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Corrected transposition of the great arteries (c-TGA) is a congenital abnormality characterized by atrioventricular (AV) and ventriculoarterial discordance, associated with early and late-onset conduction disturbances. We report the case of a c-TGA patient affected by congenital complete AV block, with right ventricular lead malfunction with prolonged dwell time and two abandoned leads. He underwent leadless VDD pacemaker implantation at an unusual site (i.e. the anterior wall of subpulmonic left ventricle), with an optimal electrical performance, a good AV synchrony, and QRS narrowing. Leadless VDD pacing is safe and feasible in patients affected by corrected transposition of the great arteries, even with an unusual implant site such as the anterior wall of subpulmonic left ventricle. [ABSTRACT FROM AUTHOR]

Epicardial access is often crucial for successful ventricular tachycardia (VT) ablation, but it is often burdened by significant procedural risk. Intentional coronary vein exit and intrapericardial CO 2 insufflation (EpiCO 2) can facilitate subxiphoid pericardial access. This prospective study aimed to assess procedural feasibility, safety, and impact of the introduction of intrapericardial CO 2 insufflation for epicardial access in a referral center for VT ablation. All consecutive patients treated with epicardial VT ablation between November 2022 and January 2024 with the EpiCO 2 technique at Pisa University Hospital were prospectively enrolled and compared in terms of feasibility, efficiency, and safety with a local retrospective cohort of patients treated with subxiphoid dry puncture between July 2018 and October 2022. Twenty-two consecutive patients (90.9% male; mean age, 54.3 years) underwent VT ablation with EpiCO 2 during the study period. Epicardial access was achieved in all patients; median time from coronary sinus (CS) cannulation to epicardial access was 33 minutes. Intentional vein exit was successful in all cases, whereas CO 2 insufflation was not feasible in 1 patient. There were no major complications and no significant bleeding. Since EpiCO 2 introduction, epicardial approach utilization increased from 17.8% to 40% of all VT procedures. Comparison with 20 standard dry approach epicardial ablations showed no significant differences in terms of total procedural duration (322.5 [interquartile range, 296.75–363.75] minutes vs 359 [interquartile range, 323–409] minutes; P =.08). In our single-center experience, EpiCO 2 was feasible and safe and led to significant increase in procedural volume without affecting total procedural time compared with standard dry puncture. [ABSTRACT FROM AUTHOR]

A 63-year-old man with hypertension and 3-vessel coronary artery disease previously treated with coronary artery bypass graft was admitted to our emergency room complaining of chest pain. He had undergone pacemaker implant 5 months before due to paroxysmal advanced atrioventricular block. Electrocardiography and troponin testing were unremarkable. Echocardiography and chest X-ray ruled out lead displacement and perforation. Interrogation showed normal parameters [right atrium: impedance 550 Ohm bipolar, sensing 2.4 mV bipolar; threshold 0.50 V/0.4 ms bipolar; right ventricle (RV): impedance 580 Ohm bipolar, sensing > 25 mV bipolar; threshold 1.5 V/0.4 ms bipolar and 0.4 V/0.4 ms unipolar]. Pain was evoked only during RV pacing. An electrophysiology study demonstrated painful RV pacing from multiple sites. We hypothesized that pain was associated with pacing-induced dyssynchrony. His-bundle pacing (HBP) was considered as a solution. We achieved HBP with a bipolar fixed-screw catheter connected to a cardiac resynchronization therapy pacemaker generator. During HBP above threshold (4.00 V/1.00 ms) the patient did not complain of any pain. He was discharged 3 days later pain-free with His-bundle lead amplitude set at 5.00 V/1.00 ms. After 6 months the patient was asymptomatic, with the device showing normal functioning. This is the first clinical experience of painful RV pacing treated with HBP. < Learning objective: Painful right ventricular pacing in the absence of perforation is a rare but potentially underdiagnosed condition. Ventricular dyssynchrony could represent the underlying mechanism. Physiological electromechanical activation achieved via His-bundle pacing could represent an effective therapeutic option.> [ABSTRACT FROM AUTHOR]

Aims: Sympathetic dys-innervation may play an important role in the development of post-ischemic ventricular arrhythmias (VA). Aim of this study was to prove that perfusion/innervation mismatch (PIM) evaluated by SPECT can identify areas of local abnormal ventricular activities (LAVA) on electroanatomic mapping (EAM). Methods: Sixteen patients referred to post-ischemic VA catheter ablation underwent pre-procedural and 1-month post-ablation 123I-MIBG/99mTc-tetrofosmin rest SPECT myocardial imaging. PIM was defined according to the segmental distributions of 99mTc-tetrofosmin and 123I-MIBG. A 17-segment LV analysis was used for either SPECT or LV EAM voltage map. All patients were followed up clinically for at least 1 year. Results: Before ablation, the mean voltage in the PIM segments was higher than in the scarred ones but lower than in the normal regions. The presence of PIM in a specific LV zone was an independent predictor of LAVA. After ablation, PIM value was significantly reduced, mainly due to an increase in perfusion summed rest score, in particular in patients that were responders to ablation. Conclusions: PIM may associate with VA substrate expressed by LAVA and might provide a novel guide for substrate ablation. A significant reduction of PIM could predict a positive clinical response to ablation. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of radiofrequency catheter ablation (RFCA) in atrial tachyarrhythmias correlates with lesion transmurality. Ablation Index (AI) is an index that incorporates contact force, time, and radiofrequency power simultaneously and is able to predict lesion size and outcomes in RFCA of atrial fibrillation.Objective: The purpose of this study was to assess whether AI could be an acute and long-term success predictor in RFCA of premature ventricular complexes (PVCs).Methods: One hundred forty-five patients with idiopathic outflow tract PVCs undergoing RFCA were retrospectively enrolled. The maximum and maximum AI values were calculated for each ablation site. Acute and 6-month outcomes were analyzed. Patients were divided into 3 outcome subgroups-success, acute failure, and 6-month failure-and the maximum and mean AI values were compared.Results: Acute and 6-month success rates were 95% and 77%, respectively. The maximum and mean AI values were statistically higher in the success group (median of the maximum AI 630 [IQR 561-742]; median of the mean AI 489 [IQR 411-560]) than in the acute failure group (median of the maximum AI 487 [IQR 445-583]; median of the mean AI 372 [IQR 332-434]; P < .0001 for both) and the 6-month failure group (median of the maximum AI 519 [IQR 476-568]; median of the mean AI 410 [IQR 368-472]; P < .0001 for both). Both maximum and mean AI values were confirmed to be statistically higher in the success group than in the failure/6-month failure group (P = .001 and P = .04, respectively) and right ventricular free wall (P = .007 and P = .01, respectively) PVC origin subgroups.Conclusion: Our data support the concept that AI could be a long-term success predictor in RFCA of PVCs. However, further prospective studies are required to assess the feasibility of the AI-guided PVC ablation approach. [ABSTRACT FROM AUTHOR]

Superior vena cava (SVC) syndrome is an uncommon but serious complication associated with chronic transvenous implanted leads. In the recent past, open-heart surgery combining lead extraction and epicardial implant was usually performed to reduce syndrome recurrences. We describe the case of a 78-year-old man successfully treated by percutaneous lead extraction associated with venous balloon angioplasty and reimplantation of leadless pacemaker. < Learning objective: Chronic vascular complications following lead implantation usually require surgical treatment, due to the need for subsequent epicardial implantation. Percutaneous lead extraction along with leadless pacing allowed effective non-surgical management of chronic complications of transvenous pacing.> [ABSTRACT FROM AUTHOR]

An 86-year-old man with unremarkable clinical history complaining of asthenia and dyspnea was diagnosed with low-flow low-gradient aortic stenosis [LFLG-AS; left ventricular ejection fraction (LVEF) 40% and transaortic mean gradient 37 mmHg, increasing to 52% and 55 mmHg after dobutamine infusion]. The patient underwent transcatheter aortic valve implantation (TAVI; Edwards CENTERA™ 29, Irvine, CA, USA). The procedure and the following hospital stay were free from complications, with no changes on electrocardiography (ECG). Six months later, few syncopal episodes occurred. No signs of orthostatic hypotension or neurologic disorders were present. Echocardiography showed normal functioning of the prosthetic valve and recovery of LV systolic function (LVEF 55%). Baseline ECG and 24-h Holter monitoring were unremarkable. An implantable loop recorder (ILR) was implanted to verify the occurrence of paroxysmal conduction disturbances. One month later, during a syncopal episode, ILR interrogation showed a complete atrioventricular (AV) block. Therefore, a dual chamber, single lead pacemaker was implanted. We are providing the first report of complete AV block occurring months after TAVI, possibly because of reverse LV remodeling following TAVI, with ensuing relative oversizing of the prosthetic valve. This possibility should be considered in patients with syncope not otherwise explained, and previous TAVI, especially in cases of LFLG-AS. < Learning objective: Complete atrioventricular block can occur even months after transcatheter aortic valve implantation (TAVI), possibly because of left ventricular reverse remodeling following valve replacement, with ensuing relative valve oversizing. This possibility should be considered in patients with syncope not otherwise explained, and previous TAVI, especially in cases of low flow low gradient aortic stenosis. Loop recorder implantation should be considered in this group of patients.> [ABSTRACT FROM AUTHOR]

Objectives The aim of the CoreValve prospective, international, post-market ADVANCE-II study was to define the rates of conduction disturbances and permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement with the Medtronic CoreValve System (Minneapolis, Minnesota) using optimized implantation techniques and application of international guidelines on cardiac pacing. Background Conduction disturbances are a frequent complication of transcatheter aortic valve replacement. The rates of PPI in the published reports vary according to bioprosthesis type and the indications for PPI. Methods The primary endpoint was the 30-day incidence of PPI with Class I/II indications when the Medtronic CoreValve System was implanted at an optimal depth (≤6 mm below the aortic annulus). The timing and resolution of all new-onset conduction disturbances were analyzed. Results A total of 194 patients were treated. The overall rate of PPI for Class I/II indications was 18.2%. An optimal depth was reached in 43.2% of patients, with a nonsignificantly lower incidence of PPI in patients with depths ≤6 mm, compared with those with deeper implants (13.3% vs. 21.1%; p = 0.14). In a paired analysis, new-onset left bundle branch block and first-degree atrioventricular block occurred in 45.4% and 39.0% of patients, respectively, and resolved spontaneously within 30 days in 43.2% and 73.9%, respectively. In patients with new PPI, the rate of intrinsic sinus rhythm increased from 25.9% at 7 days to 59.3% at 30 days (p = 0.004). Conclusions Optimal Medtronic CoreValve System deployment and adherence to international guidelines on cardiac pacing are associated with a lower rate of new PPI after transcatheter aortic valve replacement, compared with results reported in previous studies. (CoreValve Advance-II Study: Prospective International Post-Market Study [ADVANCE II]; NCT01624870 ) [ABSTRACT FROM AUTHOR]

Background Riata (RT) and Sprint Fidelis (SF) leads were recalled by the United States Food and Drug Administration because of an increased rate of failure mainly due to conductor fracture or insulation abrasion. According to lead design and type of failure, extraction complexity may be different, potentially affecting procedural outcomes and indications. Objective The purpose of this study was to assess the extraction profile of RT leads with and without cable externalization in comparison to SF leads. Methods From January 1997 to April 2014, all consecutive RT and SF leads extracted transvenously were analyzed. Among 661 consecutive patients with 705 ventricular implantable cardioverter-defibrillator (ICD) leads extracted, 194 patients with 134 RT leads (RT group) and 61 SF leads (SF group) were identified. Removal indications often were infective (64%), and extracted leads had a prevalence of dual-coil design (89%). Baseline patients and lead characteristics were comparable between groups. Results Success rate was high in both groups (97.8% RT vs 100% SF) without major complications. Mechanical dilation was comparable between groups, but RT leads often required larger sheaths (11.7 ± 1.4 vs 11.3 ± 1.4), a more frequent crossover to the internal transjugular approach (14% vs 3%), and a longer procedural time (23 ± 33 minutes vs 12 ± 16 minutes). Implantation time (odds ratio 4.84, 95% confidence interval 1.05–22.2, P = .042) and RT leads (odds ratio 1.04, 95% confidence interval 1.02–1.06, P <.001) were independent predictors of the internal transjugular approach. Conclusion Extraction of RT leads is feasible and effective. However, extraction of RT leads is more complex than that of SF leads. Lack of coil backfilling and cable externalization in RT group may account for these differences. [ABSTRACT FROM AUTHOR]

Background Percutaneous removal of implantable cardioverter-defibrillator (ICD) leads is a difficult procedure because of the consequence of massive fibrous tissue growth along the lead. Objective The purpose of this study was to describe the occurrence and location of fibrous adherences in ICD lead extraction and to identify potential predictors among patient and lead characteristics. Methods We studied 637 consecutive patients who underwent transvenous extraction of 678 ICD leads from 1997 to 2013. Results Procedural success rate was 99%, without major complications. Areas of adherence were found in the subclavian vein (78%), innominate vein (65%), superior vena cava (66%), and heart (73%). Dwell-time, passive fixation, and dual-coil lead design were independently associated with adherences. Dual-coil lead design was associated with adherences in the innominate vein and superior vena cava, whereas coil treatment (eg, expandable polytetrafluoroethylene-coated or medical adhesive back-filled strategies) prevented adherences. Passive fixation mechanism was associated with adherences in the heart. Conclusion ICD leads, after long dwell-time, are affected by fibrous adherences uniformly distributed along the lead course. Lead features represent major predictors of the phenomenon. Careful lead selection is recommended at the time of implantation to prevent adherences. In addition, lead-related risk stratification is mandatory before a transvenous extraction procedure. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the diagnostic performance of 99mTc-hexamethypropylene amine oxime labeled autologous white blood cell (99mTc-HMPAO-WBC) scintigraphy in patients with suspected infections associated with cardiovascular implantable electronic devices (CIEDs). Background: Early, definite recognition of CIED-related infections combined with accurate localization and quantification of disease burden is a prerequisite for optimal treatment strategies. Methods: All 63 consecutive patients underwent clinical examination, blood chemistry, microbiology, and echography of the cardiac region/venous pathway of the device. Final diagnosis of infection was established in 32 of 63 patients and in 23 of 32 by microbiology. Results: Sensitivity of 99mTc-HMPAO-WBC single-photon emission computed tomography/computed tomography (SPECT/CT) was 94% for both detection and localization of CIED-associated infection. SPECT/CT imaging had a definite added diagnostic value over both planar and stand-alone SPECT. Pocket infection was often associated with lead(s) involvement; the intracardiac portion of the lead(s) more frequently exhibited 99mTc-HMPAO-WBC accumulation and presented the highest rate of complications, infectious endocarditis, and septic embolism. Two false negative cases and no false positive results were observed. None of the patients with negative 99mTc-HMPAO-WBC scintigraphy developed CIED-related infection during follow-up of 12 months. Echography of the cardiac region/venous pathway of the device had 90% specificity, but low sensitivity (81% when intracardiac lead[s] infection only was considered). The Duke criteria had 31% sensitivity for the definite category (100% specificity) and 81% for the definite and possible categories (77% specificity). Conclusions: 99mTc-HMPAO-WBC scintigraphy enabled the confirmation of the presence of CIED-associated infection, definition of the extent of device involvement, and detection of associated complications. Moreover, 99mTc-HMPAO-WBC scintigraphy reliably excluded device-associated infection during a febrile episode and sepsis, with 95% negative predictive value. [Copyright &y& Elsevier]

Background: Conduction abnormalities are frequent after transcatheter aortic valve implantation with the CoreValve (Medtronic, Minneapolis, MN) and are often treated with liberal permanent pacemaker (PPM) implantation. Our aim was to assess the 1-year outcome of a conservative approach to pacing and to identify its predictors. Methods: We analyzed 275 consecutive patients without a PPM before transcatheter aortic valve implantation who underwent successful CoreValve implantation at our 3 centers, sharing a conservative approach to pacing. Results: Of the 47 patients (17.1%) who developed postprocedural complete atrioventricular block, 14 recovered spontaneous atrioventricular conduction <72 hours and did not receive a PPM. Sixty-six patients (24.0%) received a PPM before discharge, and 74 more patients (26.9%) developed a new left bundle-branch block (LBBB). Independent predictors of PPM implantation were as follows: lower CoreValve implantation below the aortic annulus (odds ratio [OR] 1.16/mm, 95% CI 1.03-1.30, P = .01), right bundle-branch block (OR 3.72, 95% CI 1.5-9.2, P = .004), left anterior hemiblock (OR 2.34, 95% CI 1.1-5.1, P = .03), and longer PR interval (OR 1.02/ms, 95% CI 1.00-1.04, P = .03). One-year survival was similar between patients who received a PPM and patients who did not receive a PPM (P = .90), with no case of sudden death in the latter group, and between patients with a new LBBB not receiving a PPM and patients without postprocedural LBBB (P = .37). Conclusion: A high CoreValve implantation level and avoidance of prophylactic pacing in patients with new LBBB without persistent bradyarrhythmias allowed for a relatively low rate of PPM implantation. This conservative approach spared unwarranted pacing and did not affect 1-year survival. [Copyright &y& Elsevier]

Interatrial communications (ICs) have been linked to paradoxic embolism, which may be prevented using both surgical and percutaneous interventions. The case of a 61-year-old woman with a history of transient cerebral ischemic attack who developed repetitive ventricular arrhythmias and an intermittent left branch bundle block immediately after percutaneous closure of an IC is described. Transthoracic echocardiography showed that the device had migrated into the left ventricular outflow tract, and the patient consequently underwent emergency cardiac surgery to retrieve the device and repair the IC. In conclusion, percutaneous transcatheter closure of ICs is more rapid and less invasive compared with surgery, but nevertheless may be associated with significant short-term morbidity. [Copyright &y& Elsevier]

Abstract: We present the case of a super-responder patient with a basal left bundle branch block, who underwent cardiac resynchronization therapy and showed, during biventricular pacing, typical electrocardiographic signs of cardiac memory. [Copyright &y& Elsevier]

Cardiac resynchronization therapy (CRT) and beta blockers (BB) are effective in advanced heart failure (HF). Often, due to side effects, BB are not used or dose not increased. We evaluated the titration of BB therapy with carvedilol (Carv) in CRT Responders (R) and Not Responders (NR), recruiting 65 HF outpatients (pts) with CRT indication and on optimal treatment [70% males; age 67.9±12.6 years, ys; NYHA 2.7±0.7; aetiology 44% coronary artery disease (CAD), 43% dilated cardiomyopathy (DCM)]. All underwent ECG, echocardiography, NYHA evaluation before and after 1 y of CRT. Considering NYHA response and improvement of systolic left ventricular function (EF,%), R (ΔNYHA> 1 and/or ΔEF> 5%) and NR were defined. During follow-up, Carv was titrated. Basally R and NR were similar for age, sex, HF aetiology (R 40% CAD, 42.5% DCM; NR 48% CAD, 40% DCM), QRS duration (168±32 vs 178±29 msec), end-diastolic (EDV, ml), end-systolic (ESV) volume, EF (R 25.1±7.9 NR 27.4±8.2), BB treatment (85 vs 88%) and Carv dose (16.3±18.6 vs 13.2±10.3 mg/day). Only basal NYHA (R 2.9±0.7 NR 2.4±0.6, p=0.002) was significantly different. There was no significant difference in QRS duration postCRT (R 123±32, NR 127±36 msec). After 1 y, R showed greater variation of EDV and ESV (ΔEDV -45±46 vs -2±56 p=0.01; ΔESV -46±46 vs -1±45 p=0.003) and mitral regurgitation entity (-0.5±0.7 vs 0±0.7 p=0.02). After 1 y there was an overall increase of pts on BB (92.5 vs 92%), but R achieved a greater Carv dose (25.1±20.4 vs 14.5±7.3 mg/day p=0.002, Δdose 8.7±11 vs 1.2±10.7 p=0.009). Carv dose increase and EF improvement were correlated (r=0.40, p=0.02), while dose increase and ventricular remodeling (LVR) were negatively related (ΔEDV r=0.42 p=0.02; ΔESV r=0.45 p=0.01). In both groups CRT allows to introduce and augment BB dose, but only in R dose increase is statistically significant, correlating with LVR regression. Such results suggest an addictive role of BB titration in determining CRT positive response. [Copyright &y& Elsevier]

Cardiac resynchronization therapy (CRT) is an effective treatment of advanced heart failure (HF). Recent studies showed a positive effect of CRT on HF symptoms, left ventricular ejection function (EF,%), reduction of hospitalizations and survival. However, most studies evaluated clinical and echocardiographic response to CRT after a limited follow-up (ranging from 6 to 12 months). Thus we evaluated clinical and functional response to CRT in HF patients (pts) after a longer follow-up period (up to 3 years, ys). We enrolled 75 HF outpts with CRT indication [30% females, mean age 67.9±12.6 ys, mean NYHA class 2.8±0.7, mean EF 25.7±8.1, HF aetiology: 44% coronary artery disease (CAD), 43% dilated cardiomyopathy (DCM), 6% hypertensive cardiomyopathy (HT), 7% valvular disease (V)]. All were evaluated by means of ECG, echocardiography, NYHA functional class before CRT device implant and re-evaluated after 1 (95% of pts), 2 (80% of pts), and 3 (45% of pts) ys. After 1 y, NYHA significantly improved (from 2.8±0.7 to 2.3±0.6, p<0.0001), as well as EF (from 25.7±8.1 to 30.1±9.0, p=0.005). This improvement was maintained after 2 ys (NYHA 2.3±0.6, EF 31.8±9.4) and 3 ys (NYHA 2.2±0.6, EF 33.4±10.2). Overall, we registered 8 deaths, of which 2 (2.7%) after 1 y, 3 (4%) after 2 ys and 3 (4%) after 3 ys. Dividing pts on the basis of HF aetiology, after 1 y all pts presented a significant improvement, while further on DCM pts showed a steady increase of EF (basal 22.9±7.8, after 1 y 28.8±9.5, after 2 ys 31.3±11.1 and after 3 ys 35.4±13.3), while CAD pts showed stabilization of EF on the first y values (basal 26.3±7.3, after 1 y 29.5±7.4, after 2 ys 29.7±6.3 and after 3 ys 29.9±5.2). Echocardiographic response to CRT in terms of EF is clearly evident after 1 y and remains improved after 2 and also 3 ys, with a not significant trend to further improve in DCM. All pts significantly improved NYHA within the first y. Benefit deriving from CRT is maintained during long term follow-up. [Copyright &y& Elsevier]

We evaluated left ventricular remodeling (LVR) in patients (pts) with heart failure (HF) of the 2 main aetiologies, coronary artery disease (CAD) and dilated cardiomyopathy (DCM) after 1 year (y) of cardiac resynchronization therapy (CRT). We enrolled 65 HF outpts with CRT indication (mean age 67.5±13.2 ys 74.6% males, M): 33 had CAD-caused HF (70.2±6.7 ys, 84.4% M) and 32 DCM (64.6±17.3 ys, 64.5% M). All underwent ECG, echocardiography, NYHA evaluation before and after 1 y of CRT. Before CRT, NYHA was similar (CAD 2.7±0.7, DCM 2.7±0.8) and after 1 y it significantly (p<0.05) and equally improved in both (CAD 2.3±0.5, DCM 2.2±0.7). Before CRT left ventricular ejection function (EF,%) was significantly (p=0.04) less in DCM (22.9±7.7) than CAD (26.3±7.3) while end-diastolic (EDV, ml) and end-systolic (ESV) volume, end-diastolic (EDD, mm) and end-systolic (ESD) diameter were significantly greater in DCM than CAD (EDV 239±78 vs 207±62 p=0.04, ESV 192±81 vs 152±57 p=0.03, EDD 72.8±8.1 vs 68.8±8.6 p=0.05, ESD 59.5±10.7 vs 53.8±8.8 p=0.03). After 1 y EF significantly improved in both (DCM 28.8±9.5 p=0.01, CAD 29.5±7.4 p=0.05) with a borderline trend to a greater increase in DCM. After 1 y EDV, ESV, EDD and ESD were reduced in both, with a significant reduction only in DCM. Expressing LVR as the volume parameters variation (Δ), it was significantly greater in DCM than CAD: ΔEDV DCM 44±72 vs CAD 20±34, p=0.04; ΔESV DCM 47±64 vs CAD 19±35, p=0.04. Before CRT QRS duration (msec) was similar in both (DCM 172±33 CAD 176±28, p=ns) as well as after (DCM 123±33 CAD 134±31, p=ns). Pre and post-CRT QRS duration and ΔQRS weren’t related to any modification of the above indicated parameters, both in the overall population and the 2 groups. Thus, CRT determines EF increase and LVR regression in both examined HF aetiologies. Volume reduction is greater in DCM than CAD. No relation exists between the volume and function parameters modifications and QRS duration both before and after CRT. [Copyright &y& Elsevier]

Accelerated coronary artery disease remains the limiting factor in the long-term survival of heart transplant (HT) recipients and occurs in approximately 50% of patients by 5 years after transplantation. Sequelae of graft arteriosclerosis include congestive heart failure (due to acute or chronic ischemia), graft loss, and death. Unfortunately, as a consequence of cardiac denervation, symptoms are often atypical or completely absent, and thus presentation with an acute coronary syndrome is extremely uncommon. We describe the case of an HT recipient with a typical clinical picture of an acute myocardial infarction (MI), who presented to our hospital 2 hours after the onset of symptoms and was successfully treated with primary percutaneous transluminal coronary angioplasty (PTCA). [Copyright &y& Elsevier]