Miguel Ventura

Circulating endothelial progenitor cells as a predictor of response to cardiac resynchronization therapy: the missing piece of the puzzle?

It would be important to better identify heart failure (HF) patients most likely to respond to cardiac resynchronization therapy (CRT). Because endothelial progenitor cells (EPCs) play a crucial role in the maintenance of vascular endothelium integrity, we hypothesize that patients who have higher circulating EPCs levels have greater neovascularization potential and are more prone to be responders to CRT.

Registo Nacional de Eletrofisiologia Cardíaca (2010 e 2011)

Based on a survey sent to Portuguese centers that perform diagnostic and interventional electrophysiology and/or implant cardioverter-defibrillators (ICDs), the authors analyze the number and type of procedures performed during 2010 and 2011 and compare these data with previous years. In 2011, a total of 2533 diagnostic electrophysiologic procedures were performed, which were followed by ablation in 2013 cases, a steady increase over previous years. The largest share of this increase compared to 2010 was in atrial fibrillation, which is now the second most frequent indication for ablation, after atrioventricular nodal reentrant tachycardia. The total number of ICDs implanted in 2011 was 1084, of which 339 were biventricular (BiV) cardiac resynchronization devices (BiV ICDs). This represents an increase in the total number relative to previous years, 2011 being the first year in which the rate of new ICD implantations in Portugal exceeded 100 per million population. However, compared to 2010, the number of BiV ICDs implanted decreased, despite the recent publication of updated European guidelines on device therapy in heart failure, which clarified and expanded the indications for implantation of these devices. Some comments are made on the current status of cardiac electrophysiology in Portugal and on factors that may influence its development in the coming years.

Ablação de taquicardia auricular em cardiopatia congénita operada

The authors describe the case of a 57-year-old woman with surgically treated superior vena cava sinus-venosus atrial septal defect who underwent an electrophysiology study with the CARTO ® 3 mapping system (Biosense Webster, J&J) due to recurrent episodes of tachycardia. The patient was found to be in narrow QRS-complex tachycardia, with a cycle length of 310 ms and concentric activation sequence in the coronary sinus (Figure 1A and 1B), suggesting atrial tachycardia (AT) originating from the right atrium (RA). High-density electroanatomical mapping of the RA was performed using the PentaRay catheter (Figure 2C). The AT activation map (Figure 2B) indicated microreentry and centrifugal activation mainly on the lateral RA wall (Figure 2B), coinciding with the border zone of the scar (Figure 2C) and reveals ≥75% of the tachycardia cycle on the PentaRay catheter (Figure 2A). Radio frequency was applied with the SmartTouch ablation catheter in the initial activation region, resulting in conversion to sinus rhythm (SR).

Who still remains at risk of arrhythmic death at time of implantable cardioverter-defibrillator generator replacement?: MADEIRA et al.

Implantable cardioverter‐defibrillator (ICD) is associated with reduction in arrhythmic mortality. However, at the time of generator replacement (GR) some patients had not experienced therapies and had a different clinical profile. Therefore, the risk‐benefit ratio of ICD may have changed. Our aim was to determine the proportion of patients with ICD implanted in primary prevention that maintain guideline‐derived indications at the time of GR and assess predictors of therapies in the postreplacement period. We evaluate the long‐term benefit of ICD after GR in nonischemic cardiomyopathy (NICM) versus ischemic cardiomyopathy (ICM).