Applications designed to successfully implant in challenging left atrial appendage occlusion cases: a new tool for the interventional cardiologist.

An 85-year-old patient with permanent atrial fibrillation with a DDD pacemaker, and with indication for left atrial appendage occlusion (LAAO). Sent for LAAO due to recurrent gastrointestinal bleedings even on apixaban and with a CHA 2 DS 2 VASc and HAS-BLED scores of 4 and 3 respectively.

Síndrome de Tako-tsubo: análisis de una serie de 60 casos / Tako-tsubo syndrome: Analysis of a series of 60 cases

Fundamentos y objetivo: El síndrome de Tako-tsubo (SmT) es una miocardiopatía aguda reversible que simula un infarto. Analizamos los 60 pacientes ingresados con SmT en nuestro centro. Pacientes y método: El 73,3% eran mujeres (edad media [DE] de 70,6 [8,11] años). El 83,3% tenía algún factor de riesgo cardiovascular, el 25% tenía trastorno ansiosodepresivo y en el 58,3% se identificó algún desencadenante, siendo el estrés emocional el más frecuente. El 15,3% mostró bloqueo completo de rama izquierda (BCRI). En el 23,3% las alteraciones de la contractilidad respetaban el ápex (formas medioventriculares o diafragmáticas). Resultados: La arteria descendente anterior mostró lesiones no significativas en el 35% de los pacientes, y en el 68,3% tenía trayecto diafragmático. El 40% desarrolló insuficiencia cardiaca (ICC) y el 18,3% shock cardiogénico (SC). La mortalidad hospitalaria global fue del 3,3%, siendo del 8,3% entre aquellos que desarrollaron ICC. La incidencia de SC fue mayor entre los pacientes con BCRI (44,4 frente a 13,7%; p=0,05) y los varones (43,8 frente a 9,1%; p=0,005). Conclusiones: Aunque la mortalidad hospitalaria del SmT es baja, un porcentaje importante de pacientes desarrollan ICC, siendo la mortalidad de este subgrupo elevada. Los pacientes varones y aquellos con BCRI presentaron mayor morbilidad hospitalaria

Background and objective: The Tako-tsubo syndrome (TS) is a reversible acute cardiomyopathy simulating an infarction. We analyzed 60 patients admitted with TS in our center. Patients and method: A percentage of 73.3 were women (mean age: 70.6±11.8 years); 83.3% had some cardiovascular risk factor, 25% had an anxiety-depressive disorder and in 58.3% a precipitating factor was identified, emotional stress being the most frequent. A percentage of 15.3 showed complete left bundle branch block (LBBB). In 23.3% of patients, contractile abnormalities respected the apex (mid ventricular or diaphragmatic types). Results: The anterior descending artery showed no significant lesions in 35% of patients and in 68.3% it had a diaphragmatic segment. Forty percent of patients developed heart failure (HF) and 18.3% cardiogenic shock (CS). The overall in-hospital mortality was 3.3%, while it was 8.3% among those patients who developed HF. The incidence of CS was higher among patients with LBBB (44.4 vs. 13.7%, P=.05) and males (43.8 vs. 9.1%, P=.005). Conclusions: Although in-hospital mortality in patients admitted due to TS is low, a significant percentage of these patients develop HF with a high mortality in this subgroup. Males and patients with LBBB had higher in-hospital morbidity

[Tako-tsubo syndrome: analysis of a series of 60 cases]. / Síndrome de Tako-tsubo: análisis de una serie de 60 casos.

BACKGROUND AND OBJECTIVE: The Tako-tsubo syndrome (TS) is a reversible acute cardiomyopathy simulating an infarction. We analyzed 60 patients admitted with TS in our center. PATIENTS AND METHOD: A percentage of 73.3 were women (mean age: 70.6 ± 11.8 years); 83.3% had some cardiovascular risk factor, 25% had an anxiety-depressive disorder and in 58.3% a precipitating factor was identified, emotional stress being the most frequent. A percentage of 15.3 showed complete left bundle branch block (LBBB). In 23.3% of patients, contractile abnormalities respected the apex (mid ventricular or diaphragmatic types). RESULTS: The anterior descending artery showed no significant lesions in 35% of patients and in 68.3% it had a diaphragmatic segment. Forty percent of patients developed heart failure (HF) and 18.3% cardiogenic shock (CS). The overall in-hospital mortality was 3.3%, while it was 8.3% among those patients who developed HF. The incidence of CS was higher among patients with LBBB (44.4 vs. 13.7%, P=.05) and males (43.8 vs. 9.1%, P=.005). CONCLUSIONS: Although in-hospital mortality in patients admitted due to TS is low, a significant percentage of these patients develop HF with a high mortality in this subgroup. Males and patients with LBBB had higher in-hospital morbidity.

A prospective randomised study of the paclitaxel-coated balloon catheter in bifurcated coronary lesions (BABILON trial): 24-month clinical and angiographic results.

AIMS: Paclitaxel drug-eluting balloons (pDEB) could be an attractive option to minimise side branch (SB) restenosis in bifurcated coronary lesions. We compared angiographic and clinical outcomes with pDEB plus bare metal stent (BMS) versus drug-eluting stents (DES) in de novo bifurcated lesions. METHODS AND RESULTS: This multicentre randomised trial included 108 patients. Sequential main branch (MB)/SB dilatation with pDEB, with provisional T-stenting with BMS in the MB was performed in the pDEB group, and with everolimus DES in the DES group. The primary endpoint was late lumen loss (LLL) at nine months. The secondary endpoint was the incidence of major adverse cardiac events (MACE: death, myocardial infarction, or target lesion revascularisation). In-segment MB LLL was 0.31±0.48 mm in the pDEB group, and 0.16±0.38 mm in the DES group (p=0.15); mean difference was 0.15 mm (upper limit one-sided 95% CI: 0.27 mm; p=0.001; non-inferiority test). LLL in SB was -0.04±0.76 mm in the pDEB group and -0.03±0.51 mm in the DES group (p=0.983). MACE and TLR were higher in the pDEB group (17.3% vs. 7.1%; p=0.105, and 15.4% vs. 3.6%; p=0.045), due to higher MB restenosis (13.5% vs. 1.8%; p=0.027). CONCLUSIONS: pDEB bifurcation pretreatment with BMS implantation in MB showed greater LLL (ns) and increased incidence of MACE compared to everolimus DES. Both strategies showed similar results in the SB.