patients (17 male, mean age 43 ± 17 years) with a noninvasive diagnosis of ARVC according to current criteria. All patients underwent 3-dimensional EAM-guided EMB. Results Twenty-nine (97%) of 30 patients presented an abnormal voltage map. Histology and immunohistochemistry confirmed the diagnosis of ARVC in 15 patients, and showed active myocarditis according to Dallas criteria in the remaining 15 patients. Patients with ARVC were not distinguishable on the basis of clinical features, presence, and severity of structural and functional right ventricular abnormalities and 3-dimensional EAM findings. On the basis of clinical and histological features, a cardioverter-defibrillator was implanted in 13 patients with biopsy-proven ARVC and in 1 patient only with myocarditis. At a mean follow-up of 21 ± 8 months, 7 (47%) patients with ARVC experienced a recurrence of symptomatic sustained ventricular arrhythmias with appropriate defibrillator intervention in all cases. All patients with myocarditis remained asymptomatic and free from arrhythmic events. Conclusions Right ventricular myocarditis frequently mimics ARVC. Three-dimensional EAM-guided EMB is a safe and effective tool in differential diagnosis and in the selection of the most appropriate therapeutic strategy.

[Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] In August 2004, a 59-year-old woman received the diagnosis of idiopathic dilated cardiomyopathy on the basis of normal coronary angiography and magnetic resonance evidence of a hypokinetic, dilated, nonhypertrophic left

We evaluated the diagnostic contribution and the therapeutic and prognostic implications of 3-dimensional electroanatomic mapping (EAM)-guided endomyocardial biopsy (EMB) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).ARVC is a frequent cause of life-threatening ventricular arrhythmias and sudden death in young people. The value of current diagnostic criteria and the role of imaging techniques and EMB are still debated.We studied 30 consecutive patients (17 male, mean age 43 +/- 17 years) with a noninvasive diagnosis of ARVC according to current criteria. All patients underwent 3-dimensional EAM-guided EMB.Twenty-nine (97%) of 30 patients presented an abnormal voltage map. Histology and immunohistochemistry confirmed the diagnosis of ARVC in 15 patients, and showed active myocarditis according to Dallas criteria in the remaining 15 patients. Patients with ARVC were not distinguishable on the basis of clinical features, presence, and severity of structural and functional right ventricular abnormalities and 3-dimensional EAM findings. On the basis of clinical and histological features, a cardioverter-defibrillator was implanted in 13 patients with biopsy-proven ARVC and in 1 patient only with myocarditis. At a mean follow-up of 21 +/- 8 months, 7 (47%) patients with ARVC experienced a recurrence of symptomatic sustained ventricular arrhythmias with appropriate defibrillator intervention in all cases. All patients with myocarditis remained asymptomatic and free from arrhythmic events.Right ventricular myocarditis frequently mimics ARVC. Three-dimensional EAM-guided EMB is a safe and effective tool in differential diagnosis and in the selection of the most appropriate therapeutic strategy.

Background. The treatment of patients with angma pectoris refractory to medical therapy and unsuitable for revascularization procedures is a challenging problem in the modern cardiology but it is not well standardized yet. Previous large retrospective studies and small prospective studies suggested beneficial effects of spinal cord stimutation (SCS) in these patients. Method. We organized a Prospective Multicenter Italian Registry of SCS to evaluate the short and long term clinical outcome of patients undergoing SCS device implantation because of severe refractmy angina pectoris and the clinical effects of this form of therapy. Patients were followed-up with periodic medical visits in out-patient clinics. Results. Overall, 104 patients were enrolled in the Registry (70 men, age 67.&17 years), most of whom (83%) had 3.vessel coronary artery disease. Average follow-up was 13.2+7.9 months, ranging from 6 to 24 months. Overall, 17 patients (16.8%) died during the follow-up period, 8 (7.9%) of whom of cardtac death. Among clinical variables, only age was found to be significantly associated both with total mortality (p=O.O4) and cardiac mortality (P=O.O2) on Cox regression analysis. At the last follow-up, a significant improvement of angina1 symptoms (>50% reduction of weekly angina1 episodes, compared to baseline) was reported by 73.0% of patients, and the Canadian Cardiovacular Society class of angina was improved by ~1 class in 80.5% and by x2 classes in 42.3% of patients. A relevant reduction in the rate of hospital admission and days spent in the hospital because of angina (pcO.0001 for both) was also observed. No life-threatening or clinically serious events were observed as related to the SCS treatment. Conclusions. Our prospective data show that SCS can be performed safely and is associated with a sustained improvement of angina1 symptoms in a relevant number of patients with refractory stable angina pectoris. suggesting that it should be seriously taken into account for the treatment of these patients.

superoxide production (lucigenin chemiluminescence) and expression levels of cardiac autophagic markers and signaling proteins (Western blot) and hypertrophic genes (real time-PCR) were analyzed. Fructose-fed mice exhibited normal plasma insulin, but were glucose intolerant and hyperglycaemic. In the absence of obesityand hypertension-induced loading influences, elevated superoxide production (fructose, 553± 28 counts/s/mg vs. control, 489± 11 counts/s/mg, p< 0.05) and suppression of the PI3K/Akt cell survival pathway (decreased pAkt:Akt and pS6:S6 protein expression ratio) were observed in hearts of fructose-fed mice. Fructose feeding induced cardiac autophagy activation (LC3B-II:LC3B-I protein expression ratio, 46%increase), suggestiveofmyocyte loss. The high fructose diet decreased gene expression of cardiacgrowthmarkers ( -MHC:71%decrease,p< 0.05; BNP: 58% decrease, p< 0.05) despite no change in whole heart weight. The present study demonstrates that insulin resistance and hyperglycemia is associated with suppressed myocardial cell survival signaling and activated cardiac autophagy.Thesefindingshave important implications for the characterization of diabetic cardiomyopathy and further work is required to elucidate the precisemechanisms involved. doi:10.1016/j.hlc.2010.06.759