Incidence and clinical relevance of uncontrolled ventricular rate during atrial fibrillation in heart failure patients treated with cardiac resynchronization therapy.

Aims: Uncontrolled ventricular rate (VR) during atrial fibrillation (AF) may cause clinical deterioration in heart failure (HF) patients who need continuous biventricular pacing to achieve cardiac resynchronization therapy (CRT). We aimed at evaluating the association between AF, uncontrolled VR, and sub-optimal CRT, defined as low biventricular pacing percentage (BIVP%).

Methods And Results: All 1404 patients had HF, New York Heart Association (NYHA) ≥II, left ventricular ejection fraction (LVEF) ≤35%, and QRS ≥120 ms, and received an implantable CRT defibrillator (CRT-D).

Automatic adjustment of stimulation output in resynchronization therapy: impact and effectiveness in clinical practice.

Background: Algorithms for automatic pacing output adjustment have been implemented in pacemakers and implantable defibrillators (ICD) and recently in cardiac resynchronization therapy defibrillators (CRT-D). We assessed the impact and effectiveness of these automatic features.

Method And Results: We prospectively enrolled patients successfully implanted with the following Medtronic CRT-Ds: Concerto [with automatic left ventricular (LV) output management algorithm], Consulta [automatic management of atrial, right ventricular (RV) and LV voltage], and Sentry (only manual voltage adjustments).

Physiopathologic correlates of intrathoracic impedance in chronic heart failure patients.

Background: Increased plasma levels of amino-terminal fraction of brain natriuretic peptide (NT-proBNP) and alterations of diastolic filling as described by Doppler transmitral flow pattern are well-known markers of decompensated heart failure (HF). Recently, some implantable defibrillators have allowed monitoring of intrathoracic impedance, which is related to lung water content, potentially indicating HF deterioration. The aim of this study was to assess the correlation between intrathoracic impedance and NT-proBNP and echo-Doppler transmitral flow indexes.

Intrathoracic and ventricular impedances are associated with changes in ventricular volume in patients receiving defibrillators for CRT.

Background: Some implantable cardioverter defibrillators (ICD) are able to monitor intrathoracic impedance to detect pulmonary fluid overload. This is achieved by measuring impedance between the ICD case and the right ventricular (RV) lead. We hypothesized that the measured impedance would rise with improvement in left ventricular (LV) volumes during cardiac resynchronization therapy (CRT), and that such impedance changes would be more apparent when measured with an alternative pacing vector.

Monitoring intrathoracic impedance with an implantable defibrillator reduces hospitalizations in patients with heart failure.

Purpose: Some implantable cardioverter-defibrillators (ICDs) are now able to monitor intrathoracic impedance. The aim of the study was to describe the use of such monitoring in clinical practice and to evaluate the clinical impact of the fluid accumulation alert feature of these ICDs.

Methods And Results: Five hundred thirty-two heart failure (HF) patients implanted with these ICDs were followed up for 11 +/- 7 months.

Implantable CRT device diagnostics identify patients with increased risk for heart failure hospitalization.

Purpose: To determine the association between device-determined diagnostic indices, including intrathoracic impedance, and heart failure (HF) hospitalization.

Methods: Clinical and device diagnostic data of 558 HF patients indicated for CRT-D therapy (In Sync Sentry, Medtronic Inc.) were prospectively collected from 34 centers.

Congenital coronary artery anomalies angiographic classification revisited.

Many fragmental classification of coronary artery anomalies (CAAs) exist, but a simple practical angiographic classification for angiographers has been never proposed. This study is aimed to suggest a simplified angiographic classification of congenital CAAs based on just a few univocal common angiographic patterns. The authors reviewed 5100 coronary angiographies in order to select CAAs patients and identify simple common angiographic features.