Dilated cardiomyopathy (DCM) is a common heart muscle disorder of nonischemic etiology associated with heart failure development and the risk of malignant ventricular arrhythmias and sudden cardiac death. A tailored approach to risk stratification and prevention of sudden cardiac death is required in genetic DCM given its variable presentation and phenotypic severity. Currently, advances in cardiogenetics have shed light on disease mechanisms, the complex genetic architecture of DCM, polygenic contributors to disease susceptibility and the role of environmental triggers. Parallel advances in imaging have also enhanced disease recognition and the identification of the wide spectrum of phenotypes falling under the DCM umbrella. Genotype-phenotype associations have been also established for specific subtypes of DCM, such as DSP (desmoplakin) or FLNC (filamin-C) cardiomyopathy but overall, they remain elusive and not readily identifiable. Also, despite the accumulated knowledge on disease mechanisms, certain aspects remain still unclear, such as which patients with DCM are at risk for disease progression or remission after treatment. Imagenetics, that is, the combination of imaging and genetics, is expected to further advance research in the field and contribute to precision medicine in DCM management and treatment. In the present article, we review the existing literature in the field, summarize the established knowledge and emerging data on the value of genetics and imaging in establishing genotype-phenotype associations in DCM and in clinical decision making for DCM patients.

Background: Force‐time integral (FTI) is an ablation marker of lesion quality and transmurality. A target FTI of 400 gram‐seconds (gs) has been shown to improve durability of pulmonary vein isolation, following atrial fibrillation ablation. However, relevant targets for cavotricuspid isthmus (CTI) ablation are lacking.Hypothesis: We sought to investigate whether CTI ablation with 600 gs FTI lesions is associated with reduced rate of transisthmus conduction recovery compared to 400 gs lesions.Methods: Fifty patients with CTI‐dependent flutter were randomized to ablation using 400 gs (FTI400 group, n = 26) or 600 gs FTI lesions (FTI600 group, n = 24). The study endpoint was spontaneous or adenosine‐mediated recovery of transisthmus conduction, after a 20‐min waiting period.Results: The study endpoint occurred in five patients (19.2%) in group FTI400 and in four patients (16.7%) in group FTI600, p = .81. First‐pass CTI block was similar in both groups (50% in FTI400 vs. 54.2% in FTI600, p = .77). There were no differences in the total number of lesions, total ablation time, procedure time and fluoroscopy duration between the two groups. There were no major complications in any group. In the total population, patients not achieving first‐pass CTI block had significantly higher rate of acute CTI conduction recovery, compared to those with first‐pass block (29.2% vs. 7.7% respectively, p = .048).Conclusions: CTI ablation using 600 gs FTI lesions is not associated with reduced spontaneous or adenosine‐mediated recurrence of transisthmus conduction, compared to 400 gs lesions.

Atrial fibrillation (AF) and heart failure (HF) are common and commonly coexisting cardiovascular diseases in hospitalized patients. We report the absolute number and interrelation between AF and HF, assess the daily burden of both diseases on health-care system and report the medical treatment in a real world, nationwide conducted snapshot survey. A questionnaire was equally distributed to various health care institutions. Baseline characteristics, prior hospitalizations and medical treatment of all hospitalized patients with AF and HF at a predefined date were collected and analyzed. Seventy-five cardiological departments participated in this multicenter Greek nationwide study. Six hundred three (n: 603) patients (mean age 74.5±11.4 years), with AF, HF, or combination of both were nationwide admitted. AF was registered in 122 (20.2%), HF in 196 (32.5%) and combination of both in 285 (47.3%). First time hospital admission was recorded in 273/597 (45.7%) of the patients, whereas 324/597 (54.3%) had readmissions in the past 12 months. Of the entire population, 453 (75.1%) were on b-blockers (BBs) and 430 (71.3%) were on loop diuretics. Furthermore, 315 of patients with AF (77.4%) were on oral anticoagulation, of which 191 (46.9%) were on a direct oral anticoagulant and 124 (30.5%) on a vitamin-K antagonist. Hospitalized patients with AF and/or HF have more than one admission within a year. Coexistence of AF and HF is more common. BBs and loop diuretics are the most commonly used drugs. More than three quarters of the patients with AF were on oral anticoagulation.

Background: The aim of this study was to develop a structured 2‐step approach, based on noninvasive diagnostic criteria, that led to an electrophysiology study in patients with unexplained syncope. Methods and Results: Two independent cohorts were used: the derivation cohort with 665 patients based on electronic health record data to develop our 2‐step diagnostic approach, and the validation cohort based on 160 prospectively screened patients, presenting with unexplained syncope episodes. Noninvasive electrocardiographic and imaging markers and an electrophysiology study–based invasive assessment were combined. A positive diagnostic approach according to our study's prespecified criteria resulted in a decision to proceed with a permanent pacemaker/implantable cardioverter‐defibrillator. The primary end point was the time until the event of recurrent syncope (syncope‐free survival). Number needed to treat was calculated for patients with a positive diagnostic approach. The number of patients with unexplained syncope and borderline sinus bradycardia needed to treat was 5, and the number of patients with unexplained syncope and bundle branch block needed to treat was 3 over a mean follow‐up of ≈4 years. After the structured 2‐step approach, the primary outcome occurred in 14 of 82 (17.1%) with a pacemaker/implantable cardioverter‐defibrillator and 19 of 57 (33%) with a negative approach, with a mean follow‐up of ≈2.5 years (29.29±12.58 months, P =0.03). Conclusions: The low number needed to treat in the derivation cohort and the low percentage of syncope recurrence in the validation cohort supports the proposed 2‐step electrophysiology‐inclusive algorithm as a potentially low‐cost, 1‐day, structured tool for these patients.

Background/Objectives: Non-dilated left ventricular cardiomyopathy (NDLVC) is a recently defined clinical entity associated with increased risk of ventricular arrhythmias (VA) and sudden cardiac death (SCD), despite preserved LV geometry. The role and temporal variability of noninvasive electrocardiographic (ECG) risk markers in this population remain insufficiently characterized. To assess the temporal variability of ECG-derived risk markers in patients with NDLVC and explore their association with major adverse cardiac events, including heart failure (HF) and VA hospitalization. Methods: We prospectively studied 55 patients with NDLVC who underwent cardiac magnetic resonance imaging and serial 24 h Holter monitoring, signal-averaged ECG, and standard 12-lead ECG over a one-year period. Patients were followed up for 39.5 ± 8.6 months. Nine ECG-based risk markers were analyzed, including premature ventricular contraction (PVC) burden, non-sustained ventricular tachycardia (NSVT) occurrence, its maximum rate and maximum beats, mean QTc interval, standard deviation of NN intervals (SDNN), deceleration capacity (DC), heart rate turbulence onset and slope (TO/TS), T-wave alternans (TWA), and late potentials. Clinical outcomes were HF and VA hospitalization. Logistic regression was used to evaluate associations between changes in ECG parameters and outcomes. Results: A change (from positive to negative and vice versa) in at least one ECG parameter was detected in 67.3% of patients, with the highest variability observed in TWA (34.5%), NSVT (23.6%), and PVC burden (23.6%). Despite this variability, only SDNN was significantly associated with increased risk of VA hospitalization during follow-up (OR = 0.98, 95% CI: 0.97–0.99, p = 0.006). No ECG changes were associated with HF hospitalization. Conclusions: Patients with NDLVC exhibit substantial temporal variability in noninvasive ECG risk markers. While most changes do not correlate with clinical events, an inverse association was found between SDNN and VA risk. These findings support the ongoing evaluation and the necessity to identify more effective risk stratification markers in this subgroup of patients.

Cardiac resynchronization therapy (CRT) represents a cornerstone in the management of patients with heart failure and electrical dyssynchrony, improving symptoms, reducing hospitalizations, and prolonging survival. CRT can be delivered via a pacemaker (CRT-P) or an ICD (CRT-D). Despite its widespread use, the mortality benefit of CRT-D over CRT-P remains uncertain, as no head-to-head randomized trials have been designed to directly compare the two modalities, making device selection a frequent clinical dilemma. In practice, CRT-D accounts for 70–80% of CRT implantations in developed countries, yet solid evidence demonstrating its superiority over CRT-P is lacking. Specific patient groups, including those with non-ischemic cardiomyopathy, advanced age, multiple comorbidities, or limited life expectancy, may derive limited incremental benefit from CRT-D, which should be balanced against device costs and specific risks such as lead failure and inappropriate shocks. The present review aims to provide a comprehensive comparison between CRT-D and CRT-P, focusing on the existing body of evidence, criteria for patient selection, comparative clinical outcomes, and risk–benefit considerations for clinical decision-making.