Performance of an active fixation bipolar left ventricular lead vs passive fixation quadripolar leads in cardiac resynchronization therapy, a randomized trial.

Background: Usage of active fixation bipolar left ventricular (LV) leads represents an alternative approach to the more commonly used passive fixation quadripolar leads in cardiac resynchronization therapy (CRT). We compared a bipolar LV lead with a side screw for active fixation and passive fixation quadripolar LV leads.

Methods: Sixty-two patients were before CRT implantations randomly allocated to receive a bipolar (n = 31) or quadripolar (n = 31) LV leads.

Clinical outcome of cardiac resynchronization therapy in patients randomized to an active fixation bipolar left ventricular lead a passive quadripolar lead.

To compare the clinical outcome of cardiac resynchronization therapy (CRT) in patients receiving a bipolar left ventricular (LV) lead with a side helix for active fixation to the outcome in patients receiving a quadripolar passive fixation LV lead. Sixty-two patients (mean age 72 ± 11 years) were blindly and randomly assigned to the active fixation bipolar lead group ( = 31) or to the quadripolar lead group (= 31). The LV leads were targeted to the basal LV segment in a vein concordant to the LV segment with the latest mechanical contraction chosen on the basis of preoperative radial strain (RS) echocardiography.

Impact of Cardiac Implantable Electronic Device Infection: A Clinical and Economic Analysis of the WRAP-IT Trial.

Background: Current understanding of the impact of cardiac implantable electronic device (CIED) infection is based on retrospective analyses from medical records or administrative claims data. The WRAP-IT (Worldwide Randomized Antibiotic Envelope Infection Prevention Trial) offers an opportunity to evaluate the clinical and economic impacts of CIED infection from the hospital, payer, and patient perspectives in the US healthcare system.

Methods: This was a prespecified, as-treated analysis evaluating outcomes related to major CIED infections: mortality, quality of life, disruption of CIED therapy, healthcare utilization, and costs.

Performance of a novel active fixation quadripolar left ventricular lead for cardiac resynchronization therapy: Attain Stability Quad Clinical Study results.

Introduction: The Medtronic Attain Stability Quad lead is a quadripolar left ventricular (LV) lead with an active fixation helix assembly designed to fixate the lead within the coronary sinus and pace nonapical regions of the LV. The primary objective of this study was to determine the safety and effectiveness of this novel active fixation quadripolar LV lead.

Methods: Patients with standard indications for cardiac resynchronization therapy (CRT) were enrolled.

Leadless pacemaker implant in patients with pre-existing infections: Results from the Micra postapproval registry.

Introduction: Leadless pacemakers may provide a safe and attractive pacing option to patients with cardiac implantable electronic device (CIED) infection. We describe the characteristics and outcomes of patients with a recent CIED infection undergoing Micra implant attempt.

Methods And Results: Patients with prior CIED infection and device explant with Micra implant within 30 days, were identified from the Micra post approval registry.

Atrioventricular nodal ablation in patients with resynchronization therapy and atrial fibrillation - long term results.

Objectives: Atrioventricular nodal ablation (AVNA) is recommended for patients (pts) with cardiac resynchronization therapy (CRT) having atrial fibrillation (AF) and incomplete ventricular capture (Class IIa, level B). AVNA reduces mortality and improves the New York Heart Association (NYHA) functional class during intermediate term follow-up. The objectives were to study the long-term outcome regarding quality of life (QoL) and survival of our CRT pts after AVNA.

Active fixation of a thin transvenous left-ventricular lead by a side helix facilitates targeted and stable placement in cardiac resynchronization therapy.

Aims: Suboptimal placement, phrenic nerve stimulation, and dislodgements of left-ventricular (LV) leads are main challenges in cardiac resynchronization therapy. We investigated the handling, performance, safety, and stability for a novel 4Fr LV lead with a small side helix located proximal to the ring electrode for active fixation of the LV lead.

Methods And Results: The novel LV lead was successfully implanted in 103 of 106 patients.

The impact of left ventricular lead position on left ventricular reverse remodelling and improvement in mechanical dyssynchrony in cardiac resynchronization therapy.

Aims: To investigate the influence of left ventricular (LV) lead position on LV dyssynchrony in cardiac resynchronization therapy (CRT).

Methods And Results: The LV lead was prospectively targeted to the latest activated LV segment (concordant) evaluated by two-dimensional speckle tracking radial strain (ST-RS) echocardiography in 103 CRT recipients (67 ± 12 years). Mechanical dyssynchrony was assessed by anteroseptal-to-posterior (AS-P) delay and interventricular mechanical delay (IVMD).

Cardiovascular complications of spinal cord injury.

Background: The aim of this paper is to provide an overview of the autonomic innervation of the cardiovascular system and the cardiovascular sequelae of spinal cord injuries.

Method: A literature search was carried out in the PubMed database, with the search phrases "traumatic spinal cord injury"/"traumatic spinal cord injuries" together with "autonomic dysfunction", "autonomic dysreflexia" and "cardiovascular disease".

Results: The most important cardiovascular complications in the acute phase are bradyarrhythmia, hypotension, enhanced vasovagal reflexes, supraventricular/ventricular ectopic beats, vasodilation and venous stasis.

Right ventricular pacing and sensing function in high posterior septal and apical lead placement in cardiac resynchronization therapy.

Background: The conventional right ventricular (RV) lead position in cardiac resynchronization therapy pacemakers (CRT-P) is the RV apex (RV-A). Little is known about electrophysiological stability and associated complications of pacing leads in RV high posterior septal (RV-HS) position in CRT-P.

Methods: Two hundred and thirty-five consecutive CRT-P patients were included from 1999-2010.

Clinical implication of right ventricular to left ventricular interlead sensed electrical delay in cardiac resynchronization therapy.

Aims: To evaluate the clinical implication of right ventricular (RV) to left ventricular (LV) interlead sensed electrical delay (RV-LVs) and the relation to ventricular lead position in cardiac resynchronization therapy (CRT).

Methods And Results: Eighty-five consecutive CRT patients (mean age 66 ± 11 years) received LV lead prospectively targeted to the latest mechanical activated segment (concordant), assessed by two-dimensional speckle tracking radial strain (ST-RS) echocardiography. The RV lead was randomized to RV apex (n= 43) or RV high posterior septum (n= 42).

A randomized study of haemodynamic effects and left ventricular dyssynchrony in right ventricular apical vs. high posterior septal pacing in cardiac resynchronization therapy.

Aims: The effect on left ventricular (LV) systolic function and LV dyssynchrony by alternative right ventricular (RV) lead position in cardiac resynchronization therapy (CRT) is unclear. In the present study, RV apical (RV-A) was compared with RV high posterior septal (RV-HS) lead position in CRT.

Methods And Results: In 85 consecutive CRT patients (mean age 66 ±11 years) the RV lead placement was randomized to RV-A (n = 43) or RV-HS (n = 42).

Cardiovascular and urological dysfunction in spinal cord injury.

Objective: A spinal cord injury (SCI) above the sixth thoracic vertebra interrupts the supraspinal control of the sympathetic nervous system causing an imbalance between the sympathetic and the parasympathetic nervous system. This article focuses on the symptoms, treatment and examination of autonomic disturbances of the cardiovascular and the urinary system after a SCI.

Methods: A non-systematic literature search in the PubMed database.

Treatment of cardiogenic shock with left ventricular assist device combined with cardiac resynchronization therapy: a case report.

Cardiogenic shock has a poor prognosis with established treatment strategies. We report a 62 years old man with heart failure exacerbating into refractory cardiogenic shock successfully treated with the combination of a percutaneous left ventricular assist device (LVAD) and subacute cardiac resynchronization therapy (CRT) implantable cardioverter-defibrillator device (CRT-D).

[Cardiac resynchronization therapy in severe congestive heart failure].

Background: Cardiac resynchronization therapy (CRT) is an established method for treatment of patients with severe congestive heart failure and asynchronous left ventricular contraction. Its clinical and haemodynamic benefits are well documented. We have retrospectively reviewed CRT performed at our centre.

Techniques for identification of left ventricular asynchrony for cardiac resynchronization therapy in heart failure.

The most recent treatment option of medically refractory heart failure includes cardiac resynchronization therapy (CRT) by biventricular pacing in selected patients in NYHA functional class III or IV heart failure. The widely used marker to indicate left ventricular (LV) asynchrony has been the surface ECG, but seems not to be a sufficient marker of the mechanical events within the LV and prediction of clinical response. This review presents an overview of techniques for identification of left ventricular intra- and interventricular asynchrony.

Assessment of regional timing of left ventricular systolic longitudinal movement by Doppler tissue synchronization imaging in structurally normal hearts.

Aims: To study the feasibility of a new semiautomatic echocardiographic modality called Tissue Synchronization Imaging (TSI) for measurement of the longitudinal left ventricular (LV) movement.

Methods And Results: TSI was used in 20 subjects with structurally normal hearts to measure the time aspect of the regional longitudinal LV systolic movement in the apical four chamber view. Inter- and intraobserver agreement and the beat to beat variation were tested and compared to previously manually measured peak systolic delay (PSD) between the interventricular septum (IS) and the lateral free wall (LFW) at basal and mid LV, respectively (n=19).

Device treatment of atrial tachycardia--minor additional effect of repeating pacing sequences.

Purpose: Ramp and burst pacing as treatment for atrial tachycardia (AT), one known trigger mechanism of atrial fibrillation (AF) are available in permanent pacemakers to reduce the burden of AF. An analysis of the success rate of three consecutive antitachycardia pacing sequences is presented.

Method: The AT 500 (Medtronic) pacemaker was implanted in 36 patients (18 female, mean age 77+/-11 years) with pacemaker indication due to tachybrady arrhythmias (n=34), and other indications (n=2).

Reducing atrial tachycardia and atrial fibrillation episodes with a prevention and treatment device and tailored treatment.

Background: Pacemaker treatment of known trigger mechanisms for atrial tachyarrhythmias (AT) and atrial fibrillation (AF) has shown reduction in the incidence of AF. A new arrhythmia management device, which included storage of AT/AF (for tailoring treatment) and three prevention algorithms and one for treatment, was examined in order to identify the influence on arrhythmia episodes over a 12-month follow-up (FU) period.

Methods: Twenty-three consecutive patients with known tachybradyarrhythmias were examined.

Proportionality of rate response to metabolic workload provided by a rate adaptive pacemaker with automatic rate profile optimization.

Objective: The rate response of a pacemaker (PM) was compared with the sinus rate in patients during repeated exercise tests, at different settings of the rate response parameters.

Methods And Results: In patients with paroxysmal sick sinus syndrome (n=3) or atrioventricular block (n=8), a rate responsive PM was implanted. The activity-dependent pacing rate is represented by the sensor indicated rate (SIR).

Reverse remodelling of systolic left ventricular contraction pattern by long term cardiac resynchronisation therapy: colour Doppler shows resynchronisation.

Objective: To quantify long term effects of cardiac resynchronisation therapy (CRT) by biventricular pacing in patients with heart failure (HF).

Methods: Regional changes in left ventricular (LV) contraction patterns effected by CRT in 19 patients with HF (12 with ischaemia; mean (SD) age 66 (9) years) with bundle branch block were examined by colour Doppler tissue velocity imaging (c-TVI). Time differences during main systolic tissue velocity peak (SYS) were compared in the basal and mid LV interventricular septum and in the corresponding LV free wall segments.

Color Doppler tissue velocity imaging demonstrates significant asynchronous regional left ventricular contraction and relaxation in patients with bundle branch block and heart failure compared with control subjects.

Bundle branch block in patients with severe heart failure (HF) may result in asynchronous regional left ventricular (LV) contraction. Colour Doppler tissue velocity imaging (c-TVI) allows tissue velocity profiles to be measured with a resolution of 10 ms. Normal subjects (n = 30) showed a synchronous regional longitudinal LV pattern of movement, and HF patients with bundle branch block (n = 30) showed asynchronous contraction and relaxation patterns which were quantified by c-TVI as ranging from -22 to 19 ms.

Feasibility of color doppler tissue velocity imaging for assessment of regional timing of left ventricular longitudinal movement.

OBJECTIVE--The feasibility of color Doppler tissue velocity imaging (c-TVI) with a high time resolution of 10 ms for simultaneous measurement of the temporal characteristics of regional left ventricular (LV) tissue velocities at different LV sites was examined. Methods and results--In 20 subjects with structurally normal hearts, inter- and intraobserver agreement and the beat-to-beat variation were tested in c-TVI profiles from basal and mid-LV segments of the interventricular septum (IS) and of the lateral free wall (LFW). For peak tissue velocities a mean error of less than 1 cm/s was demonstrated.