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Background: Catheter ablation (CA) is routinely used for the treatment of arrhythmias. Vascular complications are the most common complications during these procedures. Previous data reported that ultrasound (US)-guided puncture is a useful method to avoid vascular complications. We reported our experience using US-guided puncture in patients undergoing CA for arrhythmias., Methods: A total of 273 patients (mean age 57 ± 17 years; 58% male) were referred to our center for CA of arrhythmias from January 2016 to December 2019. All procedures were performed by expert operators, and US-guided vascular access was performed on all patients. Doppler sonography was performed the day after the procedure on all patients., Results: Eighty-four patients (31%) underwent atrioventricular nodal reentrant tachycardia ablation, 49 patients (18%) atrioventricular reentrant tachycardia ablation, 14 patients (5%) atrial tachycardia ablation, 25 patients (9%) atrial flutter ablation, 63 patients (23%) atrial fibrillation ablation, and 38 patients (14%) ventricular tachycardia ablation. Vascular pseudo-aneurysms and arteriovenous fistula were defined as major complications; furthermore, venous thrombosis and inguinal hematomas were as defined minor complications. The percentage of major vascular complications was 0.3% (1 arteriovenous fistula) and the percentage of minor vascular complications was 0.3% (1 venous thrombosis)., Discussion: Ultrasound-guided vascular puncture in patients undergoing CA is useful to improve procedural success and reduce complications., Competing Interests: Authors declare no conflict of interests for this article., (© 2022 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.)

We report the case of an incomplete diagnosis of chronic thromboembolic pulmonary hypertension, with relevant prognostic implications, missing the presence of a primary pulmonary artery angiosarcoma. After the late neoplasm diagnosis, the patient, treated for months with riociguat, was considered inoperable and died soon after. This case highlights the need to manage patients with suspected pulmonary arterial hypertension by expert referral centers with specific and multi-professional expertise (heart and thoracic imaging) in order to avoid incomplete or delayed diagnoses.

Background: The presence of viable stunned myocardium recovering after primary angioplasty is not easy to identify in the early phase of acute myocardial infarction (AMI) by noninvasive bed-side methods. We therefore aimed to assess whether a simple electrocardiogram parameter may be of help in identifying the presence of stunned viable myocardium recovering after reperfusion with primary angioplasty., Materials and Methods: A total of 14 consecutive patients with ST-elevation AMI (STEMI) were enrolled in the study and underwent QT duration assessment after admission: the difference between QT corrected (QTc) in the ischaemic areas and QTc values in nonischaemic areas was therefore calculated and compared with the presence and the extension of viable stunned myocardium, assessed by comparing akinetic/dyskinetic areas at admission echocardiography with akinetic/dyskinetic areas and extension of scar at 6-month cardiac magnetic resonance imaging (cMRI)., Results: In subjects with viable recovering myocardium, 75% had a QTc max > 440 ms (vs. 17%, P = 0·03); higher differential QTc values and smaller scar areas were found (33 ms vs. -17 ms, 14% vs. 27%, P = 0·03, 0·06 respectively). Differential QTc values > 0 were able to identify the presence of viable myocardium with an odds ratio of 35 (P < 0·05, sensitivity 88%, specificity 83%, positive predictive power 88%, negative predictive power of 83%). Differential QTc values were related to the extension of viable recovering myocardium (P < 0·001)., Conclusion: Viable myocardium recovering after primary angioplasty in STEMI may be predicted by the presence of increased QTc values in ischaemic areas in comparison with nonischaemic areas., (© 2016 Stichting European Society for Clinical Investigation Journal Foundation.)

Background: Tissue Doppler imaging (TDI) may be useful in identifying subjects at higher risk among patients with chronic heart failure (CHF). The clinical role of newly developed TDI parameters, however, still needs to be documented., Methods: A total of 287 consecutive patients with CHF enrolled in the Daunia Heart Failure Registry underwent echocardiography assessment and were followed prospectively for a median 255 (204-316) days. Conventional echocardiography and TDI parameters were calculated. We also quantified by TDI a combined index (EAS index) of diastolic and systolic performance E'/(A'xS') and assessed its possible additional prognostic role in combination with 'traditional' parameters such as left ventricular ejection fraction (LVEF) and myocardial performance index (MPI)., Results: Subjects readmitted for worsening HF were characterized by higher levels of EAS index (median 0·14 (95% C.I. 0·12-0·21) vs. 0·11 (0·10-0·12, P < 0·05)). Increased rates of rehospitalization were found in subjects with EAS index >median (0·115) (21% vs. 10%, P < 0·05); higher EAS index values predicted the incidence of readmissions for worsening HF during follow-up, even at multivariable analysis. The assessment of EAS index in addition to LVEF and MPI showed an adjunctive prognostic value (log-rank P < 0·001 and P < 0·05, respectively)., Conclusions: EAS index assessed by TDI may be helpful in predicting the risk of rehospitalizations in subjects with CHF. EAS index may represent an independent adjunctive tool for the risk stratification of patients with CHF in addition to 'traditional' tools such as LVEF or MPI., (© 2015 Stichting European Society for Clinical Investigation Journal Foundation.)

A 45-year-old woman was admitted to our cardiology department for palpitations and dyspnoea. She had previously been investigated by echocardiography several times, resulting in a diagnosis of hypertrophic cardiomyopathy. However, a congenitally corrected transposition of the great arteries was diagnosed by our echocardiographic examination. The patient underwent electrophysiological evaluation and the accessory pathway was successfully ablated by applying radiofrequency pulses. This case report identifies that in patients with congenitally corrected transposition of the great arteries the primary diagnosis by echocardiography can sometimes be missed and that these patients are increasingly liable to develop Congestive Heart Failure with advancing age. In order to avoid diagnostic mistakes, more widespread dissemination of information about this congenital heart defect is essential.