ABSTRACT
In modern Medicine, team working has become crucial to guarantee favorable outcomes in most therapeutical procedures. Electrophysiology (EP) represents an exemplary paradigm of it. Herein, the role of the EP staff members and the importance of cooperation before, during and after the procedure is highlighted. Moreover, the strategies and the future challenges for developing a strong and efficient teamwork through a continuous process of improvement (the so-called "Kaizen Methodology") are widely discussed.
Subject(s)
Electrocardiography , Electrophysiology , HumansABSTRACT
BACKGROUND: Compared to angiotensin inhibition, angiotensin-neprilysin "blockade" improves mortality and reduces hospitalizations in patients with heart failure (HF) with reduced ejection fraction (EF). Sacubitril/valsartan is known to influence left ventricular (LV) reverse remodeling with systolic function improvement, although underlying mechanisms remain partially unclear. Our objectives were to evaluate whether sacubitril/valsartan promotes LV remodeling and improves LV ejection fraction (LVEF) (above the 35% threshold by echocardiographic evaluation) and to identify predictors of reverse remodeling in a real-world setting. METHODS: New York Heart Association (NYHA) class II-III patients with EF ≤ 35% were consecutively enrolled. All patients were on optimal medical therapy on the initiation of sacubitril/valsartan therapy. Full clinical and multi-parametric echocardiographic evaluation, electrocardiogram, and laboratory tests were performed at baseline and after 3, 6, 12, and 24 months. RESULTS: In total, 69 patients were recruited from July 2016 to August 2018. Reverse remodeling was observed in 57.7% (30/52) of patients, occurring within 3, 6, 12, and 24 months in 2, 11, 13, and 4 patients, respectively. Twenty-four (46%) patients showed LVEF improvement above the threshold of 35% during follow-up, occurring in 1, 10, 9, and 4 patients within 3, 6, 12, and 24 months, respectively. Primitive dilated cardiomyopathy and female gender were identified as significant predictors of reverse remodeling. NYHA class was improved in both remodeling and non-remodeling patients. CONCLUSION: Sacubitril/valsartan promotes favorable cardiac remodeling and significantly improves LVEF in a significant proportion of HF patients within 24 months, both in NYHA class II and III patients with HF.
ABSTRACT
We have described some unusual findings of radiofrequency interference with ICD functioning during AV nodal ablation, guiding the reader to the possible explanation of the phenomena.
