A. Dello Russo

Cardiac mesenchymal stromal cells are a source of adipocytes in arrhythmogenic cardiomyopathy

Fibro-adipose substitution has a double detrimental effect on the myocardium in arrhythmogenic cardiomyopathy (ACM), worsening arrhythmogenesis by creating a non-conductive substrate, and causing ventricular dysfunction leading to heart failure. Notably, to-date no etiological therapy is available. This work introduces, for the first time, the stromal cardiac compartment as a key player in ACM ventricular adipose substitution: we demonstrated that cardiac human mesenchymal stromal cells undergo adipogenic differentiation both in ACM explanted hearts and in culture through a PKP2-dependent mechanism. Cardiac mesenchymal stromal cells constitute a suitable cellular platform for future mechanistic studies and a potential target for future therapies.

C reactive protein is associated with malignant ventricular arrhythmias in patients with ischaemia with implantable cardioverter-defibrillator

Patients with ischaemic heart disease and low ejection fraction (EF) are at increased risk of sudden death. MADIT (Multicenter Automated Defibrillator Implantation Trial) II has shown that implantable cardioverter-defibrillators (ICDs) reduce the risk of death by 31% at two years in patients with previous myocardial infarction and EF < 30%.1 The absolute risk reduction over an average follow up of 20 months, however, was only 5.6%. In addition, the high prevalence of patients who have had a myocardial infarction with EF ⩽ 30% makes the cost of this strategy high. This has led to an ongoing search for reliable markers of future episodes of life-threatening ventricular tachycardia (VT) or ventricular fibrillation (VF) to identify a higher-risk subgroup in which ICD therapy can be more beneficial and cost effective. The difficulty in predicting major ventricular arrhythmias probably reflects a limited understanding of their complex mechanisms. This is particularly true for patients who have had a myocardial infarction and with LV dysfunction, in whom myocardial ischaemia may trigger major ventricular arrhythmias. C reactive protein (CRP) concentration has been shown to be raised both in subjects studied …

Rhythm‐Symptom Correlation in Patients on Continuous Monitoring After Catheter Ablation of Atrial Fibrillation

Correlation between symptoms and atrial fibrillation (AF) episodes after catheter ablation may have clinical relevance, especially for anticoagulation usage. The aim of our project was to analyze the relationship between symptoms and AF recurrences in unselected patients following AF catheter ablation during long‐term follow‐up.

Left ventricular ejection fraction for the risk stratification of sudden cardiac death: friend or foe?

More than 450 000 Americans die suddenly each year from sustained ventricular tachycardia or fibrillation. A correct identification of these patients is crucial for a rational clinical management, because the demonstrated effectiveness of implantable cardioverter‐defibrillators (ICD) on the reduction of sudden cardiac death. Basing on the results of multiple clinical trials, left ventricular systolic function, measured as ejection fraction, is currently the only recommended tool to identify patients at higher risk of sudden death that would benefit from a prophylactic ICD. However, the systematic implementation of prophylactic ICD recommendations results in a substantial number of inappropriate ICD implantations, while failing to prevent the majority of sudden deaths occurring in the general population. That has been the case implementing arrhythmic risk stratification with a rough arrhythmic risk marker, such as ejection fraction, that lacks sensitivity and specificity in the prediction of sudden cardiac death. The aim of this viewpoint is to critically revise the value of ejection fraction in the identification of patients at risk of sudden cardiac death.