This third edition of what has now become a well-established textbook in cardiovascular medicine is again edited by Dr Eugene Braunwald with the assistance of 65 other authors who read like a Who's Who of American Cardiology. Since the second edition, 12 new chapters have been added or substituted and others have been significantly revised. The first volume includes Part I on "Examination of the Patient" and Part II on "Normal and Abnormal Circulatory Function." The second volume deals with specific diseases. Part III, "Diseases of the Heart, Pericardium and Vascular System," includes new sections on "Risk Factors for Coronary Artery Disease," "The Pathogenesis of Atherosclerosis," and "Interventional Catheterization Techniques." Part IV, "Broader Perspectives on Heart Disease and Cardiologic Practice," includes new chapters on "Genetics and Cardiovascular Disease," "Aging in Cardiac Disease," and "Cost Effective Strategies in Cardiology." The last 200 pages of the book (Part V) are devoted to

Heart Disease: A Textbook of Cardiovascular Medicine

Since publication of the last American Heart Association (AHA) scientific statement on this topic in 1998,1 device technology, advances in interventional techniques, and an innovative spirit have opened the field of congenital heart therapeutic catheterization. Unfortunately, studies testing the safety and efficacy of catheterization and transcatheter therapy are rare in the field because of the difficulty in identifying a control population, the relatively small number of pediatric patients with congenital heart disease (CHD), and the broad spectrum of clinical expression. This has resulted in the almost exclusive “off-label” use of transcatheter devices, initially developed for management of adult diseases, for the treatment of CHD.

The objective of the present writing group, which included representatives of the AHA and endorsements from the Society for Cardiovascular Angiography and Interventions and the American Academy of Pediatrics, was not only to provide the reader with an inventory of diagnostic catheterization and interventional treatment options but also to critically review the literature and formulate relative recommendations that are based on key opinion leader expertise and level of evidence. The writing group was charged with the task of performing an assessment of the evidence and giving a classification of recommendations and a level of evidence to each recommendation. The American College of Cardiology/AHA classification system was used, as follows:

### Classification of Recommendations

Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease A Scientific Statement From the American Heart Association

Quality of Life in Patients with Atrial Fibrillation: A Systematic Review

Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus.

Jonathan L. Halperin, MD, FACC, FAHA, Chair 

Glenn N. Levine, MD, FACC, FAHA, Chair-Elect 

Jeffrey L. Anderson, MD, FACC, FAHA, Immediate Past Chair [¶][1]

Nancy M. Albert, PhD, RN, FAHA[¶][1]

Sana M. Al-Khatib, MD, MHS, FACC, FAHA

Kim K. Birtcher, PharmD, AACC

Biykem Bozkurt, MD, PhD, FACC

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Background: We evaluated the usefulness of heart rate turbulence (HRT) parameters and frequency of ventricular premature beats (VPBs) for risk-stratifying postinfarction patients with depressed left ventricular function enrolled in Multicenter Automatic Defibrillator Trial II (MADIT II).



Methods: In 884 MADIT II patients, 10-minute Holter monitoring at enrollment was used to evaluate HRT parameters and frequency of VPBs. The primary endpoints were defined as all-cause mortality in patients randomized to conventional treatment and as appropriate therapy for ventricular tachycardia or fibrillation in patients randomized to implantable cardioverter defibrillator (ICD) therapy.



Results: The median turbulence slope was lower in patients who died in comparison to survivors in the conventional arm (2.3 vs 4.5 ms/RR; P 3/10 min were associated with death in the conventional arm (HR = 1.63; P = 0.070) and were predictive for appropriate ICD therapy in the ICD arm (HR = 1.75; P = 0.003).



Conclusion: In postinfarction patients with severe left ventricular dysfunction, frequent VPBs are associated with increased risk of mortality and with appropriate ICD therapy. HRT obtained from 10-min Holter ECG showed a trend toward the association with mortality in univariate analysis but HRT parameters were not predictive of the outcome in multivariate analyses.

/pdf/risk-stratification-using-heart-rate-turbulence-and-4g6xn1239f.pdf

Risk Stratification Using Heart Rate Turbulence and Ventricular Arrhythmia in MADIT II: Usefulness and Limitations of a 10‐Minute Holter Recording

ERDOGAN, A., et al.: Quality-of-Life in Patients with Paroxysmal Atrial Fibrillation After Catheter Ablation: Results of Long-Term Follow-Up.Paroxysmal atrial fibrillation (PAF) significantly impairs patients' quality-of-life (QOL). The effect on QOL of recently developed ablation techniques with curative intention has not been studied. Thirty patients (21 men, age54.1 ± 9.5years) with PAF (duration5.6 ± 5.2years) who failed antiarrhythmic(3.8 ± 1.2 trials)drug therapy underwent catheter ablation. The follow-up time was33.9 ± 11months. QOL was assessed preablation, 3, 6, 9, 12, 24, and 36 months after catheter ablation. The Medical Outcomes Survey Short-Form (SF-36), scored on a 0–100 scale for each of eight domains: bodily pain, general health, mental health, physical functioning, role-emotional, role-physical, social functioning, and vitality, was used. Simultaneously, patients filled out a symptom-specific checklist (SSC) with seven clinical items scored 1–4 (1 best): dyspnea, nausea, palpitations, anxiety, syncope, presyncope, and NYHA classification. Patients with successful catheter ablation had a significant benefit in seven of eight subscales while patients with recurrence had an impact on QOL in two of eight subscales. Using SSC, a successful ablation influenced scores in all seven items while patients with recurrence had a significant change of clinical symptoms in only one item, anxiety. The subscales of the study group compared to a healthy population show higher scores after 24 months of follow-up. Patients with PAF experience a significant improvement in QOL after a successful catheter ablation. In contrast, in patients with recurrence of PAF the QOL showed improvement to a lesser extent and patients experienced ongoing symptoms. (PACE 2003; 26:678–684)

Quality-of-life in patients with paroxysmal atrial fibrillation after catheter ablation: results of long-term follow-up.

Introduction: Pulmonary vein stenosis (PVS) is a potential complication of pulmonary vein isolation (PVI) using radiofrequency energy. The aim of our study was the evaluation of the severity and long-term outcome of primary angioplasty and angioplasty with pulmonary vein stenting for PVS.



Methods and Results: Twelve patients with 15 PVS (greater than 70% stenosis) were prospectively evaluated. Primary dilation of the stenosis was performed because of clinical symptoms (10 patients) and/or the lung perfusion scans showed a significant perfusion defect (11 patients). Magnetic resonance imaging and lung perfusion scans performed before, directly after, during 3-month, and 6-month follow-up. In the stenting group additional multislice CT-scans directly after, during 6-month, and 12-month follow-up were performed.



Within 2 months after primary balloon angioplasty, the PV size parameters were significantly reduced (P < 0.001) with recurrence of PVS in 11 of 15 PVs (73%). Pulmonary vein stenting in 8 patients and 11 PVs resulted in no vein stenosis during 12-month follow-up. Normalization of lung perfusion was noted in 8 of 12 patients. We observed 2 patients with hemoptysis during PV dilation, as severe complications with potential life-threatening character.



Conclusion: PVS stenting seems to be superior to balloon angioplasty and effective at least over a period of 12 months in treating acquired PVS after pulmonary vein isolation.

Percutaneous Pulmonary Vein Stenting for the Treatment of Severe Stenosis After Pulmonary Vein Isolation

Background: The definition of symptomatic improvement after pulmonary vein isolation (PVI) is controversial. We assessed primarily the usefulness and predictive accuracy (PA) of AF (atrial fibrillation) burden (AFB) within the first 3 months after the procedure as an early predictor for curative success as well as reduction of symptoms.



Methods: We studied 100 pts (62 men, mean age: 54 ± 9 years, LVEF: 57 ± 9%, paroxysmal AF, 85, persistent AF, 15) who underwent PVI. RF ablation was used in 63 patients. The combination of cryoablation and RF (Hybrid therapy) was used in the remaining 37 patients, in 19 patients of whom additionally linear lesions were performed. All patients were followed up 3 months after PVI (the blanking period) and every 3 months thereafter. The significance of early recurrence of AF (ERAF) was separately analyzed for RF and for hybrid therapy arm. Quality of life (QoL) was assessed using the physical composite summary score (PCS) and mental composite summary score (MCS). AFB was dichotomized at: 0, 0.5, 1, 6, 12, and 24 hours.



Results: ANOVA revealed significant differences between PCS at baseline and after PVI in patients without recurrence and with those with postablation AFB <12 hours. There was no difference between PCS in patients with AFB ≥12 hours within a 3 months interval and PCS at baseline. ERAF occurred in 35% of patients (16 patients, AFB ≥12 hours). Symptomatic ERAF occurred in 29 patients (17 patients AFB ≥12 hours). After the blanking period, documented AF recurrence was found in 50 patients (17 patients, AFB ≥12 hour). Symptomatic late recurrence was found in 47 patients (31 patients with AFB ≥12 hours). Absence of ERAF was revealed to be predictive for long-term success and symptomatic ERAF was found to be predictive for symptomatic AF recurrence (P <0.0001).



Conclusion: AF recurrence with AFB ≥12 hours within 3 months is associated with a missed improvement of QoL. Symptomatic ERAF predicts recurrence independently of therapy.

Usefulness of Atrial Fibrillation Burden as a Predictor for Success of Pulmonary Vein Isolation

Cryocatheter Ablation of Ventricular Tachycardia. Introduction: Cryocatheter techniques have been successfully applied to treat supraventricular tachycardia but there are no reports on their value in treating ventricular tachycardia (VT). We present our initial experience with cryocatheter ablation of right ventricular outflow tract (RVOT) tachycardia. Methods and Results: Cryocatheter ablation was attempted in 14 patients (13 females, age 45.9 ′ 12.7 years) who were highly symptomatic due to frequent monomorphic ventricular extrasystole (VES) or nonsustained VT originating within the RVOT. A 9-Fr, 8-mm-tip cryocatheter was used for both mapping and ablation. Cryoablation was started after localizing the arrhythmic focus by pace and activation mapping. Ablation success, defined by complete disappearance of target VES/VT acutely and during a follow-up of 9.3 ′ 1.4 weeks, was achieved in 13 of 14 patients. Ablation was successful with local activation times of 35 ′ 4 ms, 5.8 ′ 3.3 applications, 18.8 ′ 7.5 minutes total cryo time, 9.4 ′ 4.2 minutes fluoroscopy time, and 66.9 ′ 26.1 minutes total procedure time, the latter two measures showing a reduction with number of patients treated. Three patients reported slight pain related to local pressure of the catheter on the RVOT wall. No pain was described related to delivery of cryothermal energy. Conclusions: Initial experience shows that focal VES/VT originating in the RVOT can be successfully treated using cryocatheter ablation. Acute and short term success rates, fluoroscopy times, and duration of procedure are comparable to conventional ablation techniques. A major advantage seems to be the virtual absence of ablation related pain.

Alexander Berkowitsch

Papers

Risk Stratification Using Heart Rate Turbulence and Ventricular Arrhythmia in MADIT II: Usefulness and Limitations of a 10‐Minute Holter Recording

Quality-of-life in patients with paroxysmal atrial fibrillation after catheter ablation: results of long-term follow-up.

Percutaneous Pulmonary Vein Stenting for the Treatment of Severe Stenosis After Pulmonary Vein Isolation

Usefulness of Atrial Fibrillation Burden as a Predictor for Success of Pulmonary Vein Isolation

Cryocatheter Ablation of Right Ventricular Outflow Tract Tachycardia