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Introduction:Symptomatic tricuspid regurgitation (TR) is associated with a high mortality rate and high HF-related hospitalization. Symptomatic therapy in the elderly and very elderly patients remains weak in controlling severe TR. Patients with an increased risk of surgical repair of the TR seemed to benefit from transcatheter tricuspid valve repair procedures.Hypothesis:Therefore, we thought to analyze the postprocedural safety and success of the transcatheter tricuspid valve repair in octogenarians and older patients.Methods:Elderly patients with severe and symptomatic TR were presented and evaluated in the heart team. Patients with high surgical risks underwent transcatheter tricuspid valve repair procedures in our center. Post-procedural transthoracic echocardiography (TTE) procedure was performed to determine the TR grade and exclude procedure-related complications.Results:Thirty-three consecutive patients, older than 80 years (84.45 ±3.12, 14 men and 19 women, who received transcatheter TR repair between September 2021 and January 2022 were enrolled. The baseline characteristics are presented in table 1. Procedural success, defined as reducing the TR to grad I-II, was achieved in 97 % of the patients (3.79±0.65 vs. 1.55±0.56, P = 0.011). All patients improved in the New York Heart Association functional class (2.85±0.50 vs. 1.39±0.056 30 days after the intervention). No procedure-related death was registered. 87.9 % (n=29) survival rate was achieved 3 months after the intervention. No clip embolization was detected in 3 months echocardiography control.Conclusions:Our preliminary results indicate that transcatheter tricuspid valve repair procedures are safe and effective therapeutic option in elderly and very elderly patients with severe TR and high surgical risks. Therefore, this therapy should be considered despite age and comorbidities for effective symptomatic treatment in this cohort.

Introduction:Symptomatic mitral regurgitation (MR) is associated with a high mortality rate and high HF-related hospitalization. Symptomatic therapy in the elderly and very elderly patients remains weak in controlling severe MR. Patients with an increased risk of surgical repair of the MR seemed to benefit from MitraClip procedures.Hypothesis:Therefore, we thought to analyze the postprocedural safety and success of the MitraClip in octogenarians and older patients.Methods:Elderly patients with severe and symptomatic MR were presented and evaluated in the heart team. Patients with high surgical risks underwent MitraClip (Abbot, USA) procedure in our center. Post-procedural transthoracic echocardiography (TTE) procedure was performed to determine the MR grade and exclude procedure-related complications.Results:Two hundred eleven consecutive patients, older than 80 years (83.75 ±2.95, 106 Men (83.5±3.06) and 105 Women (84.01±2.83)), who received MitraClip between May 2015 and May 2020 were enrolled. The baseline characteristics are presented in table 1. Procedural success, defined as reducing the MR to grad I-II, was achieved in 93% of the patients (3.11±0.34 vs. 1.25±0.46, P = 0.002). All patients improved in the New York Heart Association functional class (3.04±0.40 vs. 1.92±0.76 one year after the intervention). No procedure-related death was registered. 81% (n=168) survival rate was achieved one year after the intervention. No clip embolization was detected in 3 months echocardiography control, Table 2.Conclusions:Our preliminary results indicate that MitraClip is a safe and effective therapeutic option in Elderly and very elderly patients with severe MR and high surgical risks. Therefore, this therapy should be considered despite age and comorbidities for effective symptomatic treatment in this particular cohort.

Introduction:Clinical implication of chronic kidney disease (CKD) and cardiac sympathetic nerve activity (CSNA) for lethal arrhythmic events has not been fully elucidated in patients with chronic heart failure (CHF).Hypothesis:The combination of CKD and abnormal CSNA, assessed by 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy, may provide useful prognostic information for the incidence of lethal arrhythmic events.Methods:We studied 165 consecutive hospitalized CHF patients without dialysis. In a clinically stable condition, cardiac 123I-MIBG scintigraphy was performed. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2, and abnormal CSNA was defined as late heart to mediastinum ratio <1.6. We then investigated the incidence of lethal arrhythmic events (sustained ventricular arrhythmia, appropriate implantable cardioverter-defibrillator therapy, or sudden cardiac death).Results:During a median follow-up of 5.3 years, lethal arrhythmic events were observed in 40 patients (24.2%). The patients were divided into 4 groups according to the presence of CKD and CSNA abnormality: non-CKD/ normal CSNA (n= 52), CKD/ normal CSNA (n= 39), non-CKD/ abnormal CSNA (n= 33), and CKD/ abnormal CSNA (n= 41).The Kaplan-Meier analysis showed that CKD/ abnormal CSNA had the highest event rate (log-rank p= 0.004). In addition, the multivariable Cox proportional hazard analysis after the adjustment of multiple confounders showed that CKD/ abnormal CSNA was an independent predictor for lethal arrhythmic events compared to non-CKD/ normal CSNA (HR, 4.667, p= 0.006). However, the other two groups did not show significant differences compared to non-CKD/ normal CSNA.Conclusions:The combination of CKD and abnormal CSNA, assessed by cardiac 123I-MIBG scintigraphy, had a significant prognostic value for the incidence of lethal arrhythmic events in patients with CHF.

Background:Ablation using cryothermal energy has several potential advantages over radiofrequency (RF) ablation including a greater catheter stability due to adherence to the myocardial tissue during applications, reduced risk of thrombus formation, less pain, and etc. Several studies have reported the effects of cryoablation for the treatment of the cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) with similar efficacy and safety rates as reported for RF ablation. However, the details of freezing profile during CTI cryoablation still remain unknown.Methods:This study included 40 consecutive patients (32 men; 65±10 years) who underwent CTI cryoablation for common AFL. Patients were divided into 2 groups: one pass group who achieved first-pass conductional block of the CTI (n=30) and non-one pass group who did not (n=10). CTI ablation was performed with 2.5-min freezing cycle and 8-mm tip cryocatheters. A multidetector computed tomography scan with contrast injection which was performed before ablation in all the patients. We examined temperature changes at the catheter tip during first pass in CTI cryoablation and anatomical features of CTI in three regions: anterior, middle, and posterior.Results:There was no significant difference in the minimum freezing temperature between the one pass group and the non-one pass group (-82.6±1.6 vs. -83.2±1.2°C, P=0.245) in all the three regions. However, only in the anterior CTI, the time to reach the minimum freezing temperature was significantly shorter in the one pass group than in the non-one pass group (31.4±5.9 vs. 38.7±8.6 sec, P=0.012). The thickness of the anterior CTI was significantly thinner in the one pass group than in the non-one pass group (4.1±1.2 vs. 5.5±1.3 mm, P=0.021). On the other hand, there was no significant difference in the thickness of the middle and posterior CTI between the two groups. The time to reach the minimum freezing temperature showed a significant positive correlation with the thickness of the CTI (R=0.415, P<0.001).Conclusions:The time to reach the minimum freezing temperature in the anterior CTI may predict a first-pass conductional block of CTI cryoablation. The thickness of the anterior CTI may relate to this mechanism.

Introduction:Visit-to-visit blood pressure variability (VV-BPV) has been shown to be associated with cardiovascular risk in patients with hypertension (HT). However, it remains unclear whether the preprocedural VV-BPV can affect pulmonary vein isolation (PVI) outcome in atrial fibrillation (AF) patients with HT.Methods:Fifty-seven hypertensive AF patients (51 male; mean age, 63 ? 7 years) who underwent successful PVI were enrolled in the study and classified into 2 groups: Group 1 (n = 39), the patients who had no AF recurrence during the mean follow-up periods of 12 ? 6 months; and Group 2 (n = 18), those who showed AF recurrence. Systolic and diastolic VV-BPV (Sys-BPV and Dia-BPV) were calculated as standard deviation. For the evaluation of predictor of AF recurrence, Cox regression analysis was performed. Receiver-operating characteristic (ROC) analysis was performed to calculate the optimal cut off value. Kaplan-Meyer analysis was performed to evaluate the effect of VV-BPV on PVI outcome. The endpoint of the study was AF reccurrence, defined as the documentation of AF lasting over 30 sec.Results:Systolic BP and Sys-BPV in Group 2 were higher than those in Group 1 (139 ? 22 mmHg vs. 127 ? 16mmHg, P = 0.025; and 10.2 ? 3.4 vs. 7.8 ? 3.6, P = 0.021, respectively). There was no significant difference in diastolic BP and Dia-BPV between the 2 groups (P > 0.05). Cox multivariate regression analysis revealed that both Sys-BPV and Dia-BPV were the independent predictors of AF recurrence (Hazard ratio (HR): 1.125, P = 0.027; and HR 1.105, P = 0.045, respectively). ROC analysis revealed Sys-BPV of 9.4 and Dia-BPV of 6.5 as the cut-off values for AF recurrence. To evaluate the impact of cut-off value of Sys-BPV and Dia-BPV on PVI outcome, the study subjects were divided into two groups based on each cut-off of value. Kaplan-Meyer analysis showed that AF recurrence rate in high Sys-BPV and Dia-BPV was significantly higher than that in low Sys-BPV and Dia-BPV groups (P = 0.035 and P = 0.002, respectively).Conclusions:The findings of the current study suggested that VV-BPV is useful for the prediction of recurrence of AF after PVI in hypertensive patients.

Introduction:Cardiac amyloidosis (CA) is characterized by left ventricular hypertrophy (LVH) and autonomic nervous imbalance due to the amyloid accumulation. However, autonomic dysfunction is often seen in heart failure (HF) patients with LVH from other etiologies. We aimed to examine the autonomic function in HF patients with LVH from various etiologies using Holter monitoring and characterize the autonomic dysfunction in CA.Methods:The study subjects consisted of 55 hospitalized HF patients (38 males, mean age 65?12 years) with LVH. LVH was defined as wall thickness of interventricular septum and posterior wall being greater than 12 mm by echocardiography, and the etiology was as follows [CA, n=14; hypertrophic cardiomyopathy (HCM), n=21; and aortic stenosis (AS), n=20]. In stable condition before discharge, heart rate variability and heart rate turbulence, which reflect autonomic dysfunction, were measured in 24-hour Holter monitoring and compared among three groups.Results:Standard deviation of all R-R intervals (SDNN), standard deviation of the 5-min mean R-R intervals (SDANN) and turbulence slope (TS) were significantly lower in CA and AS compared to HCM (P<0.001, respectively) as shown in Table. In addition, turbulence onset (TO) was significantly higher in CA and AS compared with HCM (P<0.001). However, SDNN, SDANN, TS and TO were not different between CA and AS. Additionally, brain natriuretic peptide levels, the degree of LVH, and left ventricular systolic and diastolic function were not different among three groups. On the ROC analysis for the identification of CA in HF with LVH, the best cut-off value for SDNN, SDANN, TO and TS were 68.5 msec (AUC: 0.830), 58.5 msec (AUC: 0.807), 0.01% (AUC: 0.833) and 1.00 msec/RR (AUC 0.724), respectively.Conclusions:Autonomic dysfunction is a hallmark of CA, and its non-invasive assessment by Holter monitoring may be a useful tool for differential diagnosis for etiology of HF with LVH.