Cardiology News / Recent Literature Review / Last Quarter 2017

Abstract

AF Symposium 2018: Orlando, FL, 11-13/1/208

ACC.18 Congress: Orlando, FL, 10-12/3/2018

EHRA Meeting: Barcelona, 18-20/3/2018

HRS Meeting: Boston, 9-12/5/2018

EuroPCR Meeting: Paris, 22-25/5/2018

ESC Meeting: Munich, 25-29/8/2018

SPAIN Study: Dual-Chamber Pacing With Closed Loop Stimulation (DDD-CLS) Reduced Syncope Burden and Time to First Recurrence by 7-Fold, and Prolonged Time to First Syncope Recurrence in Patients Age≥40 Years With Tilt-Induced Cardio-inhibitory Vasovagal Syncope

DDD-CLS pacing is a rate-responsive mode that uses intracardiac impedance as a surrogate of cardiac contractility to adapt heart rate to patient needs. Among 46 patients, aged 56.30 ± 10.63 years, with tilt-induced cardioinhiboitory vasovagal syncope, the proportion of patients with ≥50% reduction in the number of syncopal episodes was 72% with DDD-CLS compared with 28% with sham DDI mode (p=0.017). A total of 4 patients (8.7%) had events during DDD-CLS and 21 (45.7%) during sham DDI (hazard ratio: 6.7). Kaplan-Meier curve was significantly different between groups in time to first syncope: 29.2 months vs 9.3 months (p< 0.016); odds ratio: 0.11 (p< 0.0001) (Baron-Esquivias G et al, J Am Coll Cardiol 2017;70: 1720–28).

PESA Study: Skipping Breakfast is Associated With an Increased Odds of Prevalent Noncoronary and Generalized Atherosclerosis Independently of the Presence of Conventional CV Risk Factors 

Three patterns of breakfast consumption were studied: high-energy breakfast, when contributing to >20% of total daily energy intake (27% of the population); low-energy breakfast, when contributing between 5% and 20% of total daily energy intake (70% of the population); and skipping breakfast, when consuming <5% of total daily energy (3% of the population). Independent of the presence of traditional and dietary CV risk factors, and compared with high-energy breakfast, habitual skipping breakfast was associated with a higher prevalence of noncoronary (odds ratio-OR: 1.55) and generalized (OR: 2.57) atherosclerosis (Uzhova I et al, J Am Coll Cardiol 2017;70: 1833-42).

"Real life" Longevity of Implantable Cardioverter-Defibrillator Devices (ICDs) Much Shorter than Manufacturers’ Projected Longevity

Manufacturers of implantable cardioverter-defibrillators (ICDs) promise a 5- to 9-year projected longevity; however, real-life data indicate otherwise. Over 20 years, among 685 ICD patients (601 men; age, 63.1 ± 13.3 years) with coronary (n = 396) or valvular (n = 15) disease, cardiomyopathy (n = 220), or electrical disease (n = 54) (mean ejection fraction 35%) and devices implanted for secondary (n = 562) or primary (n = 123) prevention (292 single-, 269 dual-chamber and 124 CRT devices implanted in the abdomen in 17 or chest in 668), ICD pulse generator replacements were performed in 238 patients. These were 209 men and 29 women, aged 63.7 ± 13.9 years, with ejection fraction of 37.7% ± 14.0%, who had an ICD for secondary (n = 210) or primary (n = 28) prevention. The mean ICD longevity was 58.3 ± 18.7 months. In 20 (8.4%) patients, devices exhibited premature battery depletion within 36 months. Most (94%) patients had none, minor, or modest use of ICD therapy. Longevity was longest for single-chamber devices and shortest for CRT devices. Latest-generation devices replaced over the second decade lasted longer compared with devices replaced during the first decade. When analyzed by manufacturer, Medtronic devices appeared to have longer longevity by 13 to 18 months. The authors concluded that ICDs continue to have limited longevity of 4.9 ± 1.6 years, and 8% demonstrate premature battery depletion by 3 years. CRT devices have the shortest longevity (mean, 3.8 years) by 13 to 17 months, compared with other ICD devices (Manolis AS et al, Clin Cardiol 2017;40:759-764)... (excerpt)