The new journal Cardiovascular Innovations and Applications (CVIA) has just published its second issue, with a special focus on Electrophysiology. CVIA is the official journal of the Great Wall International Congress of Cardiology (GW-ICC) and its first issue was published in October 2015 to coincide with the 26th GW-ICC in Beijing, China.
The CVIA Special Issue on Electrophysiology has been Guest Edited by Dr. Jamie B. Conti of the University of Florida and brings together contributions from leading cardiologists from the United States and China.
Featured papers in this issue are:
Stroke Prevention in Atrial Fibrillation: Current Strategies and Recommendations by Gerald V. Naccarelli, Gregory Caputo, Thomas Abendroth, Samuel Faber, Mauricio Sendra-Ferrer, Deborah Wolbrette , Soraya Samii, Sarah Hussain and Mario Gonzalez. This review considers the growing incidence of atrial fibrillation (AF) which is expected to double over the next 30 years and already accounts in the United States for one third of cardiac arrhythmia hospitalizations and 70% of Medicare arrhythmia admissions. Registry data suggests that almost half of patients who should be on therapeutic anticoagulation for stroke prevention in AF (SPAF) are not. Warfarin and more recently developed agents, the "novel anticoagulants" (NOACs) reduce the risk of embolic strokes. In addition, the NOACS also reduce intracranial hemorrhage (ICH) by over 50% compared to warfarin. Anticoagulation and bridging strategies involving cardioversion, catheter ablation, and invasive/surgical procedures are reviewed. The development of reversal agents for NOACS and the introduction of left atrial appendage occluding devices will evolve the use of newer strategies for preventing stroke in high risk AF patients.
Atrial Fibrillation Ablation: Indications, New Advances, and Complications by Chang-Sheng Ma. This review considers catheter ablation as a cornerstone in the management of atrial fibrillation. As new strategies and technologies are implemented to improve the success rates of this procedure, prevention and early detection of complications will contribute to reduction of adverse outcomes with this technology.
Other papers in this issue include:
Current Management of Ventricular Tachycardia: Approaches and Timing by Roy M. John and William Stevenson. This review considers Ventricular tachycardia (VT) which in the presence of structural heart disease is associated with sudden cardiac death and warrants prompt attention. Implantable cardioverter defibrillators, although highly effective in terminating sustained ventricular arrhythmias and reducing mortality, have no effect on the arrhythmia substrate, and recurrent shocks for VT termination occur in approximately 20% of patients. Antiarrhythmic drugs, mainly in the form of beta-blockers or amiodarone, are moderately effective in reducing the need for implantable cardioverter defibrillator therapies, but drug intolerance and serious toxic effects of amiodarone necessitate drug cessation in a quarter of patients. Catheter ablation has emerged as an effective treatment for control of frequent VT episodes and can be lifesaving in cases of incessant VT or VT storm.
Principles of Arrhythmia Management During Pregnancy by Thomas Adam Burkart, William M. Miles and Jamie Beth Conti. Serious arrhythmias that threaten the lives of both the mother and the unborn child during pregnancy are fortunately rare. Documentation of the arrhythmias and correlation of findings with symptoms is imperative before initiation of any therapy. Women with previously diagnosed arrhythmias will frequently experience worsening of their arrhythmia during pregnancy. However, advances in fluoro-less mapping technologies are opening the door to the possibility of performing advanced, invasive arrhythmia therapies during any stage of pregnancy without subjecting the mother and fetus to high doses of radiation.
Changing the Way We "See" Scar: How Multimodality Imaging Fits in the Electrophysiology Laboratory by Anita Wokhlu. Substrate characterization is the mainstay of ablation for ventricular tachycardia (VT). Although the use of electro anatomic voltage mapping (EAVM) in the electrophysiology (EP) laboratory has enabled real-time approximation of myocardial scar, it has limitations. Various non-invasive methods of scar assessment have emerged, with magnetic resonance imaging (MRI) being the most accurate. Integrated MRI and electro anatomic voltage mapping studies demonstrate good correlation, although MRI has numerous advantages.
Syncope and Early Repolarization: A Benign or Dangerous ECG Finding by Matthew McKillop and William M. Miles. Electrocardiographic ER patterns are common in the normal adult population, especially in young athletes. However, the most frequently observed pattern, the rapidly ascending/upward sloping variety, is not associated with negative outcomes. There are uncommon morphologies, including the type 1 Brugada pattern and type 2 or 3 ER pattern with horizontal/descending ST segments, that have associations with sudden cardiac death, although the event rate in such patients is still very low.
Inherited Wolff-Parkinson-White Syndrome by Yang Liu, Yumei Xue, Shulin Wu and Dan Hu. Recent studies have identified several rare genetic variants associated with WPW syndrome. Present data account for only a limited percentage of the heritability of WPW syndrome. Patients with heritable WPW syndrome have a phenotype that is clearly different from that of those with sporadic WPW syndrome, who typically have structurally normal hearts. No gene defect associated with typical WPW syndrome has yet been identified. In most well-recognized cases, ventricular preexcitation is accompanied by various cardiac or noncardiac clinical manifestations. Integration of next-generation sequencing technologies, improved identification of disease causing genetic variants, and a more complete understanding of causative mechanisms behind WPW syndrome risk loci will be required.
The Subcutaneous Implantable Cardioverter-Defibrillator: A Practical Review and Real-World Use and Application by Mark E. Panna Jr and William M. Miles. The subcutaneous implantable cardioverter-defibrillator (ICD) is a novel technology using a subcutaneous (extrathoracic) system for treatment of potential lethal ventricular arrhythmias. This paper reviews patient selection, system components, the implantation technique, and screening considerations for subcutaneous ICD implantation. Its uses in specific patient populations, including children, patients with congenital heart disease, hypertrophic cardiomyopathy, or end-stage renal disease, and patients with pre-existing pacemakers, are highlighted. Areas of future investigation are reviewed, including potential use with leadless pacing and magnetic resonance imaging.
Athletes and Arrhythmias by Michael J. Jansen and Floyd W. Burke. This review considers the medical management of athletes which presents many unique challenges. The normal cardiac adaptations that occur with intense physical training can be misinterpreted and lead to unnecessary testing and withdrawal from competition. Athletes, however, can have underlying asymptomatic cardiac disease which can be exacerbated by exercise and, rarely, results in sudden cardiac death. Preventative strategies such as preparticipation cardiac screening to better identify those athletes at higher risk of sudden death are currently under investigation and remain controversial.
Implantable Cardiac Defibrillators: Who Needs Them and Who Does Not? by C. Richard Conti. ICD implantation is a subject that needs much consideration before proceeding. Dr. Conti writes: 'When the physician is advising an individual patient about the implantation of an ICD, the patient is entitled to know the benefits and the risks. It is also imperative that the physician knows the patient's expectations about life expectancy and quality of life...Finally, my advice to those who implant ICDs is "think before you implant an ICD" and have the patient and the family think before an ICD is implanted.'
Led by Editor-in-chief C. Richard Conti, Professor Emeritus of Medicine at the University of Florida and former president of the American College of Cardiology and its founding editor Professor Hu Dayi of Peking University, CVIA is a high-profile peer-reviewed journal with an international Editorial Board. The journal publishes focused articles and original clinical research that explore novel developments in cardiovascular disease, effective control and rehabilitation in cardiovascular disease, and promote cardiovascular innovations and applications for the betterment of public health globally.
CVIA is available on the IngentaConnect platform and at http://cvia-journal.
Submissions may be made using ScholarOne Manuscripts. There are no author submission or article processing fees.