Cardiology News /Recent Literature Review / Third Quarter 2014

Abstract

HCS Annual Meeting: Athens, 23-25/10/2014

AHA: Chicago, 15-19/11/14

20^th Annual Boston AF Symposium: Orlando, 8-10/1/15

HCS Working Groups Seminar: Ioannina, 2/2015

ACC: San Diego, 14-16/3/15

HRS: Boston, 13-16/5/15

EuroPCR: Paris, 19-22/5/15

Europace: Milan, 21-24/6/15

ESC: London, 29/8-2/9/15

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): ICDs Save Lives & Antitachycardia Pacing (ATP) is Highly Successful Regardless of Heart Rate

Of 137 patients enrolled in a prospective North American ARVC registry, 108 received implantable cardioverter defibrillators (ICDs); 48 had 502 sustained episodes of ventricular arrhythmias (VAs) (489 monomorphic and 13 polymorphic). In the ICD patients, independent predictors of VAs in follow-up included spontaneous sustained VAs before ICD implantation and T-wave inversions inferiorly. The only independent predictor for life-threatening VAs, defined as sustained ventricular tachycardia (VT) ≥240 beats/min or ventricular fibrillation, was a younger age at enrollment. Anti-tachycardia pacing (ATP), independent of VT cycle length, was successful in terminating 92% of VT episodes. The authors concluded that in ARVC most VAs at follow-up are monomorphic. Risk factors for VAs were spontaneous VAs before enrollment and a younger age at ICD implantation. ATP is highly successful in terminating VT, and all ICDs should be programmed for ATP, even for rapid VT (Link M et al, J Am Coll Cardiol 2014;64:119-125).

PREVAIL: Left Atrial Appendage (LAA) Occlusion a Reasonable Alternative to Warfarin for Stroke Prevention in Non-Valvular Atrial Fibrillation?

In the PROTECT AF trial in patients with nonvalvular atrial fibrillation (NVAF), LAA occlusion with the Watchman device was noninferior to warfarin for stroke prevention, but procedural safety was questionable. The PREVAIL study further assessed efficacy and safety of this device in patients with NVAF who had a CHADS2 score ≥1-2. At 1½ years, the rate of first primary efficacy endpoint (composite of stroke, systemic embolism [SE], and cardiovascular/ unexplained death) was 0.064 in the device group (n=269) vs 0.063 in the control group (n=138) and did not achieve noninferiority criteria. The rate for the second primary efficacy endpoint (stroke or SE >7 days’ post-randomization) was 0.0253 vs 0.0200 (risk difference 0.0053), achieving noninferiority. Early safety events occurred in 2.2% of the device arm (lower than in PROTECT AF). All adverse effects were lower in PREVAIL trial than in PROTECT AF (4.2% vs 8.7%; p = 0.004). Pericardial effusions requiring surgery decreased from 1.6% to 0.4% (p= 0.027), and those requiring peri-cardiocentesis decreased from 2.9% to 1.5% (p=NS). The authors concluded that LAA occlusion was noninferior to warfarin for ischemic stroke prevention or SE >7 days’ post-procedure. Noninferiority was not achieved for overall efficacy but procedural safety improved (Holmes DR et al, J Am Coll Cardiol 2014;64:1-12)... (excerpt)