Circulation: Heart Failure Editors' Picks

Abstract

The following are highlights from Circulation: Heart Failure Topic Review. This series will summarize the most important articles, as selected by the editors, that have published in the Circulation portfolio. The objective of this series is to provide our readership with a timely comprehensive selection of important papers that are relevant to the heart failure audience. The studies included in this article represent the most noteworthy research in the areas of heart failure and electrophysiology. (Circ Heart Fail. 2012;5:e56-e64 Summary: Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) reports on long-term cardiac arrhythmias recorded by an implantable cardiac monitor in patients with left ventricular ejection fraction Յ40% after myocardial infarction. Clinically significant bradyarrhythmias and tachyarrhythmias were documented in a substantial proportion of patients, most of them asymptomatic. A large number of the documented arrhythmias would result in device therapy according to the current guidelines. The most significant arrhythmia was intermittent high-degree atrioventricular block, which was associated with a very high risk of cardiac death. However, the study was observational, and whether the use of implantable cardiac monitors in this population could improve clinical outcome should be tested in larger randomized trials.Conclusions: This is the first study to report on long-term cardiac arrhythmias recorded by an implantable loop recorder in patients with left ventricular ejection fraction Յ40% after myocardial infarction. Clinically significant bradyarrhythmias and tachyarrhythmias were documented in a substantial proportion of patients with depressed left ventricular ejection fraction after acute myocardial infarction. Intermittent high-degree atrioventricular block was associated with a very high risk of cardiac death. 1 Effect of Long-Term Right Ventricular Pacing in Young Adults With Structurally Normal HeartSummary: This study elucidates the long-term effect of right ventricular (RV) pacing on clinical outcomes in patients who underwent pacemaker implantation for symptomatic isolated congenital complete atrioventricular block (ICAVB). Over a mean follow-up of 20 years (longest, 39 years), the observed survival free of new heart failure (HF) after pacemaker implant in the overall ICAVB group was significantly worse than that of the age-and sex-specific Olmsted County, Minnesota, population rates. This difference was, however, attributable to the development of HF and ventricular dysfunction in those who had tested positive for antinuclear antibody (ANA) during adulthood, with no difference between the antibody negative ICAVB patients and the Olmsted County population. The presence of a positive ANA was a strong predictor for the development of HF and death. These results suggest that in young patients without structural heart disease, pacing from the RV position does not appear to have a detrimental effect on heart size or performance. The risk of HF after p...