Vagus Nerve Stimulation for the Treatment of Heart Failure: The INOVATE-HF Trial.

Background: Heart failure (HF) is increasing in prevalence and is a major cause of morbidity and mortality despite advances in medical and device therapy. Autonomic imbalance, with excess sympathetic activation and decreased vagal tone, is an integral component of the pathophysiology of HF.

Objectives: The INOVATE-HF (Increase of Vagal Tone in Heart Failure) trial assessed the safety and efficacy of vagal nerve stimulation (VNS) among patients with HF and a reduced ejection fraction.

First experience with a novel robotic remote catheter system: Amigo™ mapping trial.

Introduction: Amigo™ (Catheter Robotics, Inc., Mount Olive, NJ) remote catheter system (RCS) was designed to provide a simple and relatively inexpensive system for remote catheter manipulation. The purpose of this study was to evaluate the performance and safety of Amigo in mapping the right side of the heart.

Subgroup analysis of a randomized controlled trial evaluating the safety and efficacy of cardiac contractility modulation in advanced heart failure.

Background: Cardiac contractility modulation (CCM) signals are nonexcitatory electrical signals delivered during the absolute refractory period intended to improve contraction. We previously tested the safety and efficacy of CCM in 428 NYHA functional class III/IV heart failure patients with EF ≤35% and narrow QRS randomized to optimal medical treatment (OMT) plus CCM (n = 215) versus OMT alone (n = 213) and found no significant effect on ventilatory anaerobic threshold (VAT), the study's primary end point. In the present analysis, we sought to identify if there was a subgroup of patients who showed a response to CCM.

Noninvasive measurement of cardiac performance in recovery from exercise in heart failure patients.

Objective: To examine the association between cardiac performance during recovery and the severity of heart failure, as determined by clinical and cardiopulmonary exercise test responses.

Methods: As part of a retrospective cohort study, 46 heart failure patients and 13 normal subjects underwent cardiopulmonary exercise testing while cardiac output was measured using a noninvasive device. Cardiac output in recovery was expressed as the slope of a single exponential relationship between cardiac output and time; the recovery-time constant was assessed in relation to indices of cardiac function, along with clinical, functional, and cardiopulmonary exercise responses.

Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial.

Background: Results of previous studies support the hypothesis that implantable haemodynamic monitoring systems might reduce rates of hospitalisation in patients with heart failure. We undertook a single-blind trial to assess this approach.

Methods: Patients with New York Heart Association (NYHA) class III heart failure, irrespective of the left ventricular ejection fraction, and a previous hospital admission for heart failure were enrolled in 64 centres in the USA.

A randomized controlled trial evaluating the safety and efficacy of cardiac contractility modulation in advanced heart failure.

Background: Cardiac contractility modulation (CCM) delivers nonexcitatory electrical signals to the heart during the absolute refractory period intended to improve contraction.

Methods: We tested CCM in 428 New York Heart Association class III or IV, narrow QRS heart failure patients with ejection fraction (EF) ≤ 35% randomized to optimal medical therapy (OMT) plus CCM (n = 215) versus OMT alone (n = 213). Efficacy was assessed by ventilatory anaerobic threshold (VAT), primary end point, peak Vo₂ (pVo₂), and Minnesota Living with Heart Failure Questionnaire (MLWFQ) at 6 months.

Quantification of the impaired cardiac output response to exercise in heart failure: application of a non-invasive device.

An impaired cardiac output (CO) response to exercise is a hallmark of chronic heart failure (CHF), and the degree to which CO is impaired is related to the severity of CHF and prognosis. However, practical methods for obtaining cardiac output during exercise are lacking, and what constitutes and impaired response is unclear. Forty six CHF patients and 13 normal subjects underwent cardiopulmonary exercise testing (CPX) while CO and other hemodynamic measurements at rest and during exercise were obtained using a novel, non-invasive, bioreactance device based on assessment of relative phase shifts of electric currents injected across the thorax, heart rate and ventricular ejection time.

End-tidal CO2 pressure and cardiac performance during exercise in heart failure.

Introduction: In patients with heart failure (HF), end-tidal CO2 pressure (PetCO2) is related to ventricular function at rest and has been shown to predict prognosis. However, little is known about the association between ventricular performance and PetCO2 responses to exercise.

Methods: Forty-eight patients with HF and 13 normal subjects underwent cardiopulmonary exercise testing (CPX), while cardiac output and other hemodynamic measurements at rest and during exercise were obtained using a novel, noninvasive, bioreactance device based on assessment of relative phase shifts of electric currents injected across the thorax, heart rate, and ventricular ejection time.

Cardiac output and cardiopulmonary responses to exercise in heart failure: application of a new bio-reactance device.

Background: Cardiopulmonary exercise testing (CPX) is widely used to evaluate heart failure (HF) patients, but lacks information about ventricular performance. There is a need for a noninvasive cardiac output (CO) measurement.

Methods And Results: Twenty-three HF patients and 13 normals underwent CPX and CO measurements with a new, noninvasive, bioreactance technology based on assessment of relative phase shifts (d phi/d t) of electric currents injected across the thorax, heart rate, and ventricular ejection time.

Nonexcitatory, cardiac contractility modulation electrical impulses: feasibility study for advanced heart failure in patients with normal QRS duration.

Background: Cardiac contractility modulation signals are associated with acutely improved hemodynamics, but chronic clinical impact is not defined.

Objectives: The purpose of this randomized, double-blind, pilot study was to determine the feasibility of safely and effectively delivering cardiac contractility modulation signals in patients with heart failure.

Methods: Forty-nine subjects with ejection fraction <35%, normal QRS duration (105 +/- 15 ms), and New York Heart Association (NYHA) class III or IV heart failure despite medical therapy received a cardiac contractility modulation pulse generator.

Relationship of treatment delay with surgical defect size from keratinocyte carcinoma (basal cell carcinoma and squamous cell carcinoma of the skin).

Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs micrographic surgery (MMS). A stratified random sample of patients treated for KC with MMS were selected for telephone interview.

Therapeutic developments in sudden cardiac death.

Sudden cardiac death is characterised by the unexpected death of a patient who has been clinically stable. It is frequently due to the development of ventricular tachyarrhythmias. With appropriate treatment, patients can be appropriately resuscitated.

Amiodarone therapy in chronic heart failure and myocardial infarction: a review of the mortality trials with special attention to STAT-CHF and the GESICA trials. Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina.

Amiodarone appears to reduce sudden death in patients with left ventricular dysfunction resulting from an acute MI or a primary dilated cardiomyopathy, particularly if complex ventricular arrhythmias are present. Amiodarone's beneficial effect on mortality in these patients could be unrelated to its antiarrhythmic effects. Multiple factors could account for the improvement in mortality such as the drug's antiischemic effects, neuromodulating effects, its effect on left ventricular function and on heart rate.

Diagnosis of cellulitis in patients infected with the human immunodeficiency virus.

A prospective microbiological evaluation of cellulitis in 22 patients infected with the human immunodeficiency virus was performed. Patients with helper lymphocyte counts of less than 200 cells/mm(3) had a greater frequency of positive cultures. The most frequently isolated pathogens were Staphylococcus aureus and Streptococcus pyogenes, and initial antibiotic therapy should cover these Gram-positive cocci.