Real-World Assessment of Acute Left Ventricular Lead Implant Success and Complication Rates: Results from the Attain Success Clinical Trial.

Background: Left ventricular lead (LVL) implant success rates have historically ranged between 70.5% and 95.5%.

Deleterious effect of right ventricular apical pacing on left ventricular diastolic function and the impact of pre-existing diastolic disease.

Aims: Right ventricular apex (RVA) pacing may have deleterious effects on left ventricular (LV) systolic function, but its impact on LV diastolic function has not been explored.

Methods And Results: Ninety-seven patients with sinus node dysfunction and ejection fraction (EF) ≥ 50% with permanent RVA pacing were randomly programmed to V-sense and V-pace modes and examined by echocardiography. Tissue Doppler imaging was employed to assess myocardial systolic velocity (S') and early diastolic velocity (E') at the mitral annulus.

Multicenter clinical experience with an atrial lead designed to minimize far-field R-wave sensing.

Aims: To evaluate a novel atrial lead designed to reduce far-field sensing.

Methods And Results: Sixty-three patients with standard pacing indications were randomized to receive an OptiSense 1699T (St Jude Medical, USA) or conventional pacing lead in the right atrium. Post-implant follow-up was conducted for all patients at 90 days and for a subset at 360 days.

Incremental prognostic value of combining left ventricular lead position and systolic dyssynchrony in predicting long-term survival after cardiac resynchronization therapy.

The efficacy of CRT (cardiac resynchronization therapy) can be affected by a number of factors; however, the prognostic significance of the LV (left ventricular) lead position has not been explored. The aim of the present study was to examine whether a PL (posterolateral) lead position has an additional value to systolic dyssynchrony in predicting a better survival after CRT. Patients (n=134) who received CRT were followed-up for 39+/-24 months.

Effect of left ventricular lead concordance to the delayed contraction segment on echocardiographic and clinical outcomes after cardiac resynchronization therapy.

Introduction: The optimal left ventricular (LV) pacing site for cardiac resynchronization therapy (CRT) is unclear. The current study aims to explore the clinical significance of LV lead concordance to delayed contraction segment in CRT.

Methods And Results: Concordant LV lead position was defined as the lead tip located by fluoroscopy at or immediately adjacent to the LV segment with latest contraction determined by tissue Doppler imaging.

Left ventricular systolic dyssynchrony is a predictor of cardiac remodeling after myocardial infarction.

Objectives: We sought to determine whether early assessment of left ventricular (LV) dyssynchrony by tissue Doppler imaging may predict progressive ventricular enlargement and cardiac dysfunction after acute myocardial infarction (MI).

Methods: Forty-seven patients (mean age 59.9 +/- 11.

Improvement of left atrial function is associated with lower incidence of atrial fibrillation and mortality after cardiac resynchronization therapy.

Background: Left atrial (LA) volume is a predictor of cardiovascular events in patients with heart failure. Improvement of LA function and reverse remodeling was observed after cardiac resynchronization therapy (CRT).

Objective: The purpose of this study was to explore the clinical significance of improvement in LA function after CRT.

Reversible left ventricular dyssynchrony and heart failure induced by right ventricular pacing.

Right ventricular (RV) pacing related heart failure is reported in some patients after long term pacing. The exact mechanism is not yet clear but may be related to left ventricular (LV) dyssynchrony induced by RV apical pacing. We report one case with baseline normal LV ejection fraction but complicated by heart failure and ventricular tachycardia after 4 months of pacing for complete heart block together with illustration of LV dyssynchrony demonstrated by tissue Doppler imaging.

Impact of atrial fibrillation in heart failure with normal ejection fraction: a clinical and echocardiographic study.

Background: The clinical significance of atrial fibrillation (AF) in heart failure with normal ejection fraction (HFNEF) remains undetermined.

Methods And Results: We compared the clinical and echocardiographic characteristics among 238 patients hospitalized for HF. Using the cutoff of left ventricular EF of 50%, there were 146 patients with HFNEF (AF = 42) and 92 with systolic HF (AF = 30).

Effect of left ventricular endocardial activation pattern on echocardiographic and clinical response to cardiac resynchronization therapy.

Objective: To explore the left ventricular (LV) electrical activation pattern in heart failure (HF) and its implication to cardiac resynchronization therapy (CRT).

Design And Setting: Observational study at the University Teaching Hospital.

Patients: 23 optimally treated patients with HF with New York Heart Association class III, QRS duration >120 ms and LV ejection fraction <35%.

Prognostic value of renal function in patients with cardiac resynchronization therapy.

Background: Renal insufficiency is prevalent in patients with heart failure and indicates poor prognosis. We examine (i) the relationship between left ventricular (LV) reverse remodeling (RR) and renal function and (ii) the prognostic value of renal function in patients receiving cardiac resynchronization therapy (CRT).

Methods: The relationship between LV-RR, defined as a 10% reduction in LV end-systolic volume, and renal function was examined in 85 consecutive patients receiving CRT.

Effect of cardiac resynchronization therapy in patients with moderate left ventricular systolic dysfunction and wide QRS complex: a prospective study.

Background: We sought to investigate the effect of cardiac resynchronization therapy (CRT) on disease progression in patients with moderate left ventricular (LV) systolic dysfunction.

Methods And Results: This is a prospective study to explore the effect of CRT in 15 optimally treated patients (age: 66.1 +/- 12.

Atrial strain rate echocardiography can predict success or failure of cardioversion for atrial fibrillation: a combined transthoracic tissue Doppler and transoesophageal imaging study.

Aims: The purpose of this study was to assess the feasibility of measuring left atrial dysfunction with tissue Doppler imaging derived strain rate and to explore its role in predicting the maintenance of sinus rhythm after cardioversion for atrial fibrillation.

Methods And Results: Strain rate (SR) and tissue Doppler imaging (TDI) were performed with offline analysis of the basal left atrial wall (LA). SR detected a systolic (Ssr) and early diastolic (Esr) deformation induced by ventricular motion.

Suboptimal medical therapy in patients with systolic heart failure is associated with less improvement by cardiac resynchronization therapy.

Background: Proven medical therapy is under-prescribed in heart failure (HF) for various reasons. Cardiac resynchronization therapy (CRT) is of proven value in selected patients with HF; however, the degree of benefit in those without the optimal therapy is not clear.

Methods: This is a retrospective study comparing the effect of CRT in 30 patients without optimal combination therapy (group 1; 10 (33%) without ACEi or equivalent and 25 (83%) without beta-blockers) to an age, sex, ejection fraction (EF) and New York Heart Association (NYHA) class matched control but with the combination (group 2; n=30) at baseline.

Cardiac resynchronization therapy: Part 2--issues during and after device implantation and unresolved questions.

Encouraged by the clinical success of cardiac resynchronization therapy (CRT), the implantation rate has increased exponentially, although several limitations and unresolved issues of CRT have been identified. This review concerns issues that are encountered during implantation of CRT devices, including the role of electroanatomical mapping, whether CRT implantation should be accompanied by simultaneous atrioventricular nodal ablation in patients with atrial fibrillation, procedural complications, and when to consider surgical left ventricular lead positioning. Furthermore, (echocardiographic) CRT optimization and assessment of CRT benefits after implantation are highlighted.

Cardiac resynchronization therapy: Part 1--issues before device implantation.

Cardiac resynchronization therapy (CRT) has been used extensively over the last years in the therapeutic management of patients with end-stage heart failure. Data from 4,017 patients have been published in eight large, randomized trials on CRT. Improvement in clinical end points (symptoms, exercise capacity, quality of life) and echocardiographic end points (systolic function, left ventricular size, mitral regurgitation) have been reported after CRT, with a reduction in hospitalizations for decompensated heart failure and an improvement in survival.

Strain rate imaging differentiates transmural from non-transmural myocardial infarction: a validation study using delayed-enhancement magnetic resonance imaging.

Objectives: The aim of this study was to determine if strain rate imaging (SRI) correlates with the transmural extent of myocardial infarction (MI) measured by contrast-enhanced magnetic resonance imaging (Ce-MRI).

Background: Identification of the transmural extent of myocardial necrosis and degree of non-viability after acute MI is clinically important.

Methods: Tissue Doppler echocardiography with SRI and Ce-MRI were performed in 47 consecutive patients with a first acute MI between days 2 and 6 and compared to 60 age-matched healthy volunteers.

Do metoprolol and carvedilol have equivalent effects on diurnal heart rate in patients with chronic heart failure?

Background: Carvedilol exerted a greater reduction in mortality than metoprolol tartrate in the Carvedilol or Metoprolol European Trial (COMET). However, it is unclear if the degree and time course of beta1-blockade during a 24-h period was similar with each agent at the doses used. Therefore we analyzed 24-h ECG Holter recordings from a study which compared the long-term clinical efficacy of metoprolol tartrate to carvedilol in chronic heart failure patients using the same dosing regimen as in COMET.