Clinical performance of implantable cardioverter-defibrillator lead monitoring diagnostics.

Background: Implantable cardioverter-defibrillator (ICD) lead monitoring diagnostic alerts facilitate the diagnosis of structural lead failure.

Objective: The purpose of this study was to prospectively study the performance of Medtronic ICD lead monitoring alerts.

Methods: A prespecified ancillary substudy, World-Wide Randomized Antibiotic Envelope Infection Prevention Trial, was conducted in patients with an ICD with all available alerts enabled.

Long-term cerebral thromboembolic complications of transapical endocardial resynchronization therapy.

Purpose: Cardiac resynchronization therapy (CRT) is an established therapeutic option in selected heart failure patients (pts). However, the transvenous left ventricular (LV) lead implantation remains ineffectual in a considerable number of pts. Transapical LV (TALV) lead implantation is an alternative minimally invasive, surgical, endocardial implantation technique.

[Catheter ablation of ventricular tachycardias].

Catheter ablation of ventricular tachycardias emerged significantly as standard therapy in the past 20 years. In this review recent advances in catheter ablation of ventricular tachycardias are discussed. The authors first present in details the technical aspects of ablation strategies, main indications and contraindications of ventricular tachycardia ablation and the necessary pre- and postinterventional diagnostic tests.

Alternative techniques for left ventricular pacing in cardiac resynchronization therapy.

Cardiac resynchronization therapy (CRT) is an important treatment modality for a well-defined subgroup of heart failure patients. Coronary sinus (CS) lead placement is the first-line clinical approach but the insertion is unsuccessful in about 5-10% of the patients. In recent years, the number of CRT recipients and the considerable need for left ventricular (LV) lead revisions increased enormously.

Could successful cryoballoon ablation of paroxysmal atrial fibrillation prevent progressive left atrial remodeling?

Background: Radiofrequency catheter ablation of atrial fibrillation (AF) has been proved to be effective and to prevent progressive left atrial (LA) remodeling. Cryoballoon catheter ablation (CCA), using a different energy source, was developed to simplify the ablation procedure. Our hypothesis was that successful CCA can also prevent progressive LA remodeling.

Comparison of the efficacy of two surgical alternatives for cardiac resynchronization therapy: trans-apical versus epicardial left ventricular pacing.

Background: Epicardial pacing lead implantation is the currently preferred surgical alternative for left ventricular (LV) lead placement. For endocardial LV pacing, we developed a fundamentally new surgical method. The trans-apical lead implantation is a minimally invasive technique that provides access to any LV segments.

[Cardiac resynchronization therapy for patients with atrial fibrillation].

Atrial fibrillation and chronic heart failure are two major and even growing cardiovascular conditions that often coexist. Cardiac resynchronization therapy is an important, device-based, non-pharmacological approach in a selected group of chronic heart failure patients that has been shown to improve left ventricular function and to reduce both morbidity and mortality in large randomized trials. The latest European and American guidelines have considered atrial fibrillation patients with heart failure eligible for cardiac resynchronization therapy.

Coupled pacing controls rapid heart rates better than paired pacing during atrial fibrillation.

Aims: Delivery of a ventricular extrastimulus shortly after the effective refractory period (ERP) of a sensed (coupled pacing; CP) or a paced (paired pacing; PP) ventricular event can instantly decrease the mechanical pulse rate (MPR) during rapidly conducting atrial fibrillation (AF). We compared the short-term rate-controlling effects of CP and PP during AF with rapid ventricular rates.

Methods And Results: Sixteen patients with ongoing, spontaneous AF were examined.

Extrasystolic stimulation with bi-ventricular pacing: an acute haemodynamic evaluation.

Aims: Cardiac resynchronization therapy (CRT) by means of biventricular pacing (BiVP) is well established as a treatment for patients with heart failure (HF). Post-extrasystolic potentiation, (PESP) which involves a transient increase in myocardial contractility following a ventricular extrasystole, can be achieved using extrasystolic stimulation (ESS). On this basis, ESS has been proposed as a therapeutic.

Feasibility of percutaneous implantation of transapical endocardial left ventricular pacing electrode for cardiac resynchronization therapy.

Failure of coronary sinus lead implantation for resynchronization therapy requires alternative approaches. For such events we have developed a transapical implantation technique as a feasible alternative. We report the outcome of this technique and its evolution from a minithoracotomy to a percutaneous approach.

[Effectiveness of D,L-sotalol in post-ablative atrial arrhythmias in patients with atrial fibrillation treated with radiofrequency ablation].

Unlabelled: Left atrial tachycardia is the most common arrhythmia developing after pulmonary vein (PV) isolation in patients with atrial fibrillation.

Aim: To compare the clinical effectiveness of class Ic propafenone and class III D,L sotalol in antiarrhythmic treatment of post-ablation left atrial tachycardias.

Methods And Results: A total of 75 consecutive patients with an age of 55.

A novel approach for endocardial resynchronization therapy: initial experience with transapical implantation of the left ventricular lead.

Background: Coronary sinus lead placement for transvenous left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) has a significant failure rate at implant and a considerable dislocation rate during follow-up. For these patients epicardial pacing lead implantation is the most frequently used alternative. Recent data support endocardial lead implantation through the atrial septum and the mitral valve, because this method provides further hemodynamic advantages.

Cavotricuspid isthmus ablation with large-tip gold alloy versus platinum-iridium-tip electrode catheters.

Background: Gold has excellent electrical conductive properties and creates deeper and wider lesions than platinum-iridium during radiofrequency (RF) ablation in vitro. We tested the maximum voltage-guided technique (MVGT) of cavotricuspid isthmus (CTI) ablation using two 8-mm tip catheters containing gold (group G) or platinum-iridium (group PI).

Methods: We enrolled 31 patients who underwent CTI ablation.

[New method for the treatment of atrial fibrillation: circumferential cryoballoon ablation of the pulmonary vein].

Atrial fibrillation is the most frequent arrhythmia with increasing prevalence. Given a limited success rate of drug therapy for atrial fibrillation, interventional treatment options have been developed during the last years. Catheter ablation of atrial fibrillation (until recently the mostly used energy source was radiofrequency energy) has been established as an important therapeutic alternative.

[Electroanatomical mapping systems in catheter ablation of cardiac arrhythmias].

Due to the recent technical development of the past years, most cardiac electrophysiological laboratories are equipped with computer-based electroanatomical mapping systems that precisely describe both the temporal and spatial characteristics of cardiac activation. This development has also been driven by the need for increased accuracy in arrhythmia localization as required for catheter ablation. Computer-based electroanatomical mapping systems are able to reconstruct cardiac anatomy and provide a straightforward representation of chamber activation.

[Implantation of subcutaneous defibrillator in a patient treated for recidive endocarditis, previously operated for tetralogy of Fallot].

Unlabelled: Implantable cardioverter-defibrillator implantation is an important adjunct in the management of these patients, although cardiac device endocarditis is an infrequent, but potentially lethal infectious complication. Cure of cardiac device endocarditis is achievable in the large majority of patients treated with an aggressive approach of combined antimicrobial treatment and complete cardiac device removal. Re-implantation of the device requires additional caution, but still associated with increased risk for recurrences.

Mid-term echocardiographic follow up of left ventricular function with permanent right ventricular pacing in pediatric patients with and without structural heart disease.

Background: Chronic right ventricular apical pacing may have detrimental effect on left ventricular function and may promote to heart failure in adult patients with left ventricular dysfunction.

Methods: A group of 99 pediatric patients with previously implanted pacemaker was studied retrospectively. Forty-three patients (21 males) had isolated congenital complete or advanced atrioventricular block.