Baseline HV-interval predicts complete AV-block secondary to transcatheter aortic valve implantation.

PURPOSE: Development of AV-block is a frequent complication associated with transcatheter aortic valve implantation (TAVI). To date little is known about the predictive value of the HV-interval prior to TAVI with respect to the risk of AV-block development. METHODS AND RESULTS: HV-interval was determined in 25 consecutive elderly patients with severe aortic valve stenosis (AS) before and immediately after TAVI. All patients subsequently underwent TAVI and 8 of these 25 patients (32%) developed complete AV-block during the TAVI procedure requiring permanent pacemaker implantation. Six of these 8 patients (75%) had marked HV prolongation (>54 ms). Pre-procedural HV-interval was significantly prolonged in the subgroup developing complete AV-block (62.1 ms±13.0 vs 49.2 ms±12.9; P=0.029). Prolongation of the HV-interval above 54 ms was associated with a higher rate of complete AV-block (sensitivity 75.0%, specificity 77.8%, P=0.01). CONCLUSIONS: HV-interval was prolonged in approximately one third of our elderly patients with aortic valve stenosis and associated with a high rate of complete AV-block following TAVI. HV-interval is easily obtained during TAVI screening procedures, thus facilitating identification of patients at risk for complete AV-block due to TAVI and consequently enabling bespoke risk management.

Overexpression of heat shock protein 60/10 in myocardium of patients with chronic atrial fibrillation.

BACKGROUND: Cardiomyocytes respond to chronic atrial fibrillation with increased expression of heat shock protein 60 (HSP60). The aim of this study was to investigate whether expression of the coprotein HSP10 is also increased. METHODS: Right atrial samples from 16 patients undergoing elective cardiac operation were excised and immediately frozen in liquid nitrogen. Eight patients had chronic atrial fibrillation and 8 patients were in sinus rhythm. The HSP60 and HSP10 protein levels were determined by SDS-PAGE, Western blot, and quantified by optical densitometry according to the immunoreactive bands of actin. RESULTS: In myocardial samples from patients with chronic atrial fibrillation we found simultaneous upregulation of both stress proteins. HSP60 expression was more than 2.3-fold and HSP10 expression was more than 2.4-fold increased in atrial myocardium of patients with chronic atrial fibrillation. CONCLUSIONS: These results indicate functional upregulation of mitochondrial HSP60 and HSP10 in response to chronic atrial fibrillation.

[Dual AV nodal nonreentry tachycardia (DAVNNT): unrecognized differential diagnosis with far-reaching consequences]. / Duale AV-nodale Nicht-Reentry-Tachykardie: Verkannte Differenzialdiagnose mit weitreichenden Konsequenzen?

BACKGROUND: The dual atrioventricular nodal nonreentry tachycardia (DAVNNT) is a rare form of tachycardia which occurs due to a time delayed double antegrade conduction via the slow and fast atrioventricular nodal pathways. Its epidemiology is not known so far. The aim of this article is to present the clinical findings in a series of patients with DAVNNT. MATERIALS AND METHODS: We retrospectively analyzed our database of patients who successfully underwent radiofrequency catheter ablation between January 2012 and March 2013 due to diagnosed supraventricular tachycardia. RESULTS: In 3 out of 231 patients DAVNNT could be successfully treated by slow pathway modulation/ablation. Patients presented with widely varying symptoms including syncope, palpitations which had been mistaken as atrial fibrillation, and inappropriate defibrillator shocks due to suspected ventricular tachycardia. CONCLUSIONS: The DAVNNT seems to be more common than previously thought. This important differential diagnosis needs to be taken into consideration as slow pathway modulation can be curative while a misdiagnosis, such as atrial fibrillation or ventricular tachycardia might result in over-treatment in patients with this arrhythmia.

Initial results of using a novel irrigated multielectrode mapping and ablation catheter for pulmonary vein isolation.

BACKGROUND: Pulmonary vein isolation (PVI) as a cornerstone for catheter ablation of atrial fibrillation (AF) remains a complex and time-consuming procedure. OBJECTIVE: To assess feasibility, safety, and acute efficacy of a novel irrigated multielectrode ablation catheter guided by an electroanatomic mapping system for PVI in patients with paroxysmal AF. METHODS: Twenty-five consecutive patients (60 ± 10 years) with paroxysmal AF underwent PVI by using a novel decapolar mapping and ablation catheter (nMARQ catheter, Biosense Webster Inc, Diamond Bar, CA). Ablation was guided by electroanatomic mapping allowing radiofrequency (RF) energy delivery in the antral region of pulmonary veins (PVs) from 10 irrigated electrodes simultaneously. The day after ablation, cardiac magnetic resonance imaging was performed routinely in order to assess for potential acute PV stenosis. RESULTS: Overall, 97 of 97 (100%) targeted PVs could be isolated with a mean of 27 ± 11 RF applications and a mean total burning time of 15 ± 6 minutes per patient. The total procedure time from femoral vein access to catheter withdrawal was 110 ± 31 minutes, including a mean total fluoroscopy time of 23 ± 9 minutes. On average, 6 ± 3 RF impulses with a maximum of 25 W were applied per vein. After a short learning curve, procedure, fluoroscopy, and total burning times decreased to 94 ± 16, 16 ± 3, and 9 ± 2 minutes, respectively (P < .05). Entrance and exit blocks could be verified by placing the ablation catheter into 90 of 97 (93%) PVs in 18 of 25 (72%) patients. No procedure-related complications were observed, especially no acute PV stenosis could be detected. CONCLUSIONS: The use of a novel irrigated multielectrode ablation system for PVI is feasible and safe, resulting in acute isolation of all targeted PVs with no complications and short procedure times. Sustainability of these initial results has to be confirmed in long-term efficacy and follow-up trials.

Improvement of left ventricular function under cardiac resynchronization therapy goes along with a reduced incidence of ventricular arrhythmia.

OBJECTIVES: The beneficial effects of cardiac resynchronization therapy (CRT) are thought to result from favorable left ventricular (LV) reverse remodeling, however CRT is only successful in about 70% of patients. Whether response to CRT is associated with a decrease in ventricular arrhythmias (VA) is still discussed controversially. Therefore, we investigated the incidence of VA in CRT responders in comparison with non-responders. METHODS: In this nonrandomized, two-center, observational study patients with moderate-to-severe heart failure, LV ejection fraction (LVEF) ≤35%, and QRS duration >120 ms undergoing CRT were included. After 6 months patients were classified as CRT responders or non-responders. Incidence of VA was compared between both groups by Kaplan-Meier analysis and Cox regression analysis. ROC analysis was performed to determine the aptitude of LVEF cut-off values to predict VA. RESULTS: In total 126 consecutive patients (64±11 years; 67%male) were included, 74 were classified as responders and 52 as non-responders. While the mean LVEF at baseline was comparable in both groups (25±7% vs. 24±8%; P = 0.4583) only the responder group showed an improvement of LVEF (36±6% vs. 24±7; p<0.0001) under CRT. In total in 56 patients VA were observed during a mean follow-up of 28±14 months, with CRT responders experiencing fewer VA than non-responders (35% vs. 58%, p<0.0061). Secondary preventive CRT implantation was associated with a higher likelihood of VA. As determined by ROC analysis an increase of LVEF by >7% was found to be a predictor of a significantly lower incidence of VA (AUC = 0.606). CONCLUSIONS: Improvement of left ventricular function under cardiac resynchronization therapy goes along with a reduced incidence of ventricular arrhythmia.

Expression of mortalin in patients with chronic atrial fibrillation.

BACKGROUND: In myocardium of patients with chronic atrial fibrillation (AF) the expression of the mitochondrial heat shock proteins HSP60 and HSP10 is increased. They are responsible for folding and translocation of proteins inside the mitochondria. Import of these proteins is accomplished by mortalin. The aim of our study was to investigate if the expression of the heat shock protein mortalin is also increased in patients with AF. METHODS: Right atrial samples from 18 patients undergoing elective cardiac surgery were excised and immediately frozen in liquid nitrogen: 8 patients had chronic AF (> or = 3 month) and 10 patients were in sinus rhythm (SR). Mortalin was determined by SDS-PAGE, Western blot and quantified by optical densitometry. RESULTS: In myocardial samples from patients with chronic AF we found a more than 2-fold increase in mortalin expression. CONCLUSIONS: The increased expression of mortalin may represent an adaptive heat shock response to restore cellular homeostasis.

The expression of heat shock protein 60 in myocardium of patients with chronic atrial fibrillation.

OBJECTIVE: Cardiomyocytes respond to stress with the expression of different heat shock proteins (HSP). HSP60 is induced by various stress factors. The aim of this study was to investigate the expression of HSP60 in human atrial fibrillation (AF). METHOD: Right atrial samples from 14 patients undergoing elective cardiac surgery were excised and immediately frozen in liquid nitrogen. Eight patients had chronic AF and six patients were in sinus rhythm. The HSP60 protein level was determined by SDS-PAGE, Western blot and quantified by optical densitometry according to the immunoreactive bands of actin. RESULTS: In myocardial samples from patients with chronic AF, we found a more than 2.5-fold increase in HSP60 expression compared to atrial myocardium of patients in sinus rhythm. CONCLUSION: This result indicates an up regulation of HSP60 in response to chronic atrial fibrillation.