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ARVD is part of the group of cardiomyopathies characterised pathologically by fibrofatty replacement of the right ventricular myocardium and clinically by right ventricular arrhythmias of the LBBB pattern. Pathogenesis, prevalence, and aetiology are yet not fully known. The diagnosis of ARVD is based on the presence of structural, histological, electrocardiographic, and genetic factors. Therapeutic options include antiarrhythmic medication, catheter ablation, implantable cardioverter defibrillation, and surgery. Angiography and echocardiography lack sensitivity and specificity in the diagnosis of ARVD. MR imaging allows a three-dimensional evaluation of especially the right ventricle, and provides the most important anatomical, functional, and morphological criteria for diagnosis of ARVD within one single study. Although demonstration of morphological/functional abnormalities of the right ventricle, especially fat in the right ventricular myocardium, shows high specificity but low sensitivity, MR imaging appears to be the optimal imaging technique for detection and follow-up of clinically suspected ARVD. Positive MR imaging findings, based on the criteria of McKenna et al. [16], should be used as important additional criteria in the clinical diagnosis of ARVD, although negative MR imaging findings do not rule out ARVD.

Patients with SSS should be implanted with a dual-chamber pacemaker. Alternative sites appear superior to the traditional right appendage site since they improve atrial synchrony and may reduce AF recurrences. The hig percentage of ventricular pacing in DDD mode in all studies is a common pitfall comparing physiological pacing and VVI mode is characteristic of a common pitfall: ventricular pacing has a deleterious effect on both atrial and ventricular function that may mask the real beneficial entity of atrial pacing. New pacing site in the right ventricle and use of algorithms to minimise ventricular pacing is likely to lead to more consistent positive results. In conclusion, data from the literature suggest that in patients with SSS atrial pacing from an alternative site should be used, employing algorithms to attain the highest possible percentage of atrial pacing and to reduce ventricular pacing as much as possible.

OAT currently represents the most effective therapy for cardio-embolic prevention in patients with non-valvular AF at moderate-to-high risk. Antiplatelet therapy may represent an alternative for low-risk patients or patients who are poor candidates for OAT, due to a high risk of bleeding or limited compliance. The hope for the future is the development of newer alternatives to OAT with a more convenient pharmacological profile, less risk of bleeding and easier management [21]. At present, oral direct thrombin inhibitors seem the most promising alternatives, but further studies are needed to confirm their safety.

L’angiografia coronarica costituisce ancora oggi la metodica diagnostica di riferimento nello studio del circolo coronarico nativo e dei controlli degli interventi di rivascolarizzazione coronarica, sia chirurgica (confezionamento di bypass) che tramite procedure interventistiche (angioplastica percutanea-PTCA e ).

Catheter ablation of atrial fibrillation (AF) has become a real therapeutic option for symptomatic patients resistant to or intolerant of antiarrhythmic drugs. Since the first reports of curative catheter ablation a decade ago, several techniques have evolved [1-5]. Despite the fact that these techniques vary significantly, they all have something in common: the predominant target has become the left atrium and pulmonary veins (PVs). Underestimated by many operators, the variability of the anatomy makes the procedure complex and seems to explain most failures and/or complications. The aim of this review is to discuss the importance of imaging techniques for guidance of catheter ablation of AF.

The identification of the macroreentrant nature of atrial flutter and the ability to localise the circuit by endocardial activation mapping and pacing resulted in attempts to interrupt the circuit by ablative interventions. Nowadays, catheter ablation of atrial flutter has become a safe, curative, and highly successful procedure, particularly when the right atrial isthmus is incorporated in the flutter circuit. Demonstration of bidirectional isthmus block after ablation predicts a high long-term success rate. Scar-related and left atrial flutters present more complex patterns of activation, making the ablation more difficult and the 3D system often mandatory.

Platelets play a pivotal role in the development and progress of atherosclerotic vascular disease, as well as in the pathogenesis of its unstable clinical manifestations (e.g., unstable angina, non-ST elevation myocardial infarction (MI), ST elevation MI, and stroke) [1].

Therefore, antiplatelet therapy is an integral component in the treatment of patients with atherosclerotic cardiovascular disease, which represents the leading cause of death and disability worldwide.

Aspirin is the cornerstone of oral antiplatelet therapy and is effective for the prevention and treatment of cardiovascular events [2].

The availability and cost-effectiveness of aspirin have made it the most widely employed antiplatelet agent for the prevention and treatment of vascular disease.

Patients with SSS should be implanted with a dual-chamber pacemaker. Alternative sites appear superior to the traditional right appendage site since they improve atrial synchrony and may reduce AF recurrences. The hig percentage of ventricular pacing in DDD mode in all studies is a common pitfall comparing physiological pacing and VVI mode is characteristic of a common pitfall: ventricular pacing has a deleterious effect on both atrial and ventricular function that may mask the real beneficial entity of atrial pacing. New pacing site in the right ventricle and use of algorithms to minimise ventricular pacing is likely to lead to more consistent positive results. In conclusion, data from the literature suggest that in patients with SSS atrial pacing from an alternative site should be used, employing algorithms to attain the highest possible percentage of atrial pacing and to reduce ventricular pacing as much as possible.

The response to CRT is largely determined by the baseline degree of interand intraventricular dyssynchrony, and echocardiography seems to be the ideal technique by which to identify responders to CRT.At present the definition of echocardiographic indices of ventricular dyssynchrony is undergoing intense research, and several indices have been proposed that may or may not prove useful in a prospective evaluation. It is time for a prospective trial to evaluate these different parameters with regard to their impact on the efficacy of CRT. These data will provide a better basis for the clinical decision as to which heart failure patients are likely to benefit from this new form of therapy.

Although the implantation success rate does not differ significantly between over-the-wire and stylet leads, procedure duration, fluoroscopy time, and perioperative complication decrease when an over-the-wire left ventricular lead is primarily implanted by experienced teams. This novel lead, sometimes combined with coronary vein angioplasty [8, 9], represents a decisive improvement of the technique, especially for pacing of the left ventricle in the optimal spot. Despite all these efforts, a 100% success rate will probably never be reached by the endovascular approach. A surgical approach via a minimally invasive thoracotomy should be considered for those 5% of patients in whom endovascular CRT device implantation has failed.