Mortality risk score for patients with Chagas cardiomyopathy and pacemaker.

Background: Prognosis of Chronic Chagasic Cardiomyopathy (CCC) patients depends on functional and clinical factors. Bradyarrhythmia requiring pacemaker is a common complication. Prognosis of these patients is poorly studied, and mortality risk factors are unknown.

Effect of chronic kidney disease in ischemic cardiomyopathy: Long-term follow-up - REVISION-DM2 trial.

A strong association exists between chronic kidney disease (CKD) and coronary artery disease (CAD). The role of CKD in the long-term prognosis of CAD patients with versus those without CKD is unknown. This study investigated whether CKD affects ventricular function.

Impact of diabetes mellitus on ischemic cardiomyopathy. Five-year follow-up. REVISION-DM trial.

Background: Patients with ischemic cardiomyopathy and severe left ventricular dysfunction have a worse survival prognosis than patients with preserved ventricular function. The role of diabetes in the long-term prognosis of this patient group is unknown. This study investigated whether the presence of diabetes has a long-term impact on left ventricular function.

A cohort study of cardiac resynchronization therapy in patients with chronic Chagas cardiomyopathy.

Aims: Cardiac resynchronization therapy (CRT) is an established procedure for patients with heart failure. However, trials evaluating its efficacy did not include patients with chronic Chagas cardiomyopathy (CCC). We aimed to assess the role of CRT in a cohort of patients with CCC.

Predictors of death in chronic Chagas cardiomyopathy patients with pacemaker.

Background: Chronic Chagas cardiomyopathy (CCC) is the most serious and frequent manifestation of Chagas disease. Conduction abnormalities and bradycardia requiring pacemaker are common. The aim of this study was to determine the rate and predictors of death in CCC patients with pacemaker.

Evidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus.

Aims: To perform a comprehensive evaluation of heart rhythm disorders and the influence of disease/therapy factors in a large systemic lupus erythematosus (SLE) cohort.

Methods And Results: Three hundred and seventeen consecutive patients of an ongoing electronic database protocol were evaluated by resting electrocardiogram and 142 were randomly selected for 24 h Holter monitoring for arrhythmia and conduction disturbances. The mean age was 40.

Effects of cardiac resynchronization therapy on muscle sympathetic nerve activity.

Introduction: Muscle sympathetic nerve activity (MSNA) is an independent prognostic marker in patients with heart failure (HF). Therefore, its relevance to the treatment of HF patients is unquestionable.

Objectives: In this study, we investigated the effects of cardiac resynchronization therapy (CRT) on MSNA response at rest and during exercise in patients with advanced HF.

Global and regional ventricular repolarization study by body surface potential mapping in patients with left bundle-branch block and heart failure undergoing cardiac resynchronization therapy.

Background: The controversial effects promoted by cardiac resynchronization therapy (CRT) on the ventricular repolarization (VR) have motivated VR evaluation by body surface potential mapping (BSPM) in CRT patients.

Methods: Fifty-two CRT patients, mean age 58.8 ± 12.

"Hyper-response" evaluated by 3D echocardiography after cardiac resynchronization therapy.

Cardiac resynchronization therapy consists of a promising treatment for patients with severe heart failure, but about 30% of patients do not exhibit clinical improvement with this procedure. However, approximately 10% of patients undergoing this therapy may have hyperresponsiveness, and three-dimensional echocardiography can provide an interesting option for the selection and evaluation of such patients.

Efficacy of antibiotic prophylaxis before the implantation of pacemakers and cardioverter-defibrillators: results of a large, prospective, randomized, double-blinded, placebo-controlled trial.

Background: Although routinely administered, definitive evidence for the benefits of prophylactic antibiotics before the implantation of permanent pacemakers and implantable cardioverter-defibrillators from a large double-blinded placebo-controlled trial is lacking. The purpose of this study was to determine whether prophylactic antibiotic administration reduces the incidence of infection related to device implantation.

Methods And Results: This double blinded study included 1000 consecutive patients who presented for primary device (Pacemaker and implantable cardioverter-defibrillators) implantation or generator replacement randomized in a 1:1 fashion to prophylactic antibiotics or placebo.

Cardiac resynchronization therapy evaluated by myocardial scintigraphy with 99mTc-MIBI: changes in left ventricular uptake, dyssynchrony, and function.

Purpose: (99m)Tc-MIBI gated myocardial scintigraphy (GMS) evaluates myocyte integrity and perfusion, left ventricular (LV) dyssynchrony and function. Cardiac resynchronization therapy (CRT) may improve the clinical symptoms of heart failure (HF), but its benefits for LV function are less pronounced. We assessed whether changes in myocardial (99m)Tc-MIBI uptake after CRT are related to improvement in clinical symptoms, LV synchrony and performance, and whether GMS adds information for patient selection for CRT.

Cardiac resynchronization therapy improves the uptake of MIBI-99mTc and cardiac function.

This case shows the improvement promoted by cardiac resynchronization therapy (CRT) on myocardial perfusion and left ventricular (LV) performance assessed by gated myocardial perfusion scintigraphy. The patient had idiopathic dilated cardiomyopathy, left bundle branch block and severe heart failure despite optimized medical treatment. After CRT, clinical improvement, QRS reduction and improvement of previously hypoperfused anterior and septal walls were observed.

ICD patients with elevated defibrillation threshold: clinical behavior and therapeutic alternatives.

Background: The ideal programming of the implantable cardioverter defibrillator (ICD) shock energy should be at least 10J above the defibrillation threshold (DFT), requiring alternative techniques when the DFT is elevated.

Objective: To assess the clinical behavior of ICD patients with DFT>25J and the efficacy of the chosen therapy.

Methods: Patients who had undergone ICD implantation between Jan/00 and Aug/04 (prospective database) and presented intraoperative DFT>25J were selected.

Functional behavior of patients with conventional pacemakers undergoing cardiac resynchronization.

Background: Cardiac resynchronization therapy (CRT) is an efficient treatment for patients with heart failure (HF), severe ventricular dysfunction and intraventricular block. Conventional pacemakers (CPM) implanted in the right ventricular apical area cause alterations in the normal sequence of cardiac activation similar to those induced by LBBB (left bundle-branch block). Therefore, patients with CPM and advanced HF could be candidates to undergo CRT, but as only small numbers of patients have been evaluated so far, definitive conclusions are lacking.

Cardiac sympathetic activity pre and post resynchronization therapy evaluated by 123I-MIBG myocardial scintigraphy.

Background: Imaging with (123)I-metaiodobenzylguanidine (MIBG) is used for the assessment of cardiac sympathetic activity (CSA). We analyzed CSA before and after cardiac resynchronization therapy (CRT), and correlated these data with CRT response.

Methods And Results: Thirty patients with chronic heart failure and classic indications for CRT were prospectively studied before and at least 3 months after CRT.

Repercussions of cardiac resynchronization therapy on the ventricular repolarization of heart failure patients as assessed by body surface potential mapping.

Objective: Cardiac resynchronization therapy (CRT) is an adjunct treatment for heart failure (HF) which associates with left bundle-branch block (LBBB) and is refractory to medical therapy. However, nearly 1/3 of the patients still do not respond, the reasons for which have yet to be determined. Additionally, experimental studies proved that epicardial left ventricle (LV) pacing yields reversed electrical activation sequence, increasing QT interval duration and dispersion of the ventricular repolarization, and leaving patients at greater risk for ventricular arrhythmias.

Ventricular synchrony in patients with dilated cardiomyopathy and normal individuals: assessment by radionuclide ventriculography.

Objective: To establish the parameters of intra- and interventricular synchrony in normal individuals and to compare them with patients with dilated cardiomyopathy with and without conduction disorders shown in the electrocardiogram (ECG) examination.

Methods: Three groups of patients were included in this study: 18 individuals (G1) with no cardiomyopathy and with a normal ECG (52+/-12 years, 29% male); 50 patients with dilated cardiomyopathy and severe left ventricular dysfunction, with 20 patients (G2) presenting QRS <120 ms (51+/-10 years, 75% male) and 30 patients (G3) with QRS >120 ms (57+/-12 years, 60% male). All patients underwent RV.

Incidence of shock and quality of life in young patients with implantable cardioverter-defibrillator.

Objectives: To analyze the incidence and causes of ICD therapies in children and young adults and verify their impact on the quality of life (QoL).

Methods: From March/1977 to February/2006, 29 patients (15.7+/-5.

Ventricular electrical activation in cardiac resynchronization as characterized by body surface potential mapping.

Objectives: To assess cardiac electrical activation by using body surface potential mapping (BSPM), in patients with congestive heart failure (CHF) and left bundle branch block (LBBB) undergoing cardiac resynchronization therapy (CRT) with biventricular pacemaker (BIV-PM) implantation.

Methods: Mean cardiac electrical activation times were analyzed in the right ventricle (RV) (mean RV activation time = mRV), anteroseptal area (mAS), and left ventricle (mLV) of 28 patients (mean age 61.2 +/- 9.

Ventricular remodeling in right ventricular apical pacing.

Objective: To determine ventricular remodeling (VR) and the role of clinical and functional variables in patients with normal cardiac function who underwent right ventricular apical pacing (RVAP).

Methods: Among the 268 consecutive patients with standard pacemaker due to complete atrioventricular block (CAVB), those with left ventricular ejection fraction (LVEF) < 55% and left ventricular end-diastolic diameter (LVEDD) > 53 mm on Doppler echocardiography were excluded. Ventricular remodeling was defined as echocardiographic changes documented at least six months after implantation, namely, a >10% increase in LVEDD and a > 20% decrease in LVEF.

Body surface potential mapping investigating the ventricular activation patterns in the cardiac resynchronization of patients with left bundle-branch block and heart failure.

Body surface potential mapping assessed mean cardiac electrical activation times displayed by isochronal maps in the right ventricle (RV; right ventricle mean activation time [mRV]), anterior septal area (anterior septal area mean activation time [mAS]), and left ventricle (left ventricle mean activation time [mLV]) of 28 patients (mean, 61.07 years; congestive heart failure class III-IV; ejection fraction, < or =40%; left bundle-branch block [LBBB] QRS, 180.17 milliseconds), before and after biventricular pacemaker implantation, comparing them, using reference values from a control group of healthy individuals with normal hearts (GNL), in (1) baseline native LBBB, where mRV and mAS values were similar (40.

[Myotonic dystrophy and heart disease: behavior of arrhythmic events and conduction disturbances].

Objective: To study the prevalence and natural evolution of arrhythmic events and conduction disturbances in myotonic dystrophy; to correlate the genetic defect with cardiovascular findings; to assess cardiac mortality, frequency, and predictive factors of sudden death; to correlate the severity of the neuromuscular and cardiac involvement; and to define the role of the electrophysiological study (EPS), in myotonic dystrophy.

Methods: Periodic clinical assessment and the following tests were performed in 83 consecutive patients with a mean follow-up of 42+/-30.63 months: complementary examinations, genetic tests, electrocardiography, echocardiography, and Holter; electrophysiological study was performed in 59 cases.