Background: Platypnea-orthodeoxia syndrome (POS) is a rare clinical phenomenon, associating normal oxygen saturation in a supine position and arterial hypoxemia in an upright position. This pathology can be secondary to an intracardiac shunt, a pulmonary vascular shunt or a ventilation-perfusion mismatch. Cardiac POS occurs in the presence of a right-to-left cardiac shunt, most commonly through a patent foramen ovale (PFO). Methods and results: From our single-center prospective database of percutaneous PFO closure we identified five patients (4 females, mean age: 77 ± 11 years) out of 224 (2.2%) patients with a PFO who presented with a POS of cardiac origin. Transthoracic and transoesophageal echocardiographic examinations revealed the underlying mechanisms of POS and the diagnosis was confirmed by right-and-left cardiac catheterization (RLC) and by measuring serial blood oxygen saturation in the pulmonary veins and left atrium in supine and upright positions. PFO was associated with atrial septal aneurysm and a persistent prominent Eustachian valve in 3 patients. All patients underwent a successful percutaneous PFO closure without any immediate or subsequent complications (mean follow-up of 24 ± 18 months). Immediately after the procedure, mean arterial oxygen saturation improved from 83% ± 3 to 93% ± 2 in an upright position and symptoms disappeared. Conclusion: POS is a rare and under-diagnosed pathology that must be actively investigated in the presence of position-dependent hypoxemia. The diagnostic work-up must exclude other causes of hypoxemia and confirm the intracardiac shunt using either contrast echocardiography or RLC. For cardiac POS, percutaneous PFO closure is a safe and effective technique that immediately relieves orthodeoxia and patient symptoms.

A FPD >140 ms is a marker of AF recurrences after RFCA and probably reflects the extent of atrial remodelling.

Background: Accurate markers of atrial fibrillation (AF) recurrences after electrical cardioversion (ECV) are lacking. This study was conducted to assess the value of P-wave signal averaging (SAPW) for predicting AF recurrences in a nonselected patients population submitted to ECV.Methods: A total of 133 patients (107 males, 26 females, mean age 66 ± 9 years) were included after successful ECV for persistent AF (mean duration of AF 3.6 ± 2.2 months). The mean ejection fraction (EF) was 60 ± 9%, and left atrial (LA) diameter was 44 ± 6 mm. SAPW ECG was obtained immediately after ECV and patients were prospectively followed.Results: During a mean follow-up of 8.9 ± 5.2 months, AF recurrences occurred in 40.6% (54/133). No SAPW parameters was statistically different between the group of patients with and the group without recurrences. Recurrences were less often observed in patients with a total P-wave duration <150 ms (16/52 or 31% vs 38/81 or 47% in patients with total P-wave duration ≥150 ms) but the difference was not statistically different (P = 0.07). P-wave duration was correlated with age (r = 0.32; P < 0.001) and left atrial diameter (r = 0.19; P = 0.02). Age, sex, structural heart disease, amiodarone therapy, or hypertension were not associated with AF recurrences but patients without recurrences had a shorter AF duration (P = 0.001) and more often had a history of previous ablation (P = 0.027).Conclusion: In this unselected "real-life" group of patients submitted to ECV for persistent AF, none of the SAPW parameters, including total filtered P-wave duration, was able to predict AF recurrences.

No abstract

Diabetes mellitus with preexisting end-organ damage (EOD) is considered a contraindication for heart transplantation. The outcome of such patients has not been well characterized. Among 138 patients transplanted between 12/88 and 7/94, 29 were diabetic (11 insulin-dependent); of these, 12 had preexisting EOD, defined as a creatinine clearance < or = 50 ml/min, a 24-hour urine protein concentration > or = 500 mg/L or typical symptoms of peripheral or autonomic polyneuropathy, and 17 had no EOD. We compared diabetics with and without EOD and non-diabetics (n = 109) for operative mortality, length of stay, serum creatinine, fasting glucose levels, and postoperative prednisone doses at 1,6, and 12 months. Actuarial survival and freedom from rejection and infection were analyzed. Both diabetic groups were significantly older than nondiabetics, Ischemic time, operative mortality, surgical technique, ICU- and total length of stay were similar. Actuarial survival and freedom from rejection were similar among the three groups. Infection rates including CMV did not differ. Serum creatinine levels increased in all groups compared to pretransplant levels (p = 0.001), but without significant differences among the groups. Post-transplant glucose levels at 6 and 12 months were higher for diabetic patients with EOD than for those without or for nondiabetics (183, 153, and 94 mg/dl at 6 months, p = 0.01; 202, 161, and 102 mg/dl at 12 months, p = 0.0001). Prednisone dosage was lower in diabetics with EOD at 6 months, but did not differ among the three groups at 12 months. The incidence of angiographically proven transplant vasculopathy did not differ at 1 and 2 years. Diabetics with preexisting EOD undergoing heart transplantation experience similar short- and intermediate-term results when compared to diabetics without EOD and nondiabetics. Metabolic control is more difficult to achieve, as indicated by higher fasting glucose levels. Larger and longer-term prospective studies have to confirm our findings, since the shortage of donor organs would increase if such patients were transplanted routinely.