Search

Introduction: Transvenous lead extraction (TLE) is generally considered a safe procedure, albeit not without risks. While gender‐based disparities have been noted in short‐term outcomes following TLE, a notable gap exists in understanding the long‐term consequences of this procedure. The objective of this analysis was to investigate sex differences in both acute and long‐term outcomes among patients who underwent TLE at a tertiary referral center. Methods: In this retrospective cohort study, consecutive patients who underwent TLE between January 2014 and January 2016 were enrolled. The primary outcome comprised a composite of all‐cause mortality and need for repeated TLE procedures. Secondary outcomes included fluoroscopy time, lead extraction techniques, success rates, and major and minor complications. Results were compared between female and male cohorts. Results: The study population comprised 191 patients (median age, 70 years), 29 (15.2%) being women and 162 men (84.8%). Study groups had similar baseline characteristics. Complete procedural success was achieved in 189 out of 191 patients (99.0%), with no significant difference observed between the two groups (p =.17). No major complications were reported in the total cohort. However, there was a significantly higher incidence of minor complications in women compared to men (17.2% vs. 2.5%, p <.01). Following a median follow‐up of 6.5 years, the incidence of the primary composite outcome occurred similarly between the study groups (log‐rank p =.68). Conclusion: Women who underwent TLE exhibited a significantly higher incidence of minor acute intra‐ and peri‐procedural complications than men. However, no differences in long‐term outcomes between genders were observed. [ABSTRACT FROM AUTHOR]

A case of idiopathic dilated cardiomyopathy with an arrhythmic storm refractory to the usual antiarrhythmic therapy will be reported. The idiopathic structural heart disease of the patient is a vulnerable anatomic substrate in itself, for electrical instability and reentry mechanism, because of heterogeneous areas of scarred myocardium and low left ventricle ejection fraction. In this case, the ranolazine administration was safe and effective for the prevention of further electrical storms. [ABSTRACT FROM AUTHOR]

Background: The increasing use of biological substitutes for surgical aortic valve replacement (AVR), has led to the development of new bioprostheses with improved hemodynamics and expected durability., Methods: In this observational retrospective two-center cohort study, two innovative bioprostheses, INSPIRIS Resilia and AVALUS were analyzed. We analyzed early and 2.4-year follow-up results in terms of safety, clinical outcome and hemodynamic performance., Results: From November 2017 to February 2021, 148 patients underwent AVR with INSPIRIS Resilia (N.=74) or AVALUS (N.=74) bioprosthesis. The 30-day and mid-term mortality was comparable (1% vs. 3%, P=0.1 and 7% vs. 4%, P=0.4, respectively). Valve-related mortality was observed in one AVALUS patient. Three (4%) patients of the AVALUS group developed prosthetic endocarditis and two of them died after reoperation. No other cases of prosthetic endocarditis were observed. No cases of structural valve degeneration or significant paravalvular leak were detected at follow-up. Median follow-up peak pressure gradient was 21 vs. 23 mmHg (P=0.4) and the mean pressure gradient was 12 vs. 13 mmHg (P=0.9) for Inspiris and AVALUS, respectively. The effective orifice area (EOA) and indexed EOA were 1.5 cm 2 vs. 1.4 cm 2 (P=0.4) and 0.8 vs. 0.7 cm 2 /m 2 (P=0.5), respectively. Indexed left ventricular mass regression was -33 vs. -52 g/m 2 for the Inspiris and AVALUS groups, respectively, (R 2 -adjusted =0.14; P<0.01)., Conclusions: INSPIRIS Resilia and AVALUS bioprostheses were reliable with comparable results in safety, clinical outcome and hemodynamic performance. After statistical adjustment, AVALUS was associated with better left ventricular mass reduction. Long-term follow-up would provide definitive comparative results.

Cardiac resynchronization therapy (CRT) is an important tool for the treatment of patients with chronic heart failure, as it can correct the heterogeneity of regional left ventricular mechanical contraction, known as dyssynchrony. Although this therapy is strongly indicated in patients with both heart failure with left ventricular systolic dysfunction and wide Q-, R- and S-waves (QRS) on electrocardiogram, about one-third of these patients are non-responders. Since the degree of mechanical dyssynchrony can vary greatly, it is interesting to quantify dyssynchrony by means of imaging methods, such as echocardiography, which might be able to lead to a better selection of CRT candidates. This article will review the role of old and new echocardiographic techniques to predict CRT response.