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Natriuretic peptides are widely used in clinical practice as cardiac markers for early diagnosis, prognosis and for the monitoring of treatment efficiency of heart Failure (HF). According to the clinical relevance of natriuretic peptides testing, it is important to assess the performances of novel platform for testing. Our study showed the overall good performances of a new NT-proBNP ABEI-based automated immunoassay.

AIMS: The current study assessed the impact of COVID-19-related public containment measures (i.e. lockdown) on the ST elevation myocardial infarction (STEMI) epidemic in Belgium. METHODS AND RESULTS: Clinical characteristics, reperfusion therapy modalities, COVID-19 status and in-hospital mortality of consecutive STEMI patients who were admitted to Belgian hospitals for percutaneous coronary intervention (PCI) were recorded during a three-week period starting at the beginning of the lockdown period on 13 March 2020. Similar data were collected for the same time period for 2017-2019. An evaluation of air quality revealed a 32% decrease in ambient NO2 concentrations during lockdown (19.5 µg/m³ versus 13.2 µg/m³, p 12 h after onset of pain) (14% versus 7.6%, p = .04) and with longer door-to-balloon times (median of 45 versus 39 min, p = .02). Although the in-hospital mortality between the two periods was comparable (5.9% versus 6.7%), 5 of the 7 (71%) COVID-19-positive STEMI patients died. CONCLUSION: The present study revealed a 26% reduction in STEMI admissions and a delay in treatment of STEMI patients. Less exposure to external STEMI triggers (such as ambient air pollution) and/or reluctance to seek medical care are possible explanations of this observation. ispartof: ACTA CARDIOLOGICA vol:76 issue:8 pages:863-869 ispartof: location:England status: published

Case description : A 74-year-old man suffering from severe heart failure (NYHA III – LVEF 28%) associated with left bundle branch block (LBBB) (Figure 1(A)) and uncontrolled permanent atrial fibrillation (AF) despite optimal medical treatment was referred for His ablation and rescue physiological pacing after a first unsuccessful LV lead implantation through the coronary sinus (CS). Careful review of the occluded CS angiogram indeed revealed no side branches. Concordantly, the patient was offered a ‘rescue’ HBP procedure. Using the SelectSecure lead (model 3830) and a C315 His sheath (Both Medtronic, Inc. MN), His mapping (HV ¼ 106ms) and recruitment were easily obtained, unfortunately without LBBB correction.

This subanalysis of the Euro-CRT survey II specifically focus on Belgian practice for CRT implantation. It explores Belgian adherence with the guidelines but also benchmark CRT practice in Belgium against the other European countries. Overall, Belgian management of CRT implantation is performed with great agreement with guidelines. This report could be used to provide guidance for both practical and economical approaches.

The wording « fragmentation of the QRS complex » or « fragmented QRS » (fQRS) indicates the presence of high frequency potentials (spikes) inside the QRS complex. The term was first coined in 1973 in the report of an experimental study of canine hearts where coronary occlusion provoked the appearance of fragmented electrograms which were a source of reentrant activity [1]. Previously, it had already been suggested that a high frequency « notching » of the QRS complex could be a marker for cardiac structural diseases causing biventricular enlargement [2]. The appearance of fQRS can be provoked by any condition interfering with the normally homogeneous depolarisation process within the myocardium and leading to local conduction slowing, e.g. ischemia, scar, fibrosis, myofiber disarray, inflammation, and microvascular abnormality.

DESCRIPTION : We report a sequence of ECGs recorded in a 61-yearold man admitted to a primary care hospital for a persistent chest pain. The patient was diagnosed 3 years ago for an asymptomatic Brugada type 1 syndrome (SCN5A Gly752Arg variant) as illustrated by the coved ST-segment elevation in the right precordial leads followed by a negative T wave (Panel A). He did not show positive evidence of sudden death in his family history. Although, his father died at age 38 in a car accident in unclear circumstances. The first ECG recorded in the emergency department showed an inferior STEMI with ST-segment elevation in the inferior leads (DII, DIII, aVF), posterior extension as demonstrated by a marked ST-segment depression in V1-V2 partially masking the electrocardiographic aspect of the Brugada pattern, and complete atrioventricular block (Panel B). Afterward, the patient developed malignant ventricular arrhythmias successfully treated by electrical cardioversion (Panel C). The ECG recorded after a thrombolytic reperfusion therapy showed the resurgence of the Brugada electrical abnormalities as previously observed before the right coronary occlusion (Panel D). [...]

Percutaneous device implantation is the method of choice for secundum atrial septal defect (ASD) closure. Some occluder devices use thin polymeric membranes that can undergo unexpected degradation. This can lead to early failure of the implant, typically within weeks or months after implantation. Here we report a case of delayed device failure. [...]

This report presents and discusses, on behalf of the Belgian College of Cardiology, the evolution of the peer review process in arrhythmology, focussing on pacemaker implantation. Data from the last 22 years are compared. The national annual increase in implants is around 1%, clinical patient characteristics remained stable over the years while dual chamber pacing was proportionally increasing. Analyses of the normalised sick sinus and complete atrioventricular block ratios revealed a quite homogenous practice between centres and patient district with the only exception of the two more crowded districts. Battery longevity and infection rate were also assessed. With an incidence of 1/1000 device-years follow-up, Belgium remains below accepted European levels.

Background For selected patients with symptomatic aortic stenosis, transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (AVR). In addition to co-morbidities, frailty has to be taken into account in the decision-making process. Criteria for patient selection, according to current guidelines, include EuroSCORE and STS score but frailty is not easy to quantify. ISAR (Identifi cation of Seniors At Risk) detects seniors at risk for adverse health outcome after an emergency visit and SHERPA (Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie) assesses the risk of functional decline after hospitalization. Objectives The aim of the present study was to evaluate the impact of ISAR and SHERPA scores in the prediction of patient outcome after TAVI. Methods and results A prospective cohort of 30 consecutive octogenarian patients (16 males, 86 ± 3 y, EuroSCORE 34 ± 12%) underwent a transfemoral TAVI and a complete geriatric assessment in our institution. Survival at one year was 73%. The ISAR score was similar between both groups (3.1 ± 1 vs. 3.6 ± 1; P = 0.10) but the SHERPA score was signifi cantly higher in non-survivors (7.8 ± 1.6) than among survivors (4.9 ± 2.4; P = 0.001). With multivariate analysis, SHERPA score and BMI were independent predictors of 1-year mortality. Kaplan-Meier analysis showed that 1-year survival was signifi cantly lower in patients with than in those without a SHERPA score > 7 (40 vs. 89%; P = 0.004). Conclusions The result of this study showed that SHERPA score predicts 1-year survival after transfemoral TAVI and could be considered as a useful frailty score in patient selection.

Background High platelet reactivity (HPR) to clopidogrel is associated with an increased risk of ischaemic complications during and after coronary interventions and concerns up to 50% of patients undergoing PCI. Aim of the study The aim of the study was to identify patients with HPR to clopidogrel using bedside clinical information obtained in the Stent Thrombosis In Belgium (STIB) trial. Methods Data on platelet reactivity using the VerifyNow (R) point-of-care assay were obtained in 844 patients undergoing PCI for stable coronary artery disease 12 to 24 hours after a 600-mg loading dose of clopidogrel was given. Demographic, clinical and baseline routine biological tests were obtained and compared with P2Y12 reaction units (PRU). Patients with PRU >230 (HPR) were considered as non-responders to clopidogrel. Results HPR was observed in 424/844 pts. Age, weight, body mass index (BMI), HPR to aspirin, diabetes, renal failure (MDRD 28 kg/m(2) and presence of diabetes were equally associated to predict HPR and can be added to derive a simple score to predict clopidogrel resistance. Although 38.5% of patients without a single clinical predictor still have HPR, 2/3 patients with 2 or 3 risk factors are resistant to clopidogrel. Conclusions STIB HPR score allows identification of patients with a high probability of resistance to clopidogrel based on diabetes, Hb 28 kg/m(2). This bedside clinical test could be useful for the identification of patients in whom another P2Y12 inhibitor should be recommended before and after PCI.

Cardiac perforation is an infrequent but potentially life-threatening complication of pacemaker implantation. We report a case of right atrial lead perforation complicated by pneumopericardium shortly after pacemaker lead insertion. Transthoracic echocardiography revealed no evidence of pericardial effusion and pacemaker lead displacement, but a thoracic computed tomography scan illustrated the lead course and confirmed the diagnosis. This case suggests that computed tomography is a sensitive modality to confirm the diagnosis at the early stage of this complication.