Cardioneuroablation is one of the emerging therapies in vasovagal syncope. In this study, we present a simple method of cardioneuroablation performed via a right-sided approach, targeting anterior-right and right-inferior ganglionated plexi, along with procedural and follow-up data. Patients who had underwent cardioneuroablation between March 2018 and September 2019 with vasovagal syncope in 2 clinics were enrolled in the study. All patients underwent radio-anatomically guided radiofrequency ablation targeting anterior-right ganglionated plexi and right-inferior ganglionated plexi. Syncope and symptom burden, 24-hour ambulatory electrocardiogram data at presentation, and at follow-up were assessed along with procedural data. A total of 23 patients underwent modified right-sided cardioneuroablation. Mean basal cycle length decreased significantly from 862.3 ± 174.5 ms at the beginning of the procedure 695.8 ± 152.1 ms following the final radiofrequency ablation (P < .001). Mean 24-hour ambulatory heart rate increased significantly from 66.4 ± 10.7 bpm at baseline to 80 ± 7.6 bpm at follow-up (P < .001). Only 1 patient had 1 episode of syncope following the procedure at the mean follow-up period of 10 ± 2.9 months. The same patient had recurrent presyncope. The right-sided cardioneuroablation approach was found to be an effective treatment for vasovagal syncope and may be regarded as a default initial cardioneuroablation technique.

COVID-19,echocardiography,2-dimensional speckle tracking imaging

Background: Ventricular fibrillation (VF) is a poorly understood arrhythmia that is one of the main mechanisms of sudden cardiac death in patients with structural heart disease (SHD). Fascicular and Purkinje tissue (FPT) has been implicated in VF. Objective: In this study, we sought to analyze the involvement of FPT colocalized with the scar area of SHD. Additionally, we aimed to investigate outcomes of FPT and scar substrate ablation in SHD VF patients and compare outcomes with VT ablation patients. Methods: This is a retrospective observational study. Clinical and procedural data were collected. Results: Sixteen patients undergoing VF ablation were assigned to the VF group, and their outcomes were compared to those of 170 patients who underwent structural VT ablation. In 15 patients, FPT targets colocalized with low voltage area, LPs, and/or LAVAs. Septal Purkinje and left posterior fascicle were most commonly involved. Procedural metrics were similar with patients undergoing VT ablation. During median follow‐up of 5.5 months (interquartile range [IQR]: 3.5–10), VF recurred in two patients. Conclusion: This study has shown frequent colocalization of FPT with electrophysiologic substrate (late potentials [LPs], low voltage area, etc.) in patients with SHD and VF. We have shown the feasibility of FTP and substrate ablation with good mid‐term outcomes in a small group of patients. Larger studies are necessary for definitive evidence.

Visual estimation of left ventricular ejection fraction (LVEF) is still used in routine clinical practice. However, most of the studies evaluating the agreement between the visually estimated LVEF (ve-LVEF) and quantitatively measured LVEF (qm-LVEF) either have not used appropriate statistical methods or gold standard imaging modality. In this study, we aimed to assess the agreement between the ve-LVEF and qm-LVEF using contemporary statistical methods and cardiac magnetic resonance imaging (CMRI). In 54 subjects who underwent 1.5-T CMRI, echocardiographic images were recorded after the CMRI procedure on the same day. Two independent observers estimated ve-LVEFs on echocardiographic records in a random and blinded fashion, and qm-LVEF was obtained by CMRI. Agreement between the ve-LVEF and qm-LVEF values and intra/interobserver ve-LVEF estimations were assessed using intraclass correlation coefficient (ICC), Bland-Altman analysis, and kappa statistics. There was a high agreement between the ve-LVEF and qm-LVEF (ICC 0.93, 95% confidence interval 0.88–0.96). Bland-Altman analysis also demonstrated a good agreement between ve-LVEF and qm-LVEF with ve-LVEF, on average, being 0.6% lower than that obtained by CMRI (mean −0.6, limits of agreement −10.5 and +9.3). A good agreement was also observed for LVEF categories ≤35%, 36%–54%, and ≥55% (unweighted kappa 0.71, linearly weighted kappa 0.76); and LVEF of <55% and ≥55% (kappa 0.80). Intra/inter observer agreement was good for ve-LVEFs (ICC value 0.96 and 0.91, respectively). Visual approach for LVEF assessment may be used for rapid assessment of left ventricular systolic function in clinical practice, particularly in patients with good image quality.

Background: Heart failure (HF) is still an important disease with high mortality rates worldwide. HF treatment is also difficult due to different phenotypes. Diuretic response (DR) is one of the main differences across these subgroups. Novel urinary parameters are used for DR prediction. We sought to determine whether the MELD score could be used as an additional parameter for predicting the DR. Methods: Eighty‐one consecutive patients diagnosed with decompensated HF between June and October 2020 were included. The second hour urine sodium (UNa) level after the first intravenous diuretic administration and serum parameters were recorded. All patients underwent a comprehensive echocardiographic examination. MELD score derivatives were tested to assess the DR. Results: A total of 81 patients (mean age: 66.4 ± 13.5; mean ejection fraction: 29.6 ± 12.7%) were divided into two groups according to UNa. 26 (32%) patients had poor DR. MELD Na score was independently associated with DR (OR = 0.88 [−0.21 to (−0.03)]; p = 0.008). Furthermore, MELD Na score was correlated with urinary sodium ( r = −0.354; p = 0.004). Daily furosemide dose was higher (237.9 ± 204.7 vs. 129.3 ± 83.5 mg; p = 0.001) and length of hospital stay was longer (15.6 ± 10.8 vs. 8.5 ± 6.1 days; p < 0.01) in the low UNa group. Conclusion: The MELD score derivative was associated with DR according to urinary sodium and may be used as an additional parameter to predict the DR.