Rhythmos (E-Journal - First Department of Cardiology / Evagelismos General Hospital of Athens)
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Long COVID: An Emerging Puzzle: Long COVID
No full textSome patients, estimated at ~10%, recovering from COVID-19 infection may have persistent (>4-12 weeks) symptoms and/or prolonged organ dysfunction attributed to COVID-19 infection (long Covid). The facets of this long Covid syndrome are slowly emerging and the chronic impact of this viral pandemic is gradually unfolding. All these issues are herein reviewed. Rhythmos 2021;16(1): 1-6
Electroanatomical Mapping to Curtail Heart Block Occurrence and Enhance Safety During Slow Pathway Ablation in Patients with Atrioventricular Nodal Reentrant Tachycardia: Electroanatomical Mapping for AVNRT Ablation
No full textA case is presented of use of electro-anatomical mapping (EAM)-guided ablation of a slow pathway in a patient with symptomatic atrioventricular (AV) nodal reentrant tachycardia (AVNRT) as a safeguard against inadvertent AV block. Rhythmos 2022;17(4):79-80.
 
Ventricular Arrhythmias Originating from the Papillary Muscles of the Left Ventricle in the Structurally Normal Heart and the Role of Catheter Ablation: Ventricular Arrhythmias from the Papillary Muscles
No full textVentricular arrhythmias arising from the left ventricular papillary muscles, having a right bundle branch block (RBBB) QRS morphology on the electrocardiogram, account for approximately 15% of arrhythmias in a structurally normal heart and have usually a benign prognosis. The mitral valve usually has two papillary muscles, anterolateral and posteromedial, with the latter one being always more arrhythmogenic. These arrhythmias are not typically inducible by programmed ventricular or atrial stimulation, suggesting a non-reentrant mechanism. Ventricular arrhythmias originated from the papillary muscles should be distinguished from other idiopathic left ventricular arrhythmias such as fascicular or mitral annular arrhythmias, which also have a RBBB pattern. Catheter ablation in these cases is always challenging and the recurrence risk is higher compared to other idiopathic ventricular arrhythmias. Rhythmos 2021;16(1):7-10
COVID-19 Breakthrough Infections in Vaccinated Individuals: COVID-19 Breakthrough Infections
No full textVaccine breakthrough COVID-19 infections are increasingly occurring in fully vaccinated individuals, who may also spread COVID-19 to others. Hence, one is better protected if one wears a mask and maintaining distancing when in indoor public places. Mild infections pose little risk to vaccinated individuals and their contacts, while they may boost the individual immune responses and thus necessitate only monitoring as a precautionary measure. However, higher infectiousness and transmissibility of viral variants remain worrisome. Variants of concern are overrepresented among post-vaccination breakthrough COVID-19 infections. Identifying subgroups at a high risk for severe breakthrough infections is important in prioritizing early preventive treatment or prophylaxis. Despite a strong protection afforded by vaccination against severe disease, breakthrough infections may still advance to severe or critical illness at not-insignificant rates. The age distribution of patients with severe breakthrough infections is skewed towards older age groups and individuals with underlying comorbidities. All these issues and factors modulating the probability of a breakthrough COVID-19 infection in vaccinated people are herein discussed, and a tabulated list of the recommendations of the World Health Organization on COVID-19 infection prevention and control is also presented. Rhythmos 2022;17(1): 92-99
Cardiology News / Recent Literature Review / Last Quarter 2021: Cardiology News
No full textRecent Cardiology Literature Review (Rhythmos 2022;17(1):107-114. )
Cardiology Meetings:
27th Annual International AF Symposium, 13-15/1/22, New York, NY, USA
ACC.22, Washington, DC, USA, 2-4/4/22
EHRA 22, Copenhagen, Denmark, 3-5/4/22
HRS 22, San Francisco, CA, USA, 29/4-1/5/22
EuroPCR, Paris, France, 17-20/5/22
ESC Meeting, Barcelona, Spain, 26-29/8/2022
TCT 22, Boston, MA, USA, 16-20/9/22
Brugada Syndrome (BrS) is Associated With Increased Collagen Content Throughout Both Ventricles, With Maximal Collagen Proportions Observed Within BrS RVOT Epicardium
Evaluation of 28 whole hearts from consecutive sudden cardiac death cases attributed to BrS (75% men; median age of death 25 years, death occurred in sleep or at rest in 86%) and 29 hearts from a comparator group comprised of noncardiac deaths (control subjects), showed that the highest proportion of collagen was observed in the epicardial right ventricular outflow tract (RVOT) of the BrS group (23.7%). Ventricular myocardium from BrS decedents demonstrated a higher proportion of collagen compared with controls (ratio 1.45; P<0.001), with no significant interactions with respect to sampling location or tissue layer. There was insufficient evidence to support differences in collagen proportion in SCN5A-positive cases (n=5) vs control subjects (ratio 1.23; P=0.27) (Miles C et al, J Am Coll Cardiol 2021;78:1511–21).
XIENCE Short DAPT Program: Among High Bleeding Risk (HBR) Patients Undergoing PCI, 1-Month DAPT, Compared With 3-Month DAPT, Was Associated With Similar Ischemic Outcomes and Lower Bleeding Risk
Patients who received 1-month DAPT (XIENCE 28 USA and 28 Global; n=1392) were compared with those on 3-month DAPT (XIENCE 90; n= 1972) using propensity score stratification. The primary endpoint of all-cause mortality or myocardial infarction was similar between the 2 groups (7.3% vs 7.5%; P=0.41). The key secondary endpoint of BARC (Bleeding Academic Research Consortium) type 2-5 bleeding was lower with 1-month DAPT compared with 3-month DAPT (7.6% vs 10%; P=0.012). Major BARC type 3-5 bleeding did not differ at 12 months (3.6% vs 4.7%; P=0.082), but was lower with 1-month DAPT at 90 days (1.0% vs 2.1%; P=0.015) (Valgimigli M et al, J Am Coll Cardiol 2021;78:2060–2072).
A Booster (Third Dose) at Least 5 Months After a Second Dose of BNT162b2 Vaccine (Pfizer–BioNTech) Conferred 90% Lower Mortality Due to Covid-19 vs Those Who Did Not Receive a Booster
Among 843,208 participants 758,118 (90%) received the booster during the 54-day study period. Death due to Covid-19 occurred in 65 participants in the booster group (0.16 per 100,000 persons per day) and in 137 participants in the nonbooster group (2.98 per 100,000 persons per day). The adjusted hazard ratio–HR for death due to Covid-19 in the booster group, as compared with the nonbooster group, was 0.10 (P<0.001) (Arbel R et al, N Engl J Med 2021; 385:2413-2420)... (excerpt
Cardiology News / Recent Literature Review / Last Quarter 2020: Cardiology News
No full textRhythmos 2021;16(1): 14-21.
26th Annual International AF Virtual Symposium, 29-31/1/2021
EHRA online Congress, 23-25/4/2021
ACC Meeting: Atlanta, 15-17/5/2021
EuroPCR online, 18-20/5/201
ESC Digital Congress 27-30/8/2021
TCT Meeting, San Francisco, 22-26/10/2021
Active Myocardial Inflammation is a Powerful Predictor of Recurrent Ventricular Tachycardia (VT) Following Catheter Ablation: VT Ablation Should be Avoided During Active Myocarditis (AM), But is Often of Benefit for Recurrent VT After the Acute Phase of Myocarditis
Among 125 consecutive patients (age 51±14 years, 91% men, LVEF 52%±9%) with myocarditis diagnosed by endomyocardial biopsy (59%) and/or cardiac magnetic resonance (90%), undergoing VT ablation, with all patients showing low-voltage areas (LVA) at electro-anatomical map (97% epicardial or endoepicardial), VT recurrences were documented in 25 patients (20%) by 12 months, and in 43 (34%) by last follow-up (median 63 months). At multivariable analysis, active myocarditis (AM) stage was the only predictor of VT recurrences by 12 months (hazard ratio: 9.5; p < 0.001), whereas both AM stage and wide border zone were associated with arrhythmia recurrences anytime during follow-up. No VT episodes were found after redo ablation was performed in 23 patients with previous (non-active) myocarditis (Peretto G et al, J Am Coll Cardiol 2020;76:1644–1656).
Left Ventricular (LV) Non-Compaction (LVNC): Vigorous Recreational Physical Activity (VPA) May be a Possible Determinant of LV Hypertrabeculation in Asymptomatic Individuals
In PESA (Progression of Early Subclinical Atherosclerosis) study participants (n = 4,184 subjects free of cardiovascular disease), LVNC phenotype prevalence according to the Petersen criterion was significantly higher among participants in the highest VPA quintile (Q5 = 30.5%) than in participants with no VPA (14.2%). The Jacquier and Grothoff criteria were also more frequently fulfilled in participants in the highest VPA quintile (Jacquier Q5 = 27.4% vs no VPA = 12.8% and Grothoff Q5 = 15.8% vs no VPA = 7.1%). The prevalence of the systolic Stacey LVNC criterion was low (3.6%) and did not differ significantly between no VPA and Q5 (de la Chica JA et al, J Am Coll Cardiol 2020;76: 1723–1733).
Interleukin-1β (IL-1β) Measured on Admission is Associated with Risk of Premature Death in Patients with Myocardial Infarction
IL-1β concentration measured at admission in 1,398 patients with ST-segment elevation MI (STEMI) was associated with all-cause mortality at 90 days (adjusted hazard ratio - adjHR: 1.47 per 1 SD increase; p < 0.002). The relation was nonlinear, and the highest tertile of IL-1β was associated with higher mortality rates at 90 days (adjHR: 2.78; p = 0.0002) and at 1 year (adjHR: 1.93; p = 0.005), regardless of the hs-CRP concentration. Significant relationships were equally observed when considering cardiovascular mortality and MACEs at 90 days (adjHR: 2.42; p = 0.002, and adjHR: 2.29; p = 0.004, respectively) and at 1 year (adjHR: 2.32; p = 0.002, and adjHR: 2.35; p = 0.001, respectively) (Silvain J et al, J Am Coll Cardiol 2020;76:1763–1773)... (excerpt
Endocardial Left Atrial Appendage Occlusion and its Place in Contemporary Management of Atrial Fibrillation: Left Atrial Appendage Occlusion
No full textAtrial fibrillation (AF) is the most common arrhythmia, affecting 1-2% of the general population in Western countries and it is a well-known risk factor for cardioembolic ischemic stroke, which increases the risk 4 to 5 times. Stroke is responsible for 14% of all annual deaths and every year 8 million people suffer a stroke in European countries. The standard stroke preventive strategy in patients with AF is the administration of anticoagulants. However, contraindications to these agents are not rare, the use of anticoagulants, especially the vitamin-K antagonists, is quantitatively sub-optimal, and many patients with high thromboembolic risk also have increased bleeding risk. Considering that the most frequent location of intracardiac thrombi associated with AF is the left atrial appendage (LAA), the endocardial occlusion of this structure has emerged as a potential alternative treatment. Rhythmos 2022;17(1): 100-104
COVID-19 Related Myocarditis: Diagnosis and Management: COVID-19 Related Myocarditis
No full textA comprehensive review of current data on COVID-19 related myocarditis is herein presented. Rhythmos 2022;17(2): 25-31
Eggshell Calcification of the Heart
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A case of a patient with extensive egg-shell calcification of the pericardium is presented without signs of constriction. This was imaged by fluoroscopy during an ablation procedure performed for persistent atrial fibrillation. Rhythmos 2022; 17(1):105-106
Aortic Valve Stenosis and Cardiac Amyloidosis: An Underestimated Coexistence : Aortic Stenosis and Cardiac Amyloidosis
No full textCoexistence of aortic valve stenosis (AS) and cardiac amyloidosis (CA) is frequent in the elderly as both conditions increase with age. Wild type transthyretin (TTR) amyloidosis is the most common type of amyloidosis in AS cohorts. Cardiac amyloidosis and AS share common clinical characteristics making diagnosis of dual pathology challenging. However, certain features should raise suspicion of CA presence in AS patients leading to specific imaging modalities to confirm diagnosis. Dual pathology (AS & CA) increase mortality risk and prompt diagnosis is crucial. Novel pharmacological agents targeted for TTR CA should be initiated to improve prognosis. The role of the Heart Team for decision-making in these cases regarding the optimal management of AS is crucial. Transcatheter aortic valve replacement may be the preferred procedure in these high-risk patients. Rhythmos2022;17(3): 53-57