Tag Archives: cardiology

MCQ 16.04.2015

All of the following arrhythmias are usually seen in structurally normal heart except

A. Right ventricular outflow tract ventricular tachycardia

B. Fascicular reentry ventricular tachycardia

C. Bundle branch reentry ventricular tachycardia

D. Catecholaminergic polymorphic ventricular tachycardia

 

Explanation:

Bundle branch reentry (BBR) ventricular tachycardia (VT) is a unique, fast (200 to 300 beats/min), monomorphic tachycardia associated with hemodynamic collapse, syncope, and/or cardiac arrest.

It is caused by a macroreentry circuit involving the right and left bundle branches, an upper common pathway, and septal ventricular muscle.

BBRoccurs in patients who have dilated cardiomyopathy and in those with coronary artery disease, valvular heart disease, myotonic dystrophy, or even no heart disease with associated His-Purkinje system disease.

The incidence is reported to be 3.5% and 6% of ventricular tachycardias

Classification of ventricular arrhythmias in the absence of structural heart disease

I. Non–life-threatening (typically monomorphic)
A. Outflow tract
Right ventricular outflow
Left ventricular outflow
Aortic sinus of Valsalva
Peri His bundle
B. Idiopathic left ventricular tachycardia
Left posterior fascicle
Left anterior fascicle
High septal fascicle
C. Other
Mitral annulus
Tricuspid annulus
Papillary muscle
Perivascular epicardial
II. Life-threatening (typically polymorphic)
A. Genetic syndromes
Long QT
Brugada
Catecholaminergic polymorphic ventricular tachycardia
Short QT
B. Idiopathic ventricular fibrillation

Answer: C

Ref:

1. Blanck Z, Dhala A, Deshpande S, et al: Bundle branch reentrant ventricular tachycardia: Cumulative experience in 48 patients. J Cardiovasc Electrophysiol 4:253–262, 1993.

2 . Blanck Z, Jazayeri M, Dhala A, et al: Bundle branch reentry: A mechanism of ventricular tachycardia in the absence of myocardial or valvular dysfunction. J Am Coll Cardiol 22:1718–1722, 1993.

3. Eric N. Prystowsky, Benzy J. Padanilam, Sandeep Joshi,  Richard I. Fogel. Ventricular Arrhythmias in the Absence of Structural Heart Disease. J Am Coll Cardiol 2012;59:1733–44

Keywords: Cardiology review, Cardiology, Multiple choice questions, medical students, Electrophysiology, Ventricular tachycardia

One MCQ a day- 15.04.2015

MCQ 15.04.2015

Which of the following statements describes the ECG findings of Intramural septal premature ventricular contractions ?

A. RBBB morphology with inferior axis

B. RBBB morphology with superior axis

C. LBBB morphology with inferior axis

D. LBBB morphology with superior axis

 

Explanation:

Intramural septal PVCs arise from the interventricular septum. They have been described recently.  In one series seven of 93 consecutive patients (8%) referred for ablation of idiopathic ventricular arrhythmias (mean age, 4914 years; 52 men; ejection fraction, 5212%) were found to have a site of origin in the interventricular septum.Five of 7 patients had symptomatic frequent premature ventricular complexes (PVCs) and 2 had frequent asymptomatic PVCs. The left ventricular ejection fraction was reduced in 2 of 7 patients who had ejection fractions of 30% and 42% before the ablation. The mean ejection fraction of the 7 patients was 55.9%. There was no evidence of structural heart disease in these patients, based on echocardiography, stress testing, and cardiac MRI.

-All 7 patients with an intramural focus had PVCs with a left bundle-branch block, inferior-axis morphology

-The differential diagnosis of a intramural septal PVC includes origin from

1. RVOT

2. Aortic cusp

3. Para-Hisian area

There are no definite ECG findings to differential these sites of origin and final localization needs mapping.

The mapping is done through advancing a catheter through a septal perforator vein

Answer : C

 

One MCQ a day- 14.04.2015

Answer to the question on 13.04.2015:

Answer : A (Right ventricular outflow tract)

Explanation:

12-lead electrocardiographic (ECG) morphology helps in identifying the PVC origin

Left bundle branch block morphology with an inferior axis indicates an outflow tract origin of the PVCs, with a late precordial transition (>V3) pointing to an origin in the right ventricular outflow tract, and an early transition (V3) suggesting an origin from the aortic cusps, the left ventricular outflow tract, or the basal left ventricular epicardium.

Right bundle branch block PVC morphologies indicate a left ventricular origin, with positive concordance indicating a basal origin and a precordial transition to an R/S complex suggesting origin in the papillary muscle.

Intramural arrhythmias are more difficult to localize, and a specific pattern has not yet been described.

Ref:

1. Baman TS, Ilg KJ, Gupta SK, et al: Mapping and ablation of epicardial idiopathic ventricular arrhythmias from within the coronary venous system.Circ Arrhythm Electrophysiol 3:274–279,2010.

2. Good E, Desjardins B, Jongnarangsin K, et al: Ventricular arrhythmias originating from a papillary muscle in patients without prior infarction: A comparison with fascicular arrhythmias. Heart Rhythm 5:1530–1537, 2008.
3. Yokokawa M, Good E, Chugh A, et al: Intramural idiopathic ventricular arrhythmias originating in the intraventricular septum: Mapping and ablation. Circ Arrhythm Electrophysiol 5:258–263, 2012.

MCQ 14.04.2015

Treatment to decrease or eliminate frequency of premature ventricular contractions (PVC) is indicated in all of the following cases except

A. PVC triggering VT/VF

B. Frequent PVC causing nonresponse to cardiac resynchronization therapy

C. Asymptomatic occasional PVC

D. Very frequent PVC (>24% of QRS complexes on holter monitoring)

See below for answers

 

Explanation:

Treatment to decrease or eliminate PVCs should be considered in patients when an expected benefit in terms of symptoms or cardiac function exists. The categories of patients who should undergo treatment that targets PVCs can be summarized as follows:
• Patients with PVCs believed to be causing or contributing to LV dysfunction or dilatation
• Patients with symptomatically limiting PVCs • Patients with VT or VF for which a PVC trigger can be identified
• Patients in whom response to cardiac resynchronization therapy is limited by frequent PVCs
• Patients in whom deterioration of LV function may be expected, such as those with very frequent PVCs (>24%), may also be considered for therapy to reduce PVCs

Although clinical data regarding the last category are not yet definitive, PVC frequency in this range has been shown to often result in LV dysfunction, and a decision must be made on an individual basis between close follow-up of cardiac function versus prophylactic treatment to eliminate the PVCs.

Answer : C

(Ref: Cardiac Electrophysiology: From Cell to Bedside: 6th edition. Page 810)

Keywords: Cardiology review, Cardiology, Multiple choice questions, medical students, Electrophysiology

One MCQ a day: 13.04.2015

Answer to the question on 12.04.2015:

Answer : A

Explanation:

The ECG is showing atrial fibrillation with fast ventricular rate. The important issue in this ECG is that the ventricular rate is extremely fast, reaching up to 300 bpm. AF with very fast ventricular rate is suggestive of conduction over bypass tracts. Patients with preexcited atrial fibrillation who are hemodynamically stable are to be treated with intravenous procainamide or ibutilide. Patients who present with hemodynamic instability should undergo urgent direct current cardioversion. So the right answer is intravenous procainamide. after management of the acute episode the patient should be advised to undergo electrophysiological study with ablation of the accessory pathway as definitive therapy.

Ref: Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al: ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—executive summary: A report of the American College of Cardiology/American Heart Association task force on practice guidelines and the European Society of Cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with
supraventricular arrhythmias). Circulation 108:1871–1909, 2003.

MCQ 13.04.2015:

What is the site of origin of the premature ventricular contractions :

VPC-RVOT

A. Right ventricular outflow tract

B. Left ventricular outflow tract

C. Papillary muscle

D. Left ventricular basal epicardium

Answers please

I will put the explanation and answer tomorrow

Keywords: Cardiology review, Cardiology, Multiple choice questions, medical students, Electrophysiology

One MCQ a day – 12.04.2015

Answer to the question on 11.04.2015

Answer : D

localizing the AP

1. Left free-wall APs are associated with positive delta waves in lead V1 and negative delta
waves in leads I and aVL

2. The ECG in a patient with a manifest right-sided AP shows a negative delta wave in lead V1 and positive delta waves in leads I and aVL.

3. The polarity of the delta waves in leads III and aVF is helpful in localizing the AP on the AV annulus. Positive delta waves in these leads point to an insertion at the anterior, anterolateral, or lateral aspect of the tricuspid or mitral annulus. Negative delta waves in these leads are consistent with an insertion at the inferior aspect of the AV valves (e.g., posterior, posterolateral, or posteroseptal aspect of the tricuspid or mitral annulus)

4. For anteroseptal and midseptal accessory pathways, a few additional observations are helpful. Typically, a negative delta wave is present in lead V1 in patients with anteroseptal and midseptal accessory pathways. Septal accessory pathways may be distinguished
from right free-wall pathways if the precordial QRS transition (negative to positive) occurs at or before lead V3. If the transition occurs between V3 and V4, the amplitude of the delta
wave in lead II is examined. An amplitude of 1.0 mV or greater is consistent with a septal AP, whereas amplitude less than 1.0 mV suggests a right free wall connection. In a patient whose ECG is consistent with a posteroseptal AP, a steeply negative delta wave in lead II is suggestive of an epicardial connection.

(Ref: Cardiac Electrophysiology: From Cell to Bedside: 6th edition, Page : 758)

MCQ 12.04.2015

A 32 years old male patient presented to emergency with complains of palpitation for 30 mins. He has history of recurrent episodes of palpitation for last one year. On examination his pulse was variable, blood pressure was 100/70 mmHg. The ECG is shown below. Which is the initial drug of choice for this patient

WPW-AF

A. Intravenous procainamide

B. Intravenous adenosine

C. Intravenous diltiazem

D. Intravenous Verapamil

Keywords: Cardiology, Multiple choice questions, medical students, Electrophysiology

One MCQ a day – 11.04.2015

Answer to the question on 10.04.2015

Answer: B

Accessory pathways are anomalous bypass tracts composed of working myocardial cells. Most APs insert along the mitral or tricuspid valve and are referred to as AV accessory pathways. Approximately 60% of APs insert along the mitral valve and are referred to as left free-wall pathways. About 25% insert along the septal aspect of the tricuspid or mitral valve and are classified as septal pathways. The remaining 15% are right freewall pathways.

Occasionally one may encounter APs that do not insert along the AV valves. Examples include atriofascicular, nodoventricular, nodofascicular, and atrionodal pathways.

Atriofascicular pathways connect the right atrium to the distal ramifications of the right bundle branch and are capable of only anterograde conduction.

Nodoventricular and nodofascicular pathways connect the AV node to the right ventricular myocardium and the specialized conduction system, respectively.

Atriofascicular and nodoventricular/nodofascicular connections are also notable for their decremental conduction properties.

Atrionodal pathways are rare and connect the right atrial myocardium to the AV node.

(Ref: Cardiac Electrophysiology: From Cell to Bedside: 6th edition, Page : 755)

 

MCQ 11.04.2015

Q. Localize the accessory pathway (AP) from the ECG

ANTEROSEPTAL AP

A. Left free wall AP

B. Posteroseptal AP

C. Right free wall AP

D. Anteroseptal AP

Please post your answers as comments.

Keywords: Cardiology, Multiple choice questions, medical students, Electrophysiology

One MCQ a day – 10.04.2015

One Cardiology MCQ a day

I will  post one MCQ on cardiology per day and next day I will submit the answer. So lets test our knowledge on cardiology.

Q.  Which of the following statements about location of accessory pathways (AP) is correct?

A.  10% of APs  are left free-wall pathways, 80% are septal and 10-15% are right freewall     pathways

B. 60% of APs  are left free-wall pathways, about one-fourth are septal and 15% are right freewall  pathways

C.  60% of APs  are left free-wall pathways, about 10% are septal and 30% are right freewall  pathways

D.  40% of APs  are left free-wall pathways, about 15% are septal and 45% are right freewall  pathways

Answers please (Tomorrow I will post the answer)

Top 10 Cardiology Articles of the week

Top 10 Cardiology Articles of the week (02.03.2015-08.03.2015)

1. Low-Level Transcutaneous Electrical Vagus Nerve Stimulation (LLTS) Suppresses Atrial Fibrillation

Conclusion: LLTS suppresses AF and decreases inflammatory cytokines in patients with paroxysmal AF. The results support the emerging paradigm of neuromodulation to treat AF.

2. Implantable Cardioverter-Defibrillator Therapy in Brugada Syndrome:A 20-Year Single-Center Experience

Background: Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications.

Objectives: The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome.

Methods: Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study.

Results A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence.

Conclusions: ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming.

3.Evaluation and Treatment of Patients With Lower Extremity Peripheral Artery Disease

The lack of consistent definitions and nomenclature across clinical trials of novel devices, drugs, or biologics poses a significant barrier to accrual of knowledge in and across peripheral artery disease therapies and technologies. Recognizing this problem, the Peripheral Academic Research Consortium, together with the U.S. Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, has developed a series of pragmatic consensus definitions for patients being treated for peripheral artery disease affecting the lower extremities. These consensus definitions include the clinical presentation, anatomic depiction, interventional outcomes, surrogate imaging and physiological follow-up, and clinical outcomes of patients with lower-extremity peripheral artery disease. Consistent application of these definitions in clinical trials evaluating novel revascularization technologies should result in more efficient regulatory evaluation and best practice guidelines to inform clinical decisions in patients with lower extremity peripheral artery disease.

4. Long-Term Survival Benefit of Revascularization Compared With Medical Therapy in Patients With Coronary Chronic Total Occlusion and Well-Developed Collateral Circulation

Objectives: The purpose of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) and well-developed collateral circulation treated with revascularization versus medical therapy.

Background: Little is known about the clinical outcomes and optimal treatment strategies of CTO with well-developed collateral circulation.

Methods: 2,024 consecutive patients with at least 1 CTO detected on coronary angiogram were screened. Of these, data was analyzed from 738 patients with Rentrop 3 grade collateral circulation who were treated with medical therapy alone (n = 236), coronary artery bypass grafting (n = 170) or percutaneous coronary intervention (n = 332; 80.1% successful). Patients who underwent revascularization and medical therapy (revascularization group, n = 502) were compared with those who underwent medical therapy alone (medication group, n = 236) in terms of cardiac death and major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and repeat revascularization.

Results: During a median follow-up duration of 42 months, multivariate analysis revealed a significantly lower incidence of cardiac death (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p < 0.01) and MACE (HR: 0.32; 95% CI: 0.21 to 0.49; p < 0.01) in the revascularization group compared with the medication group. After propensity score matching, the incidence of cardiac death (HR: 0.27; 95% CI: 0.09 to 0.80; p = 0.02) and MACE (HR: 0.44; 95% CI: 0.23 to 0.82; p = 0.01) were still significantly lower in the revascularization group than in the medication group.

Conclusions In patients with coronary CTO and well-developed collateral circulation, aggressive revascularization may reduce the risk of cardiac mortality and MACE.

5.Percutaneous Circulatory Assist Devices for High-Risk Coronary Intervention

A unifying definition of what constitutes high-risk percutaneous coronary intervention remains elusive. This reflects the existence of several recognized patient, anatomic, and procedural characteristics that, when combined, can contribute to elevating risk. The relative inability to withstand the adverse hemodynamic sequelae of dysrhythmia, transient episodes of ischemia-reperfusion injury, or distal embolization of atherogenic material associated with coronary intervention serve as a common thread to tie this patient cohort together. This enhanced susceptibility to catastrophic hemodynamic collapse has triggered the development of percutaneous cardiac assist devices such as the intra-aortic balloon pump, Impella (Abiomed Inc., Danvers, Massachusetts), TandemHeart (CardiacAssist, Inc., Pittsburgh, Pennsylvania), and extracorporeal membranous oxygenation to provide adjunctive mechanical circulatory support. In this state-of-the-art review, we discuss the physiology underpinning their application. Thereafter, we examine the results of several randomized multicenter trials investigating their use in high-risk coronary intervention to determine which patients would benefit most from their implantation and whether there is a signal to delineate whether they should be used in an elective pre-procedure, standby, rescue, or routine post-procedure fashion.

6.Porcelain Aorta: A Comprehensive Review

Calcification of the thoracic aorta is often associated with valvular and coronary calcification, reflecting an underlying atherosclerotic process. It has been found to be associated with an increased rate of mortality and cardiovascular disease. Porcelain aorta (PA) is extensive calcification of the ascending aorta or aortic arch that can be completely or near completely circumferential. This entity is rare in the general population, but it has an increasing incidence in older patients and in patients with coronary artery disease (CAD) or aortic stenosis (AS). The clinical relevance is based on the fact that it can complicate surgical aortic valve replacement (SAVR) for the treatment of severe AS by preventing safe access via the ascending aorta. PA is associated with increased morbidity and mortality, especially as a result of increased perioperative stroke risk. Recently, transcatheter aortic valve replacement (TAVR) has emerged as a less invasive and feasible treatment option in patients at high risk for conventional SAVR. In some series, ≈20% (5%–33%) of patients undergoing TAVR were diagnosed with PA. Inconsistencies in the definition and the use of different diagnostic modalities contribute to this wide range of PA prevalence. This article reviewed the available published data to seek a consistent, clinically relevant definition based on contemporary imaging, a firm understanding of the pathogenesis and associations, and the clinical implications of this disease entity.

7.Digoxin use in patients with atrial fibrillation and adverse cardiovascular outcomes: a retrospective analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)

Conclusion: Digoxin treatment was associated with a significant increase in all-cause mortality, vascular death, and sudden death in patients with AF. This association was independent of other measured prognostic factors, and although residual confounding could account for these results, these data show the possibility of digoxin having these effects. A randomised trial of digoxin in treatment of AF patients with and without heart failure is needed.

8.Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis

Background:Among patients with atrial fibrillation, the risk of stroke is highest for those with a history of stroke; however, oral anticoagulants can lower the risk of recurrent stroke by two-thirds. No consensus has been reached about how atrial fibrillation should be investigated in patients with stroke, and its prevalence after a stroke remains uncertain. The authors did a systematic review and meta-analysis to estimate the proportion of patients newly diagnosed with atrial fibrillation after four sequential phases of cardiac monitoring after a stroke or transient ischaemic attack.

Methods: The authors searched PubMed, Embase, and Scopus from 1980 to June 30, 2014 and included studies that provided the number of patients with ischaemic stroke or transient ischaemic attack who were newly diagnosed with atrial fibrillation. They stratified cardiac monitoring methods into four sequential phases of screening: phase 1 (emergency room) consisted of admission electrocardiogram (ECG); phase 2 (in hospital) comprised serial ECG, continuous inpatient ECG monitoring, continuous inpatient cardiac telemetry, and in-hospital Holter monitoring; phase 3 (first ambulatory period) consisted of ambulatory Holter; and phase 4 (second ambulatory period) consisted of mobile cardiac outpatient telemetry, external loop recording, and implantable loop recording. The primary endpoint was the proportion of patients newly diagnosed with atrial fibrillation for each method and each phase, and for the sequential combination of phases. For each method and each phase, they estimated the summary proportion of patients diagnosed with post-stroke atrial fibrillation using random-effects meta-analyses.

Findings:  The systematic review returned 28 290 studies, of which 50 studies (comprising 11 658 patients) met the criteria for inclusion in the meta-analyses. The summary proportion of patients diagnosed with post-stroke atrial fibrillation was 7·7% (95% CI 5·0–10·8) in phase 1, 5·1% (3·8–6·5) in phase 2, 10·7% (5·6–17·2) in phase 3, and 16·9% (13·0–21·2) in phase 4. The overall atrial fibrillation detection yield after all phases of sequential cardiac monitoring was 23·7% (95% CI 17·2–31·0).

Interpretation: By sequentially combining cardiac monitoring methods, atrial fibrillation might be newly detected in nearly a quarter of patients with stroke or transient ischaemic attack. The overall proportion of patients with stroke who are known to have atrial fibrillation seems to be higher than previously estimated. Accordingly, more patients could be treated with oral anticoagulants and more stroke recurrences prevented.

9.Comparative Outcomes of Catheter-Directed Thrombolysis Plus Anticoagulation Versus Anticoagulation Alone in the Treatment of Inferior Vena Caval Thrombosis

Conclusions—There has been a steady increase in the use of CDT in the treatment of patients with inferior vena cava thrombosis in the United States. This observational study showed no significant difference in mortality between CDT versus anticoagulation alone; however, the bleeding events and resource utilization were higher in the CDT group. Adequately powered randomized controlled trials are needed in this area.

10.Drug-eluting stents versus bare metal stents prior to noncardiac surgery

DES implantation was not associated with higher adverse events after NCS. Moreover, the incidence of adverse events following NCS was lower when NCS was performed >90 days post-DES implantation suggesting that it may not be necessary to wait until 12 months post PCI with DES before NCS.

ECG-full

Simplest approach to reading the ECG. Part-1

APPROACH TO READING THE ECG

ECG or EKG (the electrocardiogram) has retained its role as the first and foremost investigations for many cardiovascular diseases. ECG is absolutely mandatory for diagnosis of heart rhythm and for myocardial ischemia. It has a prominent role in the diagnosis and management planning of a variety of cardiac diseases starting from heart failure and cardiomyopathy to valvular diseases and pericardial diseases.

Health care professionals are expected to be familiar with ECG. But to make sense of the variously shaped lines we need a few basic steps. Is article is part of a series of articles on ECG.

There is a systematic approach to reading the ECG. Medical students should always try to make a written report of the ECG according to the heading as listed below. Try to report as many ECGs as you get, and try to remember the systematic approach to ECG reading.

Now lets start with our ECG reading.

1. Speed – Paper speed is conventionally 25 mm/sec. It is normally written at the bottom of the Ecg.

2. Calibration – Vertically, the ECG graph measures the height (amplitude) of a given wave or deflection, as 10 mm (10 small boxes) equals 1 mV with standard calibration. Always check the calibration otherwise a false diagnosis of chamber enlargement or hypertrophy will be made or missed.

3. Rate

4. Rhythm

5. Axis

6. Loop (mainly in congenital heart disease)

7. P-wave

8. PR- interval

9. QRS complex

10. ST- segment

11. T-waves

12. QT- interval

13. U- Wave

14. Any other abnormal waves (like:- osborn wave, epsilon wave etc)

These 14 points when remembered and applied in the analysis of ECG will give the diagnosis in almost all cases.

We will further delineate each point in simple and clear terms in the subsequent posts.

Top 10 Cardiology Articles of the week

Top 10 Cardiology Articles of the week  (24.11.14 – 30.11.14)

1. Transcatheter Closure of Large Atrial Septal Defects: Feasibility and Safety in a Large Adult and Pediatric Population

Conclusions—Closure of large atrial septal defects using the Amplatzer device is safe and effective in both adults and children. Superior and posterior rim deficiencies are associated with procedural failure. Closure can be performed under transthoracic  echocardiographic guidance in experienced centers. Early device migration is rare and can be safely managed by device extraction.  Long-term follow-up showed no deaths or major late complications in  311 patients.

2. Stent Coverage and Neointimal Proliferation in Bare Metal Stents Postdilated With a Paclitaxel-Eluting Balloon Versus Everolimus-Eluting Stents: Prospective Randomized Study Using Optical Coherence Tomography at 6-Month Follow-Up

Conclusions—Good stent strut coverage of >94% was found in both therapy groups. Despite greater suppression of global neointimal growth in DES, both DES and BMS+DEB effectively prevented clinically relevant focal restenosis at 6-month follow-up.

3. Multicenter Evaluation of a Next-Generation Balloon-Expandable Transcatheter Aortic Valve
Conclusions – This third-generation device addresses major deficiencies of earlier valves in terms of ease of use, accuracy of positioning, and paravalvular sealing. The rates of mortality and stroke with transfemoral access are among the lowest reported and support further evaluation as an alternative to open surgery in intermediate-risk patients.
(Safety and Performance Study of the Edwards SAPIEN 3 Transcatheter Heart Valve [SAPIEN3]; NCT01808287)

4. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

5. Percutaneous Left Atrial Appendage Closure: Procedural Techniques and Outcomes

6. Atenolol versus Losartan in Children and Young Adults with Marfan’s Syndrome

Conclusion – Among children and young adults with Marfan’s syndrome who were randomly assigned to losartan or atenolol, no significant difference was found in the rate of aortic-root dilatation between the two treatment groups over a 3-year period.

7. Inactivating Mutations in NPC1L1 and Protection from Coronary Heart Disease

Conclusion – Naturally occurring mutations that disrupt NPC1L1 function were found to be associated with reduced plasma LDL cholesterol levels and a reduced risk of coronary heart disease.

8. MagnaSafe: MRI safe for patients with pacemakers, ICDs

9. Catheter Ablation of Atrial Fibrillation in Patients with Left Ventricular Systolic Dysfunction: A Systematic Review and Meta-Analysis

10. Long-term Clinical and Angiographic Outcomes of the Mini-STAR Technique as a Bailout Strategy for Percutaneous Coronary Intervention of Chronic Total Occlusion