Gender difference in coronary sinus anatomy and left ventricular lead pacing parameters in patients with cardiac resynchronization therapy.

Background:  Recent studies have suggested better outcomes from cardiac resynchronization therapy (CRT) in women. Gender differences in coronary sinus (CS) anatomy and left ventricular (LV) lead parameters in patients undergoing CRT, however, have not been well studied.

Methods And Results:  Two hundred and twenty-three consecutive patients, undergoing CRT at the University of California in San Diego Medical Center from 2003 to 2011 were included in this study.

Recovery of mitral isthmus conduction leads to the development of macro-reentrant tachycardia after left atrial linear ablation for atrial fibrillation.

Background: Left atrial linear ablation for atrial fibrillation (AF) may be proarrhythmic, leading to left atrial macro-reentrant tachycardia (LAT). Whether due to failure to achieve block initially or to recovery of conduction after ablation is unknown. This study was designed to evaluate the frequency of recovery of mitral isthmus (MI) conduction compared with cavo-tricuspid isthmus (CTI) conduction, and the relationship between recovery of MI conduction and postablation LAT.

Congenital narrowing of a pulmonary vein: slit-like pulmonary vein ostium.

We report the case of a 60-year-old female with a history of refractory paroxysmal atrial fibrillation. Preablation contrast enhanced pulmonary vein computed tomography (CT) scan demonstrated a slit-like narrowing of the left inferior pulmonary vein ostium. The narrowing measured approximately 3 mm, with poststenotic dilation.

Circumferential pulmonary vein ablation with additional linear ablation results in an increased incidence of left atrial flutter compared with segmental pulmonary vein isolation as an initial approach to ablation of paroxysmal atrial fibrillation.

Background: There has been growing concern that linear ablation is associated with an increased risk of iatrogenic arrhythmias in patients undergoing ablation for atrial fibrillation (AF). Therefore, we compared circumferential pulmonary vein ablation plus left atrial linear ablation (CPVA+LALA) with segmental pulmonary vein isolation (PVI)in patients with paroxysmal AF.

Methods And Results: Sixty-six consecutive patients with paroxysmal AF were prospectively randomly assigned to receive PVI versus CPVA+LALA (consisting of encircling lesions around the pulmonary veins), a roof line, and a mitral isthmus line with documentation of bidirectional mitral isthmus block.

Effect of mitral isthmus block on development of atrial tachycardia following ablation for atrial fibrillation.

Background: Successful mitral isthmus (MI) ablation may reduce recurrence of atrial fibrillation (AF) and macro-reentrant atrial tachycardia (AT) after pulmonary vein isolation (PVI) for AF.

Objective: To determine if achieving bidirectional MI conduction block (MIB) during circumferential pulmonary vein ablation (CPVA) plus left atrial linear ablation (LALA) affects development of AT.

Methods: Sixty consecutive patients with persistent (n = 25) or paroxysmal (n = 35) AF undergoing CPVA plus LALA at the MI and LA roof were evaluated in a prospective, nonrandomized study.

Five-year outcomes after segmental pulmonary vein isolation for paroxysmal atrial fibrillation.

Most studies evaluating the efficacy of atrial fibrillation (AF) ablation report follow-up periods of 1 year to 2 years, but few report long-term results of > or =5 years after ablation. Therefore, we evaluated the long-term efficacy (i.e.

What is the optimal approach for ablation of paroxysmal atrial fibrillation?

The optimal approach for catheter ablation of paroxysmal atrial fibrillation (PAF) is the subject of some controversy. Recent guidelines define PAF as recurrent AF that terminates spontaneously within seven days. For patients with PAF, the three most commonly employed approaches for ablation include, (1) segmental ostial or antral pulmonary vein isolation (PVI), (2) circumferential pulmonary vein ablation (CPVA) alone or in combination with additional left atrial linear ablation (LALA), and (3) complex fractionated atrial electrograms (CFAE) ablation alone or in combination with segmental PVI or CPVA (with or without additional LALA).

Sudden cardiac arrest in patients with preserved left ventricular systolic function: a clinical dilemma.

Stratifying the risk for sudden cardiac arrest (SCA) in individuals with preserved systolic function remains a pressing public health problem. Current guidelines for the implantation of cardiac defibrillators largely ignore patients with preserved systolic function, even though they account for the majority of cases of SCA. Risk stratification for such individuals may be increasingly feasible.

Diagnosis and management of typical atrial flutter.

Typical atrial flutter (AFL) is a common atrial arrhythmia that may cause significant symptoms and serious adverse effects including embolic stroke, myocardial ischemia and infarction, and rarely a tachycardia-induced cardiomyopathy as a result of rapid atrioventricular conduction. As a result of the well-defined anatomic and electrophysiological substrate, and the relative pharmacologic resistance of typical AFL, radiofrequency catheter ablation has emerged in the past decade as a safe and effective first-line treatment. This article reviews the electrophysiology of typical AFL and the techniques currently used for its diagnosis and management.

Diagnosis and management of typical atrial flutter.

Can "past decade" be rephrased to refer to more specific years? Typical atrial flutter (AFL) is a common atrial arrhythmia that may cause significant symptoms and serious adverse effects, including embolic stroke, myocardial ischemia and infarction, and, rarely, a tachycardia-induced cardiomyopathy resulting from rapid atrioventricular conduction. As a result of the well-defined anatomic and electrophysiologic substrate and the relative pharmacologic resistance of typical AFL, radiofrequency catheter ablation has emerged since its first description in 1992 as a safe and effective first-line treatment. This article reviews the electrophysiology of typical AFL and techniques currently used for its diagnosis and management.

Clinical outcomes after cardiac resynchronization therapy: importance of left ventricular diastolic function and origin of heart failure.

Background: Cardiac resynchronization therapy (CRT) improves functional outcomes in patients with severe systolic heart failure. Whether the effects of CRT on left ventricular (LV) diastolic function and clinical outcomes are influenced by the cause as either ischemic or nonischemic cardiomyopathy (CM) has not been well established.

Methods: A total of 57 patients (age 60 +/- 11 years; 25% women; LV ejection fraction 25 +/- 5%) were studied before and 4 +/- 2 months after CRT by echocardiography.

Prospective comparison of echocardiographic atrioventricular delay optimization methods for cardiac resynchronization therapy.

Background: Atrioventricular (AV) delay optimization can be an important determinant of the response to cardiac resynchronization therapy (CRT) in patients with medically refractory heart failure and a ventricular conduction delay.

Objectives: The purpose of this study was to compare two Doppler echocardiographic methods of AV delay optimization after CRT.

Methods: Forty consecutive patients (age 59 +/- 12 years) with severe heart failure, New York Heart Association class 3.

Randomized prospective trial of atrioventricular delay programming for cardiac resynchronization therapy.

Objectives: The purpose of this study was to determine if AV delay optimization with continuous-wave Doppler aortic velocity-time integral (VTI) is clinically superior to an empiric program in patients treated with cardiac resynchronization therapy (CRT) for severe heart failure.

Background: The impact of AV delay programming on clinical outcomes associated with CRT is unknown.

Methods: A randomized, prospective, single-blind clinical trial was performed to compare two methods of AV delay programming in 40 patients with severe heart failure referred for CRT.

Resynchronization Therapy for Congestive Heart Failure.

Ventricular contraction is achieved by the coordinated electrical activation of the ventricles through the action of the cardiac conduction system. In the presence of left bundle branch block (LBBB) or interventricular conduction delay (IVCD), the ventricular contraction pattern is desynchronized and the stroke volume is reduced as a consequence. In patients with congestive heart failure (CHF) due to systolic dysfunction, the presence of LBBB or IVCD further degrades ventricular function, contributing directly to the severity of their CHF symptoms.