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The leads of cardiovascular implantable electronic devices often need to be extracted because, for example, of infection or the lead has been recalled. In this Review, Wazni and Wilkoff summarize the common indications and techniques for lead extraction, and assess data on the safety, efficacy, and outcomes of these procedures.
Statins remain the first-line therapy for dyslipidaemia. In 2015, however, effectiveness in reducing serum cholesterol levels and decreasing rates of cardiovascular disease in combination with statins has been demonstrated for two new classes of drugs: cholesterol-absorption inhibitors and PCSK9 inhibitors. The latter rival statins in their capacity to lower cholesterol levels.
The proportion of the lay population that is trained in cardiopulmonary resuscitation is closely linked to the probability of an individual surviving cardiac arrest. New mobile-assisted technologies might increase the benefit of population-based training. Furthermore, admission of patients to specialized hospitals can increase the likelihood of survival.
Cardiovascular genomics has evolved substantially in the past 2 decades. Numerous papers published in 2015 demonstrate that new genomic approaches, often used synergistically, can yield noteworthy findings. A range of laboratory, analytical, and bioinformatic techniques to uncover genetic contributors to coronary artery disease, myocardial infarction, and dilated cardiomyopathy are described.
Third-generation drug-eluting stents (DES) have emerged as first-line devices for percutaneous coronary intervention, even in patients with high bleeding risk. Studies published in 2015 report that bioabsorbable vascular scaffolds are equally effective and safe as DES in low-risk populations and, with the addition of extended dual antiplatelet therapy, might improve long-term outcomes.
Cardiac arrhythmias produce considerable morbidity and mortality, and are challenging to treat. Advances reported in 2015 will help to guide physicians in the use of therapeutic approaches ranging from established pharmaceutical agents through ablation of arrhythmic sources to novel uses of implanted devices for life-threatening bradyarrhythmias and tachyarrhythmias.
In 2015, success in clinical trials in heart failure was obtained mainly from prevention, whereas treatments showed neutral or even adverse effects. A new glucose-lowering medication prevents development of heart failure. Treating central sleep apnoea might be harmful. In Chagas cardiomyopathy, benznidazole treatment did not affect long-term clinical outcomes.
In the first multicentre, randomized trial to compare undersized annuloplasty versus mitral replacement in severe ischaemic mitral regurgitation (MR), higher recurrence of clinically significant MR and increased rehospitalization occurred after repair. With the rapid development of transcatheter mitral valve interventions, valve replacement might be the preferable transcatheter mitral valve therapy.
The Purkinje system can be a source of arrhythmias and has been shown to trigger ventricular fibrillation. The complexity of the molecular mechanisms of ventricular fibrillation, and the incomplete understanding of Purkinje arrhythmogenicity, make the identification of vulnerable individuals challenging. In this Review, Haissaguerre and colleagues discuss the current knowledge of the pathophysiological mechanisms underlying Purkinje-related arrhythmias, and highlight the current therapeutic options.
