Anatomical variations in coronary venous drainage: Challenges and solutions in delivering cardiac resynchronization therapy.

Aims: To investigate the abnormalities of the coronary venous system in candidates for cardiac resynchronization therapy (CRT) and describe methods for circumventing the resulting difficulties.

Methods: From four implanting institutes, data of all CRT implants between October 2008 and October 2020 were screened for abnormal cardiac venous anatomy, defined as an anatomical variation not conforming to the accepted 'normal' anatomy. Patient demographics, procedural detail, and subsequent left ventricle (LV) lead pacing indices were collected.

Successful Identification of and Discrimination Between Atrial and Ventricular Arrhythmia with the Aid of Pacing and Defibrillator Devices.

The presence of supraventricular tachycardia is the leading cause of inappropriate shock in ICD recipients, and it can be a significant cause of morbidity, psychological distress and worsened clinical outcome. Modern pacing and ICD systems offer a number of discriminators that are integrated into algorithms to differentiate sustained ventricular tachycardia from supraventricular tachycardia. These algorithms can be adapted and optimised for each individual patient to ensure that only those arrhythmias that need treatment through the use of an ICD, are actually treated.

Percutaneous management of lead-related cardiac perforation with limited use of computed tomography and cardiac surgery.

Background: Cardiac implantable electronic device (CIED)-related perforation is uncommon but potentially lethal. Management typically includes the use of computed tomography (CT) scanning and often involves cardiac surgery.

Methods: Patients presenting to a single referral centre with CIED-related cardiac perforation between 2013 and 2019 were identified.

Multi-lead cephalic venous access and long-term performance of high-voltage leads.

Background: Cardiac resynchronization therapy-defibrillator (CRT-D) implantation via the cephalic vein is feasible and safe. Recent evidence has suggested a higher implantable cardioverter-defibrillator (ICD) lead failure in multi-lead defibrillator therapy via the cephalic route. We evaluated the relationship between CRT-D implantation via the cephalic and ICD lead failure.

The prognostic significance of serum sodium in a population undergoing cardiac resynchronisation therapy.

Purpose: To determine the prognostic implications of changes towards hyponatremia at varying time-points in the treatment of patients undergoing cardiac resynchronisation therapy (CRT).

Methods: A retrospective series of 249 patients was studied from 2002 to 2013. The population was categorized on the basis of serum sodium profile at baseline, at 1 month and at 6 month follow up visits following successful CRT implantation.

Should We Let Sleeping Dogs Lie? Controversies of Treating Central Sleep Apnoea in HFrEF Following the SERVE-HF Study.

Central sleep apnoea (CSA) is common in patients with heart failure (HF), with a prevalence of 20-45 %. It is a marker of severity of HF and is independently associated with increased morbidity and mortality rates in patients with HF. Targeting CSA with adaptive servoventilation (ASV) was postulated to improve outcomes; however, the results of the recent SERVE-HF (Treatment of Sleep-disordered Breathing by Adaptive Servo-ventilation in Heart Failure Patients) trial showed that in patients with CSA and HF with reduced ejection fraction (HFrEF), ASV, despite successfully treating CSA, was associated with increased risk of cardiovascular death compared with medical therapy.

Sleep-disordered breathing in heart failure.

Sleep-disordered breathing-comprising obstructive sleep apnoea (OSA), central sleep apnoea (CSA), or a combination of the two-is found in over half of heart failure (HF) patients and may have harmful effects on cardiac function, with swings in intrathoracic pressure (and therefore preload and afterload), blood pressure, sympathetic activity, and repetitive hypoxaemia. It is associated with reduced health-related quality of life, higher healthcare utilization, and a poor prognosis. Whilst continuous positive airway pressure (CPAP) is the treatment of choice for patients with daytime sleepiness due to OSA, the optimal management of CSA remains uncertain.

Sleep-disordered Breathing in Heart Failure.

Sleep-disordered breathing affects over half of patients with heart failure (HF) and is associated with a poor prognosis. It is an under-diagnosed condition and may be a missed therapeutic target. Obstructive sleep apnoea is caused by collapse of the pharynx, exacerbated by rostral fluid shift during sleep.

Breathless after bypass.

A 65-year-old normotensive, non-athletic man presented to the cardiology clinic with exertional dyspnoea and chest discomfort. Echocardiography revealed mild left ventricular hypertrophy with good systolic function but with regional wall motion abnormalities suggesting ischaemia. Coronary angiography showed significant three-vessel disease.

Two cases of massive mitral annular calcification mimicking left atrial neoplasms.

The authors describe two cases of massive mitral annular calcification, initially picked up on echocardiography and suspected of being neoplastic. Subsequent evaluation by CT scanning confirmed the location, aetiology, structure and diagnosis. Both cases demonstrated large masses, with calcification of varying density.