Explore the vast range of titles available.

Effective stroke prevention with oral anticoagulation (OAC) is the cornerstone of the management of patients with atrial fibrillation. The use of OAC reduces the risk of stroke and death. For most patients with atrial fibrillation without moderate or severe mitral valve stenosis or prosthetic mechanical heart valves, treatment options include vitamin K antagonists, such as warfarin, and non-vitamin K antagonist oral anticoagulants (NOACs). Although most guidelines generally recommend NOACs as the first-line OAC, caution is required in some groups of patients with atrial fibrillation at high risk of stroke and bleeding who have been under-represented or not studied in the randomized clinical trials on NOACs for stroke prevention. In addition to OAC, non-pharmacological, percutaneous therapies, including left atrial appendage occlusion, for stroke prevention have emerged, sometimes used in combination with catheter ablation for the treatment of the atrial fibrillation. High-risk groups of patients with atrial fibrillation include patients with end-stage renal failure (including those receiving dialysis), extremely old patients (such as those aged >80 years with multiple risk factors for bleeding), patients with dementia or those living in a long-term care home, patients with previous intracranial bleeding or recent acute bleeding (such as gastrointestinal bleeding), patients with acute ischaemic stroke and patients with an intracardiac thrombus. This Review provides an overview of stroke prevention strategies, including left atrial appendage occlusion, in patients with atrial fibrillation at high risk of stroke and bleeding.Effective stroke prevention with oral anticoagulation is a cornerstone of the management of patients with atrial fibrillation. Caution is required in patients with atrial fibrillation at high risk of stroke and bleeding. In this Review, Lip and colleague discuss strategies for reducing the risk of stroke in patients with atrial fibrillation.

Abbreviations 3D three‐dimensional AF atrial fibrillation AP accessory pathway ARVC arrhythmogenic right ventricular cardiomyopathy AT atrial tachycardia AVB atrioventricular block AVNRT atrioventricular nodal reentrant tachycardia AVRT atrioventricular reentrant tachycardia BBR bundle branch reentry BrS Brugada Syndrome CFAE complex fractionated atrial electrogram CHD congenital heart disease CPVT catecholaminergic polymorphic ventricular tachycardia CT computed tomography DSM dynamic substrate map EP electrophysiology EPS electrophysiology study ER early repolarization syndrome FTI force‐time integral ICD implantable cardioverter defibrillator ICE intracardiac echocardiography ICM ischemic cardiomyopathy IPAS inherited primary arrhythmias syndrome IVF idiopathic ventricular fibrillation LAVA local abnormal ventricular activity LBBB left bundle branch block LQTS long QT syndrome LV left ventricle MB moderator band MRI magnetic resonance imaging NCM noncontact mapping NICM nonischemic cardiomyopathy OT outflow tract PCCD progressive cardiac conduction disturbance PM papillary muscle PSI pixel signal intensity PV pulmonary vein PVC premature ventricular contraction PVI pulmonary vein isolation RBBB right bundle branch block RF radiofrequency RFCA radiofrequency catheter ablation RV right ventricle SQTS short QT syndrome SVT supraventricular tachycardia TEE transesophageal echocardiography VA ventricular arrhythmia VF ventricular fibrillation VT ventricular tachycardia PREAMBLE This document describes the use of three‐dimensional mapping systems and includes recommendations regarding their application in clinical practice based on scientific evidence. [...]their availability as well as reimbursement practice varies widely across different countries largely depending on the economic situation. The societies involved in the development of this document recognize the existence of these factors and the significant barriers that these may pose in everyday practice and on the decision to use or not use a three‐dimensional mapping system in a given patient. [...]in cases where these useful systems are not available or cannot be used in a wide scale due to financial constraints, electrophysiology procedures should certainly be offered to the patients based on established indications. Good catheter contact, correct interpretation of the colors in the map, appropriate choice of reference electrogram, complete mapping of the correct chamber of interest, and strategies to address catheter tip migration with respiration or change in cardiac rhythm and annotation of complex intracardiac signals are all necessary prerequisites for the success of ablation.

Background/Objectives: Trimethylamine N-oxide (TMAO) is implicated in the development of atherosclerosis and cardiovascular diseases. Preventive strategies must recognize the excessive consumption of products rich in choline, carnitine, and betaine, which are substrates essential for TMAO synthesis. The aim of this study was to develop and validate a dietary questionnaire to assess the consumption of these compounds and investigate the correlation with serum TMAO levels in a Central European population. Methods: A dietary questionnaire was designed based on a literature review identifying foods high in TMAO precursors. The tool was validated in a prospective study with 94 participants. The theoretical relevance and reliability of the tool were assessed using factor analysis and statistical indices. Reproducibility was evaluated in a subgroup of 10 participants who completed the questionnaire a second time 24 h later. The results of the questionnaire helped us to determine factors contributing to serum TMAO levels. Results: The final questionnaire consisted of 15 questions, providing acceptable data quality (KMO = 0.654). Three main dietary factors were detected: (1) the consumption of fish products and legumes (SS loadings = 1.72; 10.78% variance), (2) the consumption of cereal products and root vegetables (SS loadings = 1.61; 10.05% variance), and (3) the consumption of meat (SS loadings = 1.47; 9.22% variance). Conclusions: The validated questionnaire is a useful tool for assessing the intake of TMAO-promoting foods in post-myocardial infarction patients from Central Europe. It may support dietary risk assessment and nutritional counseling in clinical practice, particularly for secondary cardiovascular prevention.

Introduction: Iatrogenic atrial septal defect (iASD) resulting from MitraClip procedures may cause volume overload and deterioration of right ventricular (RV) function. The concurrent MitraClip procedure, along with an intervention to close iASD appears to yield a potentially favorable impact on the functioning of the right ventricle. Aim of the study: The study aims to evaluate the effect of iASD closure with an occluder immediately after the MitraClip procedure on RV function, pulmonary resistance, and right ventricle-pulmonary artery coupling (RV-PAc). Methods: The study group (ASDc) consisted of consecutive patients who underwent concomitant iASD closure with the Amplatzer occluder (n = 10). The control group (n = 9) comprised patients with iASD left untreated (CT group). RV assessment before MitraClip and during follow-up visits was based on transthoracic echocardiography (TTE). Results: In the CT group, fractional area change (FAC) increased from 33.3 ± 15.6% to 38.2 ± 14.0%; P = .28, and in the ASDc group, from 38.9 ± 11.6% to 40.4 ± 13.7%; P = .76. In the CT group, tricuspid annular plane systolic excursion (TAPSE) decreased from 19.2 ± 4.3 mm to 17.3 ± 3.8 mm; P = .47, and in the ASDc group from 19.1 ± 6.8 mm to 16.5 ± 6.1 mm; P = .04. In the entire group, right ventricular systolic pressure (RVSP) dropped from 52.7 ± 16.0 mmHg to 45.1 ± 8.1 mmHg; P = .01. The reduction in RVSP was 11 mmHg in the ASDc group versus 4 mmHg in the CT group (P = .35). Pulmonary vascular resistance (PVR) itself did not change significantly before and after the procedure. RV-PAc increased respectively by 36% and 9.75% from baseline values in the ASDc and CT groups. Conclusion: Closure of the iASD results in a greater reduction in RVSP but also TAPSE. RV-PAc, a parameter unaffected by RV preload, reveals notably improved hemodynamic conditions for RV performance after iASD closure.

Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes 3–15% of all acute myocardial infarctions. Women are more frequently diagnosed with MINOCA, although the influence of sex on long-term outcomes is still unclear. In this study we aimed to compare sex-based differences in baseline characteristics and clinical outcomes in patients with suspected MINOCA. We have retrospectively analyzed 6063 patients diagnosed with MINOCA (3220 females and 2843 male patients) from combined 3 large polish registries (PL-ACS, SILCARD and AMI-PL). Male patients were significantly younger (63 (55–74) vs. 71 (61–79) years, p  < 0.05) and less frequently diabetic (20.1% vs. 24.1%, p  < 0.05). Mortality was significantly higher in male population (11.8% vs. 10.2%, p  < 0.05 at 1 year and 17.6% vs. 15.0%, p  < 0.05 at 3 years). Male sex was an independent predictor of both mortality (HR = 1.29; CI 1.11–1.51; p  < 0.05) and myocardial infarction (HR = 1.39; CI 1.1–1.75, p  < 0.05) at 3 years follow-up. All-cause readmission rates were similar in male and female patients both at 1 year (46.0% vs. 44.4, p  = 0.2) and 3 years follow-up (56.4% vs. 56.5%, p  = 0.93). However, cardiovascular readmissions were more prevalent in male patients at both timepoints (33.9% vs. 29.10%, p  < 0.05 at 1 year, and 41.0% vs. 37.6%, p  < 0.05 at 3 years). This large-scale registry-based analysis demonstrated higher 3 years rates of adverse events, including death and MI among male patients with suspected MINOCA.

Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF), but the mechanism(s) by which DM affects AF prevalence remains unclear. This study aims to evaluate the impact of diabetes mellitus severity (expressed as its known duration), antihyperglycemic treatment regimen and glycaemic control on AF prevalence. From the representative sample of 3014 participants (mean age 77.5, 49.1% female) from the cross-sectional NOMED-AF study, 881 participants (mean age 77.6 ± 0.25, 46.4% female) with concomitant DM were involved in the analysis. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1 days. The mean DM duration was 12 ± 0.35 years, but no significant impact of DM timespan on AF prevalence was observed. No differences in the treatment pattern (oral medication vs insulin vs both oral + insulin) among the study population with and without AF were shown (p = 0.106). Metabolic control reflected by HbA1c levels showed no significant association with AF and silent AF prevalence (p = 0.635; p = 0.094). On multivariate analyses, age (Odds Ratio (OR) 1.35, 95%CI: 1.18–1.53, p < 0.001), p = 0.042), body mass index (BMI; OR 1.043, 95%CI: 1.01–1.08, p = 0.027) and LDL < 100 mg/dl (OR 0.64, 95%CI: 0.42–0.97, p = 0.037) were independent risk factors for AF prevalence, while age (OR 1.45, 95%CI: 1.20–1.75, p < 0.001), LDL < 100 mg/dl (OR 0.43, 95%CI 0.23–0.82, p = 0.011), use of statins (OR 0.51, 95%CI: 0.28–0.94, p = 0.031) and HbA1c ≤ 6.5 (OR 0.46, 95%CI: 0.25–0.85, p = 0.013) were associated with silent AF prevalence. Diabetes duration, diabetic treatment pattern or metabolic control per se did not significantly impact the prevalence of AF, including silent AF detected by prospective continuous monitoring. Independent predictors of AF were age, BMI and low LDL levels, with statins and HbA1c ≤ 6.5 being additional independent predictors for silent AF. Trial registration: NCT03243474.

Conduction system pacing (CSP), encompassing His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), revolutionizes cardiac pacing, allowing a more physiological left ventricular activation than conventional right ventricular (RV) pacing through electrode placed in RV apex, interventricular septum or right ventricular outflow tract. Echocardiography plays a pivotal role in patient assessment, primarily by measuring left ventricular ejection fraction (LVEF) to determine the pacing strategy in alignment with current guidelines. Clinical data, simulations and ongoing trials on CSP explore CSP viability across various LVEF conditions. CSP is supposed to defer pacing-induced cardiomyopathy (PiCM) associated with conventional right ventricular pacing (RVP). This paper aims to review the current literature regarding the use of echocardiography in CSP. Images from our experience in the echocardiographic lab were used throughout this document to show our proposals of imaging in CSP. Echocardiography may help to determine lead localization within the interventricular septum (IVS), customizing pacing to individual anatomy and electromechanical indices (like atro-ventricular delay) and evaluates often-overlooked valvular function, a potential PiCM contributor. Three-dimensional (3-D) echocardiography widens the knowledge of lead localization and valvular dysfunction, as well as dyssynchrony assessment. Dyssynchrony, crucial both to resynchronization per se and physiological stimulation is quantified via echocardiography, especially using speckle-tracking imaging. Baseline LVEF and follow-up observation of CSP effects: early in Global Longitudinal Strain (GLS), afterwards in LV volumes and LVEF may improve the future proper qualification of patients. Limited left atrial (LA) and right atrial (RA) strain assessments hold potential in the CSP qualification and response assessment context. Echocardiography complements other imaging modalities for comprehensive patient evaluation. Echocardiography is integral in the CSP clinical use, from patient selection (by showing subtle changes in myocardial function) to post-procedure follow-up (tricuspid regurgitation, LV and RV function, leads and synchrony assessment). GLS, assessed by speckle tracking imaging and profound 2D and 3D (lead placement, septum morphology and global heart function under CSP) analyses show promise in CSP outcome assessment, though standardization is needed. Graphical Abstract

Background Left atrial appendage closure (LAAC) procedures prevent cardioembolic stroke in patients with atrial fibrillation who have contraindications to oral anticoagulant medications. However, these procedures carry certain risks of peri-procedural complications. One such complication is silent brain infarcts (SBI), which can lead to cognitive impairment and mood disturbances. The implementation of mechanical neuroprotection systems during LAAC procedures may reduce the risk of SBI and associated cognitive and mood disorders. Methods The LAAC-SBI trial is a prospective, multicenter, randomized, and double-blind interventional study. The study aims to enroll a total of 240 patients, with 120 patients allocated to each group. The study group will evaluate the use of the Sentinel CPS during LAAC, while the control group will undergo LAAC procedures without the Sentinel CPS. The primary endpoint of the study is the number of new SBIs or stroke foci detected by diffusion-weighted magnetic resonance imaging (DW MRI). Secondary endpoints include deterioration of cognitive function, development of dementia syndrome, and occurrence of depressive disorders. These endpoints will be assessed using questionnaire tools such as the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Controlled Oral Word Association Test (COWAT), and Hospital Anxiety and Depression Scale (HADS). The observational period for patients in the study is 2 years. Discussion If the study demonstrates a favorable outcome with reduced incidence of SBI and improved cognitive and mood outcomes in patients receiving cerebral protection devices during LAAC, it will have significant implications for clinical management standards. This would support the use of neuroprotection devices not only for LAAC but also in procedures such as atrial fibrillation ablation or transcatheter mitral valve interventions, where the risk of embolic events and subsequent brain injury may also be present. Trial registration ClinicalTrials.gov NCT05369195. Registration on 11.05.2022.

Mild therapeutic hypothermia (MTH) is one of the treatment methods recommended in post-sudden cardiac arrest (SCA) patients who remain unconscious after cardiopulmonary resuscitation. The present study aimed at assessing the prognostic impact of intravascular MTH on invasively treated patients with an acute myocardial infarction complicated by SCA. The presented data were collected via a single-center retrospective analysis of the hospitalization and follow-up of 54 patients with post-myocardial infarction complicated by SCA. The patients were treated in the years 2014-2020 and the average follow-up period was 1141 ± 163 days. The population was divided into two groups: 28 patients treated with MTH (a therapeutic hypothermia [TH] group) and 26 patients treated without MTH (a non-TH group). The results indicate a trend toward improved in-hospital prognosis in the TH group, but the differences did not reach statistical significance: TH 25.0% vs. non-TH 34.5%, p = 0.554. An additional analysis of younger patients (under 60 years of age) revealed no significant differences between the TH and non-TH subgroups concerning in-hospital survival (in-hospital mortality rate: TH 6.7% vs. non-TH 30.0%, p = 0.267). Still, TH patients aged < 60 achieved a significantly better rate of follow-up survival (p = 0.041). The older (≥ 60) patient group showed no in-hospital mortality rate differences (TH 46.2% vs. non-TH 37.5%, p = 0.638). However, in-hospital bleeding frequency was significantly higher in patients aged ≥ 60 from the hypothermia group (TH 50.0% vs. non-TH 6.7%, p = 0.011). Intravascular MTH may improve the follow-up prognosis in patients aged < 60 with SCA in the early phase of myocardial infarction.

The clinical context of drug interactions detected by automated analysis systems is particularly important in older patients with multimorbidities. We aimed to provide unique, up-to-date data on the prevalence of potentially inappropriate medications (PIMs) and drug–drug interactions (DDIs) in the Polish geriatric population over 80 years old and determine the frequency and the most common PIMs involved in DDIs. We analyzed all non-prescription and prescription drugs in a representative national group of 178 home-dwelling adults over 80 years old with excessive polypharmacy (≥10 drugs). The FORTA List was used to assess PIMs, and the Lexicomp® Drug Interactions database was used for DDIs. DDIs were detected in 66.9% of the study group, whereas PIMs were detected in 94.4%. Verification of clinical indications for the use of substances involved in DDIs resulted in a reduction in the total number of DDIs by more than 1.5 times, as well as in a nearly 3-fold decrease in the number of interactions requiring therapy modification and drug combinations that should be strictly avoided. The most common PIMs involved in DDIs were painkillers, and drugs used in psychiatry and neurology. Special attention should be paid to DDIs with PIMs since they could increase their inappropriate character. The use of automated interaction analysis systems, while maintaining appropriate clinical criticism, can increase both chances for a good therapeutic effect and the safety of the elderly during treatment processes.