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Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: In patients with sinus node disease (SND), the dual‐chamber pacemaker (PM) is programmed in DDDR mode with an algorithm to avoid unnecessary right ventricular (RV) pacing. This pacing mode may prolong PR interval with consequently atrioventricular (AV) asynchrony which is associated with a higher risk of atrial fibrillation (AF). We evaluate whether preserving AV synchrony by setting a fixed AV delay during physiological RV pacing, that is, His bundle pacing (HBP), could reduce the risk of AF occurrence in comparison with a standard pacing mode with an algorithm to avoid unnecessary RV pacing (DDD‐VPA). Methods and Results: We collected retrospective data from 313 consecutive patients who had undergone PM for SND. The first occurrence of persistent AF (>7 consecutive days) as a function of the pacing mode was evaluated. HBP and DDD‐VPA were implemented in 82 and 231 patients, respectively. Persistent AF occurred in 128 (40.9%) patients over a median follow‐up of 70 months (67–105). The DDD‐VPA pacing mode was significantly correlated with the occurrence of persistent AF only when the basal PR was long (>180 ms). The risk of persistent AF was significantly lower in patients on HBP than in those on DDD‐VPA, adjusted HR =.57 (95% CI,.36–.89, p=.014). Other independent predictors of persistent AF occurrence were: A history of AF (HR = 3.91; 95% CI, 2.48–6.19, p =.001), age, and long PR interval (HR = 2.98; 95% CI, 2.00–4.43, p=.001). Conclusion: In SND patients and long basal PR interval, the HBP may reduce the risk of persistent AF in comparison with the DDD‐VPA. [ABSTRACT FROM AUTHOR]

Aims: Right bundle branch block (RBBB) typically presents with only delayed right ventricular activation. However, some patients with RBBB develop concomitant delayed left ventricular (LV) activation. Such patients may show a specific electrocardiographic (ECG) pattern resembling RBBB in the precordial leads in association with an insignificant S-wave in lateral limb leads (atypical RBBB). We therefore postulated that the ECG pattern of atypical RBBB might be able to identify a subgroup of patients likely to respond to cardiac resynchronization therapy (CRT). The purpose of this study was to assess the impact of RBBB ECG morphology on CRT response in patients with heart failure (HF).Methods and results: We evaluated the echocardiographic clinical response of 66 patients with RBBB treated with CRT and followed up for almost 2 years. The patients were divided electrocardiographically into 2 groups: 31 with typical RBBB and 35 with atypical RBBB. Responders were classified in terms of reduction in LV end-systolic volume index (ESVi) ≥ 15% or reduction in the New York Heart Association (NYHA) Class ≥ 1 or Packer score variation (NYHA response with no HF-related hospitalization events or death). The atypical RBBB group presented a longer LV activation time compared with the typical RBBB group (111.9 ± 17.6 vs. 73.2 ± 15.4 ms; P < 0.001). In the atypical and typical RBBB groups, respectively, 71.4% and 19.4% of patients were ESVi responders (P = 0.001) 74.3% and 32.3% were NYHA responders (P = 0.002); similarly, 71.4% and 29.0% of patients exhibited a 2-year Packer score of 0 (P = 0.002).Conclusion: Patients with atypical RBBB, which is a pattern highly suggestive of concomitant delayed LV conduction, may show a satisfactory response to CRT. [ABSTRACT FROM AUTHOR]

Background: Left atrial function is impaired in patients with patent foramen ovale. This study aimed to evaluate the role of left atrial function index in monitoring the course of left atrial function in a patient with patent foramen ovale before and after percutaneous closure., Methods: We retrospectively reviewed the findings of consecutive patients evaluated in our tertiary center for patent foramen ovale closure to identify those subjects with acute ischemic stroke, transient ischemic attack, or radiological evidence of cerebral ischemic events (index event) who performed a complete echocardiography evaluation reporting evidence of patent foramen ovale between September 2004 and September 2018. The left atrial function was evaluated at baseline and then yearly using the left atrial function index., Results: The cohort of 448 consecutive patients (mean age 43.4 ± 10.4 years, 257 males) was divided into 2 groups according to the temporal window between the index event and patent foramen ovale closure, defined as <1-year (216 patients) and ≥1-year (232 patients). Patients treated within 1 year from the index event maintained similar parameters of left atrial function and left atrial function index over the time, also after the interventional procedure. Conversely, patients treated after 1 year demonstrated a significant reduction of left atrial emptying function and maximal left atrial volume (P < .001 for all) compared to the basal values. The same parameters slightly increased after the percutaneous closure during the second year without reaching the basal values., Conclusions: Left atrial function index can be used as a non-invasive marker of atrial dysfunction severity in patients with patent foramen ovale before and after the interventional procedure.

Aims: Right bundle branch block (RBBB) typically presents with only delayed right ventricular activation. However, some patients with RBBB develop concomitant delayed left ventricular (LV) activation. Such patients may show a specific electrocardiographic (ECG) pattern resembling RBBB in the precordial leads in association with an insignificant S-wave in lateral limb leads (atypical RBBB). We therefore postulated that the ECG pattern of atypical RBBB might be able to identify a subgroup of patients likely to respond to cardiac resynchronization therapy (CRT). The purpose of this study was to assess the impact of RBBB ECG morphology on CRT response in patients with heart failure (HF)., Methods and Results: We evaluated the echocardiographic clinical response of 66 patients with RBBB treated with CRT and followed up for almost 2 years. The patients were divided electrocardiographically into 2 groups: 31 with typical RBBB and 35 with atypical RBBB. Responders were classified in terms of reduction in LV end-systolic volume index (ESVi) ≥ 15% or reduction in the New York Heart Association (NYHA) Class ≥ 1 or Packer score variation (NYHA response with no HF-related hospitalization events or death). The atypical RBBB group presented a longer LV activation time compared with the typical RBBB group (111.9 ± 17.6 vs. 73.2 ± 15.4 ms; P < 0.001). In the atypical and typical RBBB groups, respectively, 71.4% and 19.4% of patients were ESVi responders (P = 0.001) 74.3% and 32.3% were NYHA responders (P = 0.002); similarly, 71.4% and 29.0% of patients exhibited a 2-year Packer score of 0 (P = 0.002)., Conclusion: Patients with atypical RBBB, which is a pattern highly suggestive of concomitant delayed LV conduction, may show a satisfactory response to CRT.

Central venous catheters (CVC) are commonly used in clinical practice. Although long-term complications are uncommon, catheter-related right atrial thrombosis is a rare but potentially life-threatening one. The optimal management is still controversial. We report the case of a young woman affected by Hodgkin lymphoma with CVC-related right atrial thrombosis diagnosed during routine echocardiography. After initial anticoagulation treatment, she complicated with pulmonary embolism, and the mass was surgically removed via a minimally invasive approach with right minithoracotomy access. Surgery was well tolerated, without complications and with prompt recovery. This case confirms how CVC can lead to thrombosis in the right atrium and how this complication can rapidly deteriorate. Moreover, the possible treatment options for the successful management of this complication are discussed, along with the available literature, showing the advantages of a minimally invasive approach.