Percutaneous treatment of mitral regurgitation in patients with impaired ventricular function: Impact of intracardiac electronic devices (from the German Transcatheter Mitral Valve Interventions Registry).

Objectives: To identify prevalence/impact of previous implantation of cardiac electronic devices (CEDs), such as cardioverter defibrillator (ICD) and cardiac resynchronization (CRT), in a group of MitraClip (MC) candidates with LVEF < 30%.

Background: MC therapy is nowadays often considered in patients with depressed left ventricular ejection fraction (LVEF%) and symptomatic severe secondary MR.

Methods: Data from the German Transcatheter Mitral Valve Interventions (TRAMIs) registry were analyzed.

Different impact of aortic regurgitation assessed by aortic root angiography after transcatheter aortic valve implantation according to baseline left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide.

Transcatheter aortic valve implantation (TAVI) is an alternative therapeutic option for severe aortic stenosis. Aortic regurgitation (AR) is commonly observed after TAVI and increases the mortality rate. We hypothesized that the influence of significant AR, defined as that more severe than mild AR, on survival rate after TAVI might differ according to the baseline left ventricular ejection fraction (LVEF) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) level.

Elevated Mitral Valve Pressure Gradient After MitraClip Implantation Deteriorates Long-Term Outcome in Patients With Severe Mitral Regurgitation and Severe Heart Failure.

Objectives: This single-center study was performed to analyze the effect of an increased transvalvular gradient after the MitraClip (MC) (Abbott Laboratories, Abbott Park, Illinois) procedure on patient outcome during follow-up.

Background: Percutaneous transcatheter repair of the mitral valve with the MC device has been established as a novel technique for patients with severe mitral regurgitation and high surgical risk. This study investigated the influence of an increased pressure gradient after MC implantation on the long-term outcome of patients.

Prognosis associated with redo cardiac resynchronization therapy following complete device and lead extraction due to device-related infection.

Aims: An increase in the number of cardiac resynchronization therapy (CRT) device implantations worldwide has led to a consequent increase in the number of infections associated with the device, making extraction of the CRT device inevitable. Redo CRT implantation after treatment and recovery following device extraction is challenging. This study aimed to evaluate the success rate, complications, and long-term prognosis of redo CRT implantation, including the rates of subclavian, cava, and coronary sinus (CS) vein thrombosis as well as re-infection.

Interaction between renal function and percutaneous edge-to-edge mitral valve repair using MitraClip.

Background: MitraClip (MC; Abbott Vascular, Menlo Park, CA, USA) is a treatment option for mitral regurgitation. Renal dysfunction is closely associated with cardiovascular disease. However, the influence of renal function in MC remains not fully understood.

Impact of left ventricular systolic dysfunction on the outcomes of percutaneous edge-to-edge mitral valve repair using MitraClip.

Left ventricular systolic dysfunction (LVD) is associated with poor outcomes after mitral regurgitation (MR) surgery. MitraClip (MC) is a novel treatment option for MR patients with a high surgical risk. However, outcomes of LVD patients underwent MC remain unclear.

Increased Prevalence of Diastolic Heart Failure in Patients with Rheumatoid Arthritis Correlates with Active Disease, but Not with Treatment Type.

Objective: Although heart failure (HF) is a major cause of premature mortality, there is little information regarding its prevalence and associated risk factors in patients with rheumatoid arthritis (RA). In this study, we evaluated the prevalence of HF in a community-based RA cohort. Further, we investigated the effect of RA activity and present treatment on HF rate and cardiac structure.

Long-term survival after MitraClip(®) therapy in patients with severe mitral regurgitation and severe congestive heart failure: A comparison among survivals predicted by heart failure models.

Background: The aim of the study was to investigate mortality following transcatheter mitral valve repair with the MitraClip System (MC) (Abbott Vascular, Santa Clara, CA, USA) in patients with mitral regurgitation and moderate-to-severe symptomatic heart failure in comparison to mortality predicted by the Seattle Heart Failure Model (SHFM) and the heart failure calculator of the meta-analysis global group in chronic heart failure (MAGGIC).

Methods And Results: This retrospective study included 194 consecutive patients, who received a MC implantation between 2009 and 2013 at our institution. The observed mortality was compared with that predicted by the SHFM and the MAGGIC after 1 year: 24% observed, 18% by SHFM (p=0.

MitraClip in CRT non-responders with severe mitral regurgitation.

Background: Severe mitral regurgitation (MR) ≥ 3+ and left ventricular dyssynchrony in heart failure patients are markers of CRT non response. The MitraClip (MC) implantation is a therapy for MR ≥ 3+ in patients with high surgical risk of mitral valve reconstruction.

Methods And Results: We investigated 42 patients with CRT and MR ≥ 3+ who received an MC device at our center.

[Pacemaker dependant and/or repetitive ICD therapies. How to solve the dilemma of lead extraction?].

Bridging pacemaker-dependent patients or patients with repetitive ICD therapies after device and lead extraction is often challenging. Temporary pacing by means of an active fixation lead connected to an external reusable permanent pacemaker, or of a subxiphoidally implanted pacemaker with an epicardial lead is a safe option for bridging pacemaker-dependent patients after device and lead explantation. The wearable cardioverter defibrillator (WCD; LifeVest(®)) is a safe and effective tool for patients who need a continuous monitoring and ICD backup after device explantation.

Patient selection criteria and midterm clinical outcome for MitraClip therapy in patients with severe mitral regurgitation and severe congestive heart failure.

Aims: The implantation of a MitraClip (MC) is a new treatment modality for severe mitral regurgitation (MR) in patients whose condition is inoperable or who are at high conventional operative risk. This study reports the follow-up data of patients implanted with an MC in our heart centre to find selection criteria for this procedure in patients with severe congestive heart failure.

Methods And Results: This study included 163 implantation procedures in 157 patients between March 2009 and November 2012.

Baseline vectorcardiography as a predictor of invasively determined acute hemodynamic response to cardiac resynchronization therapy.

Aims: Identifying potential responders to cardiac resynchronization therapy (CRT) may be sometimes difficult and time consuming. Searching for a simple method, we chose vectorcardiography (VCG) for our study. The aim was to evaluate whether a VCG parameter can be used to predict invasively measured acute hemodynamic changes after CRT onset.

Rotational angiography for preinterventional imaging in transcatheter aortic valve implantation.

Objective: To evaluate the clinical value of 3D rotational angiography, as a tool for imaging and measuring 3D anatomy, coupled with transesophageal echocardiogram (TEE) as preinterventional imaging for transcatheter aortic valve implantation (TAVI) procedures.

Background: TAVI is a growing field in cardiology. An understanding of the 3D anatomy of the aortic root is crucial for patient selection and for the optimal planning and guidance of such procedures.

Long-term outcome of cardiac contractility modulation in patients with severe congestive heart failure.

Aims: Cardiac contractility modulation (CCM) is a new form of electrical therapy in patients with congestive heart failure. Recently published clinical studies provide evidence of safety and improvements of exercise tolerance and quality of life. In this study, we investigated the impact of CCM on cardiac and all-cause mortality.

Radiation exposure of patient and physician during implantation and upgrade of cardiac resynchronization devices.

Background: Cardiac resynchronization therapy (CRT) is often associated with extended fluoroscopic exposure during placement of the devices. The objective of this study was to measure the radiation exposure sustained by different parts of the body of patients and operators during fluoroscopically guided cardiac resynchronization device implantation.

Methods: Dosimetry data were prospectively recorded in a series of 104 consecutive patients, who underwent resynchronization device implantation or upgrade in our cardiac catheterization laboratory.

Influence of pacing configurations, body mass index, and position of coronary sinus lead on frequency of phrenic nerve stimulation and pacing thresholds under cardiac resynchronization therapy.

Aims: Phrenic nerve stimulation (PNS) can affect, and in some cases considerably limit, the long-term success of cardiac resynchronization therapy (CRT) therapy. To address this common problem, the manufacturers of CRT devices offer a range of configurations aimed at preventing high left ventricular pacing thresholds (LVPTs) and PNS.

Methods And Results: In 101 consecutive patients who had undergone implantation of a CRT system, we investigated prospectively the parameters LVPT and PNS threshold in relation to coronary sinus (CS) lead position, CS lead configuration, body position, and body mass index.