Atrial fibrillation (AF) is a very common arrhythmia that mainly affects older individuals. The mechanism of atrial fibrillation is complex and is related to the pathogenesis of trigger activation and the perpetuation of arrhythmia. The pulmonary veins in the left atrium arei confirm that onfirm the most common triggers due to their distinct anatomical and electrophysiological properties. As a result, their electrical isolation by ablation is the cornerstone of invasive AF treatment. Multiple factors and comorbidities affect the atrial tissue and lead to myocardial stretch. Several neurohormonal and structural changes occur, leading to inflammation and oxidative stress and, consequently, a fibrotic substrate created by myofibroblasts, which encourages AF perpetuation. Several mechanisms are implemented into daily clinical practice in both interventions in and the medical treatment of atrial fibrillation.

The radiographic technique factors and the quality of each radiographic image for three common examinations (chest PA, pelvis PA and lumbar spine LAT) were compared with the European criteria and entrance surface dose (ESD) was measured for each radiograph in two Greek hospitals. The measurements were carried out using calibrated LiF thermoluminescence dosemeters. The patients were selected so that their weight was close to 70 ± 10 kg and their height to 170 ± 10 cm. Effective dose values were calculated using a PC-based Monte Carlo program. All four X ray rooms in the survey achieved mean doses well below the European reference doses. However the mean doses in the X ray rooms differed by a factor of about 3.

Cardiac resynchronization therapy (CRT) using biventricular (BiV) pacing is the standard treatment for heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) and electrical dyssynchrony. However, one in three patients remains a non-responder. Left bundle branch area pacing (LBBAP) could represent a more physiological alternative, but its effectiveness is limited in cases of atypical left bundle branch block (LBBB) or intraventricular conduction delay (IVCD). Left Bundle Branch Pacing Optimized cardiac resynchronization therapy (LOT-CRT) integrates LBBAP with coronary sinus (CS) lead pacing to improve electrical synchrony and clinical outcomes. This review evaluates the feasibility, advantages, disadvantages, and clinical outcomes of LOT-CRT. Additionally, we describe our center’s experience and propose an evidence-based implantation algorithm. A review of published studies investigating LOT-CRT was conducted, comparing its effectiveness with BiV-CRT and LBBAP alone using QRS narrowing, LVEF improvement, left ventricular remodeling, New York Heart Association (NYHA) class changes and NT-proBNP levels. It was found that LOT-CRT outperforms BiV-CRT or LBBAP alone in selected populations, at the cost of higher clinical skills, longer procedural times, and specific device setups. Randomized trials are underway to further define its role in clinical practice.

Background: Pacemaker implantation involves intraoperative testing of ventricular sensing using a device called a pacing system analyzer (PSA). The value obtained is expected to correspond to those taken by the pacemaker after its implantation. This study determined the latency period for sensing intracardiac electrogram (EGM) by the right ventricular (RV) lead. Methods: Patients without significant heart disease and underlying intrinsic atrioventricular (AV) conduction underwent Medtronic or Abbott dual-chamber pacemaker implantation with the RV lead positioned on the mid-septum. Real-time sensing data were obtained through PSA and after pacemaker implantation to evaluate latency as the time interval Q-VS between the onset of QRS on surface electrocardiogram and the sensed EGM by the RV lead. Results: Of 157 patients, 105 had narrow QRS (<120ms) and 52 had wide QRS of complete right bundle branch block (RBBB). Both narrow-QRS and RBBB patients had longer sensing latency through PSA (50.9 +/- 24.2 and 67.8 +/- 32.9 ms, respectively) than through pacemaker (18.2 +/- 12.8 and 31.2 +/- 14.8 ms, respectively, both p <0.001). RBBB patients had longer sensing latency compared with narrow QRS patients, either through PSA or through pacemaker (p < 0.001). The sensing latency of Medtronic recipients was longer than those of Abbott in narrow-QRS (p < 0.05), but not in RBBB. Conclusion: We demonstrated longer RV lead sensing latency (1) through PSA than through pacemaker, (2) in RBBB than in narrow-QRS, and (3) in Medtronic pacemakers compared with Abbott pacemakers. Knowledge of sensing latency helps the optimization of the AV delay.

Lupus myocarditis (LM) is a rare but potentially life threatening manifestation of systemic lupus erythematous (SLE). LM may be rarely the initial presentation of SLE or ma y be presented during the course of the disease. Herein, we report a case of an adult female patient who presented with a 3-day history of abdominal pain, fever and recent onset dyspnea on exertion. Twenty-four hours later the patient developed acute heart failure went into cardiac arrest during her transfer from the internal medicine department to the CT scanner. She was intubated, an intra-aortic balloon pump was inserted, and was transferred to the intensive care unit (ICU). Based on clinical signs, laboratory parameters and cardiac imaging and after the exclusion of other causes of acute heart failure LM was diagnosed. The patient received high doses of corticosteroids and cyclophosphamide and she was improved. The vasopressors were tapered off and the intra-aortic balloon pump was removed. The patient improved and she shifted out of the ICU. The initially increased t roponin levels were decreased, while the ejection fraction increased to 60% five days later. The patient was followed as an outpatient after hospital discharge. At 6 months of follow-up the she was on treatment with low doses of oral steroids, hydroxychloroquine and azathioprine and her ejection fraction is 73% without signs of active disease. No recurrences of her LM have been observed during her 32 month follow-up. Prompt recognition and aggressive immunosuppressive treatment may lead to favourable prognosis.

Background/Objectives: Evidence on myocardial-work indices beyond 12 months after left bundle branch area pacing (LBBAP) remains limited. We compared global myocardial work efficiency (GWE) and the left ventricular ejection fraction (LVEF) after LBBAP and right ventricular mid-septal pacing (RVP). Methods: This prospective, non-randomised cohort included 63 patients with advanced atrioventricular block and preserved pre-implantation LVEF: 34 assigned to an LBBAP strategy and 29 to RVP. Ventricular pacing burden was 100%. GWE was the primary endpoint; LVEF was the principal adjusted secondary endpoint. Analyses adjusted for age, sex, hypertension and atrial fibrillation. Follow-up averaged approximately two years, with an individual range of 0.64–4.23 years. Results: GWE was higher with LBBAP (85.23 ± 6.82% versus 80.00 ± 9.41%; p = 0.016), with an adjusted difference of +4.96 percentage points (95% CI 0.87 to 9.04; p = 0.018). The adjusted LVEF difference was +5.73 percentage points (95% CI 2.77 to 8.68; p < 0.001). Exploratory within-patient LVEF analyses showed mean changes of +1.20 percentage points with LBBAP (95% CI −1.25 to +3.65) and −6.15 with RVP (95% CI −9.16 to −3.14), with an unadjusted between-group difference of +7.35 percentage points (95% CI 3.55 to 11.16; p < 0.001). Conclusions: LBBAP was associated with higher GWE and LVEF at extended follow-up, although some propensity-score GWE confidence intervals included zero. LVEF-change findings are exploratory and do not estimate a common-time trajectory. These observational findings do not establish causality or clinical benefit.