Patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension (PAH/CTEPH) may experience physiological stress at high...

AbstractBackground and AimsImplementing societal recommendations for primary prevention implantable cardioverter-defibrillators (ICDs) in cardiac sarcoidosis requires an accurate diagnosis. However, cardiac sarcoidosis diagnostic schemes are inconsistent and often produce conflicting results. This study aimed to compare the discriminative accuracy of cardiovascular magnetic resonance imaging (CMR) phenotyping with the societal recommendations for predicting long-term ventricular arrhythmic outcomes in patients with suspected cardiac sarcoidosis, regardless of their diagnostic status.MethodsThis multicentre study included patients with histology-supported sarcoidosis who underwent CMR for suspected cardiac involvement and were ineligible for secondary prevention ICDs. The study outcome was a composite of fatal or life-threatening ventricular arrhythmias. Outcomes were compared based on eligibility for ICDs by societal recommendations and CMR phenotyping.ResultsAmong 1514 patients, 84 experienced the study outcome during a median follow-up of 4.5 years and a maximum follow-up of 10 years. The high-risk CMR phenotype was associated with higher 5- and 10-year incidences of the outcome (24.0% and 35.0%, respectively) compared with those who met societal recommendations. Patients with low-risk phenotypes had lower incidences (0.7% and 2.6%). Cardiovascular magnetic resonance imaging phenotyping outperformed societal recommendations in discriminative accuracy, with areas under the curve of 0.861 and 0.776 for 5- and 10-year outcomes, respectively. Additionally, CMR phenotyping had the highest adjusted subdistribution hazard ratio (19.8) for the study outcome.ConclusionsIn patients with suspected cardiac sarcoidosis, CMR phenotyping showed greater discriminative accuracy than societal recommendations for predicting fatal or life-threatening ventricular arrhythmias, suggesting that it may be more effective at identifying candidates for primary prevention ICDs.

AbstractAimsEpicardial ablation for Brugada syndrome (BrS) has shown promise in reducing ventricular fibrillation (VF), but its role remains controversial due to the lack of randomized trials. This study evaluates the efficacy of catheter ablation in high-risk BrS patients.Methods and resultsThis prospective, single-centre, randomized (2:1) study enrolled BrS patients with cardiac arrest (CA) or appropriate ICD therapies. All patients had an ICD and were randomized to undergo epicardial ablation (ablation group) or no ablation (control group). Enrolment began in September 2017 and prematurely terminated in February 2024. The primary endpoint was freedom from VF recurrences. Secondary endpoints included procedure safety, ICD-related complications, and quality-of-life assessment. Forty patients (83% male, mean age 43.7 ± 12.1) were randomized: 26 in the ablation group and 14 in the control group. Thirty-six patients received appropriate ICD therapies before enrolment: 24 (92%) in the ablation group and 12 (86%) in the control group. One patient in the ablation group experienced a post-procedural pericardial effusion requiring pericardiocentesis. Thirteen patients (33%) had major ICD-related complications. After a mean follow-up of 4.0 ± 1.7 years, freedom from VF recurrence was 96% (25/26) in the ablation group and 50% (7/14) in the control group (P < 0.001). No unexplained or arrhythmic deaths occurred during follow-up.ConclusionEpicardial catheter ablation was associated with a reduction in VF recurrence compared with ICD therapy alone. These findings support the use of epicardial ablation in high-risk BrS patients.ClinicalTrials.govID NCT03294278

Bayer announced initiation of a phase I clinical trial with BAY 3670549, an investigational highly selective G─protein─coupled inwardly rectifying potassium channel 4 (GIRK4) inhibitor, which has the potential to help control the

Author(s): Dr Riddhi DhanakkkpatelAuthor(s): Riddhi Dhanak, Kartik PatelAs stenting remains the first choice in left main coronary artery (LMCA) compression syndrome with Eisenmengerization, the authors present a case where pulmonary artery reduction plasty relieves LMCA compression in surgically correctible adult congenital heart disease. Subspecialty(ies): CardiacCongenitalContent Area(s): 2024 Resident Video Competition

Posterior left pericardiotomyPALACSExtended follow-up

AbstractAimsEpicardial ablation for Brugada syndrome (BrS) has shown promise in reducing ventricular fibrillation (VF), but its role remains controversial due to the lack of randomized trials. This study evaluates the efficacy of catheter ablation in high-risk BrS patients.Methods and resultsThis prospective, single-centre, randomized (2:1) study enrolled BrS patients with cardiac arrest (CA) or appropriate ICD therapies. All patients had an ICD and were randomized to undergo epicardial ablation (ablation group) or no ablation (control group). Enrolment began in September 2017 and prematurely terminated in February 2024. The primary endpoint was freedom from VF recurrences. Secondary endpoints included procedure safety, ICD-related complications, and quality-of-life assessment. Forty patients (83% male, mean age 43.7 ± 12.1) were randomized: 26 in the ablation group and 14 in the control group. Thirty-six patients received appropriate ICD therapies before enrolment: 24 (92%) in the ablation group and 12 (86%) in the control group. One patient in the ablation group experienced a post-procedural pericardial effusion requiring pericardiocentesis. Thirteen patients (33%) had major ICD-related complications. After a mean follow-up of 4.0 ± 1.7 years, freedom from VF recurrence was 96% (25/26) in the ablation group and 50% (7/14) in the control group (P < 0.001). No unexplained or arrhythmic deaths occurred during follow-up.ConclusionEpicardial catheter ablation was associated with a reduction in VF recurrence compared with ICD therapy alone. These findings support the use of epicardial ablation in high-risk BrS patients.ClinicalTrials.govID NCT03294278

Tiakis Biotech has announced the appointment of Christoph Schmidt to its supervisory board. Based in Kiel, Germany, the clinical-stage biotech company...

Patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension (PAH/CTEPH) may experience physiological stress at high...

The 2024 European Society of Cardiology (ESC) Guidelines for hypertension introduced the ‘elevated BP’ (eBP) category (120–139/70–89 mm Hg). I...

To determine if electrocardiogram (ECG)-gated magnetic resonance angiography (MRA) can be used to assess candidacy for transcatheter pulmonary valve r...

Transcatheter tricuspid valve-in-ring implantation (TVIRI) has emerged as a viable therapy for high-risk patients with symptomatic severe tricuspid re...

Tiakis Biotech has announced the appointment of Christoph Schmidt to its supervisory board. Based in Kiel, Germany, the clinical-stage biotech company...

Nature Reviews Cardiology, Published online: 22 May 2025; doi:10.1038/s41569-025-01173-8

AbstractBackground and AimsImplementing societal recommendations for primary prevention implantable cardioverter-defibrillators (ICDs) in cardiac sarcoidosis requires an accurate diagnosis. However, cardiac sarcoidosis diagnostic schemes are inconsistent and often produce conflicting results. This study aimed to compare the discriminative accuracy of cardiovascular magnetic resonance imaging (CMR) phenotyping with the societal recommendations for predicting long-term ventricular arrhythmic outcomes in patients with suspected cardiac sarcoidosis, regardless of their diagnostic status.MethodsThis multicentre study included patients with histology-supported sarcoidosis who underwent CMR for suspected cardiac involvement and were ineligible for secondary prevention ICDs. The study outcome was a composite of fatal or life-threatening ventricular arrhythmias. Outcomes were compared based on eligibility for ICDs by societal recommendations and CMR phenotyping.ResultsAmong 1514 patients, 84 experienced the study outcome during a median follow-up of 4.5 years and a maximum follow-up of 10 years. The high-risk CMR phenotype was associated with higher 5- and 10-year incidences of the outcome (24.0% and 35.0%, respectively) compared with those who met societal recommendations. Patients with low-risk phenotypes had lower incidences (0.7% and 2.6%). Cardiovascular magnetic resonance imaging phenotyping outperformed societal recommendations in discriminative accuracy, with areas under the curve of 0.861 and 0.776 for 5- and 10-year outcomes, respectively. Additionally, CMR phenotyping had the highest adjusted subdistribution hazard ratio (19.8) for the study outcome.ConclusionsIn patients with suspected cardiac sarcoidosis, CMR phenotyping showed greater discriminative accuracy than societal recommendations for predicting fatal or life-threatening ventricular arrhythmias, suggesting that it may be more effective at identifying candidates for primary prevention ICDs.