Non-invasive visualization of the cardiac venous system in coronary artery disease patients using 64-slice computed tomography.

Objectives: This study was designed to evaluate the value of 64-slice computed tomography (CT) to visualize the cardiac veins and evaluate the relation between variations in venous anatomy and history of infarction.

Background: Cardiac resynchronization therapy (CRT) is an attractive treatment for selected heart failure patients. Knowledge of venous anatomy may help in identifying candidates for successful left ventricular lead implantation.

Epicardium-derived cells are important for correct development of the Purkinje fibers in the avian heart.

During embryonic development, the proepicardial organ (PEO) grows out over the heart surface to form the epicardium. Following epithelial-mesenchymal transformation, epicardium-derived cells (EPDCs) migrate into the heart and contribute to the developing coronary arteries, to the valves, and to the myocardium. The peripheral Purkinje fiber network develops from differentiating cardiomyocytes in the ventricular myocardium.

Beneficial hemodynamic and clinical effects of surgical ventricular restoration in patients with ischemic dilated cardiomyopathy.

Background: Surgical ventricular restoration is increasingly applied in patients with ischemic dilated cardiomyopathy. Previous studies show promising results with regard to survival and clinical outcome. However, a comprehensive midterm analysis of this approach on left ventricular (LV) and right ventricular function is not yet available.

Right ventricular pacing can induce ventricular dyssynchrony in patients with atrial fibrillation after atrioventricular node ablation.

Objectives: This study was designed to assess the effects of long-term right ventricular (RV) pacing on left ventricular (LV) dyssynchrony, LV function, and heart failure symptoms.

Background: Atrioventricular (AV) node ablation and subsequent long-term RV pacing is a well-established treatment option in patients with atrial fibrillation (AF).

Methods: In 55 patients with drug-refractory AF, AV node ablation and implantation of a pacemaker was performed.

Outcome of implantable cardioverter defibrillators in adults with congenital heart disease: a multi-centre study.

Aims: To investigate outcome and complications of implantable cardioverter defibrillators (ICDs) in adults with congenital heart disease (CHD) and to identify predictors of (in-) appropriate shocks.

Methods And Results: Sixty-four CHD patients >/= 18 years at first ICD implantation [63% tetralogy of Fallot (TOF) and age at implantation 37 +/- 13 years] were identified using the Dutch adult CHD registry and a Belgian tertiary care centre database. Median follow-up duration was 3.

Extent of viability to predict response to cardiac resynchronization therapy in ischemic heart failure patients.

Unlabelled: The response to cardiac resynchronization therapy (CRT) varies significantly among individuals. Preliminary data suggest that the presence of myocardial viability may be important for response to CRT. The aim of this study was to evaluate whether the extent of viability could predict response to CRT after 6 mo.

Sustained effect of autologous bone marrow mononuclear cell injection in patients with refractory angina pectoris and chronic myocardial ischemia: twelve-month follow-up results.

Background: Cell therapy has recently been introduced to treat patients with refractory angina. Because most studies have only included short-term follow-up, the effects of cell therapy over a longer period are unknown.

Methods: In 25 patients (mean age 64 +/- 10 years, 21 men) with refractory angina, a total of 84 +/- 29 x 10(6) bone marrow-derived mononuclear cells was injected intramyocardially in regions with ischemia on technetium-99m tetrofosmin single-photon emission computed tomography.

Implantable defibrillator early after primary percutaneous intervention for ST-elevation myocardial infarction: rationale and design of the Defibrillator After Primary Angioplasty (DAPA) trial.

Background: It has been shown that an implantable cardioverter defibrillator (ICD) may be beneficial when added to optimal drug treatment in patients with reduced left ventricular function who survive a myocardial infarction (MI). However, it is not known whether patients with increased risk of death after primary percutaneous coronary intervention (PCI) for ST-elevation MI also have benefit of prophylactic ICD therapy to reduce sudden cardiac death.

Methods And Study Design: The DAPA trial is designed to evaluate the efficacy and safety of ICD in high-risk patients after primary PCI for ST-elevation MI.

Epicardial cells of human adults can undergo an epithelial-to-mesenchymal transition and obtain characteristics of smooth muscle cells in vitro.

Myocardial and coronary development are both critically dependent on epicardial cells. During cardiomorphogenesis, a subset of epicardial cells undergoes an epithelial-to-mesenchymal transition (EMT) and invades the myocardium to differentiate into various cell types, including coronary smooth muscle cells and perivascular and cardiac interstitial fibroblasts. Our current knowledge of epicardial EMT and the ensuing epicardium-derived cells (EPDCs) comes primarily from studies of chick and mouse embryonic development.

Fragmented, long-duration, low-amplitude electrograms characterize the origin of focal atrial tachycardia.

Background: Focal atrial tachycardias (FAT) originate from areas with poor cell-to-cell coupling. Due to cellular uncoupling extracellular potentials become fractionated. The degree of fragmentation may be used to identify the site of origin of FAT prior to catheter ablation.

Progressive increase in conduction velocity across human mesenchymal stem cells is mediated by enhanced electrical coupling.

Objective: The purpose of the study was to investigate the development of electrical transmission across human adult bone marrow-derived mesenchymal stem cells (hMSCs) during long-term co-incubation with cardiomyocytes (CMCs).

Methods: Neonatal rat CMCs were cultured in multi-electrode array dishes. A conduction block was induced by creating a central acellular channel, yielding two asynchronously beating CMC fields.

Elucidation of the spatial ventricular gradient and its link with dispersion of repolarization.

The ventricular gradient, a notion conceived by Wilson et al during the 1930s, has contributed considerably to a better understanding of the ECG manifestations of the cardiac repolarization process. The power of the ventricular gradient is its ability to assess the primary factors that contribute to the T wave (i.e.

Surgical ventricular restoration in patients with ischemic dilated cardiomyopathy: evaluation of systolic and diastolic ventricular function, wall stress, dyssynchrony, and mechanical efficiency by pressure-volume loops.

Objectives: Surgical ventricular restoration aims at improving cardiac function by normalization of left ventricular shape and size. Recent studies indicate that surgical ventricular restoration is highly effective with an excellent 5-year outcome in patients with ischemic dilated cardiomyopathy. We used pressure-volume analysis to investigate acute changes in systolic and diastolic left ventricular function, mechanical dyssynchrony and efficiency, and wall stress.

Postero-lateral scar tissue resulting in non-response to cardiac resynchronization therapy.

In large cardiac resynchronization therapy (CRT) trials, approximately 20-30% of patients did not respond to CRT. Recent studies indicated that left ventricular (LV) dyssynchrony is needed for response to CRT. However, the presence of LV dyssynchrony may not be the only determinant of response, because some patients with LV dyssynchrony do not benefit from CRT.

[Intramyocardial injection of autologous bone-marrow stem cells in a 74-year-old man with untreatable angina pectoris and demonstrated myocardial ischaemia].

For a 74-year-old man with angina pectoris and demonstrated myocardial ischaemia, optimal medical treatment was insufficient. He was ineligible for coronary revascularization. To improve myocardial perfusion, autologous bone-marrow stem cells were injected into the ischaemic myocardium.

Benefit of combined resynchronization and defibrillator therapy in heart failure patients with and without ventricular arrhythmias.

Objectives: We attempted to assess the efficacy of combined cardiac resynchronization therapy-implantable cardioverter-defibrillator (CRT-ICD) in heart failure patients with and without ventricular arrhythmias.

Background: Because CRT and ICDs both lower all-cause mortality in patients with advanced heart failure, combination of both therapies in a single device is challenging.

Methods: A total of 191 consecutive patients with advanced heart failure, left ventricular ejection fraction <35%, and a QRS duration >120 ms received CRT-ICD.

Role of calcified spots detected by intravascular ultrasound in patients with ST-segment elevation acute myocardial infarction.

Electron beam computed tomographic studies have demonstrated that the extent of intracoronary calcium is related to risk of coronary events. This study was performed to gain further insight into the distribution of focal calcifications and their relation to the site of plaque rupture within the culprit artery in consecutive patients (n = 60) with acute myocardial infarction (AMI) using intravascular ultrasound imaging. Calcifications in the culprit lesion and adjacent segments were classified and counted according to their arc (< 45 degrees, 45 degrees to 90 degrees, 90 degrees to 180 degrees, > 180 degrees), length (< 1.

Serial reevaluation for ARVD/C is indicated in patients presenting with left bundle branch block ventricular tachycardia and minor ECG abnormalities.

Introduction: Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is based on a set of criteria proposed by the International Task Force (TF) for Cardiomyopathies in 1994. To fulfill these criteria, presence of both electrocardiographic and anatomical abnormalities must be assessed with ECG and imaging techniques, respectively. This may be difficult in patients with early/mild forms of the disease as detectable structural abnormalities may still be absent.

Cardiac resynchronization therapy in patients with systolic left ventricular dysfunction and symptoms of mild heart failure secondary to ischemic or nonischemic cardiomyopathy.

Cardiac resynchronization therapy (CRT) is beneficial in selected patients with moderate to severe heart failure (New York Heart Association [NYHA] classes III to IV). Patients with mildly symptomatic heart failure (NYHA class II) are currently not eligible for CRT and the potential beneficial effects in these patients have not been well studied. Fifty consecutive patients in NYHA class II heart failure and 50 consecutive patients in NYHA classes III to IV (control group) were prospectively included.

Assessment of left ventricular dyssynchrony in patients with conduction delay and idiopathic dilated cardiomyopathy: head-to-head comparison between tissue doppler imaging and velocity-encoded magnetic resonance imaging.

Objectives: This study sought to compare tissue Doppler imaging (TDI) with velocity-encoded (VE) magnetic resonance imaging (MRI) for left ventricular (LV) dyssynchrony assessment.

Background: Cardiac resynchronization therapy (CRT) is proposed for patients with heart failure, depressed LV function, and a wide QRS complex. Selection is based mainly on electrocardiogram criteria, but recent data suggest that intraventricular dyssynchrony may be preferred for selection.

Ablation of focal atrial arrhythmia in patients with congenital heart defects after surgery: role of circumscribed areas with heterogeneous conduction.

Background: In patients late after surgical repair of congenital heart disease (CHD), areas with abnormal electrophysiologic properties may serve as slow conducting pathways within a macroreentrant circuit or may be the source of focal atrial tachycardia.

Objectives: The purpose of this study was to evaluate the role of abnormal areas during focal atrial tachycardia prior to ablation.

Methods: Electroanatomic activation mapping of 62 atrial tachycardias was performed in 43 consecutive patients (37 +/- 12 years) after surgical repair of CHD.