1,721,258 research outputs found
Benefit of Implantable Cardioverter-Defibrillators in Patients with Catecholaminergic Polymorphic Ventricular Tachycardia - Reply
No full textIn Reply: We thank Maass and Cox for their comment on our work,1 and for stimulating the discussion on the role of implantable cardioverter-defibrillators (ICDs) in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT).
In our cohort, we did not observe an excess of crude mortality rates in ICD carriers (0.15 per 100 person-years) compared with noncarriers (0.56 per 100 person-years; P = .38). Considering that in this relatively young population, the dominant contributor to mortality is sudden cardiac death, we assessed the likelihood of survival at the occurrence of the first life-threatening arrhythmic event (LTAE; composite of sudden cardiac death, aborted cardiac arrest, or hemodynamically nontolerated sustained ventricular tachycardia), a previously validated hard end point.2,3 Our data show that patients without an ICD were 25-fold more likely to die at the occurrence of the first LTAE compared with ICD carriers, supporting the conclusion that ICD confers a survival benefit in high-risk patients with CPVT.1 However, when discussing the benefits and drawbacks of ICD, mortality should not be the only factor considered, since patients without an ICD may survive an out-of-hospital cardiac arrest with neurological disability secondary to anoxic brain injury, as in the case of 2 of 6 patients without an ICD who survived a cardiac arrest in our cohort.
We agree with the authors that appropriate ICD shocks are not always necessary, especially on self-terminating arrhythmias. We acknowledge that a typographic mistake occurred during the editing of the article, and the sentence cited by the authors regarding the episodes terminated by the ICD should read, “Overall, all 15 episodes of VF [ventricular fibrillation] were successfully interrupted, while only 3 of 6 episodes (50%) of hemodynamically unstable, polymorphic fast VT [ventricular tachycardia] were terminated (P < .001).”4 We thank the authors for giving us the opportunity to clarify that the majority of ICD shocks on LTAE occurred on ventricular fibrillation, which are known to not cease spontaneously. This is also explained by our long-standing collaboration with Maurizio Gasparini, MD, which led to us to adopt into our clinical practice ICD programming with a long detection to deliver a shock only on ventricular fibrillation, a strategy demonstrated to reduce the rate of both appropriate and inappropriate shocks without differences in mortality.5 Regarding the 3 of 6 shocks (50%) on polymorphic VT that failed to terminate the arrhythmia, this is not surprising, since it is known that substrate (and arrhythmia mechanism) is a potent predictor of shock efficacy.6
Lastly, neither flecainide nor verapamil nor left cardiac sympathetic denervation have been demonstrated to reduce mortality in patients with CPVT at the time of the publication of this work. Considering that the practice of modern medicine should be based on the best evidence available, at the present time, these therapies cannot represent an alternative for ICD
European Society of Cardiology Congress 2019 Together With the World Congress of Cardiology in Paris: The Scientific Chairs Give the Inside Track on Achieving Excellence and Engagement
No full textHow do you attract 33 500 people from around the world to a cardiovascular conference? Offer plenty of important new science. That was the recipe for the European Society of Cardiology (ESC) and its Congress 2019, held in Paris over 5 days this summer. Chairing the Program Committee of any congress is challenging enough, but organizing the Scientific Program of the world’s largest cardiovascular congress is a daunting task. This year, ESC President Professor Barbara Casadei appointed 2 chairs: Professor Silvia Priori and Professor Marco Roff
Sudden cardiac death in the young: Are we still missing the opportunity to prevent recurrences in the family?
No full textWhat a congress!
No full textThe 2019 Annual Congress of the European Society of Cardiology (ESC), held in collaboration with the World Congress of Cardiology of the World Heart Federation, took place in Paris from August 31 to September 4. With more than 33 500 attendees, this meeting of the largest congress of cardiovascular (CV) medicine in the world achieved an all-time record of attendance. For the first time, it was hosted in a venue in downtown Paris, Port de Versailles, which has recently been extensively renovated. Access was easy thanks to a wide range of public transportations including the Metro.
At the entrance, the ‘wow effect’ was created by a circular LED screen measuring more than 120 m long and 2 m high. The compact setting of the venue, with the vast majority of the activities taking place in the central three-story building, immediately conquered the attendees allowing delegates to easily become oriented and feel comfortable. Despite the attractiveness of Paris and the nice weather, the sessions were packed until the end of the day
Soil erosion risk, Sicilian Region (1:250,000)
No full textAssessing the risk of soil erosion caused by water at the regional level is important for current
and future planning of land use and environmental actions to combat land degradation. The
gravity of the risk depends not only on the rate of soil erosion by water, but also on other
factors, primarily soil depth and workability of the underlying rocks and sediments, which
may be used to calculate the eroded soil. We estimate the rate of erosion by water
(tons ha-1 year-1) applying the Universal Soil Loss Equation model. The map of soil
content (tons ha21) to the effective rooting depth was divided by the map of soil erosion
rate to obtain the risk of erosion by water in Sicily, expressed in terms of years of complete
loss of soil cover. This map was intersected with a map of workability of the underlying
bedrock to give advice on where the cost of soil recovery by deep ripping and rock grinding
are very high. 8382.9 km2 (32.6% of the Sicilian territory) were rated as at high or very
high risk (< 100 years), of which 1230.9 km2 developed on bedrock with low workability
and so very costly to be recovered
Programmed Electrophysiological Stimulation for Risk Prediction in Patients with Brugada Syndrome: Closing Time?,La estimulacion electrica programada para la prediccion del riesgo en pacientes con sindrome de Brugada: ?tiempo de cierre?
No full textEn un reciente artículo publicado en Revista Española de Cardiología, Rodríguez-Mañero et al.1 presentan su experiencia en la validación de 3 puntuaciones multiparamétricas diferentes propuestas a lo largo de la última década para ayudar a predecir el riesgo de muerte súbita cardiaca (MSC)2–4 en pacientes con síndrome de Brugada (SBr). La población de esta cohorte retrospectiva multicéntrica la formaron 831 pacientes con SBr de los que se llevó a cabo un estudio electrofisiológico (EFS) con estimulación eléctrica programada (EEP) y un seguimiento clínico durante una media de 10 años.
El hallazgo clave del estudio fue que las 3 puntuaciones tenían una capacidad predictiva solo moderada, principalmente al aplicarlas a pacientes asintomáticos1. Los resultados obtenidos tienen interés, ya que el uso de desfibriladores automáticos implantables (DAI) continúa siendo la única opción para proteger a los pacientes con SBr que presentan un riesgo de MSC «suficientemente alto». Sin embargo, la decisión de implantar un DAI debe ponderarse cuidadosamente, ya que no está exenta de consecuencias
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