The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. The ESC warns readers that the technical language may be misinterpreted and declines any responsibility in this respect. Translated by the Czech Society of Cardiology, the ESC cannot be held liable for the content of this translated document. (c) 2026 European Society of Cardiology. All rights reserved. Published by the Czech Society of Cardiology.
Background: Warfarin, a vitamin K antagonist oral anticoagulant, requires frequent monitoring of the international normalized ratio (INR). Telemedicine has emerged as a crucial tool for facilitating remote healthcare access, particularly during the COVID-19 pandemic. However, the efficacy and safety of this model for managing warfarin patients in Egypt remain unexplored. Aim: This study compared telemedicine with conventional warfarin clinic visits regarding achieving target INR and time in therapeutic range (TTR), while assessing differences in expenses and complications. Methods: Patients receiving warfarin at two tertiary centers in Egypt were randomized into telemedicine or conventional clinic groups. Telemedicine communication utilized telephone and WhatsApp. INR, TTR, cost analysis, and complications were evaluated. Results: This three-month study included 200 patients. No significant baseline differences existed between groups except for higher smoking rates in the clinic group (40% vs. 24%, p = 0.02). Target TTR (>70%) was achieved in 78% of clinic patients and 82% of telemedicine patients (p = 0.48). Among patients with baseline INR <2, target TTR achievement was significantly higher in the telemedicine group (76.5% vs. 30.8%, p <0.001). Supratherapeutic INR incidence was higher in the clinic group (40% vs. 20%, p = 0.002). No significant differences in bleeding or thrombotic events occurred between groups. Telemedicine services demonstrated significantly lower costs than conventional clinics. Conclusion: Telecommunication offers a feasible alternative for warfarin management with comparable efficacy and safety in both urban and rural areas. This method significantly reduces cost burden on healthcare facilities and patients. We recommend adopting standardized telecommunication methods on a broader scale in Egyptian clinical practice.
Background: Appropriate electrical storm (ES) in patients with implantable cardioverter-defibrillators (ICDs) is a life-threatening condition characterized by recurrent, appropriate ICD therapies; antitachycardia pacing (ATP) and/or shocks; within a 24-hour period. Some authors define ES as three or more VT/VF episodes separated by at least 5 minutes of sinus rhythm. ICD shocks have significant adverse effects, and available evidence indicates that patients experiencing ES have poorer outcomes. Potential triggers include changes in or non-adherence to medication, worsening heart failure, early postoperative states, emotional stress, alcohol excess, electrolyte imbalances, myocardial ischemia, and less common factors such as fever. However, many ES episodes occur without any identifiable cause. Objectives: This study aimed to evaluate clinical predictors of appropriate electrical storm in patients with ICDs. Patients and methods: This single-center, retrospective, observational case-control study was conducted at Ibn-Albitar Specialist Center for Cardiac Surgery from April 1, 2016 to January 1, 2017. Twenty-five consecutive ICD patients admitted with appropriate electrical storm were included as the case group and compared with 25 ICD recipients without ES who attended the center for routine programming and follow-up. Results: A total of 50 ICD patients were analyzed: 25 with ES (cases) and 25 without ES (controls). The mean ages of the case and control groups were 54 +/- 12.09 years and 54.8 +/- 12.19 years, respectively. Males constituted 84% of the case group and 40% of the control group. Hypertension was present in 56% of cases and 36% of controls, and diabetes was present in 36% of both groups. Ischemic heart disease was more prevalent among cases (80%) than controls (44%). Left ventricular ejection fraction (LVEF) <40% was found in 80% of cases compared with 44% of controls. Recent heart failure decompensation (within 1 month) occurred in 56% of cases and only 8% of controls. Regarding ICD indication, secondary prevention accounted for 80% of cases and 84% of controls. ICD-VR devices were more common in cases (84%) than in controls (44%), while ICD-DR devices were less frequent in cases (16%) versus controls (56%). Systolic heart failure was present in 80% of both groups. Other etiologies included HOCM (2 cases/2 controls), short QT syndrome (2 cases/2 controls), and Noonan syndrome (1 case/1 control). Obesity (BMI >30) was more prevalent in cases (68%) than in controls (16%). Fever >38 degrees C at the time of ES was documented in 28% of cases, with none reported in controls. Current smoking was more common among cases (56%) than controls (40%). Heavy alcohol use occurred in 4% of both groups. Thyroid function was normal across all subjects. Hypokalemia (<3.5 mmol/L) was present in 64% of cases and 24% of controls, while low magnesium (<1.6 mg/dL) was found in 64% of cases versus 24% of controls. No early cardiac or non-cardiac surgical interventions had occurred within 6 months in either group. Conclusion: Electrical storm is a relatively common complication that may occur at any point after ICD implantation and may recur. The study identified several predictors of ES, including reduced LVEF, ICD implantation for secondary prevention, electrolyte disturbances, and absence of amiodarone or ACE-inhibitor therapy.
Objective: This observational study investigates therapeutic efficacy of bioactive compounds (vitexin, vitamin K2, and vitamin D3, K2VD3) in alleviating claudicatio intermittens in patients with peripheral artery disease (PAD). Methods: Patients with PAD stage IIb under best medical cure were treated with life-style therapy and K2VD3 for 12 months. Results: Mean pain-free walking distance, described at baseline as 123 meters (95% CI 17-297), increase as follow: 376 (95% CI 226-527), 794 (95% CI 517-1070), 2 645 (95% CI 1511-3780), and 2 659 (95% CI 1529-3789) meters after 2, 4, 6 and 12 months, respectively (p <0.001 for each interval if compared with the previous one and the baseline). Moreover, ankle-brachial index also increased, from 0.60 (95% CI 0.22-0.87), to 0.62 after 6 months (95% CI 0.55-0.79) and 0.75 after 12 months (95% CI 0.65-0.90) (p <0.01 only for baseline vs 12 months). Conclusion: K2VD3 can contribute to alleviating claudicatio intermittens in PAD patients. The significant increases in mean pain-free walking distance and ankle-brachial index observed over the 12-month study period support the therapeutic efficacy of this bioactive compound combination. These findings suggest that K2VD3 not only enhances physical performance but also improves vascular health, thereby addressing a critical need in PAD management. Further studies are needed to assess its efficacy in randomized trials, both with and without concomitant lifestyle interventions, to fully elucidate its potential role in clinical practice.
Beta-blockers have been used in the secondary prevention of myocardial infarction for more than forty years. A number of historical clinical studies have demonstrated a significant reduction in both mortality and morbidity when they are administered. The positive effects of beta-blockers are most pronounced in patients with left ventricular systolic dysfunction or with symptoms of heart failure. In the past two years, the results of several large randomized prospective studies have been published, clarifying the role of beta-blockers even in patients after myocardial infarction with mildly reduced or preserved left ventricular ejection fraction. While the benefit of beta-blockers is unquestionable in patients with mildly reduced systolic function, in patients with preserved systolic function the need for beta-blocker administration is rather determined by the presence of other indications, such as angina pectoris, arterial hypertension, or heart rhythm disorders, and the overall cardiovascular risk of the patient.
