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This study examines how the market reacts to earnings surprises with different characteristics such as future earnings prospects and historical surprises embedded in the earnings announced. We also explore the effect of corporate governance on market reaction to earnings information disseminated through earnings announcements. The sample comprises of 1620 US firms for the period 2002–2016. Using a regression-based approach, the results reveal that the market reacts to earnings surprises, particularly, to their sign, magnitude, persistence, and the future earnings prospects. Moreover, these different characteristics of earnings surprises are more important for negative surprises than for positive surprises. Furthermore, we find evidence for the information transparency theory that earnings announcements are a relatively more important source of information for low-corporate-governance firms than for high-corporate-governance firms. Finally, historical earnings information is more relevant for low-corporate-governance firms, whereas prospective earnings information is more important for high-corporate-governance firms. This study contributes to the extant literature by revealing that the market does not only react to the magnitude/sign of the surprises but also to other additional characteristics of earnings surprises. The study also reveals that firm governance influences how the market reacts to earnings information announced. Consequently, managers should be mindful that strengthening corporate governance could improve investors' confidence in earnings announced. [ABSTRACT FROM AUTHOR]

Abstract Background Implantable cardioverter-defibrillator (ICD) is an effective therapy to reduce mortality in heart failure. When the ICD generator approaches the end of life, most of the patients undergo an elective generator replacement (GR) even if they no longer meet implantation criteria. Whether arrhythmic risk should be re-assessed at the time of GR is still an open question. The aim of our study was to assess, via a meta-analysis, the occurrence of appropriate ICD therapies after GR in patients stratified based on the presence/absence of ICD indication at the time of GR. Methods Via a systematic literature search for primary prevention studies (January 2000-Sectember 2018), 2976 studies were analyzed. 6 studies were lastly included. Patients were categorized into two groups: "with ICD indication" in case of LVEF≤35% at the time of GR and/or appropriate therapies during the first ICD life; "without ICD indication" in case of a LVEF>35% and no previous ICD therapies. Incidences of appropriate ICD therapies were computed as number of events per 100 person-year. Result We included 478 pts. (65%) with and 255 patients (35%) without persistent ICD indication. The incidence of appropriate therapies was 12.3/100-person-year in patients with vs. 3.4 in patients without persistent ICD indication (2.98 fold higher risk of ICD therapies). Conclusion Patients who no longer meet ICD implantation criteria at the time of GR present a significantly lower risk of appropriate ICD therapies after GR. The results of this study underline the importance of an arrhythmic risk re-stratification at the time of GR. Highlights • It is well acknowledged that implantable cardioverter-defibrillator (ICD) is an effective therapy for heart failure pts. • At the ICD's "end of life" most pts undergo generator replacement even if they do not longer meet ICD implantation criteria. • Pts were divided into 2 groups: with and without ICD implantation criteria at the time of generator replacement. • Pts with vs. without implantation criteria showed a significant higher risk of subsequent arrhythmias after ICD replacement. • This study underlines the importance of an arrhythmic risk re-stratification at the time of generator replacement. [ABSTRACT FROM AUTHOR]

Introduction Device related distress negatively affects the quality of life of cardiac device recipients mostly of women. A submammary approach has been proposed to reduce the physical impact of the implantation. Our aim was to assess the safety of this approach and to evaluate the patients' acceptance of the device. Methods We enrolled 42 patients who underwent a submammary device. The primary endpoint was the need for implant revision that was assessed in the study group compared with the overall control group of 72 standard cardiac device recipients (29 females and 43 males)and with the female group (29 females of controls). In the female population (42 women of the submammary group and 29 of controls) patients' acceptance was calculated with the Florida Patient Acceptance Survey (FPAS). Results The rate of implant revision was similar in the two groups and the revision-free survival was comparable with a median follow-up of about six years (Log rank test p = 0.949). Similar results were found when considering only the female population. Patients' acceptance was greater in the submammary group [total FPAS 85 (95%CI 83–86) vs 74.5 (95%CI 70.2–77.3) p < 0,001] and a strongly significant superiority of the submammary group was found regarding body image concerns [10 (95%CI 10–10) vs 8 (95%CI 8–8) p < 0.001) and device related distress [23 (95%CI 22–23) vs 1 (95%CI 1–1) p < 0.001]. Conclusions Submammary device implantation is safe and more accepted than standard approach. Our results should encourage cardiologists to suggest this approach to their patients for a better acceptance of the therapy [ABSTRACT FROM AUTHOR]

Background Accuracy in left atrial (LA) anatomical reconstruction is crucial to the safe and effective performance of catheter ablation of atrial fibrillation (AF). The aim of this study was to evaluate the accuracy of LA reconstruction performed with intracardiac echocardiography (ICE) as compared to fast anatomical mapping (FAM) both integrated in the CARTO mapping system (Biosense Webster, Diamond Bar, CA, USA). Methods A multislice computed tomography (MSCT) was preacquired from 29 patients with AF who underwent catheter ablation and 3D-LA geometry was reconstructed using both ICE and FAM separately. The accuracy of the LA anatomical definition was evaluated by comparing LA volumes, LA and pulmonary vein (PV) diameters obtained using ICE and FAM versus MSCT (gold standard). Results Anterior-posterior and superior-inferior LA diameters were shorter in ICE versus MSCT (32 ± 10 vs 46 ± 9 mm and 48 ± 7 vs 53 ± 7 mm, P < 0.01) but similar in FAM versus MSCT (45 ± 9 vs 46 ± 9 mm and 52 ± 10 vs 53 ± 7 mm). Latero-septal LA diameter was similar in ICE versus MSCT (63 ± 11 vs 63 ± 9 mm) but larger in FAM versus MSCT (69 ± 9 vs 63 ± 9 mm, P < 0.001). LA volume was lower in ICE versus MSCT (73 ± 30 mL vs 116 ± 45 mL, P < 0.0001) and slightly larger in FAM versus MSCT (132 ± 45 vs 116 ± 45 mL, P = 0.06). PV diameters were similar in FAM versus MSCT but significantly underestimated with ICE. Conclusions Overall accuracy in the LA and PV anatomical reconstruction was found to be superior with FAM compared to ICE-guided approach. ICE resulted in a significant underestimate of both LA and PV dimensions, while FAM slightly overestimated LA geometry. [ABSTRACT FROM AUTHOR]

Objectives: The study assessed whether heart rate (HR) reduction following an exercise stress test (ExStrT), an easily quantifiable marker of vagal reflexes, might identify high- and low-risk long QT syndrome (LQTS) type 1 (LQT1) patients. Background: Identification of LQTS patients more likely to be symptomatic remains elusive. We have previously shown that depressed baroreflex sensitivity, an established marker of reduced vagal reflexes, predicts low probability of symptoms among LQT1. Methods: We studied 169 LQTS genotype-positive patients < 50 years of age who performed an ExStrT with the same protocol, on and off β-blockers including 47 South African LQT1 patients all harboring the KCNQ1-A341V mutation and 122 Italian LQTS patients with impaired (IKs–, 66 LQT1) or normal (IKs +, 50 LQT2 and 6 LQT3) IKs current. Results: Despite similar maximal HR and workload, by the first minute after cessation of exercise the symptomatic patients in both IKs– groups had a greater HR reduction compared with the asymptomatic (19 ± 7 beats/min vs. 13 ± 5 beats/min and 27 ± 10 beats/min vs. 20 ± 8 beats/min, both p = 0.009). By contrast, there was no difference between the IKs+ symptomatic and asymptomatic patients (23 ± 9 beats/min vs. 26 ± 9 beats/min, p = 0.47). LQT1 patients in the upper tertile for HR reduction had a higher risk of being symptomatic (odds ratio: 3.28, 95% confidence interval: 1.3 to 8.3, p = 0.012). Conclusions: HR reduction following exercise identifies LQT1 patients at high or low arrhythmic risk, independently of β-blocker therapy, and contributes to risk stratification. Intense exercise training, which potentiates vagal reflexes, should probably be avoided by LQT1 patients. [ABSTRACT FROM AUTHOR]

An increased risk of delayed cardiac perforation (DCP) with active-fixation small-diameter ICD leads has recently been reported, especially with regard to the St. Jude Riata lead (St. Jude Medical, Sylmar, CA, USA). Few data on the risk of DCP in small versus standard-diameter leads implanted in a single high-volume center are available. Moreover, no data on the performances of St. Jude's new small-diameter Durata lead are as yet available. The aim of this study was to assess the incidence of DCP in small versus standard-diameter leads implanted in our center. Between January 2003 and October 2009, 437 small-diameter leads (190 Medtronic Sprint Fidelis [Medtronic Inc., Minneapolis, MN, USA], 196 Riata, 51 Durata) and 421 standard-diameter (>8 Fr) leads were implanted. After a median follow-up of 421 days seven of 858 (0.8%) patients experienced DCP. The incidence of DCP was higher in patients with small-diameter leads than in those with standard-diameter leads (1.6% vs 0%, P = 0.01). No cases of DCP occurred among 371 passive-fixation leads versus 1.4% of events among active-fixation leads (P = 0.02). The incidence of DCP was 2.5% in Riata, 1% in Sprint Fidelis, 0% in Durata, and 0% in standard-diameter leads (P < 0.01 for Riata vs standard-diameter leads). Small-diameter active-fixation ICD leads are at increased risk of DCP, a finding mostly due to the higher incidence of events in the Riata family. By contrast, passive-fixation small-diameter leads and standard-diameter leads appear to be safe enough regarding the risk of DCP. Our preliminary data suggest that the new Durata lead is not associated with an increased risk of DCP. (PACE 2011; 34:475-483) [ABSTRACT FROM AUTHOR]

Aims: Right ventricular (RV) dysfunction is a marker of poor prognosis in heart failure (HF) patients. It is still unclear whether RV function might influence response to cardiac resynchronization therapy (CRT). Methods: Forty-four consecutive patients with HF, large QRS, and either intraventricular or interventricular dyssynchrony underwent echocardiographic evaluation before, 1 month after, and 6 months after CRT. Response to CRT was considered in case of significant LV reverse remodeling, defined as the occurrence of LV end-systolic volume (LVESV) reduction ≥15% at 6 months. Results: All echocardiographic indexes of baseline RV function and dimensions were significantly more impaired in nonresponders versus responders to CRT: tricuspid annular plane systolic excursion (TAPSE 15 ± 4 mm vs 20 ± 5 mm, P = 0.001), RV systolic pulmonary artery pressure (RVSP 39 ± 14 mmHg vs 27 ± 8 mmHg, P = 0.02), RV end-diastolic area (RVEDA 23 ± 6 cm2 vs 16 ± 3 cm2 P < 0.001), RV end-systolic area (RVESA 16 ± 6 cm2 vs 8 ± 2 cm2, P = 0.001), and RV fractional area change (30 ± 12% vs 48 ± 8%, P < 0.001). All the indexes of RV function significantly correlated with the percentage of LVESV reduction after CRT. Severe RV dysfunction was defined as TAPSE ≤14 mm and the population was stratified into two groups based on baseline TAPSE ≤ or > 14 mm. As compared to those with high TAPSE (n = 30), patients with low TAPSE (n = 14) were less likely to show LV reverse remodeling after CRT (76% vs 14%, P < 0.001). Conclusions: Our study suggests that RV function significantly affects response to CRT. Poor LV reverse remodeling occurs after CRT in patients with HF having severe RV dysfunction at baseline. [ABSTRACT FROM AUTHOR]

The optimal left ventricular pacing location for cardiac resynchronization therapy should be individualized according to the site of maximal mechanical delay. However, the presence of vein stenosis or kinking in coronary sinus (CS) anatomy could hamper lead implantation in the target vessel. We describe the case of a patient with dilated cardiomyopathy and a dual-chamber pacemaker referred for upgrading to a biventricular device owing to New York Heart Association III heart failure symptoms. Tissue Doppler analysis before implantation showed that the area of maximum activation delay was located in the posterolateral region of the left ventricle. Insertion of the lead into a posterolateral vein of the CS by means of the standard over-the-wire approach was unsuccessful due to the presence of a stenosis at the ostium of the vein. Lead placement in an anterior vein of the CS was unsatisfactory owing to a poor local delay from QRS onset. After balloon vein angioplasty, the pacing lead passed through the stenotic tract at the ostium of the target vein and was successfully positioned in the posterolateral region. Three months after pacemaker implantation, echocardiography showed an important reduction in the indexes of both inter- and intraventricular asynchrony and a significant left ventricular reverse remodeling [ABSTRACT FROM AUTHOR]