Rhythmology news in 2023

Christophe Scavée, Varnavas Varnavas, Sébastien Marchandise Published in the journal : February 2024 Category : Cardiology

The annual congress of the European Society of Cardiology has traditionally published new recommendations on cardiac pacing and arrhythmias since 2019, but it was not the case in 2023. New guidelines are considered as a beacon of light for many. However, the absence of new guidelines does not mean that this year has not seen any new developments in the field of electrophysiology and pacemakers. Many topics could have been addressed in this review, but we have decided to focus this article on three of the most important ongoing innovations.

The first is a success story: the possibility of implanting leadless pacemakers. The first capsules have been implanted 10 years ago, but the current trend is towards more sophisticated systems, targeting the atrioventricular synchronous pacing, in other words, providing a more physiological stimulation. Pacing as close as possible to normal cardiac physiology is essential to avoid the risks of ventricular dysfunction observed in some patients, especially if the pacing is delivered to the apex of the right ventricle. This is how the pacing of the left branch of the His bundle was developed. This is a particularly ingenious technique, whose feasibility still lacks solid data, but which is extremely promising and constitutes the second point of the review.

The final point refers to the development of an alternative energy source to radiofrequency or cryotherapy for treating atrial fibrillation, known as electroporation. This non-thermal technique applies bipolar electric shocks and disconnects rapidly the pulmonary veins. The results of the first randomized study have just been published, opening up new perspectives in terms of efficacy.

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Innovations 2023 in Cardiology

Agnès Pasquet, Laurence Bamps, Leila Belkhir, Mélanie Dechamps, Julien De Greef, Véronique Roelants, Jean Cyr Yombi Published in the journal : February 2024 Category : Cardiology

The year 2023 was marked by the publication of new recommendations on infective endocarditis and new advances in our understanding of the relationship between dyslipidemias and cardiovascular diseases.

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Innovations 2022 in Cardiology

Anne-Catherine Pouleur, Joëlle Kefer, Agnès Pasquet Published in the journal : February 2023 Category : Cardiology

The year 2022 has been marked by many new developments in the fields of heart failure and valvulopathy treatment. These advances will certainly improve our daily practice and the treatment of many patients.

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SCORE 2: a new model to estimate total cardiovascular risk

Guy De Backer (1), Fabian Demeure (2), Olivier Descamps (3), Dirk De Bacquer (1) Published in the journal : October 2022 Category : Cardiology

Primary prevention of cardiovascular disease (CVD) is actually needed, though poorly implemented as yet. The choice of the most optimal preventive strategy depends on the total cardiovascular (CV) risk of a given person. Several models have been developed to estimate total CV risk. Until recently, the SCORE model, calibrated for Belgium (SCORE-Belgium), has been recommended for that purpose.

A new model has now been developed and validated (SCORE 2), with certain advantages. Four systems have been advocated, and the ‘SCORE 2 low-risk’ system has been recommended for implementation in Belgium. This easy-to-use model allows for the stratification of the apparently healthy adult population into subgroups at low-to-moderate, high, and very-high total CV risk, so that preventive strategies can then be adapted accordingly. A recalibration of this ‘SCORE 2 low-risk’ model for Belgium seems unnecessary. The international model likely underestimates slightly the total CV risk in the population, which is in accordance with the position of Belgium as one of the countries with the highest CV mortality rates among the 10 countries considered being at ‘low CV risk’. Indeed, this only marginal difference does not justify a recalibration of the international model.

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Medical treatment of chronic heart failure

Agnès Pasquet, Anne Catherine Pouleur Published in the journal : February 2022 Category : Cardiology

During the year 2021, the European Society of Cardiology published new recommendations for the management of patients with chronic heart failure (1). Classically, patients with heart failure have previously been categorized according to the left ventricular ejection fraction (LVEF). Three different groups are currently recognized:

- Patients with reduced LVEF defined as LVEF ≤40%, which is referred to as heart failure with reduced Ejection Fraction).

- Patients with LVEF between 41% and 49%, i.e,. slightly reduced, which is referred to as heart failure with mildly reduced ejection fraction or HFrEF.

- Patients with signs or symptoms of heart failure with structural or functional cardiac abnormalities or elevated natriuretic peptides and an LVEF >50%, which is referred to as heart failure with preserved ejection fraction or HFpEF.

This article has reviewed the principles of pharmacological treatment pertaining to these three groups.

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Recommendations of the European Society of Cardiology on management of patients with non-STEMI acute coronary syndrome

Agnès Pasquet, Frédéric Maes Published in the journal : February 2021 Category : Cardiology

These new European Society of Cardiology guidelines concern the management of patients with acute coronary syndrome presenting without persistent ST-segment elevation. The central role of performing an electrocardiogram and troponin assessment in the initial diagnosis is highlighted. A rapid use of high-sensitive troponin schema for ruling out acute myocardial infarction enables us to safely discharge patients without any acute syndrome. Performing fast troponin assessments within 2 hours or 24 hours of admission allows to screen patients for coronary angiography and percutaneous revascularization. Following coronary artery stent placement, anti-platelet or anticoagulant regimens should be carefully chosen so as to balance the bleeding risk against the ischemic or thrombotic risk. The different protocols are reviewed herein according to the patients’ clinical situation. Lastly, the comprehensive treatment of patients is presented.

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Cardiological aspects of COVID-19 infection

Christophe Scavée, Agnès Pasquet, Christophe Beauloye Published in the journal : May 2020 Category : Cardiology

From the beginning of the COVID-19 crisis, physicians alerted the scientific community to the emergence of severe acute respiratory problems related to viral lung infections. The vast majority of these patients require oxygen therapy and 5 to 10% need assisted ventilation or even extracorporeal membrane oxygenation in the event of an uncontrolled situation. Poor prognosis factors mainly include age, as well as the presence of comorbidities such as hypertension, diabetes, obesity, but also cardiovascular diseases. Coronaviruses are known to attack the cardiovascular system, and it also appears that the virus might attack the heart muscle directly. Data relayed namely by Chinese and Italian physicians show that besides the lungs, certain patients develop sometimes severe cardiac problems, such as acute myocarditis, acute coronary syndrome (ACS), or arrhythmias that in turn lead to heart failure, shock, or cardiac arrest in those most affected. Cardiac damage is therefore a factor contributing to the poor prognosis of COVID-19 and it must be detected. Patients who have an ACS but whose pulmonary picture prevails may have their cardiac management dangerously delayed. Conversely, patients who present with an exclusively "cardiological" picture may not be properly diagnosed as COVID-19. Finally, the focus on COVID-19 and the patients' fear of the contagiousness of this virus may delay their presentation at the hospital. These data directly impact the way physicians and hospitals should consider COVID-19 cardiac patients, especially at the first signs of the disease. It is therefore essential to have recommendations for the management of all patients with preexisting heart problems and those with demonstrated myocardial damage caused by the virus.

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Recommendations of the European Society of Cardiology for diagnosis and management of chronic coronary disease

Agnès Pasquet Published in the journal : February 2020 Category : Cardiology

Coronary artery disease is one of the most prevalent diseases in cardiology, and patient care requires adapted treatment.

The new guidelines of the European Society of Cardiology regarding coronary artery disease present coronary artery disease as a continuum and propose a new protocol for its diagnosis or antithrombotic therapy

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European Society of Cardiology and European Society of Hypertension joint guidelines for the management of arterial hypertension: key messages

Agnès Pasquet, Alexandre Persu Published in the journal : February 2019 Category : Cardiology

The European Society of Cardiology and European Society of Hypertension have published new guidelines regarding management of hypertension. This paper summarizes the key messages of these guidelines.

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The role of the right ventricle in cardiac insufficiency

Marie-Bénédicte Benats, MD, Anne-Catherine Pouleur, MD, PhD, Agnès Pasquet, MD, PhD (1) Published in the journal : December 2017 Category : Cardiology

Right ventricular dysfunction is a strong predictor of mortality in patients with heart failure. Due to the configuration right ventricle, assessing the function of the right ventricle proves complex. Cardiac RMN is actually considered the gold standard to evaluate right volumes and right heart dysfunction. There is limited information available to date on the optimal management of right ventricular dysfunction, except in arterial pulmonary hypertension cases (Group 1). Future research is needed to determine specific treatments, improve prognosis, and increase quality of life of patients with right-sided heart failure.

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