Heart Beat Journal最新文献

{"title":"Sacubitril/valsartan and the risk of sudden cardiac death","authors":"K. Ozierański, P. Balsam, J. Kosiuk, M. Grabowski","doi":"10.24255/hbj/99045","DOIUrl":"https://doi.org/10.24255/hbj/99045","url":null,"abstract":"Patients with heart failure (HF) with reduced left ventricle ejection fraction (HFrEF) are at high risk of sudden cardiac death (SCD). Therefore HFrEF treatment requires further improvement, which may be accomplished with the use of sacubitril/valsartan. Sacubitril/valsartan reduce the risks of allcause mortality, cardiovascular mortality, SCD, HF mortality, HF and all-cause hospitalizations, as well as symptoms of HF. It was also shown that use of sacubitril/valsartan may be associated with a reduced number of adequate and inadequate device interventions in HFrEF patients with an implantable cardioverter defibrillator, and an increased percentage of biventricular pacing in patients with cardiac resynchronization therapy. Sacubitril/valsartan blocks the angiotensin II receptor (valsartan) and inhibits neprilysin (sacubitril) simultaneously. It results in inhibited sympathetic activity, as well as decreased cardiac remodeling and fibrosis, resulting in a decreased pro-arrhythmogenic effect. Current trends show that the prevalence of heart failure (HF) is still increasing(1). Patients with HF with reduced left ventricle ejection fraction (HFrEF) are at high risk of sudden cardiac death (SCD)(2). In the PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With an Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial approximately 40% of deaths of HFrEF patients were related to SCD caused mainly by ventricular arrhythmia(3). The risk of SCD in HFrEF may be reduced with guideline-recommended treatment with angiotensin converting enzyme inhibitors (ACE-I), beta-blockers, mineralocorticoid receptor antagonists (MRA), as well as with device therapies such as implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT). Angiotensin-receptor blockers (ARB) should be restricted to patients unable to tolerate ACE-I or potentially used in addition to ACE-I instead of MRA in the case of intolerance(2). The PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With an Angiotensin-ConK. Ozieranski et al. 60 verting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) study was terminated ahead of time (after a median of 27 months of observation) because of observed clear benefits of sacubitril/valsartan compared to enalapril. Sacubitril/valsartan significantly reduced the risks of all-cause mortality, cardiovascular mortality, SCD, HF mortality, HF and all-cause hospitalizations, as well as symptoms of HF(3). It is important that the advantages of treatment with sacubitril/valsartan persist even after the need for dose reduction and are similar to those observed in patients without any dose reduction(4). It was also shown that use of sacubitril/valsartan was also associated with a reduced number of adequate and inadequate device interventions in HFrEF patients with an implanted ICD.","PeriodicalId":247417,"journal":{"name":"Heart Beat Journal","volume":"116 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123368242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zero-fluoroscopy approach for catheter ablation of left-sided slow-fast AVNRT.","authors":"Aleksandra Świętoniowska-Mścisz, M. Chrabąszcz, J. Śledź, Renata Korpak-Wysocka, S. Stec","doi":"10.24255/hbj/92346","DOIUrl":"https://doi.org/10.24255/hbj/92346","url":null,"abstract":"","PeriodicalId":247417,"journal":{"name":"Heart Beat Journal","volume":"162 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131928870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the conclusion from the DECODE CRT-D study?","authors":"Łukasz Januszkiewicz, Piotr Sypień, M. Grabowski","doi":"10.24255/HBJ/85212","DOIUrl":"https://doi.org/10.24255/HBJ/85212","url":null,"abstract":"Comment on: 'Appropriate implantable cardioverter-defibrillator interventions in cardiac resynchronization therapy-defibrillator (CRT-D) patients undergoing device replacement: time to downgrade from CRT-D to CRT-pacemaker? Insights from real-world clinical practice in the DECODE CRT-D analysis'. The recently published paper by Narducci et al. is focused on the ventricular tachyarrhythmia rate after cardiac resynchronization therapy defibrillator (CRT-D) replacement and an important clinical dilemma: is it rational to downgrade a CRT-D to a CRT pacemaker (CRT-P) [1]? To answer this question the authors analyzed data from the DECODE registry, which was a prospective, single-arm multicenter cohort study designed to assess the long-term follow-up in CRT-D recipients. During device replacement, about 20% of patients no longer had an indication for the defibrillation function in CRT devices, which is a considerable number. This population might be considered as a group which could benefit from downgrading the CRT-D to a CRT-P. During only one-year follow-up after replacement, appropriate device therapy occurred in 7% of patients with ejection fraction (EF) >35%, which is similar to the appropriate implantable cardioverter-defibrillator (ICD) therapy rate in patients with a primary prevention indication for an ICD. The paper by Narducci et al. raises more questions than answers. First, which population of CRT-D recipients could be downgraded to a CRT-P? Second, which patients with EF >35% require the defibrillation function? We do not have the answers yet, but ongoing studies might help us to find them. Ł. Januszkiewicz, P. Sypień, M. Grabowski 55 One of the most important studies in this area is MADIT S-ICD [2], which was designed to test the hypothesis that post-infarction patients with EF of 36-50% and diabetes will have benefits from a subcutaneous ICD. Also, the imperfections of primary prevention ICD implantation guidelines are highlighted by the results of the DECODE study [3]. Ejection fraction <35% defines the treatment population in our daily clinical practice and trials. However, we should keep in mind that the majority of sudden cardiac deaths (SCD) occur in subjects with EF >35%. Moreover, the risk of SCD is declining across major heart failure studies over time. To sum up, Narducci et al. in the DECODE study emphasize that the risk of appropriate ICD therapy in patients who no longer meet the ICD implantation criteria is not negligible. Sudden cardiac death risk stratification is needed not only in the population of patients with EF >35% but also in those with EF <35%. References 1. Narducci, M.L., Biffi M., Ammendola E., et al. Appropriate implantable cardioverter-defibrillator interventions in cardiac resynchronization therapy-defibrillator (CRT-D) patients undergoing device replacement: time to downgrade from CRT-D to CRT-pacemaker? Insights from real-world clinical practice in the DECODE CRT-D analysis. Europace 2017;0:1-9 2. Ruwald M","PeriodicalId":247417,"journal":{"name":"Heart Beat Journal","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114251665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}