{"title":"Cardioneuroablation for children with syncope.","authors":"Mitchell I Cohen, Jordan A Cohen","doi":"10.1097/HCO.0000000000001305","DOIUrl":"10.1097/HCO.0000000000001305","url":null,"abstract":"<p><strong>Purpose of review: </strong>Children with recurrent syncope with prolonged pauses who have failed traditional therapies may be candidates for a cardioneuroablation as an alternative to pacemaker implantation. This article reviews cardioneuroablation in the pediatric population.</p><p><strong>Recent findings: </strong>Cardioneuroablation has been used in adults for cardioinhibitory syncope for more than 2 decades with promising results. Despite the heterogenous patient population and variation in technical approaches to the procedure, between 85 and 90% of patients have a significant reduction in syncope and improvement in quality of life. While the data in children is limited, reports have shown similar success. Catheter ablation of ganglionated plexuses can be performed by ablating in the right or left atrium or both. The long-term effects in disrupting the sympathovagal imbalance remains unknown.</p><p><strong>Summary: </strong>Cardioneuroablation may be an option for select children with cardioinhibitory syncope who have failed standard medical approaches. Early results of vagal ablation in children have been promising. Future long-term registries following cardioneuroablation is needed.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"345-352"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Interventional procedures in congenital heart disease for atrio-ventricular valves: future possibility or fools dream.","authors":"Niall Linnane, Damien Kenny","doi":"10.1097/HCO.0000000000001309","DOIUrl":"10.1097/HCO.0000000000001309","url":null,"abstract":"<p><strong>Purpose of review: </strong>Transcatheter options for atrioventricular valve disease have skyrocketed in recent years and this review aims to outline current available technologies and how they have been used to date in congenital heart disease patients.</p><p><strong>Recent findings: </strong>Transcatheter edge to edge repair is the best described technology to date with most reports being limited to case series. The limitation of its widespread use is largely imaging based with a steep learning curve from the imaging standpoint most likely limiting its widespread use in stand-alone paediatric hospitals where a lot of adult congenital interventions take place. Valve in valve tricuspid valve replacement has been well described with off label use of balloon expandable valves but further additional technologies; transcatheter annuloplasty, transcatheter mitral valve in valve or valve in ring and native transcatheter valve replacement have limited reports in the congenital field.</p><p><strong>Summary: </strong>As the newer transcatheter options for atrioventricular valve disease become more ubiquitous in acquired cardiovascular disease attention will turn more to congenital patients. Collaboration with adult acquired structural interventionalists and imaging cardiologists will be the key which unlocks these technologies in the future for congenital patients.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"320-327"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emmanuel Orfanos, Jae Hyun Byun, Stella S Daskalopoulou
{"title":"Discontinuation of statin therapy - an updated review.","authors":"Emmanuel Orfanos, Jae Hyun Byun, Stella S Daskalopoulou","doi":"10.1097/HCO.0000000000001316","DOIUrl":"10.1097/HCO.0000000000001316","url":null,"abstract":"<p><strong>Purpose of review: </strong>This narrative review aims to provide an updated synthesis of the recent epidemiology, clinical determinants, and consequences of statin discontinuation.</p><p><strong>Recent findings: </strong>Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide, with elevated low-density lipoprotein cholesterol (LDL-C) representing a key modifiable risk factor. Statins are first-line lipid-lowering agents that reduce major adverse cardiovascular events, cardiovascular mortality, and all-cause mortality. Despite their efficacy, statin discontinuation and suboptimal adherence remain common. Discontinuation rates within the first-year range widely (0.8-70.5%), with higher rates observed in primary prevention populations. Factors associated with discontinuation include male sex, non-White ethnicity, smoking, and lack of insurance, whereas secondary prevention is consistently associated with better persistence. Interestingly, polypharmacy demonstrated conflicting associations across studies. Overall, approximately 40% of patients fail to achieve optimal adherence. Discontinuation is consistently associated with increased cardiovascular events, hospitalizations, and all-cause mortality.</p><p><strong>Summary: </strong>Statin discontinuation and poor adherence remain major barriers to effective cardiovascular risk reduction. Addressing patient-, clinician-, and system-level determinants is essential to improve long-term adherence and clinical outcomes.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"291-297"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James W Johnson, Isabella Mirro, Amy R Kontorovich
{"title":"Too high and too loose: dysautonomia and the hypertensive paradox in hypermobility disorders.","authors":"James W Johnson, Isabella Mirro, Amy R Kontorovich","doi":"10.1097/HCO.0000000000001310","DOIUrl":"10.1097/HCO.0000000000001310","url":null,"abstract":"<p><strong>Purpose of review: </strong>Hypertension in hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) represents an increasingly recognized but poorly understood clinical phenomenon. This review addresses the unique pathophysiology, diagnostic considerations, and management challenges of hypertension occurring in the context of dysautonomia - a comorbidity affecting up to 70% of patients with hEDS/HSD.</p><p><strong>Recent findings: </strong>Emerging evidence identifies distinct hypertensive endotypes in hEDS/HSD, including hyperadrenergic dysautonomia, paroxysmal hypertension, cervicogenic hypertension, and nocturnal/supine hypertension. Pathophysiologic mechanisms involve connective tissue laxity, altered baroreflex function, small fiber neuropathy, and mast cell activation. Standard antihypertensive therapies may paradoxically worsen symptoms by exacerbating orthostatic intolerance, while targeted approaches using alpha-blockers and central sympatholytics show promise in hyperadrenergic phenotypes.</p><p><strong>Summary: </strong>Management of hypertension in hEDS/HSD requires adaptation of standard guidelines to accommodate dysautonomia-specific considerations, including withdrawal of provocative medications, avoidance of volume-depleting agents, and phenotype-directed pharmacotherapy. Long-term cardiovascular outcomes remain poorly defined, highlighting critical research gaps and the need for evidence-based consensus guidelines tailored to this unique patient population.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"260-266"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephen J Nageotte, Darren P Berman, Patrick M Sullivan
{"title":"Transcatheter pulmonary valve replacement: what we know, what we still want to know.","authors":"Stephen J Nageotte, Darren P Berman, Patrick M Sullivan","doi":"10.1097/HCO.0000000000001312","DOIUrl":"10.1097/HCO.0000000000001312","url":null,"abstract":"<p><strong>Purpose of review: </strong>Transcatheter pulmonary valve replacement (TPVR) has transformed the management of patients with congenital heart disease (CHD) with dysfunctional pulmonary outflow tracts. Technological advancements have expanded the number of patients eligible for this minimally invasive alternative to surgical valve replacement. With the introduction of larger self-expanding valves and adaptive prestenting systems, TPVR has become accessible to patients with complex anatomies, including those with native right ventricular outflow tract (RVOT) disease.</p><p><strong>Recent findings: </strong>Recent studies have demonstrated the excellent clinical outcomes of TPVR thus far, while also acknowledging the occurrence of rare complications. Crucial questions guiding the future of TPVR management include: timing to refer for TPVR, how to optimize valve durability, enhance preprocedural screening with advanced imaging and electrophysiology studies, and improve hemodynamic monitoring.</p><p><strong>Summary: </strong>These advancements underscore TPVR's adaptability and efficacy, offering new solutions for complex cases and improving outcomes. Future research should focus on optimizing patient selection and intervention timing, as well as addressing long-term durability and complications.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"353-359"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The impact of sleep on heart health: contemporary research and medical practice.","authors":"Fotios Drakopanagiotakis, Evanthia Gouveri, Paschalis Steiropoulos, Nikolaos Papanas","doi":"10.1097/HCO.0000000000001290","DOIUrl":"10.1097/HCO.0000000000001290","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review discusses current research (between July 2024 and January 2026) on sleep disorders and cardiovascular disease, highlighting underlying biological processes, clinical outcomes, and therapeutic strategies.</p><p><strong>Recent findings: </strong>More than a billion adults worldwide are affected by sleep disorders that significantly increase heart disease risk. Obstructive sleep apnoea (OSA) is increasingly recognised as an independent predictor of major cardiovascular complications, with nocturnal hypoxaemia emerging as a critical marker for risk stratification. Continuous positive airway pressure (CPAP) may decrease cardiovascular complications in selected high-risk patients with OSA. In addition, irregular sleep patterns and insufficient sleep duration are associated with arrhythmias and cardiac failure. Sleep disruption contributes to adverse cardiac remodelling through mechanisms involving oxidative stress and autonomic dysfunction. Genetic studies further support a direct causal relationship between OSA and coronary heart disease. Sleep has been added by the American Heart Association to its Life's Essential 8 framework, emphasising its role in cardiovascular health.</p><p><strong>Summary: </strong>Sleep disorders represent a modifiable cardiovascular risk factor that warrants systematic assessment and targeted management. Optimal sleep health encompasses sufficient duration, appropriate timing, and regularity. Treatment of sleep disorders-particularly OSA with CPAP therapy in carefully selected high-risk populations-can confer cardiovascular benefits.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"275-285"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Esther Porras-Perez, Pablo Perez-Martinez, Elena M Yubero-Serrano
{"title":"Impact of social determinants of health on cardiovascular health.","authors":"Esther Porras-Perez, Pablo Perez-Martinez, Elena M Yubero-Serrano","doi":"10.1097/HCO.0000000000001294","DOIUrl":"10.1097/HCO.0000000000001294","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiovascular diseases remain the leading cause of global morbidity and mortality. Strategies centered on individual risk factors have been insufficient to reduce population-level cardiovascular burden or to address persistent health inequities. This review is timely given the increasing emphasis on cardiovascular health (CVH) metrics, particularly the American Heart Association (AHA) Life's Essential 8 (LE8), and the growing recognition of social determinants of health (SDOH) as fundamental drivers of cardiovascular outcomes.</p><p><strong>Recent findings: </strong>CVH, as defined by AHA frameworks, remains suboptimal across populations being a strong predictor of cardiovascular and all-cause mortality. Emerging evidence highlights food insecurity and other adverse SDOH as major contributors of poor CVH, acting primarily through modifiable behavioral domains such as diet, physical activity, nicotine exposure, and sleep. LE8 mediates a substantial proportion of the link between social disadvantages and adverse cardiovascular outcomes, underscoring its potential utility as both risk assessment and intervention framework.</p><p><strong>Summary: </strong>Collectively, current evidence supports a paradigm shift in cardiovascular prevention strategies that integrate CVH metrics with SDOH. LE8 provides a practical and scalable framework to assess CVH and target modifiable pathways linking social disadvantages to CVD. Future research and interventions should adopt multilevel, equity-focused, and life-course-oriented approaches to effectively reduce cardiovascular morbidity and mortality.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"268-274"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Renal denervation: from establishing effectiveness to measuring success.","authors":"Hyeok-Hee Lee, Anna K Krawisz, Eric A Secemsky","doi":"10.1097/HCO.0000000000001299","DOIUrl":"10.1097/HCO.0000000000001299","url":null,"abstract":"<p><strong>Purpose of review: </strong>Renal denervation has emerged as a new therapeutic option for blood pressure (BP) control and is now incorporated into contemporary hypertension guidelines. Here, we review the evolution of evidence for renal denervation, approaches to assessing treatment response, and emerging technological developments.</p><p><strong>Recent findings: </strong>Early non-sham-controlled trials of renal denervation showed substantial reductions in BP, whereas the first sham-controlled trial, SYMPLICITY HTN-3, yielded neutral findings. To address its limitations, subsequent trials incorporated key design modifications - including strict restriction of changes in background antihypertensive medications, procedural standardization, and separate conduct of trials in \"on-medication\" and \"off-medication\" cohorts - and have since consistently demonstrated the efficacy of renal denervation. In these studies, efficacy was assessed primarily by reductions in systolic BP, with additional measures including reductions in diastolic BP and antihypertensive medication burden. Alternative ablative mechanisms (e.g., alcohol-mediated neurolysis) are currently under investigation, along with multi-organ denervation approaches aimed at augmenting BP reduction while providing additional metabolic benefits.</p><p><strong>Summary: </strong>Evidence supporting renal denervation has continued to accumulate, demonstrating consistent BP reductions. The field is evolving, with new approaches using alternative ablative mechanisms or targeting multi-organ sympathetic pathways on the horizon.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"251-259"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Savvidi, Fernando Riesgo Gil, Margarita Brida
{"title":"Heart failure in adults with congenital heart disease: the role of sodium-glucose cotransporter 2 inhibitors.","authors":"Maria Savvidi, Fernando Riesgo Gil, Margarita Brida","doi":"10.1097/HCO.0000000000001311","DOIUrl":"10.1097/HCO.0000000000001311","url":null,"abstract":"<p><strong>Purpose of review: </strong>Heart failure (HF) is the leading cause of morbidity and mortality in adults with congenital heart disease (ACHD), yet evidence-based pharmacological options remain limited. Sodium-glucose cotransporter 2 inhibitors (SGLT2I) have demonstrated robust benefits across the heart failure spectrum in acquired cardiovascular disease. This review is summarizing emerging data on the use of SGLT2I in ACHD, a population characterized by unique pathophysiology and unmet therapeutic needs.</p><p><strong>Recent findings: </strong>Recent literature, predominantly comprising case reports, retrospective cohorts, and small prospective studies, suggests that SGLT2I are generally safe and well tolerated in adult congenital heart disease heart failure (ACHD-HF). Across heterogeneous ACHD populations, including those with a systemic right ventricle (SRV) and Fontan circulation, SGLT2I use has been associated with improvements in natriuretic peptides, functional status, exercise capacity, and reductions in HF hospitalizations. Early data support favourable safety and low discontinuation rates.</p><p><strong>Summary: </strong>The use of SGLT2I in ACHD-HF is feasible, well tolerated and with potential clinical benefit. Further ACHD-specific randomized clinical trials to define efficacy, optimal patient selection, and long-term outcomes are warranted.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"336-344"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Applications of genetic testing in cardiovascular disease.","authors":"Alexandra Smirnova, Mario Urtis, Eloisa Arbustini","doi":"10.1097/HCO.0000000000001281","DOIUrl":"10.1097/HCO.0000000000001281","url":null,"abstract":"<p><strong>Purpose of review: </strong>The identification of the genetic basis of an increasing number of cardiovascular diseases (CVDs) has substantially expanded the clinical demand for genetic testing. This review summarizes the major groups of genetic CVDs, the current testing strategies, the limitations of available approaches, and future perspectives for improving diagnostic accuracy.</p><p><strong>Recent findings: </strong>Growing awareness of genetic CVD has stimulated comprehensive clinical phenotyping, family screening, and the integration of advanced imaging, functional studies, and pathological investigations. This has enabled an unprecedented incorporation of genetics into clinical cardiology, representing one of the most transformative developments in the field. This evolution is occurring within multidisciplinary frameworks, generating a high demand for expertise and technological innovation.</p><p><strong>Summary: </strong>Mendelian CVDs include cardiomyopathies, arrhythmias, arteriopathies, primary calcific CVD, pulmonary hypertension, hereditary hemorrhagic telangiectasia, monogenic vasculitides, autoinflammatory disorders, syndromic cardiovascular tumors, and metabolic diseases (hypercholesterolemia and MODY). Mendelian CVDs are complemented by maternally-inherited mitochondrial diseases, characterized by heterogeneous, often syndromic phenotypes with frequent cardiovascular involvement. The genetic testing landscape is rapidly expanding, aiming to provide comprehensive and simplified \"all-in-one\" solutions while improving accessibility and sustainability. Key challenges remain related to technological limitations, result interpretation, and test completeness, representing major priorities for future development in cardiovascular genetics.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"109-119"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}