Preventive substrate ablation in chronic post-myocardial infarction patients with high-risk scar characteristics for ventricular arrhythmias: rationale and design of PREVENT-VT study.

BACKGROUND: Recent studies showed that an early strategy for ventricular tachycardia (VT) ablation resulted in reduction of VT episodes or mortality. Cardiac magnetic resonance (CMR)-derived border zone channel (BZC) mass has proved to be a strong non-invasive predictor of VT in post-myocardial infarction (MI). CMR-guided VT substrate ablation proved to be safe and effective for reducing sudden cardiac death (SCD) and VA occurrence. METHODS: PREVENT-VT is a prospective, randomized, multicenter, and controlled trial designed to evaluate the safety and efficacy of prophylactic CMR-guided VT substrate ablation in chronic post-MI patients with CMR-derived arrhythmogenic scar characteristics. Chronic post-MI patients with late gadolinium enhancement (LGE) CMR will be evaluated. CMR images will be post-processed and the BZC mass measured: patients with a BZC mass > 5.15 g will be eligible. Consecutive patients will be enrolled at 3 centers and randomized on a 1:1 basis to undergo a VT substrate ablation (ABLATE arm) or optimal medical treatment (OMT arm). Primary prevention ICD will be implanted following guideline recommendations, while non-ICD candidates will be implanted with an implantable cardiac monitor (ICM). The primary endpoint is a composite outcome of sudden cardiac death (SCD) or sustained monomorphic VT, either treated by an ICD or documented with ICM. Secondary endpoints are procedural safety and efficiency outcomes of CMR-guided ablation. DISCUSSION: In some patients, the first VA episode causes SCD or severe neurological damage. The aim of the PREVENT-VT is to evaluate whether primary preventive substrate ablation may be a safe and effective prophylactic therapy for reducing SCD and VA occurrence in patients with previous MI and high-risk scar characteristics based on CMR. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04675073, registered on January 1, 2021.

[Late failure of left ventricular leads stabilized using the retained guidewire technique in patients undergoing cardiac resynchronization therapy]. / Deterioro tardío del electrodo venoso ventricular izquierdo estabilizado con la técnica de la guía retenida para la terapia de resincronización cardiaca.

The retained guidewire technique has been proposed as an alternative method for stabilizing the left ventricular lead in patients who experience repetitive intraoperative dislocation. This article concerns three patients, out of a total of 185 (1.6%) undergoing cardiac resynchronization therapy, who had to be treated using the retained guidewire technique because of demonstrable recurrent lead dislocation. Electrode parameters were all within normal limits. Although lead dislocation could not be demonstrated macroscopically, sensing and pacing parameters were found to have changed 6 months to 1 year after implantation, with a marked elevation in impedance. Laboratory analysis showed deformation and fracture of the coil electrodes as well as deterioration of the insulation coating. In conclusion, our experience shows that the retained guidewire technique should not be used because delayed electrode damage can occur.

[Infected left atrial myxoma]. / Mixoma auricular izquierdo infectado.

Myxoma is the most common primary tumor of the heart. It is uncommon for these tumors to become infected and, at times, clinical presentation is no different from that of an uninfected myxoma. We describe the case of a 58-year-old woman with a previous pharyngeal infection that developed into infection of a left atrial myxoma and which was complicated by systemic embolism affecting the lower limbs. Streptococcus oralis was identified in blood cultures and embolic material. The tumor was resected and the patient's subsequent clinical evolution was uneventful. The incidence of infected myxoma is very low. A review of the literature based on individual case reports is presented.

Mixoma auricular izquierdo infectado / Infected left atrial myxoma

El mixoma es el tumor primario más frecuente que afecta al corazón. La infección de estos tumores es infrecuente y, en ocasiones, su presentación clínica es indistinguible de un mixoma no infectado. Describimos el caso de una mujer de 58 años con una infección faríngea previa que desarrolló infección sobre un mixoma auricular izquierdo, complicado con embolia sistémica en los miembros inferiores. Se aisló Streptococcus oralis en los hemocultivos y en el material embólico. El tumor se resecó y la evolución clínica posterior resultó sin incidencias. La frecuencia del mixoma infectado es muy baja y una revisión de la bibliografía se ha de basar en los casos aislados publicados

Myxoma is the most common primary tumor of the heart. It is uncommon for these tumors to become infected and, at times, clinical presentation is no different from that of an uninfected myxoma. We describe the case of a 58-year-old woman with a previous pharyngeal infection that developed into infection of a left atrial myxoma and which was complicated by systemic embolism affecting the lower limbs. Streptococcus oralis was identified in blood cultures and embolic material. The tumor was resected and the patient's subsequent clinical evolution was uneventful. The incidence of infected myxoma is very low. A review of the literature based on individual case reports is presented