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Cardiac implantable electronic devices (CIEDs) are essential for the management of a variety of cardiac conditions, including tachyarrhythmias, bradyarrhythmias, and medically refractory heart failure (HF). Recent advancements in CIED technology have led to innovative solutions that overcome shortcomings associated with traditional devices or address unmet needs. Leadless pacemakers, subcutaneous implantable cardioverter defibrillators (ICDs), and extravascular ICDs eliminate lead-related complications common with conventional pacemakers or ICDs. Conduction system pacing (His bundle pacing and left bundle branch pacing) is a more physiologic method of pacing and avoids the deleterious consequences associated with long-term right ventricular pacing. For HF-related devices, cardiac contractility modulation is an emerging therapy that bridges a gap for many patients ineligible for cardiac resynchronization therapy and has been shown to improve HF symptoms and decrease hospitalizations and mortality in select patients. Implantable pulmonary artery pressure monitors help guide HF management and reduce hospitalizations. Lastly, new phrenic nerve stimulating devices are being utilized to treat central sleep apnea, a common comorbidity associated with HF. While further long-term studies are still underway for many of these new technologies, it is anticipated that these devices will become indispensable therapeutics in the expanding cardiovascular armamentarium., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Background: It has been shown that a new tissue Doppler index, E/(E'×S'), including the ratio between early diastolic transmitral and mitral annular velocity (E/E'), and the systolic mitral annular velocity (S'), has a good accuracy to predict left ventricular filling pressure., Objectives: We investigated the value of E/(E'×S') to predict cardiac death in patients with heart failure., Methods: Echocardiography was performed in 339 consecutive hospitalized patients with heart failure, in sinus rhythm, after appropriate medical treatment, at discharge and after one month. Worsening of E/(E'×S') was defined as any increase of baseline value. The end point was cardiac death., Results: During the follow-up period (35.2 ± 8.8 months), cardiac death occurred in 51 patients (15%). The optimal cut-off value for the initial E/(E'×S') to predict cardiac death was 2.83 (76% sensitivity, 85% specificity). At discharge, 252 patients (74.3%) presented E/(E'×S') ≤ 2.83 (group I) and 87 (25.7%) presented E/(E'×S') > 2.83 (group II), respectively. Cardiac death was significantly higher in group II than in group I (38 deaths, 43.7% vs 13 deaths, 5.15%, p < 0.001). By multivariate Cox regression analysis, including variables that affected outcome in univariate analysis, E/(E'×S') at discharge was the best independent predictor of cardiac death (hazard ratio = 3.09, 95% confidence interval = 1.81-5.31, p = 0.001). Patients with E/(E'×S') > 2.83 at discharge and its worsening after one month presented the worst prognosis (all p < 0.05)., Conclusions: In patients with heart failure, the E/(E'×S') ratio is a powerful predictor of cardiac death, particularly if it is associated with its worsening.

Background: A new tissue Doppler index, E/(E'×S'), including the early diastolic transmitral/mitral annular velocity (E/E') ratio and systolic mitral annular velocity (S'), has a good accuracy in predicting left ventricular filling pressure., Aim: To investigate the value of E/(E'×S') measured at different sites of the mitral annulus to predict cardiac death in patientswith heart failure (HF)., Methods: Echocardiography was performed in 342 consecutive hospitalised patients with HF, in sinus rhythm, at hospital discharge and after one month. Velocities were determined at septal and lateral mitral annular sites, and average values obtained. E/(E'×S') worsening was defined as a value greater than the value determined at discharge. The end point was cardiac death., Results: During the follow-up period (35 ± 8.8 months), cardiac death occurred in 52 (15.2%) patients. Septal E/(E'×S') at hospital discharge presented the largest area under receiver operating characteristic (ROC) curve to predict cardiac death (0.85,95% CI 0.79-0.90, p < 0.001). A statistical comparison of the ROC curves demonstrated no significant differences between septal and average E/(E'×S') (p = 0.54), but the accuracy of septal E/(E'×S') was better compared to the other analysed echocardiographic parameters [E/(E'×S'), E/E', S', etc., all p < 0.05]. The optimal septal E/(E'×S') cut-off was 3.03 (75% sensitivity,83% specificity). Before discharge, 96 (28.1%) patients presented septal E/(E'×S') > 3.03. Cardiac death was significantly higher in patients with E/(E'×S') > 3.03 (39 deaths, 40.2% vs. 13 deaths, 5.3%, p < 0.001). Patients with septal E/(E'×S') > 3.03 at discharge and worsening after one month presented the worst prognosis in the overall population., Conclusions: Septal E/(E'×S') is a powerful predictor of cardiac death in patients with HF.

Background: Onset of atrial fibrillation (AF) in patients with heart failure (HF) is usually associated with a high occurrence of cardiovascular complications. E/(E'×S') ratio (E=early diastolic transmitral velocity, E'=early mitral annular diastolic velocity and S'=systolic mitral annulus velocity) has been shown to reflect left ventricular filling pressure., Objective: We investigate whether E/(E'×S') could be a predictor of new-onset AF in patients with HF., Methods: We analyzed 113 consecutive hospitalized patients with HF, in sinus rhythm, after appropriate medical treatment. Patients with histories of AF, inadequate echocardiographic images, congenital heart disease, paced rhythm, significant primary valvular disease, acute coronary syndrome, coronary revascularization during follow-up, severe pulmonary disease or renal failure were not included. E/(E'×S') was determined using the average of septal and lateral mitral annular velocities. The primary study end-point was the new-onset AF., Results: During the follow-up period (35.7±11.2 months), 33 patients (29.2%) developed AF. Mean E/(E'×S') was 3.09±1.12 in these patients, while it was 1.72±1.34 in the other patients (p<0.001). The optimal E/(E'×S') cut-off to predict new-onset AF was 2.2 (88% sensitivity, 77% specificity). There were 64 patients (56.6%) with E/(E'×S')<2.2 and 49 (43.4%) with E/(E'×S')>2.2. New-onset AF was higher in patients with E/(E'×S')>2.2 than in patients with E/(E'×S')<2.2 [29 (59.1%) versus 4 (6.2%), p<0.001]. On multivariate Cox analysis including the variables that predicted AF on univariate analysis, E/(E'×S') was the only independent predictor of new-onset AF (hazard ratio=2.26, 95% confidence interval=1.25-4.09, p=0.007)., Conclusion: In patients with HF, E/(E'×S') seems to be a good predictor of new-onset AF.

Dilated cardiomyopathy (DCM) represents a group of disorders affecting the structure and function of the heart muscle, leading to a high risk of heart failure and sudden cardiac death (SCD). DCM frequently involves an underlying genetic etiology. Genetic testing is valuable for risk stratification, treatment decisions, and family screening. Romanian population data on the genetic etiology of DCM are lacking. We aimed to investigate the genetic causes for DCM among Romanian adult patients at tertiary referral centers across the country. Clinical and genetic investigations were performed on adult patients presenting to tertiary hospitals in Romania. The genetic investigations used next-generation sequencing panels of disease-associated DCM genes. A total of 122 patients with DCM underwent genetic testing. The mean age at DCM diagnosis was 41.6 ± 12.4 years. The genetic investigations identified pathogenic or likely pathogenic variants in 50.8% of participants, while 25.4% had variants of unknown significance. Disease-causing variants in 15 genes were identified in people with DCM, with 31 previously unreported variants. Variants in TTN, LMNA, and DSP explained 75% of genetic causes for DCM. In total, 52.4% of patients had a family history of DCM/SCD. Left ventricular ejection fraction of <35% was observed in 41.9% of patients with disease-causing variants and 55% with negative or uncertain findings. Further genotype-phenotype correlations were explored in this study population. The substantial percentage (50.8%) of disease-causing variants identified in patients with DCM acknowledges the importance of genetic investigations. This study highlights the genetic landscape in genes associated with DCM in the Romanian population. [ABSTRACT FROM AUTHOR]

Background: Remote monitoring (RM) is becoming a standard of care for patients with cardiac resynchronization therapy (CRT). This technology combines the use of pacemakers or implantable cardioverterdefibrillators (ICD) and wireless communication to provide physicians with continuous, real-time information on the patient's cardiac activity. The purpose of the study was to evaluate if the remote monitoring technology in the follow-up CRT patients is feasible and safe. Methods: A total of nine patients were enrolled in the study, implanted with a CRT system with wireless transmission capabilities. Immediately after the procedure received the RM, were enrolled in the virtual clinic and instructed by the doctor how to use the device at home. Regular virtual transmissions were made automatically every 3 weeks, respecting optimal transmission conditions. The accumulation of fluid in the lungs, atrial or ventricular tachyarrhythmia together with system integrity automatically activate alerts. Results: One hundred and one transmissions were collected and analyzed from the virtual ward. Average follow-up was 7.7±4.8 months, longest follow-up was 18 months. None of the patients experienced complications during the study period, with three of them being follow-up solely through telemetric means by implanting physician. Treatment optimization was successfully conducted via phone consultations, when necessary, without any adverse events. Conclusions: The results of our study suggest that RM could be integrated into routine CRT management protocols, enhancing patients care and resource utilization. [ABSTRACT FROM AUTHOR]

Simple Summary: Acute myocardial infarction patients are at high risk for heart failure, even after successful revascularization therapy. We performed a study that aimed to identify early predictors of heart failure after myocardial infarction. The study included 244 patients discharged with a normal heart function after their first myocardial infarction. At the 2- year follow-up, we found that 186 (76%) showed an improvement in left ventricular function and 61 (24%) had a deterioration of the latter. Comparing the two groups, we found patients in the latter group were older, more often hypertensive, smokers, and had more severe clinical presentations of the acute myocardial infarction and more extensive coronary disease. A total of 19 patients (8%) had experienced hospitalizations for heart failure, 6% being from group I and 12 % from group II, and this difference was notable. We observed that the presence of heart failure at the admission for acute myocardial infarction and abnormal deformation patterns of the infarct-related myocardial segments detected by echocardiography accurately predicted the occurrence of heart failure during the next two years. The presence of these parameters might enable a better risk-stratification and initiation of an effective preventive therapy in acute myocardial infarction patients. (1) Acute myocardial infarction (AMI) patients are at risk of left ventricular (LV) remodeling and heart failure (HF), even after successful revascularization by percutaneous coronary intervention (PCI). We wanted to assess the independent predictors of these outcomes in AMI patients. (2) Methods: The study enrolled patients with a LVEF ≥50% after a successful PCI for their first AMI. After 24 months, patients were separated into two groups based on whether their LVEF remained ≥50% (group I), or decreased to <50% (group II). (3) Outcomes: 26% of the patients experienced a decrease in LVEF below 50%, 41% showed LV remodeling, and 8% had experienced HF hospitalizations. HF hospitalizations were significantly more frequent in group II patients (p < 0.0001). The Killip class at admission >2, infarct-related longitudinal strain ≤−12.5%, and the presence of LV remodeling were identified as independent predictors of HF hospitalizations. (4) Conclusions: About 26% of AMI patients with normal LV function after a successful PCI developed HF. More sensitive techniques are required that allow for a more efficient risk-stratification and preventive therapy to reduce LV remodeling and HF in AMI patients with LVEF ≥50% after a successful PCI. The detection of abnormal ventricular deformation patterns after PCI by speckle-tracking echocardiography might be a valuable method in this approach. [ABSTRACT FROM AUTHOR]

Since the prevalence of heart failure (HF) increases with age, HF is now one of the most common reasons for the hospitalization of elderly people. Although the treatment strategies and overall outcomes of HF patients have improved over time, hospitalization and mortality rates remain elevated, especially in developed countries where populations are aging. Therefore, this paper is intended to be a valuable multidisciplinary source of information for both doctors (cardiologists and general physicians) and pharmacists in order to decrease the morbidity and mortality of heart failure patients. We address several aspects regarding pharmacological treatment (including new approaches in HF treatment strategies [sacubitril/valsartan combination and sodium glucose co-transporter-2 inhibitors]), as well as the particularities of patients (age-induced changes and sex differences) and treatment (pharmacokinetic and pharmacodynamic changes in drugs; cardiorenal syndrome). The article also highlights several drugs and food supplements that may worsen the prognosis of HF patients and discusses some potential drug–drug interactions, their consequences and recommendations for health care providers, as well as the risks of adverse drug reactions and treatment discontinuation, as an interdisciplinary approach to treatment is essential for HF patients. [ABSTRACT FROM AUTHOR]

Right ventricular pacing is has deletorius effects due to left ventricular dysynchrony and remodelling and may result in heart failure. Over the last decade, His bundle pacing has emerged as the most physiologic form pacing. However, it has limitations, such as higher capture thresholds, lower R wave amplitudes, atrial oversensing, and increased risk for lead revisions from late threshold increase with subsequent premature battery depletion, which has prevented a wider adoption of this technique in routine clinical practice. Left bundle branch pacing has been developed as an alternative physiologic pacing strategy that overcomes most of His bundle pacing limitations. This article summarizes the current status of left bundle branch pacing. [ABSTRACT FROM AUTHOR]

Objectives - The European Cardiac Resynchronization Therapy Survey II is the second CRT survey of the Heart Failure Association and European Heart Rhythm Association designed to observe implantation and follow-up practices across European countries. These data allow, for the first time, a valuable insight on CRT implantation strategies for Romanian patients. Methods - A total of 214 patients undergoing CRT-P/CRT-D implantations in 7 Romanian implantation centers were included in the survey. A one-time online case report form including data on implantation indication and procedure was completed for each implantation attempt. Results - Romanian patients were younger than the other European patients (p<0.001), had more severe symptoms of heart failure, lower ejection fraction and wider QRS complexes. More than half of the patients had non-ischemic cardiomyopathy. Most of the patients were in sinus rhythm, with a median intrinsic QRS duration of 163±24 ms. Echocardiography was the imaging method most often used and the median left ventricular ejection fraction was 24.9±8%. In comparison with other European countries, CRT-D devices and multipolar ventricular leads were more rarely implanted (p<0.001). Conclusions - In Romania indications regarding CRT implantation follow the most recent ESC guidelines, but the ratio of CRT-D devices in Romania is lower than in the other European countries and patients with more severe heart failure receive CRT. CRT should be considered earlier in heart failure patients in order to improve outcome. [ABSTRACT FROM AUTHOR]

Recent data have demonstrated that a new tissue Doppler index, E/(E'×S'), index that includes the ratio between early diastolic transmitral and mitral annulus velocity (E/E'), as well as the systolic mitral annulus velocity (S'), has a good accuracy to predict cardiac death in patients with heart failure (HF). We analyzed the prognostic value of the E/(E'×S') ratio in patients with heart failure with reduced ejection fraction (HFrEF). Methods - Echocardiographic examination was performed in 166 patients hospitalized with the diagnosis of heart failure with reduced ejection fraction, before discharge as well as one month later. Worsening of E/(E'×S') was defined as a value greater than the previous value determined at discharge. The primary event consisted of cardiac death or hospital admission due to HF worsening. Results - During follow-up (34±8.8 months) cardiac events were recorded for 113 patients (68%). The optimal cut-off value for E/(E'×S') ratio was 1.96 with 84% sensitivity and 80% specificity. At discharge, 60 patients (36,2%) presented a value of the E/(E'×S') index =1.96 (group I) and 106 patients (63.8%) encountered a value of the E/(E'×S') index >1.96 (group II). The composite end point was significantly higher in group II than in group I (95 events, 89.6% versus 18 events, 30%, p<0.001). Patients with an E/(E'×S') ratio >1.96 at discharge and its worsening after one month presented the worst prognosis (p<0.05). Conclusions - In patients with with heart failure with reduced ejection fraction, a value of the E/(E'×S') index >1.96 at hospital discharge associated with its worsening after one month is an important predictor for future cardiac events. [ABSTRACT FROM AUTHOR]

Introduction -- Several studies evaluated left ventricular only pacing in patients with classical CRT with similar outcomes compared to biventricular pacing, but few data exist about CRT using bicameral devices with only 2 leads right atrium/left ventricle (RA/LV). Case report -- We present the case of a 42 y.o. male with idiopathic dilated cardiomyopathy, left bundle brunch block and symptoms of NYHA III class heart failure. Echocardiography showed severe global hypokinesia, EF 28 %, and mechanical dyssynchrony. With no evidence of ventricular arrhythmias and normal AV conduction, the patient had class I indication for CRT and was implanted with a bicameral pacemaker with only 2 leads RA/LV. At 3 months follow-up: echo examination showed important LV remodeling (EF 46%) and clinical improvement of NYHA class; same results were seen during the 5 years follow-up. This case report shows that bicameral pacemaker with only RA/LV leads may be considered an alternative to classic CRT in selected patients, as we showed in a recent small study. We hoped that future large multicenter studies can better assess indications, efficiency and advantages for CRT using dual chamber RA/LV pacing. [ABSTRACT FROM AUTHOR]