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RT3DE can quantify LVMD by providing the SDI-16 and it may prove to be more useful than DTI as it shows increasing dyssynchrony with increased QRS duration and decreased LVEF.

Ivabradine, a novel heart rate slower: Is it a sword of double blades in patients with idiopathic dilated cardiomyopathy?Ivabradin, yeni bir kalp hızı yavaşlatıcısı: İdiyopatik dilate kardiyomiyopatili hastalarda iki tarafı keskin bir kılıç mıdır?Original Investigation Özgün Araşt›rma ABSTRACTObjective: To prospectively assess the safety and efficacy of ivabradine in patients with idiopathic dilated cardiomyopathy. Methods: We included 35 patients with idiopathic dilated cardiomyopathy with an ejection fraction (EF) <40% and heart rate >70 beats/min despite optimal medical therapy, according to the international guidelines in this prospective, non-randomized, single-arm, open-label safety study. Ivabradine was used as an add-on therapy to the maximally tolerated β-blocker in an increasing titrated dose till a target dose of 15 mg/ day or resting heart rate of 60 beats/min for 3 months. During follow-up period the safety, patient tolerance and efficacy of this drug were assessed. All patients underwent 12-lead resting electrocardiography and Holter monitoring at inclusion and after 3 months. Statistical analysis was accomplished using paired t-test and Pearson correlation analysis. Results: We found a significant reduction in the resting heart rate by a mean of 25.9±9.4%, without a significant change of blood pressure. There was no prolongation of PR, QTc or QRS durations. Ventricular ectopic activity showed significant reduction (p<0.001). There was a significant correlation between the resting heart rate, NYHA and left ventricular ejection fraction (p<0.001 for both). One patient developed photopsia and decompensation was observed in another patient. Conclusion: Ivabradine is a safe and effective drug in reducing resting heart rate, improving NYHA functional class without undesirable effects on conduction parameters or ectopic activity. (Anadolu Kardiyol Derg 2011; 11: 402-6)

Background: The outcomes of pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) are suboptimal. The entire pulmonary venous component (PV-Comp), consisting of the pulmonary veins, their antra, and the area between the antra, provides triggers and substrate for AF. PV-Comp isolation is an alternative strategy for persistent AF ablation. Methods: Among 328 patients with persistent AF who underwent a first radiofrequency ablation procedure, 200 patients (PVI, n = 100; PV-Comp isolation, n = 100) were selected by propensity score matching. Both groups were followed up for 1 year. Results: At 6-and 12-month follow-up, atrial tachyarrhythmia (AF/atrial tachycardia) recurred in 41 and 61 patients in PVI group and 22 (P = .006) and 33 patients (P < .001) in PV-Comp isolation group, respectively. PV-Comp isolation was associated with longer mean time to recurrence (PVI: 8 months, PV-Comp isolation: 10 months, log-rank P < .001) and a lower probability of recurrence (odds ratio [OR] = 0.32; 95% confidence of interval [CI] = 0.18-0.56, P < .001), with no increase in procedural complications (PVI: 5 of 100, PV-Comp isolation: 6 of 100, P = .76). Procedure duration was longer in PV-Comp isolation group (PVI: 186 ± 42 min, PV-Comp isolation: 238 ± 44 min, P < .001), as well as fluoroscopy time (PVI: 22 ± 16 min, PV-Comp isolation: 31 ± 21 min, P = .001). Conclusion: PV-Comp isolation for persistent AF reduced atrial tachyarrhythmia recurrence up to 1 year compared with PVI alone. While procedure and fluoroscopy time increased, there was no difference in procedural complications. K E Y W O R D S catheter ablation, persistent atrial fibrillation, posterior wall isolation, pulmonary vein isolation, pulmonary venous component

Background Differentiation between atrioventricular nodal re‐entrant tachycardia (AVNRT), atrioventricular re‐entrant tachycardia (AVRT), and atrial tachycardia (AT) is often challenging during electrophysiology studies. This study compared the sensitivity and specificity of identifying anterograde His bundle activation during entrainment with commonly used right ventricular (RV) pacing maneuvers to differentiate between these types of supraventricular tachycardia (SVT). Methods Out of 112 consecutive patients with SVT, 90 (36 males [40%], age 37 ± 16 years) were prospectively studied. After entrainment during RV pacing, atrial response upon cessation of pacing, anterograde His activation during entrainment, stimulus‐atrial (SA), ventriculoatrial (VA) intervals, and post‐pacing interval minus tachycardia cycle length (PPI‐TCL) were determined. Ventricular extrastimulation during tachycardia and para‐Hisian pacing were performed. Results The final diagnosis was AVNRT in 54, AVRT in 33, and AT in 3 patients. Entrainment was achieved in 87(96%) patients. Anterograde His bundle activation predicted AVRT (sensitivity: 62.5%, specificity: 100%). PPI‐TCL ≥129 ms predicted AVNRT (sensitivity: 83%, specificity: 84%), as did SA‐VA value ≥85 ms (sensitivity: 91%, specificity: 87%). Atria were advanced during transition zone in 57% of AVRTs. Atrial pre‐excitation in response to progressively premature ventricular extrastimuli identified AVRT (sensitivity: 90%, specificity: 85%). Pre‐excitation index ≥87 ms identified AVNRT (sensitivity: 80%, specificity: 100%). Para‐Hisian pacing identified AVRT (sensitivity: 25%, specificity: 100%). Conclusion RV pacing maneuvers, applied in isolation, can misclassify a significant proportion of SVTs. Identifying anterograde His bundle activation during entrainment can complement other discriminators in differential diagnosis of SVT, with greatest sensitivity in septal and right‐sided accessory pathways.