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Premature ventricular contractions (PVCs) are a common finding in clinical practice, requiring a full diagnostic work-up in order to exclude an underlying cardiomyopathy. Still, in a substantial proportion of patients, these investigations do not identify any substrate, and the PVCs are labelled as idiopathic. Cardiac magnetic resonance (CMR) has proven in the last decades as the method of choice for the exploration of patients with cardiomyopathies, since it can identify subtle changes in the myocardial tissue and help with risk stratification. In patients with idiopathic PVCs and a high PVC burden, several studies report the presence of late gadolinium enhancement (LGE) at CMR, which can offer additional diagnostic and prognostic benefits, as well as assistance in catheter ablation procedures, as the risk for adverse cardiac and risk for arrhythmic events events is higher compared to patients without scar. This paper focuses on the impact of the presence of LGE in patients with idiopathic PVCs, reviewing all the relevant studies published so far, including randomized controlled clinical trials, prospective or retrospective cohort studies, case series and case reports as well as systematic reviews. [ABSTRACT FROM AUTHOR]

Background: Robotic systems have been used in a diverse spectrum of cardiac interventions, mainly in the field of invasive cardiology, namely interventional cardiology and electrophysiology (EP). The state-of-the-art robotic systems allow mapping and ablation of various arrhythmias without the need for manual conventional catheter steering. The aim of robotic procedures is to achieve the same effectiveness and safety as conventional procedures, whilst reducing the radiation exposure for patients and operators, and to be able to reach targets within the heart that are otherwise unreachable conventionally with greater precision and catheter stability. Purpose: We aimed to demonstrate the feasibility of 3D electroanatomical mapping (EAM) using the remote magnetic navigation (RMN) system (Niobe ES, Stereotaxis Inc) by comparing the mapping performance of 2 operators (one located in the electrophysiology catheter lab control room and the second ~1200 km away via remote online connection). Methods: Two operators were tasked to perform 3D fast anatomical maps (FAM, CARTO 3 RMT, Biosense Webster) of the right and left atrial and ventricular chambers, as well as the aorta of a 3D phantom representing normal cardiac anatomy. All procedures were recorded on the Odyssey Cinema system for further analysis. Parameters compared were duration of FAM, total volume acquired and average distance of surface match to a contrast enhanced computed tomography (CT) of the same phantom. A composite endpoint of map completeness, mapping time and surface match accuracy was calculated to demonstrate if quality of the maps between operators were comparable. Results: A total of 60 maps were created (6 maps for each right atrium (RA), left atrium (LA), right ventricle (RV), left ventricle (LV) and aorta (Ao) per operator) in an alternating fashion. Average mapping time was 16:08±3:36 min for all chambers with shorter mapping times for right atrial chamber 14:28±3:47 min. Total volumes did not significantly differ between operators. Match statistics also revealed no difference between map completeness. Comparing the composite endpoint, both operators achieved the same accuracy. Conclusion: A distant operator located more than 1200 km away from the RMN laboratory connected online to perform 3D electroanatomical maps of all cardiac chambers of a phantom with equal accuracy and procedure parameters as compared to an operator located in the control room. These results support the feasibility of truly remote-controlled procedures which would allow an expert operator to actively support a local team in EP interventions. [ABSTRACT FROM AUTHOR]

A 45-year-old male, hypertensive and obese presented with a 3-months history of short episodes of intermittent palpitations. Clinical examination was unremarkable; however, the electrocardiogram documented major right bundle branch block and the presence of fragmented QRS in all precordial leads. His echocardiography documented a dilated left ventricle, with mild systolic dysfunction and moderate biventricular reduction of the global longitudinal strain. On angiography, the epicardial coronary arteries were normal. A cardiac MRI revealed diffuse transmural fibrotic lesions with non-ischemic pattern of the ventricles, suggestive of chronic myocarditis. The electrophysiological study induced two ventricular tachycardia morphologies which were ablated and an ICD for sudden cardiac death primary prevention was implanted. Fortunately, at 6 months follow-up our patient had no ICD therapies and reported an alleviation of symptoms. [ABSTRACT FROM AUTHOR]

Electrophysiology is a rapidly evolving fi eld of cardiology dedicated to the diagnosis and treatment of cardiac arrhythmias, with a wide range of procedures being performed in a complex environment. An interventional electrophysiology laboratory involves the acquisition of modern technological systems, and the presence of specialized and well trained medical personnel, consisting of at least one electrophysiologist, one technician and two nurses. To be in line with the current European standards, the laboratory must support the whole spectrum of interventions for heart rhythm disorders. In this regard, a powerful fl uoroscopy system, programmable electrical stimulators and advanced ablation and 3D mapping systems are required. In recent years, the attention has focused on both the radiation dose minimization and protective radiological measures in the interventional cardiology laboratories, and thus the medical staff requires a specific set of qualifications. Continuous medical education is of paramount importance in an innovative fi eld with such a steep technological rise as the fi eld of electrophysiology. We considered it to be an opportune time to write this paper, as in February 2018 an official document attesting the training in electrophysiology and cardiac stimulation was officially launched by ministerial order in Romania. [ABSTRACT FROM AUTHOR]