Impact of time in therapeutic range (TTR) within the first 72 h on prognosis in patients with pulmonary embolism treated with unfractionated heparin.

Pulmonary embolism (PE) is a life-threatening condition often treated with unfractionated heparin (UFH) in intermediate high-risk patients. Activated Partial Thromboplastin Time (aPTT) is used to monitor UFH efficacy. We sought to evaluate the correlation between time in therapeutic range (TTR) and prognosis in patients with pulmonary embolism treated with unfractionated heparin.

High Sensitive Cardiac Troponin-I (Hs-cTnI) Levels in Asymptomatic Hemodialysis Patients.

: High-sensitivity cardiac troponin (hs-cTn) is useful for detecting acute myocardial infarction, but chronic hemodialysis patients often have elevated baseline levels that exceed the upper reference limit (URL). This study aimed to determine whether hs-cTnI levels in asymptomatic hemodialysis patients exceed the URL established for the general population, evaluate the impact of high-flux hemodialysis on hs-cTnI concentrations, and examine associations between hs-cTnI levels and subsequent hospitalization or mortality. : A prospective, single-center cohort study was conducted at a tertiary care center from August 2023 to July 2024.

New-Onset RBBB After Transcatheter Aortic Valve Replacement: Incidence and Risk Factors for Permanent Pacemaker Implantation.

Background: In contrast to left bundle branch block, right bundle branch block (RBBB) is rare after transcatheter aortic valve replacement (TAVR).

Objectives: This study sought to define the incidence of post-TAVR new-onset RBBB and the risk factors associated with permanent pacemaker implantation (PPI) need.

Methods: Data from 7,782 consecutive TAVR procedures performed in 7 Israeli centers were retrospectively analyzed.

Optimal antiplatelet therapy in patients with acute coronary syndrome and chronic kidney disease: for the Jerusalem platelets thrombosis and intervention in cardiology (JUPITER-11) study group.

Introduction: Chronic kidney disease (CKD) is a well-documented risk factor for major adverse cardiac events and bleeding events. The optimal antiplatelet strategy for patients with CKD remains unclear, especially patients with glomerular filtration rate (GFR) < 30 ml/min. We aim to compare clinical outcomes of patients with acute coronary syndrome (ACS) and CKD treated with ticagrelor or prasugrel vs.

2025 SCAI/HRS clinical practice guidelines on transcatheter left atrial appendage occlusion.

Background: Left atrial appendage occlusion (LAAO) devices reduce the risk of atrial fibrillation-associated stroke relative to no oral anticoagulation. However, uncertainty and practice variation persist in the areas of patient selection, periprocedural imaging, adjunctive antithrombotic therapy, and management of peridevice leak (PDL) and device-related thrombus. The Society for Cardiovascular Angiography & Interventions and Heart Rhythm Society developed these evidence-based guidelines to support clinicians, patients, and other stakeholders in management decisions regarding LAAO.

Pain after subcutaneous implantable cardioverter-defibrillator implantation: A secondary analysis of the PRAETORIAN-DFT trial.

Background: The subcutaneous implantable cardioverter-defibrillator (S-ICD) overcomes transvenous lead-related complications. Its extrathoracic design results in a generator twice the size of transvenous ICDs.

Objective: We investigated pain after S-ICD implantation and explore predictors for severe pain.

Prediction of Atrial Fibrillation Using Radiomic Features of Left Atrial Epicardial Adipose Tissue on Noncontrast Cardiac Computed Tomography.

Background: Early detection of atrial fibrillation (AF) can prevent AF-related complications. Radiomic analysis of epicardial adipose tissue (EAT) was shown to predict AF recurrence postablation, but only limited data exist regarding left atrial EAT (LA-EAT) radiomic analysis for predicting AF in patients with yet unknown AF. Our aim was to develop prediction model for AF, based on the association of machine learning-based radiomic analysis of LA-EAT and AF.

Validation of Takotsubo Syndrome Scoring System.

: Takotsubo syndrome (TS) mimics acute coronary syndrome in 1% to 3% of patients presenting with chest pain, ECG changes and echocardiographic transient apical wall hypokinesia. : This study aimed to validate a previously developed scoring system on a larger cohort size. : Patients admitted to an intensive cardiovascular care unit were divided into three groups: (a) patients diagnosed with TS, (b) females with anterior MI, and (c) other all-comer STEMIs.

First-line vs Second-Line Catheter Ablation Therapy for Patients with Atrial Fibrillation-Data from a National Multicentre Registry.

Background: An early catheter ablation treatment strategy is effective for rhythm control in patients with atrial fibrillation (AF). In clinical practice, most patients undergo catheter ablation as a second-line treatment, following a trial of antiarrhythmic drugs (AADs). We aimed to investigate the effectiveness and safety of AF catheter ablation performed as a first-line vs a second-line approach, based on data from the nationwide, multicentre Israeli Catheter Ablation Registry.

CHADS-VASc Score as a Predictor for Atrial Fibrillation Recurrence and Clinical Outcomes Following Pulmonary Vein Isolation.

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, associated with serious cardiovascular complications such as ischemic stroke, heart failure, and myocardial infarction. Pulmonary vein isolation (PVI) is an established rhythm-control strategy for AF. Although the CHADS-VASc score is primarily used to estimate stroke risk in patients with AF, its potential utility in predicting AF recurrence after PVI has not been fully explored in contemporary, real-world multicenter settings.

Reduced Left Ventricular Apical Rotation: A Novel Pathophysiological Correlate Underlining Acute Ischemic Mitral Regurgitation.

Background: Functional mitral regurgitation (or backward flow to the left atrium with an anatomically normal valve) is associated with adverse outcomes, yet its pathophysiology is not fully understood. We set out to investigate the association between reduced apical rotation and functional mitral regurgitation in patients presenting with first acute ST-elevation myocardial infarction.

Methods: Retrospective analysis of first echocardiographic images for patients with first acute ST-elevation myocardial infarction undergoing percutaneous coronary intervention from July 2019 to October 2022.

Effectiveness of cryoballoon ablation for atrial fibrillation in patients with left common pulmonary vein variant.

Background: Pulmonary vein isolation (PVI) with cryoballoon technology is widely used for rhythm control in atrial fibrillation (AF). However, there are limited data on its effectiveness in patients with the left common pulmonary vein (LCPV) variant.

Objective: The study aimed to examine the outcomes of cryoballoon ablation in patients with the LCPV variant.

Management of patients with transvalvular right ventricular leads undergoing transcatheter tricuspid valve interventions: a scientific statement of the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions of the ESC endorsed by the Heart Rhythm Society, the Asian Pacific Heart Rhythm Society and the Canadian Heart Rhythm Society.

Up to one-third of patients referred for transcatheter tricuspid valve intervention (TTVI) have a transvalvular pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) lead in place. Both the electrophysiology and interventional cardiology communities have been alerted to the complexity of decision-making in this situation due to potential interactions between the leads and the TTVI material, including the risk of jailing or damage to the leads. This document, commissioned by the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions of the ESC, reviews the scientific evidence to inform Heart Team discussions on the management of patients with a PPM or ICD who are scheduled for or have undergone TTVI.

European Society of Cardiology (ESC) clinical consensus statement on indications for conduction system pacing, with special contribution of the European Heart Rhythm Association of the ESC and endorsed by the Asia Pacific Heart Rhythm Society, the Canadian Heart Rhythm Society, the Heart Rhythm Society, and the Latin American Heart Rhythm Society.

Conduction system pacing (CSP) is being increasingly adopted as a more physiological alternative to right ventricular and biventricular pacing. Since the 2021 European Society of Cardiology pacing guidelines, there has been growing evidence that this therapy is safe and effective. Furthermore, left bundle branch area pacing was not covered in these guidelines due to limited evidence at that time.

Asundexian or Apixaban in Patients With Atrial Fibrillation According to Prior Oral Anticoagulant Use: A Subgroup Analysis of the OCEANIC-AF Randomized Clinical Trial.

Importance: In patients with atrial fibrillation (AF), oral anticoagulants (OACs) reduce the risk of stroke.

Objective: To investigate if patients with less prior OAC exposure respond differently to a new OAC than patients with more OAC exposure.

Design, Setting, And Participants: In this prespecified exploratory subgroup analysis of the Oral Factor 11a Inhibitor Asundexian as Novel Antithrombotic-Atrial Fibrillation (OCEANIC-AF) randomized clinical trial, patients enrolled in the OCEANIC-AF trial were categorized as OAC naive or OAC experienced based on whether they had 6 or fewer weeks or more than 6 weeks of prior OAC use.

[PRE-PARTICIPATION SCREENING RECOMMENDATIONS FOR LEISURE ACTIVITIES AIMED AT HEALTH IMPROVEMENT AND NON-COMPETITIVE SPORTS PARTICIPATION- A DOCUMENT ON BEHALF OF THE SPORTS CARDIOLOGY FORUM, THE ISRAELI CARDIOLOGY ASSOCIATION].

The present position paper focuses on screening individuals from the general population who are interested in engaging in leisure time physical activities. This document, which relies on the expert perspective of the Sports Cardiology Forum of the Israeli Heart Society, was created to equip attending physicians with essential tools for addressing such inquiries. Given that sudden death resulting from ischemic heart disease is the leading cause of mortality among individuals over 35 years old who participate in high-intensity sports, screening within this demographic aims to detect coronary disease and its risk factors.

Simultaneous Cardioflow Optimisation to facilitate haemodynamic recovery after rapid ventricular pacing during transcatheter aortic valve implantation: a case series.

Background: 'Simultaneous CardioFlow optimization' represents an innovative technique that effectively enhances post-pacing haemodynamic recovery during transcatheter aortic valve replacement. This technique was applied in two high-risk patients presenting with severe left main trunk stenosis with concomitant severe aortic stenosis (AS) and left ventricular dysfunction (LVD).

Case Summary: An 86-year-old and a 96-year-old patient were admitted with myocardial infarction.

Importance of Raw-Data Analysis When Determining the Cause of Pause Alerts Transmitted by an Implantable Loop Recorder Remote Monitoring Devices.

Introduction: Use of implantable loop recorder (ILR) for the diagnosis and documentation of cardiac arrhythmia has gained popularity during the last decade. Most ILRs are accompanied by remote monitoring (RM) devices, which allow automated daily interrogations of the ILR. These transmit arrhythmic or pause alerts to the treating clinic, enabling timely medical attention and treatment.

Prevalence and Long-Term Prognostic Significance of Advanced Diastolic Dysfunction Among Hospitalized Patients Referred for Echocardiography.

Left ventricular diastolic dysfunction (LVDD) is associated with unfavorable outcomes, and though it is recognized as an important clinical diagnosis, specific quantification and effective management continue to challenge clinicians, representing an unmet need in modern cardiology. Advanced LVDD diagnosis is likely to have a prognostic role among hospitalized patients. The aim of this study was to describe the prevalence and predictors of advanced LVDD among hospitalized patients and its long-term (5-year) prognostic significance on all-cause mortality.

Comparative analysis of anaesthesia modalities in pulmonary vein isolation: insights from a prospective multicentre registry.

Aims: Atrial fibrillation (AF), the most common sustained arrhythmia in adults, is increasing in prevalence globally. Catheter ablation (CA), particularly pulmonary vein isolation (PVI), is a key treatment option. Pulmonary vein isolation can be performed using different energy sources, including cryoballoon ablation (CBA), radiofrequency ablation (RFA), or pulse field ablation.

Evaluation of Prospective ECG-Triggered CT Scan as a Practical Alternative to Standard Retrospective ECG-Gated Scan for Pre-TAVI Patients.

CT-TAVI is a critical component of pre-TAVI assessment. The conventional method, retrospective ECG-gated scan, covering a complete cardiac cycle, measures the annulus during optimal systolic phases. Recently, prospective ECG-triggered scans acquiring images at a specific interval of the cardiac cycle were evaluated, allowing faster acquisition and lower contrast doses.

Transcatheter Aspiration of Tricuspid Vegetation.

Objective: This study sought to present the endovascular approach of transcatheter aspiration using the FlowTriever (Inari Medical) aspiration system for high surgical risk patients with right-sided infective endocarditis.

Key Steps: General anesthesia and transesophageal echocardiogram guidance; ultrasonography-guided femoral vein access, preclosure sutures, and insertion of a 24-F sheath; insertion of straight 24-F aspiration cannula over a stiff wire, parked in the superior vena cava; introduction of a 20-F curved cannula inside the 24-F cannula to create a telescopic assembly; accurate positioning using the right ventricle inflow/outflow projection in biplane mode; adjustment of the curved cannula radius by sliding the inner cannula in and out inside the mother cannula; manual aspiration of the vegetation; Postaspiration transesophageal echocardiogram assessment.

Potential Pitfalls: Avoid leaflet and annular injury and account for potential embolization.

The role of multi-modality imaging for the assessment of left atrium and left atrial appendage: a clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC).

Structural, architectural, contractile, or electrophysiological alterations may occur in the left atrium (LA). The concept of LA cardiopathy is supported by accumulating scientific evidence demonstrating that LA remodelling has become a cornerstone diagnostic and prognostic marker. The structure and the function of the LA and left atrial appendage (LAA), which is an integral part of the LA, are key elements for a better understanding of multiple clinical conditions, most notably atrial fibrillation, cardioembolism, heart failure, and mitral valve diseases.

Defensive Medicine in an Emergency Department: The Overuse of High-Sensitivity Cardiac Troponin I Testing.

Introduction: Cardiac troponin I is routinely measured in patients with suspected acute coronary syndrome. However, when a high-sensitivity cardiac troponin I (hs-cTnI) test is ordered without a clear clinical indication, unexpectedly elevated levels can lead to unnecessary diagnostic workups and inappropriate management. This study aimed to investigate physicians' rationale for performing hs-cTnI tests in an emergency department (ED).