BACKGROUND: Cardiac resynchronization therapy (CRT) is a guideline-recommended therapy in patients with heart failure with mildly reduced ejection fraction (HFmrEF, 36%-50%) and left bundle branch block or indication for ventricular pacing. Conduction system pacing (CSP) using left bundle branch area pacing or His bundle pacing has been shown to be a safe and physiologic alternative to biventricular pacing (BVP). OBJECTIVE: The aim of this study was to compare the clinical outcomes between BVP and CSP for patients with HFmrEF undergoing CRT. METHODS: Consecutive patients who underwent BVP or CSP with HFmrEF between January 2018 and June 2023 at 16 international centers were included. The primary outcome was the composite end point of time to death or heart failure hospitalization (HFH). Secondary end points included change in left ventricular ejection fraction (LVEF) and individual end points of death and HFH. RESULTS: A total of 1004 patients met inclusion criteria: BVP, 178; CSP, 826 (His bundle pacing, 154; left bundle branch area pacing, 672). Mean age was 73 ± 13 years; female, 34%; and LVEF, 42% ± 5%. Paced QRS duration in CSP was significantly narrower compared with BVP (129 ± 21 ms vs 144 ± 19 ms; P < .001). LVEF improved during follow-up in both groups (49% ± 10% vs 48% ± 10%; P = .32). CSP was independently associated with significant reduction in the primary end point of time to death or HFH compared with BVP (22% vs 34%; hazard ratio, 0.64; 95% confidence interval, 0.43-0.94; P = .025). CONCLUSION: CSP was associated with improved clinical outcomes compared with BVP in this large cohort of patients with HFmrEF undergoing CRT. Randomized controlled trials comparing CSP with BVP will be necessary to confirm these results.

• MeSH
• Bundle-Branch Block therapy   physiopathology   MeSH
• Ventricular Function, Left * physiology   MeSH
• Bundle of His physiopathology   MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Heart Conduction System * physiopathology   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Cardiac Resynchronization Therapy * methods   MeSH
• Heart Failure * therapy   physiopathology   MeSH
• Case-Control Studies MeSH
• Stroke Volume * physiology   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH
• Comparative Study MeSH

The circadian clock in choroid plexus (ChP) controls processes involved in its physiological functions, but the signals that synchronize the clock have been sparsely studied. We found that the ChP clock in the fourthventricle (4V) is more robust than that in the lateral ventricle (LV) and investigated whether both clocks use information about mealtime as a signal to synchronize with the current activity state. Exposure of mPer2Luc mice to a 10-day reverse restricted feeding (rRF) protocol, in which food was provided for 6 h during daytime, advanced the phase of the ChP clock in 4V and LV, as evidenced by shifted (1) PER2-driven bioluminescence rhythms of ChP explants ex vivo and (2) daily profiles in clock gene expression in both ChP tissues in vivo. In contrast, clocks in other brain regions (DMH, ARC, LHb) of the same mice did not shift. The 4V ChP responded more strongly than the LV ChP to rRF by modulating the expression of genes to ensure a decrease in resistance to cerebrospinal fluid drainage and increase the secretory capacity of ChP cells. Mechanistically, rRF affects the ChP clock through food-induced increases in insulin, glucose and temperature levels, as in vitro all three signals significantly shifted the clocks in both ChP tissues, similar to rRF. The effect of glucose was partially blocked by OSMI-1, suggesting involvement of O-linked N-acetylglucosamine posttranslational modification. We identified mechanisms that can signal to the brain the time of feeding and the associated activity state via resetting of the ChP clock.

• MeSH
• Circadian Clocks * physiology   genetics   MeSH
• Period Circadian Proteins metabolism   genetics   MeSH
• Circadian Rhythm physiology   MeSH
• Mice, Inbred C57BL MeSH
• Mice, Transgenic MeSH
• Mice MeSH
• Choroid Plexus * metabolism   physiology   MeSH
• Gene Expression Regulation MeSH
• Feeding Behavior * physiology   MeSH
• Lateral Ventricles metabolism   physiology   MeSH
• Animals MeSH
• Check Tag
• Male MeSH
• Mice MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Idiopathic ventricular fibrillation (IVF) is a rare cause of sudden cardiac death and is a diagnosis of exclusion. With the availability of genetic testing, this condition is becoming increasingly rare. Nevertheless, in some cases, no identifiable cause is found. Management of recurrent IVF episodes poses a significant clinical challenge, often requiring advanced interventional approaches. CASE SUMMARY: We present a 43-year-old male with a history of out-of-hospital cardiac arrest due to VF in 2015. Despite extensive examinations, including normal coronary angiography, cardiac MRI, and genetic testing, no underlying aetiology was identified. The patient received an implantable cardioverter-defibrillator (ICD) for secondary prevention. After an 8-year arrhythmia-free period, he experienced recurrent ICD shocks in 2023. Repeated diagnostics, including MRI and genetic testing, yielded inconclusive results. An electrophysiological study revealed abnormalities in the Purkinje fibre network, including a focal source within the conduction system and a localized scar in the lower mid-left ventricular septum. Radiofrequency ablation targeting these areas successfully terminated the electrical storm. DISCUSSION: This case highlights the complexities in diagnosing and managing IVF, demonstrating a strong association between the Purkinje fibre network abnormalities in arrhythmogenesis. It underscores the importance of electrophysiological studies and catheter ablation in refractory cases, even when advanced imaging and genetic testing fail to reveal a clear aetiology. CONCLUSION: In patients with recurrent IVF refractory to conventional management, targeted ablation of Purkinje-related triggers not only terminates the storm, but provides durable rhythm control, as illustrated by our 8-month follow-up.

• Publication type
• Journal Article MeSH
• Case Reports MeSH

A potential association of endogenous circadian rhythm disruption with risk of cancer development has been suggested, however, epidemiological evidence for the association of sleep traits with colorectal cancer (CRC) is limited and often contradictory. Here we investigated whether genetically predicted chronotype, insomnia and sleep duration are associated with CRC risk in males, females and overall and according to CRC anatomical subsites using Mendelian randomization (MR). The two-sample inverse variance weighted (IVW) method was applied using summary-level data in up to 58,221 CRC cases and 67,694 controls and genome-wide association data of genetic variants for self-reported sleep traits. Secondary analyses using alternative instruments and sensitivity analyses assessing potential violations of MR assumptions were conducted. Genetically predicted morning preference was associated with 13% lower risk of CRC in men (ORIVW = 0.87, 95% CI = 0.78, 0.97, P = 0.01), but not in women or in both sexes combined. Τhis association remained consistent in some, but not all, sensitivity analyses and was very similar for colon and rectal cancer. There was no evidence of an association for any other sleep trait. Overall, this study provides little to no evidence of an association between genetically predicted sleep traits and CRC risk.

• MeSH
• Genome-Wide Association Study MeSH
• Circadian Rhythm genetics   MeSH
• Genetic Predisposition to Disease MeSH
• Polymorphism, Single Nucleotide MeSH
• Colorectal Neoplasms * genetics   epidemiology   MeSH
• Humans MeSH
• Mendelian Randomization Analysis * MeSH
• Sleep Initiation and Maintenance Disorders genetics   MeSH
• Risk Factors MeSH
• Sleep * genetics   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

The management of heart failure patients with continuous-flow left ventricular assist device (LVAD) patients is challenging. While one third of these patients are recipients of cardiac implantable electronic devices (CIEDs), the risk for atrial and ventricular arrhythmias may coexist. The lack of large datasets and dedicated randomized controlled trials (RCTs) focusing on LVAD and CIED implantation and management has brought medical centres to develop their own protocols and guidelines. This clinical consensus statement of the Heart Failure Association and the European Heart Rhythm Association of the ESC is a joint effort to summarize the current literature and provide advice on patient management within this field.

• MeSH
• Defibrillators, Implantable * MeSH
• Consensus MeSH
• Humans MeSH
• Heart-Assist Devices * MeSH
• Societies, Medical MeSH
• Arrhythmias, Cardiac * therapy   MeSH
• Heart Failure * therapy   physiopathology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Geographicals
• Europe MeSH

Conduction system pacing (CSP) is being increasingly adopted as a more physiological alternative to right ventricular and biventricular pacing. Since the 2021 European Society of Cardiology pacing guidelines, there has been growing evidence that this therapy is safe and effective. Furthermore, left bundle branch area pacing was not covered in these guidelines due to limited evidence at that time. This Clinical Consensus Statement provides advice on indications for CSP, taking into account the significant evolution in this domain.

• MeSH
• Action Potentials MeSH
• Cardiology * standards   MeSH
• Cardiac Pacing, Artificial * standards   adverse effects   methods   MeSH
• Consensus MeSH
• Humans MeSH
• Heart Conduction System * physiopathology   MeSH
• Societies, Medical MeSH
• Arrhythmias, Cardiac * therapy   physiopathology   diagnosis   MeSH
• Heart Rate MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Practice Guideline MeSH
• Geographicals
• Europe MeSH

Stereotactic arrhythmia radioablation (STAR) is a novel, non-invasive, and promising treatment option for ventricular arrhythmias (VAs). It has been applied in highly selected patients mainly as bailout procedure, when (multiple) catheter ablations, together with anti-arrhythmic drugs, were unable to control the VAs. Despite the increasing clinical use, there is still limited knowledge of the acute and long-term response of normal and diseased myocardium to STAR. Acute toxicity appeared to be reasonably low, but potential late adverse effects may be underreported. Among published studies, the provided methodological information is often limited, and patient selection, target volume definition, methods for determination and transfer of target volume, and techniques for treatment planning and execution differ across studies, hampering the pooling of data and comparison across studies. In addition, STAR requires close and new collaboration between clinical electrophysiologists and radiation oncologists, which is facilitated by shared knowledge in each collaborator's area of expertise and a common language. This clinical consensus statement provides uniform definition of cardiac target volumes. It aims to provide advice in patient selection for STAR including aetiology-specific aspects and advice in optimal cardiac target volume identification based on available evidence. Safety concerns and the advice for acute and long-term monitoring including the importance of standardized reporting and follow-up are covered by this document. Areas of uncertainty are listed, which require high-quality, reliable pre-clinical and clinical evidence before the expansion of STAR beyond clinical scenarios in which proven therapies are ineffective or unavailable.

• MeSH
• Action Potentials MeSH
• Cardiology * standards   MeSH
• Tachycardia, Ventricular * physiopathology   surgery   diagnosis   MeSH
• Consensus MeSH
• Humans MeSH
• Radiosurgery * adverse effects   standards   methods   MeSH
• Risk Factors MeSH
• Patient Selection * MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Practice Guideline MeSH
• Geographicals
• Europe MeSH

BACKGROUND AND AIMS: Myocardial infarction (MI) in multivessel disease (MVD) and chronic total occlusion (CTO) is associated with high mortality. However, all-cause mortality of matched cohort without a CTO is unclear. Our aim was to analyse clinical characteristics, presenting symptoms, and survival of patients with MI in MVD and the possible impact of CTO on 1-year mortality. METHODS: All MI patients with MVD (two or three vessel disease) hospitalized in our center from January 2020 to September 2022 (1309 patients) were selected. We conducted a propensity score matching (PSM) analysis based on age, gender, type of MI, and compared patients with CTO (CTO group, n = 90) and without CTO (Control group, n = 90). RESULTS: We observed no difference in presenting clinical symptoms and initial heart rhythm between the groups. 1-year follow-up shows all-cause mortality rate of 23.3 % (n = 21) in the CTO group (Mean survival [MS] = 292.1 days, 95 % CI = 263.8 to 320.4) and 18.9 % (n = 17) in the Control group (MS = 310.2 days, 95 % CI = 285.3 to 335.2), p = 0.44. PCI alone was performed in 64.4 % (n = 58) in both groups, CABG in 18.8 % (n = 17) and 24.4 % (n = 22) (CTO vs. Control group respectively). Combination of PCI and CABG occurred in 8.8 % (n = 8) in both groups. Conservative treatment was chosen for 7 CTO and 2 Control group patients. CONCLUSION: We observed no 1-year mortality difference in patients with MI, MVD and a CTO compared to a matched cohort of patients with MI, MVD without CTO. Excellent 1-year survival was observed in patients treated by CABG, irrespective of CTO presence.

• MeSH
• Chronic Disease MeSH
• Myocardial Infarction * mortality   diagnosis   MeSH
• Cohort Studies MeSH
• Percutaneous Coronary Intervention methods   MeSH
• Coronary Occlusion * diagnosis   mortality   surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Survival Rate trends   MeSH
• Follow-Up Studies MeSH
• Coronary Artery Disease mortality   diagnosis   surgery   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Propensity Score MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Fibrilace síní a arteriální hypertenze jsou častými diagnózami v interním lékařství a nezřídka se kombinují. Přítomnost arteriální hypertenze, zejména nedostatečně korigované, je rizikovým faktorem pro vznik samotné fibrilace síní, ale také faktorem progrese onemocnění a rizikovým faktorem pro neúspěch léčby fibrilace síní. Arteriální hypertenze rovněž zvyšuje riziko komplikací fibrilace síní, zejména tromboembolických příhod, a zvyšuje riziko krvácení při antikoagulační léčbě. Terapie fibrilace síní a arteriální hypertenze se v určitých bodech překrývá, v jiných doplňuje.

Atrial fibrillation and arterial hypertension are frequent diagnoses in internal medicine and are often combined. The presence of arterial hypertension, especially insufficiently corrected, is a risk factor for the occurrence of atrial fibrillation itself, but also a factor in the progression of the disease and a risk factor for the failure of atrial fibrillation rhythm control treatment. Arterial hypertension also increases the risk of complications of atrial fibrillation, especially thromboembolic events, and increases the risk of bleeding during anticoagulant treatment. The therapy of atrial fibrillation and arterial hypertension overlaps at certain points and complements at others.

• MeSH
• Atrial Fibrillation * etiology   complications   physiopathology   therapy   MeSH
• Hypertension * complications   therapy   MeSH
• Cardiovascular Agents therapeutic use   MeSH
• Clinical Decision-Making MeSH
• Comorbidity MeSH
• Humans MeSH
• Heart Disease Risk Factors MeSH
• Practice Guidelines as Topic MeSH
• Heart Failure etiology   MeSH
• Severity of Illness Index MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH