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Aims: This study was designed to assess the prognostic value of clinical and electrocardiographic parameters in Brugada syndrome (BrS).Methods and Results: The study population included 272 consecutive patients (82% males; mean age 43 ± 12 years), with either a spontaneous (n = 137, 50%) or drug-induced (n = 135, 50%) Type 1 Brugada electrocardiogram (ECG) pattern. The study combined endpoint included sudden cardiac death (SCD), cardiac arrest, and appropriate intervention of implantable cardioverter-defibrillator (ICD). A first-degree atrioventricular (AV) block (PR = 219 ± 17 ms) was documented at basal ECG in 45 patients (16.5%); 27 of these underwent an electrophysiological study with recording in 21 (78%) of an HV interval ≥55 ms (mean 61 ± 3 ms). Patients with first-degree AV block had a wider QRS complex (median 110 ms vs. 95 ms; P = 0.04) and more often showed a left anterior hemiblock pattern (n = 13, 29% vs. n = 35, 16%; P = 0.056). During a mean follow-up of 85 ± 55 months, 17 patients (6.3%) experienced ≥1 major arrhythmic events (appropriate ICD intervention, n = 13 and SCD, n = 4). At univariate analysis, the occurrence of major arrhythmic events was significantly associated with a history of syncope or cardiac arrest (P < 0.001), Type 1 ECG pattern (P = 0.04), and first-degree AV block (P < 0.001). Univariate and multivariable predictors of events included a history of syncope or cardiac arrest [hazard ratio (HR) 5.8, 95% confidence interval (95% CI) 2.04-16.5; P < 0.001; and HR 6.68, 95% CI 2.34-19.1; P < 0.001; respectively], a spontaneous Type 1 ECG pattern (HR 1.56, 95% CI 1.03-4.24; P = 0.033; and HR 1.84, 95% CI 1.01-4.29; P = 0.044; respectively) and a first-degree AV block at baseline ECG (HR 3.84, 95% CI 1.47-9.99; P = 0.006; and HR 4.65, 95% CI 2.34-19.1; P = 0.002; respectively).Conclusion: Besides a history of cardiac arrest or syncope, first-degree AV block on basal ECG is an independent predictor of malignant arrhythmic events and a stronger marker of arrhythmic risk than a spontaneous 'coved-type' ECG pattern in patients with BrS. [ABSTRACT FROM AUTHOR]

Abstract: We report a case of a 63‐year‐old man referred for lead extraction with the bidirectional rotational Evolution® RL mechanical sheath because of systemic infection. As it was judged a “high‐risk” procedure, we opted for a “hybrid,” minimally invasive approach consisting in a minithoracotomic access. This technique is a feasible approach, and it might be a potential safer alternative in the most challenging transvenous lead extraction procedures. [ABSTRACT FROM AUTHOR]

Our report demonstrates how Twiddler's syndrome associated with subclavian crush syndrome may result in a challenging transvenous lead extraction. Thus, it should be performed in centers with experience with the appropriate tools.

Aims: This study was designed to assess the prognostic value of clinical and electrocardiographic parameters in Brugada syndrome (BrS)., Methods and Results: The study population included 272 consecutive patients (82% males; mean age 43 ± 12 years), with either a spontaneous (n = 137, 50%) or drug-induced (n = 135, 50%) Type 1 Brugada electrocardiogram (ECG) pattern. The study combined endpoint included sudden cardiac death (SCD), cardiac arrest, and appropriate intervention of implantable cardioverter-defibrillator (ICD). A first-degree atrioventricular (AV) block (PR = 219 ± 17 ms) was documented at basal ECG in 45 patients (16.5%); 27 of these underwent an electrophysiological study with recording in 21 (78%) of an HV interval ≥55 ms (mean 61 ± 3 ms). Patients with first-degree AV block had a wider QRS complex (median 110 ms vs. 95 ms; P = 0.04) and more often showed a left anterior hemiblock pattern (n = 13, 29% vs. n = 35, 16%; P = 0.056). During a mean follow-up of 85 ± 55 months, 17 patients (6.3%) experienced ≥1 major arrhythmic events (appropriate ICD intervention, n = 13 and SCD, n = 4). At univariate analysis, the occurrence of major arrhythmic events was significantly associated with a history of syncope or cardiac arrest (P < 0.001), Type 1 ECG pattern (P = 0.04), and first-degree AV block (P < 0.001). Univariate and multivariable predictors of events included a history of syncope or cardiac arrest [hazard ratio (HR) 5.8, 95% confidence interval (95% CI) 2.04-16.5; P < 0.001; and HR 6.68, 95% CI 2.34-19.1; P < 0.001; respectively], a spontaneous Type 1 ECG pattern (HR 1.56, 95% CI 1.03-4.24; P = 0.033; and HR 1.84, 95% CI 1.01-4.29; P = 0.044; respectively) and a first-degree AV block at baseline ECG (HR 3.84, 95% CI 1.47-9.99; P = 0.006; and HR 4.65, 95% CI 2.34-19.1; P = 0.002; respectively)., Conclusion: Besides a history of cardiac arrest or syncope, first-degree AV block on basal ECG is an independent predictor of malignant arrhythmic events and a stronger marker of arrhythmic risk than a spontaneous 'coved-type' ECG pattern in patients with BrS.

The diagnosis of myocarditis is difficult because there is no pathognomonic clinical presentation and the disease may mimic other non-inflammatory diseases. Thus, current classifications on cardiomyopathies (e.g., the World Health Organization and the International Society and Federation of Cardiology [WHO/ISFC], the European Society of Cardiology [ESC], and the 2013 Expert Myocarditis ESC Task Force) define myocarditis as an inflammatory disease of the myocardium, which is diagnosed on endomyocardial biopsy (EMB) based upon histological, immunological, immunohistochemical and molecular tools. This will identify etiology, and differentiate between infectious, mainly viral, and non-infectious, immune-mediated forms. The term "inflammatory cardiomyopathy" may be applied in biopsy-proven myocarditis with associated left, right or biventricular dysfunction. Myocarditis may resolve spontaneously, relapse or become chronic progressing to dilated cardiomyopathy, death or heart transplantation. The 2013 Myocarditis ESC Task Force consensus document recommends consideration of EMB and selective coronary angiography in all patients with clinically suspected myocarditis according to the Task Force criteria. It is recommended that EMB analysis includes not only histology (Dallas criteria), but also immunohistology and detection of the genome of infectious agents by molecular tools. EMB should be performed by expert teams. The rationale for this diagnostic effort is the availability of a wide range of immunosuppressive or immunomodulatory agents that, as shown in systemic extracardiac autoimmune disease and in many clinical studies, can be used in infection-negative myocarditis patients to stop or at least stabilize chronic cardiac tissue damage mediated by the immune system, and thus prevent fibrosis and progression to irreversible end-stage dilated cardiomyopathy.