Current News in Cardiology (eBook)

Preface 5
Table of Contents 7
List of Contributors 14
ATRIAL FIBRILLATION AND ATRIAL FLUTTER 17
Anti-arrhythmic Drugs in Atrial Fibrillation: Historical Perspectives and New Developments 18
Introduction 18
Rhythm Control or Rate Control and Anticoagulation 21
Discussion 22
References 23
“Pill-in-the-Pocket” Approach 25
References 29
Lone Atrial Fibrillation: Prophylactic Anti-arrhythmic Treatment 31
Introduction 31
Defining the Risk of Proarrhythmic Events 32
Types of Proarrhythmia 32
What Is the True Incidence of Proarrhythmia in Atrial Fibrillation? 34
Which Drugs Maintain Sinus Rhythm in Lone Atrial Fibrillation? 34
Out-of-Hospital Administration of Anti-arrhythmic Drugs 35
References 35
Radiofrequency Ablation of Atrial Fibrillation and Atrial Flutter: Who and When? 37
Introduction 37
Catheter Ablation of Atrial Flutter 37
Catheter Ablation of Atrial Fibrillation 38
Conclusions 40
References 40
Cryocatheter Ablation for Atrial Flutter 42
Overview of Atrial Flutter 42
Management of Patients with AFl 42
Conclusions 47
References 51
Clinical Profile, Electrophysiological Characteristics, and Outcome after Radiofrequency Catheter Ablation of Atypical Atrial Flutter 54
Suggested Reading 55
The Impact of New Imaging, Mapping and Energy Delivery Technology on the Current Approach to Ablation of Atrial Fibrillation 56
Atrial Fibrillation 56
Ablation of Atrial Fibrillation 57
Technical Developments 57
Alternative Energy Sources 58
Stereotaxis 59
References 60
Trigger vs Substrate Ablation for the Treatment of Atrial Fibrillation 62
Introduction 62
Trigger-Based Ablation 62
Substrate-Based Ablation 63
The Need for Clinical Trials 66
References 67
Complications of Atrial Fibrillation Ablation: How To Prevent Them 69
Introduction 69
Cerebrovascular Events 70
Pulmonary Vein Stenosis 70
Cardiac Tamponade 70
Severe Vascular-Access Complications 71
References 73
Pacing in Atrial Fibrillation: Is It Still Viable? 74
Introduction 74
Physiopathologic Targets for Pacing in AF 74
Pacing-Mode Selection 75
Right Ventricular Pacing and Dyssynchrony: How Can It Be Avoided? 77
Special Tools for AF Prevention and Treatment 77
Ablate and Pace: Role of Cardiac Resynchronization Therapy 79
Conclusions 80
References 80
Traditional or Device Approach for the Management of Atrial Fibrillation in Patients with Heart Failure 85
Introduction 85
Pulmonary Vein Ablation 86
Atrioventricular Node Ablation and Pacemaker Implantation 87
Dual Implantable Cardioverter Defibrillator for Atrial Fibrillation 89
Cardiac Resynchronization Therapy 90
What Is the Best Approach to Drug-Refractory Atrial Fibrillation in HF Patients? 92
Conclusions 93
References 93
Conversion of Persistent Atrial Fibrillation to Sinus Rhythm by DC Shock: Is It Still in Use Two Years After AFFIRM? 97
References 100
Lone Atrial Fibrillation and Sports Activities 102
Introduction 102
Discussion 103
References 104
HEART FAILURE 107
Heart-Failure Management: Focus on Heart-Failure Practice Guidelines 108
Introduction 108
Management of Heart Failure 109
Nonpharmacological Interventions 110
Pharmacotherapy 111
Focus on Specialized Heart-Failure Clinics 116
Implantation of an ICD To Prevent Sudden Cardiac Death in Patients with Heart Failure 116
Cardiac Resynchronization Therapy 118
Future Directions 120
Conclusions 120
References 121
Determination of Left Ventricular Contractile Reserve by Dobutamine Stress Echocardiography To Predict the Response to CRT 123
Introduction 123
Methods 123
Results 124
Conclusions 124
Focus on Optimization of Cardiac Resynchronization Therapy Techniques 125
Introduction 125
Rationale for Optimization of CRT Parameters 125
Echocardiography 126
Hemodynamic Sensors 127
IEGM-Based Method 128
Conclusions 129
References 129
Evaluation of the Clinical State of Cardiac Resynchronization Therapy Patients by Continuous Heart- Failure Monitoring 131
Introduction 131
Tools To Detect Changes in Clinical Status (Symptoms or Clinical Parameters) 132
Tools To Communicate 133
Conclusions 133
References 134
Predicting Heart Failure Events in CRT Patients: Future Challenges 135
Background 135
Heart Rate Variability 136
Implantable Hemodynamic Sensor 137
Future Perspectives 140
Conclusions 141
References 141
Use of Fluid Accumulation Monitoring in HF Patients 143
Methods 144
Results 145
Discussion 146
References 147
SYNCOPE 148
Performing Carotid Sinus Massage 149
Introduction 149
Performing Carotid Sinus Massage 149
Recommendations According to the Guidelines on Syncope of the European Society of Cardiology 151
Diagnostic Value of Carotid Sinus Massage 152
Correlation between Carotid Sinus Massage and Spontaneous Syncope 153
References 154
Performing Tilt Testing and Physical Countermaneuvers Training 156
Introduction 156
Tilt-Table Testing 157
Physical Counterpressure Maneuvers 159
References 160
Implanting a Loop Recorder 162
Holter Monitoring in Syncope 162
External Loop Recorder in Syncope 163
Implantable Loop Recorder in Syncope 163
Diagnosis 165
ECG Monitoring in Syncope: Where in the Work-up? 165
References 165
SUDDEN DEATH 167
Noninvasive Sudden Death Risk Stratification: Heart Rate Variability and Turbulence, and QT Dynamicity 168
Heart-Rate Variability 168
Heart-Rate Turbulence 171
QT Dynamicity 174
References 176
Noninvasive Risk Stratification of Sudden Death: T- Wave Alternans 180
Introduction and Background 180
Guidelines and Recommendations 183
Focus on Risk Stratification 183
T-Wave Alternans 183
Conclusions 187
References 188
Risk Stratification for Sudden Death in Hypertrophic Cardiomyopathy 191
Risk factors 193
References 195
Managing Hypertrophic Cardiomyopathy: Screening in Young Subjects 196
Introduction 196
Patients and Methods 197
Discussion 199
References 201
The Prevention of Sudden Death: New Perspectives 203
Epidemiology and Etiology 203
Prevention of Sudden Death 205
Results from Secondary-Prevention Clinical Trials 206
Primary Prevention 207
Conclusions 209
References 209
Which Patient and when Should Receive an ICD? Evolving New Indications on the Horizon 212
Introduction 212
Patients with Coronary Artery Disease 213
References 216
Implantable Cardiac Defibrillators: Is Defibrillation Threshold Testing Still Necessary in all Patients? 217
Defibrillation Threshold at Implantation 217
DFT at Follow-up 222
Causes and Correction for High DFT at Implant or Follow-up 222
DFT in the Pediatric Patient 224
Conclusions 224
References 225
Current Practice in Italy of VF Testing at Implant: What Do We Know and Where Do We Go From Here? 227
What Do We Know? 227
Where Do We Go from Here? 231
References 232
How To Choose Between Single-Chamber and Dual-Chamber ICD 234
Introduction 234
SVT Discrimination 234
Hemodynamic Benefits 235
Atrial Fibrillation in ICD Patients 236
Conclusions 237
References 237
Which Patients Should Receive Dual Defibrillators? Results of DATAS 239
Introduction 239
How Does Dual-Chamber ICD Improve Outcome? 240
The DATAS Trial Design and Results 243
DATAS and Other Clinical Studies 245
Conclusions 246
References 246
Prevention of Sudden Death in Patients with Genetic Arrhythmias 249
Introduction 249
Channelopathies 249
Genetic Cardiomyopathies 252
Identification of Risk Factors in Genetic Arrhythmias 252
Behaviors That Can Prevent Sudden Death 254
Pharmacologic Prevention of Sudden Death 254
ICD Implantation To Prevent Sudden Death 254
References 255
Cost-Effectiveness of ICD Therapy in the Prevention of Sudden Death in CAD and/ or HF Patients 257
Introduction 257
ICD Cost-Effectiveness: the Evidence from Randomized Clinical Trials 258
ICDs and the Real World: the SEARCH-MI Registry 263
The Influence of Risk Stratification among Patients on the Cost- Effectiveness of ICDs 263
Conclusions 265
References 266
CARDIAC PACING 270
Hemodynamic Impact of Right Ventricular Pacing 271
Introduction 271
What Do We Expect from DDDR Pacing? 272
What Do We Really Get from DDDR Pacemakers? 272
What Is the Hemodynamic Impact of Acute Right Ventricular Apical Pacing? 273
What Is the Hemodynamic Impact of Chronic RV Apical Pacing? 280
How Should the Heart Be Paced? 280
Conclusions 283
References 283
Hemodynamics in Standard Cardiac Pacing 285
Early Experiences with Rate-Responsive Pacing 285
Heart Rate and Atrioventricular Synchrony 286
AV Block and Ventricular Pacing 287
Role of Optimal AV Interval During Pacing 287
Hemodynamic Consequences of Ventricular Asynchrony 289
The Role of Modern Physiological Sensors in Pacing Hemodynamics 290
References 292
Hemodynamic Assessment with an Implanted Pacing Device 295
Introduction 295
Cardiac Impedance as Volume Sensor 296
Hemodynamic Monitoring with TVI 298
References 299
Hemodynamic Optimization of Pacing Configuration in Bradyarrhythmias 301
Introduction 301
Hemodynamic Implications of Ventricular Pacing 302
Tailoring the Pacing System with TVI 303
Conclusions 305
References 306
Applications of TVI Sensing in Cardiac Stimulation 308
Introduction 308
The Transvalvular Impedance Sensor 308
Ejection Surveillance with TVI 309
Benefits and Limitations of Ejection Checking 312
References 313
The Ideal Pacemaker for Complete AV Block 315
Conclusions 318
References 319
The Ideal Pacemaker for Elderly Patients 321
Introduction 321
Trial and Study Results 322
Conclusions 325
References 326
ELECTROCARDIOGRAPHY 328
Update on ACC/ESC Criteria for Acute ST Elevation Myocardial Infarction 329
Introduction 329
Methods 330
Results 331
Discussion 332
References 333
ECG-MRI based Localization of Myocardial Infarction 334
Introduction 334
DE-MRI for Infarct Quantification 335
Recent Initiatives Regarding ECG Designation of Cardiac Walls 336
Validation of Infarct-Size Measures Based on the 12-Lead ECG 336
MRI as the Gold Standard for Refining Diagnostic ECG Criteria 339
References 339
Electrocardiographic Predictors of Arrhythmias In CCU Patients 342
Introduction 342
Ventricular Arrythmias 342
Supraventricular Arrythmias 346
Conclusions 347
References 347
The Routine ECG as a Marker of Sudden Cardiac Death 351
Introduction 351
Arrhythmogenic Right Ventricular Cardiomyopathy 352
Ventricular Pre-excitation 352
Primary Electrical Heart Diseases 353
Electrocardiographic Markers of Vulnerability to Arrhythmias 355
References 356
ACUTE CORONARY SYNDROMES 358
International Guidelines on Acute Coronary Syndrome: Practical Application and Current News in Cardiology 359
Introduction 359
Risk Stratification 359
Role of Guidelines in Clinical Practice 360
Registers 360
Is Prognosis Dependent on Hospital Complexity or Adhesion to Guidelines? 361
Drug Therapy 362
Is It Necessary To Shape Risk Stratification into Organizational Ability? 362
What Difficulties Arise in the Application of Guidelines? 363
What Can Be Expected from the Next Guidelines? 363
References 364
Is There a Limit to PTCA in Elderly Patients? 366
Introduction 366
Invasive Strategy 367
Antithrombotic Therapy 368
Drug-Eluting Stents 369
Technical Aspects 369
Conclusions 369
References 370
When Should Patients with Ischemic Mitral Regurgitation Undergo Cardiac Surgery? 373
Introduction 373
Evaluation of Ischemic Mitral Regurgitation 374
Indications for Cardiac Surgery 374
References 376
Minimally Invasive Techniques in Cardiac Surgery: An Opportunity for All Patients? 377
Introduction 377
Background 378
MICS Procedures: Techniques and Results 378
Benefits of Minimally Invasive Surgery and Patient Selection 381
Discussion 383
Conclusions 385
References 385
GLOBAL CARDIOVASCULAR RISK PREVENTION 387
Cardiovascular Risk Management: An Overview 388
Introduction 388
The Challenges of Effective Cardiovascular Risk Management 388
Barriers to Comprehensive Cardiovascular Risk Assessment and Management 389
Hypertension:“ A Gateway to Risk Factor Management” 390
The Way Forward 390
The Objective of CVD Prevention in Clinical Practice 391
Identifying Those at Risk 392
The Targets in CVD Prevention 394
Conclusions 396
References 396
Is Arterial Pressure Self-Measurement Better Than Ambulatory 24- Hour Pressure Monitoring? 398
Conclusions 402
References 404
Role of Angiotensin-Receptor Blockers in the Prevention of Cardiovascular Risk: Clinical Guidelines 405
Introduction 405
Current Evidence for the Prevention of Cardiovascular Risk with Angiotensin- Receptor Blockers 406
References 410
New Evidence about the Beneficial Effects of Angiotensin- Receptor Blockers on the Heart and the Kidney 413
Introduction 413
Effects on the Kidneys 414
Effects on the Heart 416
Conclusions 418
References 418
Lercanidipine, Enalapril, and Their Combination in the Treatment of Elderly Hypertensive Patients 421
Introduction 421
Aim 421
Methods 421
Results 422
Conclusions 423
References 424
Subject Index 425