Background: Atrial fibrillation (AF) is the most frequent cardiac arrhythmia which increases the risk of thromboembolic complications and impairs quality of life. An important part of a therapeutic approach for AF is sinus rhythm restoration. Antiarrhythmic agents used in pharmacological cardioversion have limited efficacy and potential risk of proarrhythmia. Simultaneously, underlying conditions of AF should be treated (e.g. electrolyte imbalance, increased blood pressure, neurohormonal disturbances, atrial volume overload). There is still the need for an effective and safe approach to increase AF cardioversion efficacy. This randomized, double-blind, placebo-controlled, superiority clinical study is performed in patients with AF in order to evaluate the clinical efficacy of intravenous canrenone in sinus rhythm restoration. Methods: Eighty eligible patients with an episode of AF lasting less than 48 h are randomized in a 1:1 ratio to receive canrenone or placebo. Patients randomized to a treatment intervention are receiving canrenone intravenously at a dose of 200 mg within 2-3 min. Subjects assigned to a control group obtain the same volume of 0.9% saline within the same time. The primary endpoint includes return of sinus rhythm documented in the electrocardiogram within 2 h after drug or placebo administration. Other endpoints and safety outcomes analyses, due to expected lack of statistical power, are exploratory. Discussion: Current evidence supports renin-angiotensin-aldosterone system (RAAS) inhibition as an upstream therapy in AF management. Excess aldosterone secretion results in proarrhythmic effects. Among the RAAS inhibitors, only canrenone is administered intravenously. Canrenone additionally increases the plasma level of potassium, lowers blood pressure and reduces preload. It has been already used in primary and secondary hyperaldosteronism in the course of chronic liver dysfunction and in heart failure.

Background In Europe, global data on guideline adherence, geographic variations and determinants of clinical events in Chronic coronary syndrome (CCS) patients remain suboptimal. Design The European Society of Cardiology (ESC) EORP CICD-LT registry is a prospective European registry, was designed to describe the profile, management and outcomes of patients with CCS across the ESC countries. Methods We aimed to investigate clinical events at one-year follow-up from the ESC EORP CICD-LT Registry. Results One-year outcomes of 6655 patients from the 9174 recruited in this European registry were analyzed. Overall, 168 patients (2.5%) died, mostly from CV causes (n= 97, 1.5%). Northern Europe had the lowest CV mortality rate, while southern Europe had the highest (0.5% vs 2.0%, p= 0.04). Women had a higher rate of CV mortality compared with men (2.0% vs 1.3%, p = 0.02). During follow-up, 1606 patients (27.1%) were hospitalized at least once, predominantly for CV indications (n = 1220, 20.6%). Among the population with measured LDL-cholesterol level at one-year, 1434 patients (66.5%) were above the recommended target. Age, history of atrial fibrillation, previous stroke, liver disease, chronic obstructive pulmonary disease or asthma, increased serum creatinine and impaired left ventricular function were associated with an increased risk of CV death or hospitalization. Conclusion In the CICD registry, the majority of patients with CCS have uncontrolled CV risk factors. The one year mortality rate is low, but these patients are frequently hospitalized for CV causes. Early identification of comorbidities may represent an opportunity for enhanced care and better outcomes.

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Background: Exercise training (ExT) in patients with heart failure and reduced ejection fraction (HFrEF) improves clinical condition and prognosis. Data are scarce regarding the efficacy and safety of ExT in patients with HFrEF and atrial fibrillation (AFib) and with a cardiac resynchronization therapy defibrillator (CRT-D) or an implantable cardioverter-defibrillator (ICD). Purpose: The aim of the study was to evaluate the impact of exercise training in patients with HFrEF (ejection fraction