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Congenital Heart Disease (CHD) is an anatomical and functional abnormality in the structure of the heart and/or large vessels that occurs since birth. This is diagnosed in 8-10 children out of 1,000 live born in the world. Every year about 3,000 newborns are born with CHD in Poland. The development of medicine enables the long-term survival of patients with CHD, followed by an increase in the number of adult patients being treated for CHD complications, including arrhythmias. Arrhythmias contribute to decreased quality of life, increased morbidity, and mortality among adults with congenital heart disease. The following article discusses diagnostic and therapeutic procedures in subjects with CHD and arrhythmias.

Sarcoidosis is a rare multi-systemic inflammatory disease of unknown etiology. Cardiac sarcoidosis can take many forms from a subclinical condition to life-threatening arrhythmias, and the variety of symptoms depends on the location of inflammation and fibrosis in the heart. The disease can result in heart failure, disease of the conduction system, ventricular and supraventricular arrhythmias. This article summarizes the most common arrhythmias and conduction disturbances in patients with cardiac sarcoidosis and methods of their treatments.

The implantable cardioverter-defibrillator (ICD) and subcutaneous ICD (S-ICD) are well-accepted life-saving devices for treating potentially lethal ventricular arrhythmia, but little is known about quality of life (QoL) in patients with S-ICD and ICD.Our study aimed to compare QoL in patients with S-ICD and ICD.All consecutive patients who had S-ICD implanted between October 2015 and September 2021 were included in the study. A cohort of transvenous ICD (TV-ICD) patients was matched to S-ICD subjects by sex, age, indications for the device, and type of prevention. All patients were requested to fulfill two standardized questionnaires to assess QoL: 36-Item Short Form Health Survey (SF-36) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) 6 months after device implantation.Patients with S-ICD (n = 49) and TV-ICD (n = 49) did not differ regarding baseline characteristics. There were no statistically significant differences between S-ICD and TV-ICD subgroup, both for mental and physical QoL assessed in SF-36 and MLHFQ (all P = NS). The median MLHFQ total score was 24 (9-41) for S-ICD and 28 (14-43) for TV-ICD (P = 0.83). The median total score for the SF-36 questionnaire was 62.5 (29-86) vs. 59 (38-77) for S-ICD and TV-ICD, respectively (P = 0.78).Quality of life after device implantation does not differ significantly between the groups of patients with subcutaneous and conventional implantable cardioverter-defibrillator.

Ischemic strokes account for over 80% of strokes. However, the cause of about 25% of them remains undetermined. This kind of ischemic stroke is termed cryptogenic (CS, cryptogenic stroke). In most cases, cryptoge­nic stroke has an embolic origin, which is marked by worse prognosis compared to strokes of another origin. Therefore, the term Embolic Stroke of Undetermined Source (ESUS) was separated from the group of CS in 2014. Cryptogenic stroke, in the broad sense, is a complex case, which presents a challenge to both cardiologists and neurologists. We described the steps, which are essential to take in patients, who have undergone ESUS.

We report a 15-year-old male with hypoplastic left heart syndrome (HLHS) after Fontan operation with recurrent, drug-resistant atrial tachycardia. With the use of electro-anatomical mapping system (EnSite) an atrial flutter (AFl) with reentry activation around the tricuspid valve was diagnosed. Successful radiofrequency catheter ablation (RFCA) was performed.

Competitive athletes should be screened for cardiovascular diseases associated with an increased risk of sudden cardiac death. Patients with arrhythmias, channelopathies, cardiomyopathies and cardiac implantable electronic devices should be assessed, and the level of acceptable physical activity should be established. It is crucial to personalize the guidelines and involve the patients in shared decision making. The following article provides an overview of exercise recommendations for patients with arrhythmias and cardiac implantable electronic devices on the basis of the 2020 ESC Guidelines on Sports Cardiology and Exercise. It was divided into two parts.

IntroductionThe aim of the study was to analyse microbiological charac�teristics and clinical manifestations of cardiac device-related infective endo�carditis (CDRIE) in cardiac resynchronization therapy (CRT) recipients, and to compare the diagnostic value of modified Duke (MDC) versus modified Duke lead criteria (MDLC; including to MDC local infection and pulmonary infection or embolism as major criteria).Material and methodsThe study population comprised 765 consecutive CRT patients from a high-volume, tertiary care centre from 2002 to 2015. All patients were screened for CDRIE.ResultsDuring a median follow-up of 1692 days (range: 457–3067) 5.36% of patients (n = 41) developed CDRIE, which was accompanied by CRT pocket infection in 17.1% (n = 7) and recurrent pulmonary infection or pulmonary embolism in 29.3% (n = 12). Fever was present in 95.1% of patients (n = 39), whereas blood cultures were positive in 65.9% (n = 27). Staphylococcus was the most prevalent pathogen in 59.3% (n = 16), Gram-negative bacteria in 25.9% (n = 7). Transoesophageal echocardiography showed intracardiac veg�etations in 73.2% of patients (n = 30). Non-different pathogen types with the most common methicillin-sensitive Staphylococcus aureus were observed for early versus late CDRIE (endocarditis ≤ 6 vs. > 6 months from CRT or other de�vice-related procedure). All 3 inflammatory markers (C-reactive protein, white blood cells, procalcitonin) were normal in 4.9% of patients (n = 2). MDC versus MDLC indicated definite CDRIE in 48.8% versus 80.5%, respectively (p = 0.003).ConclusionsFever is the most common symptom of CRT-related CDRIE, and transoesophageal echocardiography allows vegetations to be visualised in nearly 3/4 of patients with CDRIE. Although the most common pathogens were Staphylococci, Gram-negative bacteria accounted for a quarter of CDRIE. Modified Duke lead criteria proved superior to MDC.

Competitive athletes should be screened for cardiovascular diseases associated with an increased risk of sudden cardiac death. Patients with arrhythmias, channelopathies, cardiomyopathies and cardiac implantable electronic devices should be assessed, and the level of acceptable physical activity should be established. It is crucial to personalize the guidelines and involve the patients in shared decision making. The following article provides an overview of exercise recommendations for patients with arrhythmias and cardiac implantable electronic devices on the basis of the 2020 ESC Guidelines on Sports Cardiology and Exercise. It was divided into two parts.

The most common cause of death among dialysis patients with end-stage kidney disease are cardiovascular diseases. It is estimated that 18-27% of all deaths in dialysis patients are sudden cardiac deaths due to arrhythmias and conduction disturbances. The most common arrhythmias in dialysis patients, often leading to sudden death, are not ventricular arrhythmias but bradyarrhythmias. The article below discusses the most common arrhythmias in dialysis patients and methods of preventing sudden cardiac death in this group of patients.

AimsCryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). The most frequent complication during CB-based PVI is right-sided phrenic nerve injury (PNI) which is leading to premature abortion of the freeze cycle. Here, we analysed reconnection rates after CB-based PVI and PNI in a large-scale population during repeat procedures.Methods and resultsIn the YETI registry, a total of 17 356 patients underwent CB-based PVI in 33 centres, and 731 (4.2%) patients experienced PNI. A total of 111/731 (15.2%) patients received a repeat procedure for treatment of recurrent AF. In 94/111 (84.7%) patients data on repeat procedures were available. A total of 89/94 (94.7%) index pulmonary veins (PVs) have been isolated during the initial PVI. During repeat procedures, 22 (24.7%) of initially isolated index PVs showed reconnection. The use of a double stop technique did non influence the PV reconnection rate (P = 0.464). The time to PNI was 140.5 ± 45.1 s in patients with persistent PVI and 133.5 ± 53.8 s in patients with reconnection (P = 0.559). No differences were noted between the two populations in terms of CB temperature at the time of PNI (P = 0.362). The only parameter associated with isolation durability was CB temperature after 30 s of freezing. The PV reconnection did not influence the time to AF recurrence.ConclusionIn patients with cryoballon application abortion due to PNI, a high rate of persistent PVI rate was found at repeat procedures. Our data may help to identify the optimal dosing protocol in CB-based PVI procedures.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT03645577?term=YETI&cntry=DE&draw=2&rank=1 ClinicalTrials.gov Identifier: NCT03645577.

Atrial fibrillation is known as the epidemic of the 21st century. This most common arrhythmia carries the risk of, inter alia, serious thromboembolic complications. Due to the paroxysmal nature of arrhythmia, the diagnosis of atrial fibrillation is not easy. New technologies and methods of minimally invasive, continuous ECG monitoring for early detection of arrhythmias are dynamically developing. The following article discusses new heart rate monitoring methods for the detection of atrial fibrillation.

We currently have a wide range of different imaging tests that are constantly improving and developing. Each test has its sensitivity and specificity and is used in various fields of medicine. Knowledge of the possibilities of using imaging tests in electrotherapy is an important element of the diagnostic and therapeutic process. This article presents selected issues regarding the use of imaging methods in the diagnosis and treatment of patients with cardiac implantable electronic devices.

Background A leadless pacemaker is a new concept in which a miniaturized pacing device is self-contained within the heart. Recently published data show that leadless pacemakers are associated with a decreased risk of major complications when compared with transvenous cardiac pacemakers. This seems to be of particular importance in children and young adults in whom various complications may occur during their lifetime. Case summary Herein, we report the successful implantation of Micra™ Transcatheter Pacing System in two children: 12-year-old boy and 13-year-old girl, along with a long-term follow-up. The children had indications for pacemaker implantation, however, with an expected low percentage of pacing due to paroxysmal nature of the third-degree atrioventricular block. The implantation procedures were performed in general anaesthesia. There were no complications. During the 2-year follow-up, there were no adverse events and the electrical parameters of the device remained stable. Pacing percentage was below 0.1%. Discussion Transvenous cardiac pacemakers improve quality of life and reduce mortality but may be associated with various short- and long-term complications, mainly related to the presence of transvenous leads and the pulse generator. Compared with adult patients, the implantation of conventional pacemakers in children is still a challenge, not only because of their smaller size but also due to continuing growth, as well as a higher rate of lead and device-related complications. We demonstrate that the implantation of leadless pacemakers in children is feasible and could be worth considering in certain clinical scenarios, especially when ventricular pacing is required rarely.

Patients with cardiac implantable electronic devices (CIEDs) constitute a considerable population. Issues related to CIEDs both in the field of cardiac pacemakers, cardioverter-defibrillators, and cardiac resynchronization are still intensively studied. This article presents the results of selected, relevant studies on CIEDs announced or published in 2019.

Supplemental Digital Content is available in the text., Background: Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce. Methods: The YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible. Results: A total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was −49±8°C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months. Conclusions: The incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03645577. Graphic Abstract: A graphic abstract is available for this article.

Background Advanced heart failure with reduced ejection fraction (HFrEF) is associated with poor prognosis. Cardiac resynchronization therapy (CRT) is an effective method of treatment for advanced HFrEF to reduce HF hospitalizations and mortality. Nonetheless, very long-term observation of HF patients undergoing CRT implantation is scarce. Aim To assess very long-term survival (≥10 years) and predictors of shorter survival (death within 10 years from CRT implantation). Methods We screened a large dataset of CRT population from a tertiary care university hospital comprising consecutive HF patients implanted with CRT from 2002 through 2019 to select those who were alive ≥10 years and those who died within 10 years since device implantation. We analyzed various patients' baseline, clinical and procedural characteristics and sought for predictors of mortality within 10 years from CRT implantation. Results Of 1059 CRT patients, 143 (13.5%) were alive ≥10 years since CRT implantation. On multivariable regression analysis the independent predictors for all-cause death up to 10 years from CRT implantation were as follows: age, HR 1.02, 95% CI 1.01–1.31; male sex, 1.27, 95% CI 1.01–1.60; primary prevention of sudden cardiac death (SCD), HR 0.72, 95% CI 0.58–0.89; ischemic cardiomyopathy, HR 1.41, 95% CI 1.76–1.70; NYHA class at implantation, HR 1.38, 95% CI 1.17–1.62; baseline left ventricle ejection fraction (EF), HR 0.97, 95% CI 0.96–0.98; severe mitral regurgitation, HR 1.38; 95% CI 1.08–1.75; baseline NT-proBNP concentration, HR 1.00, 95% CI 1.00–1.00; and creatinine level, HR 1.00, 95% CI 1.00–1.01. Conclusions In a real-life patient population with CRT only 13.5% survived over 10 years since device implantation. Independent predictors for death within 10 years since CRT implantation were older age, male sex, secondary prevention of SCD, ischemic and more advanced heart failure along with renal impairment. Funding Acknowledgement Type of funding sources: None.

Background Cardiac resynchronization therapy (CRT) is an effective method of treatment in patients with HF, but as complex device with three electrodes, it is prone to electrode dysfunctions and the need to replace them. However little is known about the frequency of need for leads replacement in subjects undergone CRT in a very long-term follow up. Aim To determine the frequency of leads replacement in patients undergoing CRT during long term follow-up. Methods Study population consisted of 1059 consecutive patients with CRT implanted between 2002 and 2019 in tertiary care university hospital, in a densely inhabited, urban region of Poland. The data about lead replacement was collected. Results During the median follow-up of 1661 days (IQR: 815–2792) for non-infectious reasons (dislocation, dysfunction, fracture etc.) a total of 324 leads in 251 patients (23.7%) were replaced. Median time from CRT implantation to the first lead replacement was 359 days (42–1413). The electrode replacement within first year after CRT implantation was performed in 126 subjects (50.2%), in the rest of patients (49.8%) the leads were replaced after one year of device implantation. In patients with above ten years of follow up (n=143; 13.5%) 67 subjects (46.8%) had one or more lead replacement during follow up. Patients with electrode replacement during follow-up were younger (63 vs 66 years, P Conclusions The need for leads replacement due to non-infectious reasons reaches almost 25% of patients with CRT within 4.5 years. Half of the patients have lead replacement within one year after CRT implantation and the other half during long term follow up. The duration of the first procedure (CRT device implantation) is strong predictor of lead replacement during follow up. Funding Acknowledgement Type of funding sources: None.

Introduction Percutaneous occlusion of the left atrial appendage (LAAO) is becoming an extensively used method of stroke prevention in individuals with contraindications to oral anticoagulants. Transesophageal echocardiography (TOE) is the gold standard for LAAO guiding, but intracardiac echocardiography (ICE) appears to be a potential alternative. Aim To compare the LAAO procedure guided by TOE or ICE with respect to procedural success and safety. Material and methods TOE-guided LAAO was performed in 12 patients and ICE-guided LAAO in 11 patients. ICE was performed using an 8F AcuNav probe and the ACUSON SC2000 system. For LAAO the Amplatzer Amulet was used. After 1 month TOE was performed. Results Procedural success was achieved in all patients in TOE and ICE groups. There was 1 complication (groin hematoma). The procedure time was significantly longer in the TOE group (43 to 80 min; median: 54 min) compared to the ICE group (28 to 67 min; median: 45 min), (p = 0.02) The time needed to puncture the interatrial septum and time needed to remove the sheath did not differ between groups. Fluoroscopic time was insignificantly longer in the ICE group (9.91 ±4.01s) compared to the TOE group (7.69 ±3.21s), and a significantly larger contrast media volume was used in the ICE group (30.00 ±6.67 ml vs. 40.45 ±23.18 ml, p = 0.03). There were no statistically significant differences in the results between TOE and ICE groups in follow-up assessments. Conclusions LAAO using the Amplatzer Amulet may be successfully and safely guided by ICE. ICE offered shorter procedure time and similar results irrespectively of left atrial appendage anatomy compared to TOE guidance.

Patients with cardiac implantable electronic devices (CIEDs) constitute a considerable population. During entire life, these patients often require various diagnostic tests due to co-morbidities. Magnetic resonance imaging (MRI) was one of the contraindications in patients with CIEDs. The published data showed that MRI could be made safely in patients with CIEDs. Moreover, a lot of new CIEDs are MRI conditional. In the article we summarize the knowledge about performing MRI in patients with CIEDs.

Cardiac implantable electronic devices (CIEDs) such as pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), both with or without cardiac resynchronization therapy (CRT), became one of the fundamental therapies in present-day electrocardiology. The CIED patients population is increasing year by year due to a growing number of CIED implantations annually and a life prolongation among patients with CIEDs through better pharmacology combined with the proper electrotherapy and patient care. Invasive procedures related to CIED such as an implantation, a replacement or an up-grade of any kind electrotherapy device involves the risk of complications. Pocket hematoma or infection, which are local complications, should be recognized rapidly and treat properly in order to avoid more threatening systemic complications.

The implantation of a subcutaneous cardioverter-defibrillator (S-ICD) may be used instead of a traditional transvenous system to prevent sudden cardiac death. Our aim was to compare the characteristics of S-ICD patients from the multi-center registry of S-ICD implantations in Poland with the published results of the European Snapshot Survey on S-ICD Implantation (ESSS-SICDI). We compared data of 137 Polish S-ICD patients with 68 patients from the ESSS-SICDI registry. The groups did not differ significantly in terms of sex, prevalence of ischemic cardiomyopathy, concomitant diseases, and the rate of primary prevention indication. Polish patients had more advanced heart failure (New York Heart Association (NYHA) class III: 11.7% vs. 2.9%, NYHA II: 48.9% vs. 29.4%, NYHA I: 39.4% vs. 67.7%, p &lt, 0.05 each). Young age (75.9% vs. 50%, p &lt, 0.05) and no vascular access (7.3% vs. 0%, p &lt, 0.05) were more often indications for S-ICD. The percentage of patients after transvenous system removal due to infections was significantly higher in the Polish group (11% vs. 1.5%, p &lt, 0.05). In the European population, S-ICD was more frequently chosen because of patients’ active lifestyle and patients’ preference (both 10.3% vs. 0%, p &lt, 0.05). Our analysis shows that in Poland, compared to other European countries, subcutaneous cardioverters-defibrillators are being implanted in patients at a more advanced stage of chronic heart failure. The most frequent reason for choosing a subcutaneous system instead of a transvenous ICD is the young age of a patient.

Background Triple-Site versus Standard Cardiac Resynchronization Therapy Randomized Trial (TRUST CRT) was initiated in 2009 to verify the hypothesis whether triple-site (single right, double left) cardiac resynchronization therapy (CRT) may be superior to conventional, biventricular resynchronization in patients with advanced heart failure. Objectives To report 6-month outcomes and 10-year survival in TRUST CRT. Methods 100 consecutive patients with moderate to severe heart failure, ejection fraction of 35% or less, electrical and mechanical dyssynchrony, were randomly assigned in a 1:1 fashion to triple-site CRT defibrillator (TRIV) or to conventional CRT-D. The primary objective evaluated response-rate, defined as the 6-month's combined end point of alive status, freedom from hospitalization for heart failure or heart transplantation, relative≥10% increase in ejection fraction, ≥10% in peak oxygen consumption, and ≥10% in 6-minute walking distance. The secondary objective was to assess the occurrence of major adverse cardiovascular events (hospitalization for exacerbated heart failure requiring modification of pharmacotherapy, heart transplant or death) at month 6 and during remote observation. Results At month 6, the response-rate was higher in triple-site than conventional CRT-D group (51.1 vs. 26.5%, P=0.014). There were 2 deaths or heart failure events in the triple-site group (4%) as compared with 8 in the group assigned to conventional CRT-D (16%). A triple-site resynchronization resulted in 12% absolute risk reduction for secondary end point (hazard ratio 0.25; 95 percent confidence interval, 0.05 to 1.17, P=0.056, in comparison with the conventional CRT-D group). After 10 years of observation (median follow up of 7.1 years; range: 1.2–10.4) 57 patients (58.2%) died: 24 (53.3%) in the triple-site group, 31 (60.8%) in the conventional group (P=0.46) and 2 patients with and ICD (failed CRT implantation) [Figure]. Conclusions In patients with advanced heart failure, triple-site resynchronization combined with an ICD did not result in better survival than conventional resynchronization therapy in a median observation of 7.1 years. Figure 1 Funding Acknowledgement Type of funding source: None

Aim To assess the incidence, clinical significance of depression and the impact of a cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) implantation on psychiatric status in patients with heart failure (HF). Methods The prospective, single-center study encompassed 575 consecutive HF patients implanted with a CRT-D or ICD. Finally, the study population consisted of 494 subjects (186 ICD and 308 CRT-D patients), as 81 patients taking antidepressants were excluded from the analysis. All patients underwent psychiatric examination at the time of implantation, and the assessment of psychiatric status was repeated after 3, 6, 12 and 24 months. The study population was divided into 4 groups: Group 1 encompassed 101 (20.4%) patients with persistent depression, Group 2 constituted of 95 (19.2%) patients with depression that developed after ICD/CRT-D implantation, whereas 43 (8.7%) patients with remission of depression comprised Group 3, and Group 4 encompassed 255 (51.6%) patients with never diagnosed depression. Data on long-term follow-up (median 34.1 months) were screened to identify patients who developed a composite endpoint defined as death or hospitalization for decompensated HF. Results The cumulative incidence of depression at the baseline assessment was 39.1%. Depression developed in 95 (27.1%) patients, whereas remission of depression was observed in 43 (29.9%) subjects after ICD/CRT-D implantation. ICD intervention (HR 3.3) and increase in NYHA class by at least one class (HR 2.6) were the independent risk factors for depression development, whereas mitral regurgitation reduction (HR 1.9), as well as improvement in NYHA class by at least one class (HR 2.4) were the independent predictors for depression remission. Patients with persistent depression (Group 1) and those with newly developed depression (Group 2) were at significantly higher risk of a composite endpoint compared to patients in Group 3 and Group 4 (Table 1). Conclusions Depression is a common comorbidity associated with HF, as it affects 4 of 10 HF patients. ICD intervention and HF worsening are the strongest predictors for depression development after ICD/CRT-D implantation. Depression is a strong, independent risk factor of poor outcomes in HF population. Funding Acknowledgement Type of funding source: None

Funding Acknowledgements none OnBehalf none Background The benefit of an implantable cardioverter-defibrillator (ICD) in patients with ischaemic heart failure (HF) has been well proven but the benefit of ICD in subjects with non-ischaemic systolic HF is less well-established. Consequently, there is very limited evidence which patients with non-ischaemic HF would benefit most from receiving an ICD. Aim To determine the incidence and predictors of ventricular arrhythmia in patients with ICD and non-ischaemic systolic HF. Methods Study population consisted of 420 consecutive patients with ICD and non-ischaemic systolic HF monitored remotely (on a daily basis) between 2010 and 2017 in tertiary care university hospital, in a densely inhabited, urban region of Poland. Sixty-six percentage of patients had cardiac resynchronization therapy with defibrillator (CRT-D). Results During the median follow-up of 1645 days (range: 507-3515) sustained ventricular arrhythmia occurred in 100 patients (23.8%). Of those, ventricular fibrillation (VF), ventricular tachycardia (VT) or VT/VF (combined) occurred in 10 (10.0%), 77 (77.0%) and 13 (13.0%) patients, respectively. Patients with versus without ventricular arrhythmia did differ with respect to baseline variables such as: left ventricular end diastolic diameter (LVEDD) - median of 67 mm [49-82] vs 62 mm [46-78]; post-inflammatory HF (17 vs 9.7%, P = 0.045); atrial fibrillation/atrial flutter - AF/AFL (57 vs. 38.1%, P = 0.0009); supraventricular arrhythmia (SVT) - any supraventricular arrythmia >100/min other than AF/AFL (27 vs. 15.9%, P = 0.01); and left ventricular ejection fraction - EF (25 vs. 28%, P = 0.01). No differences were observed for age, sex, NYHA class, mitral regurgitation, common comorbidities (including diabetes and chronic renal disease) or concomitant medications. On multivariable regression analysis, LVEDD (HR 1.05, 95% CI 1.004-1.09, P = 0.03), AF/AFL (HR 1.81, 95% CI 1.21-2.72, P = 0.004) and SVT (HR 1.91, 95% CI 1.21-3.01, P = 0.006) were identified as independent predictors of sustained ventricular arrhythmia in patients with ICD and non-ischaemic HF. All-cause mortality in patients with VT/VF was significantly higher than in subjects without sustained ventricular arrhythmias (33% vs. 20%, P = 0.03). Conclusions Ventricular arrhythmia occurred in 23.8% of patients with systolic non-ischaemic HF during 4.5 years of observation and was associated with significantly worse prognosis compared with subjects free of VT/VF. Left ventricular dimension, atrial fibrillation/atrial flutter and supraventricular tachycardia were identified as independent predictors for ventricular arrhythmia.

Syncope is a heterogeneous syndrome encompassing a large spectrum of mechanisms and outcomes. The European Society of Cardiology published an update of the Syncope Guidelines in 2018. The aim of the present survey was to capture contemporary management of syncope and guideline implementation among European physicians. A 23-item questionnaire was presented to 2588 European Heart Rhythm Association (EHRA) members from 32 European countries. The response rate was 48%, but only complete responses (n = 161) were included in this study. The questionnaire contained specific items regarding syncope facilities, diagnostic definitions, diagnostic tools, follow-up, and therapy. The survey revealed that many respondents did not have syncope units (88%) or dedicated management algorithms (44%) at their institutions, and 45% of the respondents reported syncope-related hospitalization rates >25%, whereas most (95%) employed close monitoring and hospitalization in syncope patients with structural heart disease. Carotid sinus massage, autonomic testing, and tilt-table testing were inconsistently used. Indications were heterogeneous for implanted loop recorders (79% considered them for recurrent syncope in high-risk patients) or electrophysiological studies (67% considered them in bifascicular block and inconclusive non-invasive testing). Non-pharmacological therapy was consistently considered by 68% of respondents; however, there was important variation regarding the choice of drug and device therapy. While revealing an increased awareness of syncope and good practice, our study identified important unmet needs regarding the optimal management of syncope and variable syncope guideline implementation.

Aims To assess and compare long-term mortality and predictors thereof in de novo cardiac resynchronization therapy defibrillators (CRT-D) vs. upgrade from an implantable cardioverter-defibrillator (ICD) to CRT-D. Methods and results Study population consisted of 595 consecutive patients with CRT-D implanted between 2002 and 2015 in a tertiary care, university hospital, in a densely inhabited, urban region of Poland [480 subjects (84.3%) with CRT-D de novo implantation; 115 patients (15.7%) upgraded from ICD to CRT-D]. In a median observation of 1692 days (range 457–3067), all-cause mortality for de novo CRT-D vs. CRT-D upgrade was 35.5% vs. 43.5%, respectively (P = 0.045). On multivariable regression analysis including all CRT recipients, the previously implanted ICD was an independent predictor for death [hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.10–2.29, P = 0.02]. For those, who were upgraded from ICD to CRT-D, the independent predictors for all-cause death were as follows: creatinine level (HR 1.01, 95% CI 1.00–1.02, P = 0.01), left ventricular end-systolic diameter (HR 1.07, 95% CI 1.02–1.11, P = 0.002), New York Heart Association (NYHA) IV class at baseline (HR 2.36, 95% CI 1.00–5.53, P = 0.049) and cardiac device-related infective endocarditis during follow-up (HR 2.42, 95% CI 1.02–5.75, P = 0.046). A new CRT scale (Creatinine ≥150 μmol/L; Remodelling, left ventricular end-systolic ≥59 mm; Threshold for NYHA, NYHA = IV) showed high prediction for mortality in CRT-D upgrades (AUC 0.70, 95% CI 0.59–0.80, P = 0.0007). Conclusion All-cause mortality in patients upgraded from ICD is significantly higher compared with de novo CRT-D implantations and reaches almost 45% within 4.5 years. A new CRT scale (Creatinine; Remodelling; Threshold for NYHA) has been proposed to help survival prediction following CRT upgrade.

Atrial fibrillation (AF) is the one of the most frequent arrhythmia in general population. In 2010 all over the world there was 20,9 mln male and 12,6 mln female with this arrhythmia [1-3]. Atrial fibrillation could be totally asymptomatic, thus the number of patients is probably underestimated. AF increases cardiovascular morbidity, and is one of the cause of stroke or heart failure. Due to the fact that AF concerns an increasing number of patients with various comorbidities in some groups of patients, it may pose many clinical problems and require special treatment.

Background: Subcutaneous implantable cardioverter-defibrillator (S-ICD) may be an alternative to transvenous ICD (TV-ICD). Aim: We sought to evaluate factors determining the choice of S-ICD vs. TV-ICD in Polish patients in comparison to other European countries. Methods: All consecutive patients who underwent TV-ICD or S-ICD implantation in centres participating in the European Heart Rhythm Association prospective snapshot survey were included. Results: During an eight-week study period, 429 patients were recruited, including 136 (31.7%) ICD patients from Poland (eight with S-ICD). In comparison to other European centres, the proportion of S-ICD implantations in Poland was lower (7% vs. 26%, p < 0.001), whereas the ratio of cardiac resynchronisation therapy defibrillator implantations was higher (43% vs. 26%; p < 0.001). Subjects receiving S-ICD in Poland were more often over 75 years old (25% vs. 0%, p < 0.001), in New York Heart Association class II (87.5% vs. 29.4%, p = 0.001), with chronic kidney disease (37.5% vs. 5.9%, p = 0.003), and with lower left ventricular ejection fraction (32% [14%–50%] vs. 50% [25%–60%], p = 0.04), compared to other European countries. Additionally, in comparison to subjects from other European centres, Polish patients were significantly more often implanted with S-ICD due to prior infection (37.5% vs. 1.5%, p < 0.001) and a lack of venous access (25% vs. 0%, p < 0.001), whereas the largest subset of patients in other European countries were implanted with S-ICD because of young age (50% vs. 25%, p = NS). Conclusions: The main reasons leading to S-ICD implantations in Polish patients differ from the indications adopted in other European countries. In Poland, patients referred for TV-ICD or S-ICD implantation had more advanced heart failure and more comorbidities in comparison to subjects from other European countries. S-ICD is still underused in Polish patients.

Background: Cardiac device-related infective endocarditis (CDRIE) is one of the most serious complications of cardiac resynchronisation therapy (CRT). Aim: We sought to assess clinical outcomes and their determinants in CRT patients with CDRIE. Methods: A tertiary cardiology centre database was screened to identify all CDRIE cases, diagnosed based on the modified Duke criteria, amongst 765 consecutive CRT implantations performed between 2002 and 2015 (70.8% de novo implantations, 29.2% upgrades). Results: During the median follow-up of 1692 days (range: 457–3067 days) CDRIE was diagnosed in 41 (5.4%) patients. Overall, in-hospital and long-term mortality rates of CDRIE patients were 51.2% and 75.6%, respectively. Among patients with CDRIE, in whom the device was vs. was not explanted, in-hospital death rates were 39.3% (11/28 patients) vs. 76.9% (10/13 patients; p = 0.025). In multivariate regression analysis, device removal was independently associated with significantly lower in-hospital mortality (hazard ratio [HR] 0.09, 95% confidence interval [CI] 0.03–0.35, p = 0.0004). The need for temporary pacing after device removal (HR 5.92, 95% CI 1.13–30.96, p = 0.035), a time period of less than seven days between CDRIE diagnosis and CRT removal (HR 6.69, 95% CI 1.48–30.27, p = 0.01), and the highest serum creatinine level during infection (HR 1.02, 95% CI 1.004–1.03, p = 0.01) were identified as independent predictors of higher in-hospital mortality. Conclusions: Device removal is independently associated with lower mortality in patients with CRT and CDRIE. Early device removal (less than seven days since the diagnosis), the need for temporary pacing after removal and acute renal failure are independent mortality predictors in CRT patients who developed CDRIE.

The aim of this European Heart Rhythm Association (EHRA) prospective snapshot survey is to assess peri-procedural practices, implantation techniques, and short-term procedure-related complications associated with implantation of subcutaneous implantable cardioverter-defibrillator (S-ICD) or transvenous implantable cardioverter-defibrillator (TV-ICD), across tertiary European electrophysiology centres. An internet-based electronic questionnaire concerning implantation settings, peri-procedural routines, techniques, personnel, complications, and patient outcomes was sent to the centres routinely implanting both TV-ICDs and S-ICDs. The centres were requested to prospectively include consecutive patients implanted with either TV-ICD or S-ICD during the 8-week enrolment period. Overall, 20 centres from 6 countries enrolled 429 consecutive patients. Subcutaneous implantable cardioverter-defibrillators (20%) compared with TV-ICD were implanted mainly under general anaesthesia (72% vs. 14%), in the surgical operation room settings (69% vs. 43%), with more frequent prophylactic antibiotic administration (82% vs. 91%), and post-implant defibrillation testing (85% vs. 7%, all P < 0.05). Feasibility (implantation duration of 45 min) and short-term complication rates (4%) were comparable for S-ICDs and TV-ICDs, but the spectrum of complications varied, despite different baseline characteristics of patients undergoing the S-ICD vs. TV-ICD implantation. This EHRA snapshot survey provides important insights into the implantable cardioverter-defibrillator implantation routines and patient outcomes. Our study showed differences between the S-ICD and TV-ICD implantation routines with respect to implantation settings, peri-procedural management, and pre-defined procedural endpoints. However, the comparable duration of S-ICD or TV-ICD implantation and similar rates of peri-procedural complications indicate that both devices can be routinely used in clinical practice.

In case of the need of pacemaker implantation, patients with artificial tricuspid valve are a special group of subjects, because of high risk of dysfunction of the prosthesis. In case of mechanical prosthesis of tricuspid valve the leads of pacemaker are usually located in coronary sinus. In case of biological prosthesis of tricuspid valve despite of the risk of prosthesis damage the electrodes are implanted endocardially. The leadless pacemakers seems to be promising alternative in patients with artificial tricuspid valve because of minor risk of valve damage. The case report concerns to the patient with tachycardia-bradycardia syndrome and biological prosthesis of tricuspid valve in whom the leadless pacemaker Micra was implanted.

People over 65 years old account for almost one fifth (19%) of the European population. A percentage of the oldest old in this group also increases. Patients over 80 years old are burdened with a number of comorbidities with the lead of cardiovascular diseases (CVD). An aging organism creates demanding conditions for pacemaker implantation and surgery in general. We report a case of a 102-year old patient with tachycardia-bradycardia syndrome and syncope who has had MicraTM Transcatheter Pacing System (Micra TPS, Medtronic, Minneapolis, MN, USA) implantated.

Background Over a quarter of all cardiac resynchronization therapy (CRT) implants are upgrades from previous devices, mainly from implantable cardioverter-defibrillator (ICD). In comparison to CRT with defibrillator (CRT-D) de novo implantation, upgrade from ICD to CRT-D carries higher risk of complications. Limited number of studies evaluated predictors of death in patients undergoing upgrade from ICD to CRT-D. Aim To determine mortality predictors and outcome in patients undergoing upgrade from ICD to CRT-D in comparison to subjects with CRT-D de novo implantation. Methods Study population consisted of 595 consecutive patients with CRT-D implanted between 2002 and 2015 in tertiary care university hospital, in a densely inhabited, urban region of Poland (480 subjects [84.3%] with CRT-D de novo implantation; 115 patients [15.7%] upgraded from ICD to CRT-D). Results The median follow-up was 1692 days (range: 457–3067). All-cause mortality in patients upgraded from ICD was significantly higher than in subjects with CRT-D implanted de novo (43.5% vs. 35.5%, P=0.045). On multivariable regression analysis, left ventricular end-systolic diameter (HR 1.07, 95% CI 1.02–1.11, P=0.002), creatinine level at baseline (HR 1.01, 95% CI 1.00–1.02, P=0.01), NYHA IV class at baseline (HR 2.36, 95% CI 1.00–5.53, P=0.049) and cardiac device-related infective endocarditis (CDRIE) during follow up (HR 2.42, 95% CI 1.02–5.75, P=0.046) were identified as independent predictors of higher mortality in patients with CRT-D upgraded from ICD. Conclusions Mortality rate in patients upgraded from ICD is higher in comparison to CRT-D de novo implanted subjects, and reaches almost 45% within 4.5 years. Left ventricular dimensions, creatinine level, high NYHA class at baseline and infective endocarditis during follow up are independent mortality predictors in patients with CRT-D upgraded from ICD.

Objectives: Chronic heart failure (HF) is associated with significantly increased prevalence of depression. The aim of the study was to assess the incidence and clinical impact of depression as well as the effectiveness of depression treatment in HF patients. Methods: A prospective interventional trial included 285 consecutive cardiac resynchronization therapy recipients. Patients underwent a psychiatric examination at the time of implantation and then it was routinely repeated at 3, 6, and 12 months after the procedure, and every 6 months thereafter. One hundred and thirty-five (47.4%) patients with depression were included in the depression group, whereas the control group was comprised of 150 patients free of depression. Sixty-eight (50.4%) subjects received antidepressants (treated group), whereas the observational group had 67 (49.6%) depressed patients who refused to take antidepressants. Results: Depression remission was achieved in 51 (75.0%) patients from the treated group. Long-term mortality and HF hospitalization rates were significantly higher in the depression group than in the control group (20.7 vs. 11.3% and 32.6 vs. 19.2%, respectively). However, remission from depression was associated with a 40% reduction in the relative risk of major adverse cardiac events (MACE). Conclusions: Patients with HF and concomitant depression are at higher risk of MACE compared with those free of depression. Effective antidepressant treatment may significantly improve long-term outcomes in this population.

To assess incidence, predisposing factors and outcomes of cardiac device-related infective endocarditis (CDRIE) in patients undergoing cardiac resynchronization therapy (CRT).High-volume, single-center cardiology database was screened to identify all CDRIE cases, based on modified Duke criteria, amongst 765 consecutive CRT implantations between 2002 and 2015 (70.8% de novo implantations, 13.7% and 15.5% up-grades from pacemaker and implantable cardioverter–defibrillator [ICD], respectively). During the median follow-up (FU) of 1207 days (range: 256–2664) overall 38 CDRIE (4.97%) cases were identified (incidence: 15/1000 person-years). Multivariate Cox regression model, incorporating significant baseline differences as covariates (model 1), demonstrated that both up-grade from ICD to CRT and higher baseline NYHA class were independently associated with increased risk of CDRIE (adjusted HR 4.29, 95%CI 1.93–9.57; and HR 2.43, 95%CI 1.32–4.49, respectively). In the second model (including all differences with P0.2) up-grade from ICD (HR 4.36, 95%CI 1.96–9.69), higher NYHA class (HR 2.04, 95%CI 1.11–3.75), hypertrophic cardiomyopathy (HR 5.85, 95% CI 1.46–23.52), lower baseline hemoglobin level (HR 0.68, 95%CI 0.50–0.94) and chronic obstructive pulmonary disease (HR 2.46, 95%CI 1.05–5.77) were all independently associated with higher risk of CDRIE. All-cause mortality in patients with CDRIE was significantly higher than in subjects without infective complications (68.4% vs. 33.7%, P0.001), and 50% of patients with CDRIE died during index hospitalization.The prevalence of CDRIE in CRT recipients is almost 5% within 3.5 years post implantation. Up-grade from ICD and high baseline NYHA class flag up patients at high-risk of CDRIE. CRT-related infective complications are associated with very poor prognosis.

Incidence and clinical significance of transient, daily fluctuations of biventricular pacing percentage (CRT%) remain unknown. We assessed the value of daily remote monitoring in identifying prognostically critical burden of low CRT%.Prospective, single-centre registry encompassed 304 consecutive heart failure patients with cardiac resynchronization therapy defibrillators (CRT-D). Patients with 24-h episodes of CRT% loss95% were assigned to quartiles depending on cumulative time spent in low CRT%: quartile 1 (1-8days), 2 (9-20days), 3 (21-60days) and quartile 4 (60days). During median follow-up of 35months 51,826 transmissions were analysed, including 15,029 in 208 (68.4%) patients with episodes of low CRT%. Overall, mean CRT%≥95% vs.95% resulted in a 4-fold lower mortality (17.3 vs. 68.2%; p0.001). Fifty-four percent of patients experienced episodes of CRT% loss, despite 85.6% having mean CRT%≥95%. Mortality was lowest in quartile 1 (7.7%), while longer periods of CRT% loss resulted in significantly higher death rates (25.0 vs. 34.6 vs. 57.7%; quartiles 2-4 respectively, p0.001), despite mean CRT% still being ≥95% in quartiles 1-3. Cumulative low CRT% burden was the independent risk factor for death (HR 1.013; 95% CI 1.006-1.021; p0.001). Mortality rose by 1.3 and 49% with every additional day and quartile of CRT% loss, respectively.Daily remote monitoring allows one to detect 24-h episodes of CRT% loss95% in over two-thirds of CRT-D recipients during median observation of 3years. Cumulative low CRT% burden (in days) independently predicts mortality before mean CRT% drop.

Despite major therapeutic advances over the last decades, complex supraventricular and ventricular arrhythmias (VAs), particularly in the emergency setting or during revascularization for acute myocardial infarction (AMI), remain an important clinical problem. Although the incidence of VAs has declined in the hospital phase of acute coronary syndromes (ACS), mainly due to prompt revascularization and optimal medical therapy, still up to 6% patients with ACS develop ventricular tachycardia and/or ventricular fibrillation within the first hours of ACS symptoms. Despite sustained VAs being perceived predictors of worse in-hospital outcomes, specific associations between the type of VAs, arrhythmia timing, applied treatment strategies and long-term prognosis in AMI are vague. Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia that may be asymptomatic and/or may be associated with rapid haemodynamic deterioration requiring immediate treatment. It is estimated that over 20% AMI patients may have a history of AF, whereas the new-onset arrhythmia may occur in 5% patients with ST elevation myocardial infarction. Importantly, patients who were treated with primary percutaneous coronary intervention for AMI and developed AF have higher rates of adverse events and mortality compared with subjects free of arrhythmia. The scope of this position document is to cover the clinical implications and pharmacological/non-pharmacological management of arrhythmias in emergency presentations and during revascularization. Current evidence for clinical relevance of specific types of VAs complicating AMI in relation to arrhythmia timing has been discussed.

Exacerbation of chronic heart failure (HF) is the most common cause of hospitalization in adults, which is associated with high morbidity and mortality rates, mainly due to HF exacerbation or sudden cardiac death (SCD). A novelty in the treatment of HF with reduced left ventricular ejection fraction (HFrEF) in recent years has been the approval of sacubitril / valsartan, a drug belonging to angiotensin receptor-neprilysin inhibitors (ARNIs). Sacubitril / valsartan significantly reduces the severity of HF symptoms as well as the risk of hospitalization and death and is characterized by a good safety profile. Therefore, it has a strong position in the guidelines of international cardiac societies. However, the precise mechanism underlying the beneficial effects of ARNIs on cardiovascular mortality is unknown. The advantages of ARNIs are likely to result from improved left ventricular ejection fraction, reduced myocardial remodeling, and increased natriuretic peptide availability. Therefore, sacubitril / valsartan may exhibit antiarrhythmic properties and reduce the risk of ventricular arrhythmias and SCD in patients with HFrEF. Importantly, the improvement of the function and electrical stabilization of cardiomyocytes may translate into a reduced risk of appropriate and inappropriate implantable cardioverter‑defibrillator interventions and improvement in the percentage of biventricular pacing. In this expert opinion of the Heart Rhythm and Heart Failure Sections of the Polish Cardiac Society, we summarize and discuss the current knowledge on the effect of sacubitril / valsartan on the occurrence of ventricular arrhythmias and the risk of SCD in patients with chronic HFrEF.

OBJECTIVES The primary aim of the study was to evaluate risk factors for ventricular fibrillation/sustained ventricular tachycardia (VF/VT) and to develop the risk score for prediction of VF/VT in patients with ST-segment elevation myocardial infarction (STEMI) treated invasively. The secondary aim was to assess the effect of VF/VT on mortality depending on timing of arrhythmia. PATIENTS AND METHODS We analyzed 4363 consecutive patients with STEMI treated invasively. Among them, 163 patients with pre-reperfusion arrhythmia were excluded from the study. Group ventricular arrhythmias (VA) encompassed patients with VF/VT - those with reperfusion-induced arrhythmia were included into group VA1, whereas group VA2 consisted of patients with postreperfusion arrhythmia. The control group comprised patients free of VF/VT. RESULTS VF or VT occurred in 313 (7.45%) patients - group VA1 encompassed 103 (32.9%) and group AV2 210 (67.1%) patients. Cardiogenic shock on admission [hazard ratio (HR) 3.5], new-onset atrial fibrillation (HR 2.1), incomplete revascularization (HR 1.7), prior myocardial infarction (HR 1.6) and symptom-to-balloon time more than 3 h (HR 1.3) were the independent predictors of VF/VT occurrence. In group VA2, the in-hospital and long-term mortality were 4- and 1.5-fold higher than in the arrhythmia-free population (20.5 vs. 4.5% and 36.2 vs. 22.6%, respectively; P

Background: The aim of the study was to assess long-term incidence of atrial fibrillation (AF) in cardiac resynchronization (CRT) recipients with and without prior arrhythmic history, factors predisposing to arrhythmia, as well as to evaluate the prognostic power of cumulative arrhythmia burden, duration of the longest episode and the number of episodes. Methods: Device-collected data on AF episodes during 24 months in 96 participants of a randomized CRT-trial were analyzed (15% in NYHA class IV, sinus rhythm, median left ventricular ejection fraction 24% and QRS 169 ms). Blindly adjudicated major adverse car­diac events (MACE) and any-cause death were censoring variables. Results : Two-year incidence of AF was 70%, including 66% of patients without previous AF history. No baseline characteristics distinguished those who developed new onset AF. Percent of time spent in AF, but not number of episodes predicted mortality (adjusted hazard ratio [HR] 1.05 ± 95% confidence interval CI 1.01–1.10) and MACE incidence (HR 1.03 ± 1.01–1.07; p = 0.03). Duration of the longest episode also predicted mortality (HR 1.06 ± 1.01–1.12; both p = 0.03). Prognostic impact of AF load was marked only in patients with slower ventricular response (< 98/min), but was independent from CHADS 2 scores, pacing burden, or prior atrioventricular nodal ablation. Conclusions: Seven out of 10 CRT-patients had AF within 2 years, including two-thirds of subjects without arrhythmic history. No baseline features distinguished those who developed new onset AF. Arrhythmia burden and duration of the longest episode, but not number of episodes influenced outcomes in CRT-patients, irrespectively from pacing burden or prior atrioventricular node ablation.

Background: Pulmonary vein isolation with cryoballoon catheter ablation (CCB) is an effective method of treatment in patients with atrial fibrillation (AF), but in patients with heart failure (HF) the role of CCB remains unknown. Aim: The aim of the study was to assess the feasibility, effectiveness, and safety of CCB in patients with HF and cardiac im­plantable electronic devices (CIEDs), the impact of the procedure on symptoms, and echocardiographic parameters. Methods: Thirty consecutive HF patients with left ventricular ejection fraction (LVEF) ≤ 40% and CIED, referred for CCB of AF, were included. Procedural parameters were compared to a group of 59 consecutive patients without cardiac diseases referred for CCB (control group). Results: The number of veins ablated per patient was smaller and application was performed less frequently in the right inferior pulmonary vein in the HF group compared with the control group (66.7% vs. 88.1%; p = 0.01, respectively). In two (6.7%) patients from the HF group and in five (8.5%) from the control group procedure-related complications occurred (p = 0.76). After six months 21 HF patients (70%), after one year 13 (43%), and after 625 days only three (10%) were free from arrhythmia. AF burden was significantly reduced after six months compared to the pre-ablation period (18.5% vs. 52.9%; p = 0.001). New York Heart Association and European Heart Rhythm Association classes were both significantly (p < 0.001) reduced and LVEF was higher after six months in the HF patients. Conclusions: Safety and feasibility of CCB for AF in HF patients with CIED are comparable to subjects with structurally nor­mal heart; however, stable positioning of the balloon in the right inferior pulmonary vein may be more challenging. Although late recurrences are common, ablation reduces arrhythmia burden and leads to a long-term improvement of symptoms and echocardiographic indices.