Heart rhythm : the official journal of the Heart Rhythm Society
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Randomized Controlled Trial
Substrate modification or ventricular tachycardia induction, mapping, and ablation as the first step? A randomized study.
The role and optimal sequence of ventricular tachycardia (VT) induction, mapping, and ablation when combined with substrate modification is unclear. ⋯ VT induction and mapping before substrate ablation prolongs the procedure, radiation exposure, and the need for electrical cardioversion without improving acute results and long-term ablation outcomes.
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In patients with an implantable cardioverter-defibrillator (ICD) and Brugada syndrome (BrS), the long-term efficacy of catheter ablation for preventing inappropriate shock therapy due to paroxysmal atrial fibrillation (PAF) has not been elucidated. ⋯ Catheter ablation is effective in patients with BrS and an ICD, and prevents inappropriate ICD therapy owing to PAF; thus, catheter ablation is an appropriate first-line therapy for PAF among such patients.
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Randomized Controlled Trial
Extended detection time to reduce shocks is safe in secondary prevention patients: The secondary prevention substudy of PainFree SST.
Prolonged ventricular fibrillation (VF) detection has been shown to reduce implantable cardioverter-defibrillator (ICD) therapies and improve prognosis in primary prevention ICD patients. Data in secondary prevention patients are limited. ⋯ This large prospective randomized study shows that prolonged detection can safely be programmed in secondary prevention ICD patients with new or existing devices. This programming strategy decreases the rate of treated events and is not associated with an increased risk of syncope or mortality.
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A direct comparison of the efficacy and safety profiles of left atrial appendage occlusion (LAAO) devices and novel oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation is warranted but currently unavailable. ⋯ Although superiority of LAAO over NOACs was not demonstrated by RCTs in terms of stroke prevention, LAAO was found to be consistently associated with a lower rate of both thromboembolic and hemorrhagic events as compared with NOACs in observational studies.
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Multicenter Study
Impact of clinical and genetic findings on the management of young patients with Brugada syndrome.
Brugada syndrome (BrS) is an arrhythmogenic disease associated with sudden cardiac death (SCD) that seldom manifests or is recognized in childhood. ⋯ Spontaneous Brugada type 1 ECG pattern and symptoms at diagnosis are predictors of LTA events in the young affected by BrS. The management of BrS should become age-specific, and prevention of SCD may involve genetic testing and aggressive use of antipyretics and quinidine, with risk-specific consideration for the implantable cardioverter-defibrillator.