Thermal quantitative sensory testing as a screening tool for cardiac autonomic neuropathy in patients with diabetes mellitus.

Introduction: Electrophysiological diagnosis of cardiac autonomic neuropathy (CAN) is based on the evaluation of cardiovascular autonomic reflex tests (CARTs). CARTs are relatively time consuming and must be performed under standardized conditions. This study aimed to determine whether thermal quantitative sensory testing (TQST) can be used as a screening tool to identify patients with diabetes at a higher risk of CAN.

Nonpharmacological Treatment of Atrial Fibrillation: What Is the Role of Device Therapy?

Atrial fibrillation is the most common arrhythmia in the adult population, and its incidence and prevalence are still rising. Cardiac devices are widely used in clinical practice in the management of various rhythm disturbances and heart failure treatment. Many patients who receive a pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization therapy also experience atrial fibrillation in the course of their life.

Is left bundle branch block pattern on the ECG caused by variable ventricular activation sequence?

Background: The presence and extent of ventricular dyssynchrony are currently assessed from the QRS complex morphology and width. However, similar electrocardiography (ECG) pattern may be caused by variable ventricular activation sequence. This may then contribute to interindividually different response to cardiac resynchronization therapy (CRT).

Cardiac autonomic neuropathy may play a role in pathogenesis of atherosclerosis in type 1 diabetes mellitus.

Aims: Cardiac autonomic neuropathy (CAN) is a frequent and severe complication of type 1 diabetes mellitus (T1DM). CAN diagnosis is associated with increased cardiovascular morbidity and mortality, often due to progressive atherosclerosis. Carotid intima media thickness (CIMT) is a surrogate marker of the atherosclerosis.

Symptomatic arrhythmias due to syringomyelia-induced severe autonomic dysfunction.

Unlabelled: Syringomyelia is characterized by cavity formation in the spinal cord, most often at C2-Th9 level. Clinical manifestation reflects extent and localization of the spinal cord injury.

Cases: 20-year old woman was admitted for recurrent rest-related presyncopes with sudden manifestation.

Ablation of hypertrophic septum using radiofrequency energy: an alternative for gradient reduction in patient with hypertrophic obstructive cardiomyopathy?

Introduction: Alcohol septal ablation and surgical myectomy represent accepted therapeutic options for treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy. Long-term experience with radiofrequency ablation of arrhythmogenic substrates raised a question if this technique might be effective for left ventricular outflow tract (LVOT) gradient reduction.

Case Report: We report on a 63-year-old patient with recurrence of symptoms 1 year after alcohol septal ablation (ASA) leading originally to a significant reduction of both symptoms and gradient.

Assessment of left ventricular function in non-dilated and dilated hearts: comparison of contrast-enhanced 2-dimensional echocardiography with multi-detector row CT angiography.

Objective: Multidetector-row CT (MDCT) and contrast-enhanced echocardiography (CEE) are being increasingly used for assessment of left ventricular (LV) function. Excellent spatial and contrast resolution of MDCT allows this evaluation along with coronary angiography. CEE improves the accuracy of 2D echocardiography.

Pulmonary vein antrum isolation, atrioventricular junction ablation, and antiarrhythmic drugs combined with direct current cardioversion: survival rates at 7 years follow-up.

Purpose: To report survival rates in patients treated with pulmonary vein antrum isolation (PVAI), atrioventricular junctional ablation (AVJA), and antiarrhythmic and direct current cardioversion (A+DCCV) at 7 years follow-up.

Methods: From February 2002-December 2004, 1,000 consecutive patients underwent PVAI or A+DCCV or AVJA. These patients were matched in a nested casecontrolled methodology.

Integration of positron emission tomography/computed tomography with electroanatomical mapping: a novel approach for ablation of scar-related ventricular tachycardia.

Background: Despite the recent advances in cardiac mapping, ablation of scar-related ventricular tachycardia (VT) still remains a clinical challenge. A detailed electroanatomical map is a prerequisite for accurate localization and ablation of the VT substrate.

Objective: The purpose of this study was to evaluate the feasibility and accuracy of integrating the positron emission tomography (PET)/computed tomography (CT) with the electroanatomical map and compare the accuracy of the voltage-based scar with the biological scar.

The impact of myocardial viability on the clinical outcome of cardiac resynchronization therapy.

Introduction: Around 30% of patients do not respond to cardiac resynchronization therapy (CRT). Nonischemic cardiomyopathy has been identified as an independent predictor of response to CRT, probably due to the absence of compact scar.

Methods And Results: The relationship between cardiac scar, ischemia, and hibernation (both at the left-ventricular pacing site and as a total burden) and response to CRT was studied in patients with ischemic cardiomyopathy using the perfusion-viability positron emission tomography (PET) test.

The magnitude of reverse remodelling irrespective of aetiology predicts outcome of heart failure patients treated with cardiac resynchronization therapy.

Aims: We assessed the relationship between cardiac resynchronization therapy (CRT)-induced reverse remodelling and mortality during a long-term follow-up in a prospective observational study.

Methods And Results: We analyzed data from a prospective registry including 398 consecutive patients who underwent CRT between September 1998 and September 2007. Left ventricular ejection fraction (LVEF) was assessed before CRT and in the period between 3 and 6 months following implant.

Efficacy, safety, and outcome of atrial fibrillation ablation in septuagenarians.

Aims: Catheter ablation is an effective treatment for atrial fibrillation (AF). The outcome of AF ablation in septuagenarians is not clear. Our aim was to evaluate success rate, outcome, and complication rate of AF ablation in septuagenarians.

Radiofrequency ablation of atypical atrial flutter after cardiac surgery or atrial fibrillation ablation: a randomized comparison of open-irrigation-tip and 8-mm-tip catheters.

Background: The efficacy of radiofrequency ablation of atypical atrial flutter (AAFL) remains relatively low. This is probably related to the complex mechanism of this arrhythmia or may be due to an inability to deliver sufficient energy during ablation.

Objective: The aim of this study is to assess whether an open-irrigation-tip catheter or an 8-mm-tip catheter is more effective for ablation of AAFL in patients with prior history of cardiac surgery and/or catheter ablation of atrial fibrillation.

Decrease in plasma B-type natriuretic peptide early after initiation of cardiac resynchronization therapy predicts clinical improvement at 12 months.

Background: Decrease in neurohormonal activation during pharmacotherapy for chronic heart failure (CHF) is associated with haemodynamic and clinical improvement. We tested the hypothesis that changes in neurohormonal activation after initiation of cardiac resynchronization therapy (CRT) predict its long-term clinical effect.

Methods: The study group included 43 patients with CHF (37 males, mean age 62+/-9 years, NYHA class 3.

Optimization of right ventricular lead position in cardiac resynchronisation therapy.

Background: The benefit of biventricular pacing (BiV) may be substantially affected by optimal lead placement.

Aim: To evaluate the importance of right ventricular (RV) lead positioning on clinical outcome of BiV.

Methods And Results: A total of 99 patients with symptomatic heart failure and implantation of BiV system were included.

Ventricular activation patterns during different pacing modes. An insight from electroanatomical mapping.

Background: Biventricular pacing (BiV) is employed as the current standard for cardiac resynchronisation therapy. Other pacing modalities have been proposed as alternatives; however, data on changes in electrical activation sequence caused by pacing from various sites are limited.

Aim: To describe changes in activation patterns during different ventricular pacing modes in patients with chronic heart failure.

Influence of different atrioventricular and interventricular delays on cardiac output during cardiac resynchronization therapy.

Restoration of the atrioventricular (AVD) and interventricular (VVD) delays increases the hemodynamic benefit conferred by biventricular (BiV) stimulation. This study compared the effects of different AVD and VVD on cardiac output (CO) during three stimulation modes: BiV-LV = left ventricle (LV) preceding right ventricle (RV) by 4 ms; BiV-RV = RV preceding LV by 4 ms; LVP = single-site LV pacing. We studied 19 patients with chronic heart failure due to ischemic or idiopathic dilated cardiomyopathy, QRS >/= 150 ms, mean LV end-diastolic diameter = 78 +/- 7 mm, and mean LV ejection fraction = 21 +/- 3%.

Technical aspects of implantation of LV lead for cardiac resynchronization therapy in chronic heart failure.

The goal of this study was to analyze total procedural and fluoroscopic time during initial experience with implantation of LV lead in a single center, and to assess the performance of electrophysiologically-guided approach for cannulation of the coronary sinus (CS) in a subsequent period. Over an initial period of 29 months, a total of 46 attempts to implant biventricular pacing system were revised. During the first phase, only one type of LV electrode was available for three implanters (11 attempts).

Is right ventricular outflow tract pacing an alternative to left ventricular/biventricular pacing?

The right ventricular apex has been used as the traditional pacing site since the development of transvenous pacing in 1959. Some studies suggest that pacing the right ventricular apex may cause remodeling and is harmful. In the past decade, there have been a multitude of studies of the hemodynamic, electrophysiological, electrocardiographic, and clinical effects of ventricular pacing at other sites.

Performance of left ventricular versus biventricular pacing in chronic heart failure assessed by stress echocardiography.

Acute hemodynamic studies suggest that resynchronization therapy using single-site left ventricular pacing (LVP) is equivalent to biventricular pacing (BIVP). The aim of this study was to assess the performance of LVP versus BIVP during exercise by means of stress echocardiography. A total of 28 patients (25 men and 3 women, mean age 60.