ICD therapy is effective in SCD prevention in patients with HCM, although the complication rate is significant. Nonsustained ventricular tachycardia seems to be the most predictive RF for appropriate device discharges. Number of RF did not impact the incidence of appropriate ICD interventions.

Background Electric cardioversion of atrial fibrillation (AF) is associated with an increased risk of embolism, with embolic material existing in the heart cavities. The initiation of oral anticoagulation therapy reduces the risk of thromboembolic events. The aims of this study were to evaluate the prevalence of left atrial appendage (LAA) thrombi in non-valvular AF, to compare vitamin K antagonists (VKAs) and non-vitamin K oral anticoagulants (NOACs) with respect to thrombus prevalence, and to evaluate the rate of LAA thrombus persistence on repeat transesophageal echocardiography (TEE) after treatment change. Methods We enrolled 160 consecutive AF patients who presented with an AF duration > 48 h and had undergone TEE before cardioversion. Results Left atrial appendage thrombus was observed in 12 (7.5%) patients, and spontaneous echo contrast 4 was observed in 19 (11.8%) patients; the incidence was similar between the NOAC and VKA groups (8.9% vs. 3.6% and 12.4% vs. 18.5 %, respectively). Among patients on NOAC, thrombus prevalence was detected in 8.4% of users of rivaroxaban, 8% of users of dabigatran, and 12.5% of users of apixaban. Conclusions The LAA thrombus developed in 7.5% of patients despite anticoagulation therapy, demonstrating similar prevalence rates among patients either on NOAC or VKA. Lower mean LAA flow velocity and a history of vascular disease were independent predictors of embolic material in the LAA. It seems that in the case of embolic materials in LAA under NOAC treatment, switching to VKA provides additional clinical benefit to the patients.

(Cardiol J 2015; 22, 6: 675-682)

from among stable hospitalized or ambula tory patients. The diagnosis of HCM was based on the presence of unexplained myocardial hy pertrophy (in the absence of abnormal loading conditions) assessed as maximal left ventricu lar wall thickness of 15 mm or more, or in ac cordance with the criteria for the diagnosis of familial disease in patients with at least 1 first degree relative with HCM. Venous blood samples were obtained from all patients. Plasma NT proBNP level was measured by 2site electrochemiluminescence immunoas say on the Cobas e601 analyzer (Roche Diagnos tics, Indianapolis, Indiana, United States). Re sults were reported in pg/ml. Normal values for the assay (0.00-125.00 pg/ml) were defined us ing manufacturer's guidelines. The primary endpoint consisted of all cause mortality or heart transplantation. Two second ary endpoints included: 1) unscheduled hospi talization due to deterioration of heart failure, and 2) resuscitated sudden cardiac death (SCD) or appropriate intervention of the implanted cardioverter defibrillator (ICD). Data on ICD intervention were obtained from device inter rogation reports. Statistical analysis was per formed using the SPSS package (version 20.0, IBM Corporation, Armonk, New York, United States). The study was approved by the local eth ics committee. Results and discussion The study included 603 patients with HCM (57.5% men, mean [SD] age,