Emmanouil Poulidakis

Fracture of left ventricular pacing lead stabilized using the retained guidewire technique.

A 67-year-old heart failure patient with traditional cardiac resynchronization therapy (CRT) indications underwent biventricular pacing with a CRT-D device, using standard techniques. However, due to repetitive intraoperative dislocation of the left ventricular (LV) lead, we used the retained guidewire technique in order to secure in the posterolateral vein. The manoeuvre consists …

Echocardiography for the management of patients with biventricular pacing: Possible roles in cardiac resynchronization therapy implementation

Cardiac resynchronization therapy (CRT) is an established therapeutic option for the subset of patients with heart failure (HF), reduced ejection fraction (EF), and dyssynchrony evidenced by electrocardiography. Benefit from CRT has been proven in many clinical trials, yet a sizeable proportion of these patients with wide QRS do not respond to this intervention, despite the updated practice guidelines. Several echocardiographic indices, targeting mechanical rather than electrical dyssynchrony, have been suggested to address this issue, but research so far has not succeeded in providing a single and simple measurement with adequate sensitivity and specificity for identification of responders. While there is still ongoing research in this field, echocardiography proves helpful in other aspects of CRT implementation, such as site selection for left ventricular (LV) lead pacing and optimization of pacing parameters during follow-up visits.

In-hospital Cardiac Arrest: an Update

Percutaneous transluminal coronary angioplasty (PTCA) was introduced in the late 1970s as an alternative to coronary artery bypass graft surgery for coronary revascularization; since then, it has been accepted as a safe, reliable, and effective treatment for coronary artery disease, and its use has spread worldwide.Hyperlipidemia is a major cause of cardiovascular disease despite the availability of first-line cholesterol lowering agents such as statins. Although statin therapy is very efficient to reduce cholesterol, nearly 10-20% of individuals on statins, experience side effects, such myopathy, which hinder the drugs ability to achieve target low-density lipoprotein (LDL) cholesterol (LDL-C) levels. Statin-intolerant patients require more effective therapies for lowering LDL-C. As proprotein convertase subtilisin kexin type 9 (PCSK9) promotes the degradation of the LDL receptor (LDLR) and prevents it from recycling to the membrane, a new therapeutic approach to lowering LDL-C acts by blocking LDL-receptor degradation by serum PCSK9. Humanized monoclonal antibodies which target PCSK9 and its interaction with the LDL receptor (REGN727/SAR23653, AMG145, and RN316), as well as agents that inhibit PCSK9 synthesis, such as ALN-PCS, are now in clinical trials. The latter is a small interfering RNA (siRNA) that directs sequence-specific messenger RNA for PCSK9 leading to reduced hepatocyte-specific synthesis of PCSK9. Ongoing phase III trials’ results are awaited with great interest in order to define these agents’ long-term safety, tolerability and efficacy for reducing cardiovascular events.Sequential surgical thoracoscopic and electrophysiological (EP) ablation is gaining popularity as a novel approach for the treatment of patients with stand-alone, persistent and long standing persistent atrial fibrillation (AF).The measurement of fractional flow reserve (FFR) has been proven useful in evaluating whether or not to perform percutaneous coronary intervention (PCI), especially in the case of “intermediate” stenosis. Nowadays, the indication of its usefulness has been expanded. While coronary angiography remains the cornerstone for assessment of epicardial coronary artery lesions in the catheterization laboratory, FFR-guided coronary treatment has established its usefulness especially after FAME 1 & 2 trials.Atrial Fibrillation (AF) is associated with increased morbidity and mortality and a more severe impairment in quality of life compared with patients with congestive heart failure or myocardial infarction. Left atrial myocardial extensions, known as “myocardial sleeves”, are present in almost all pulmonary veins (PVs), and have been recognized as the main source of triggers that initiate and perpetuate AF.