Fibroplasty (venoplasty) to facilitate transvenous lead placement: A single-center experience.

Introduction: Venous stenosis is a well-recognized complication of transvenous leads (TVLs) that is encountered during lead revisions or device upgrades. We here report the outcomes of TVL placement facilitated by fibroplasty or tunneling (TUN) procedure.

Methods: We conducted a single-center retrospective cohort study of all patients undergoing TVL implantation requiring fibroplasty or TUN from 2005 to 2017.

Super-response to cardiac resynchronization therapy reduces appropriate implantable cardioverter defibrillator therapy.

Aims: To determine the frequency of implantable cardioverter defibrillator (ICD) therapy following cardiac resynchronization therapy (CRT-D) implantation in super and non-super responders and whether greater improvement in left ventricular (LV) function after CRT is associated with a reduced burden in ICD therapy.

Methods And Results: This is a two-centre, retrospective study between January 2002 and September 2011. Patients were classified as non-super responders and super-responders based on the post-CRT ejection fraction (EF) of < 50% and ≥50%, respectively.

Palliative Care Consultation and Associated End-of-Life Care After Pacemaker or Implantable Cardioverter-Defibrillator Deactivation.

The presence of cardiac pacemakers and defibrillators complicates making end-of-life (EOL) medical decisions. Palliative care/medicine consultation (PCMC) may benefit patients and primary providers, but data are lacking. We retrospectively reviewed 150 charts of patients who underwent device deactivation at our tertiary care center (between November 1, 2008, and September 1, 2012), assessing for PCMC and outcomes.

Right Parasternal Lead Placement Increases Eligibility for Subcutaneous Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease.

Background: The subcutaneous implantable cardioverter defibrillator (S-ICD) provides an attractive option for patients with congenital heart disease (CHD) in whom a transvenous defibrillator is contraindicated. Given the unusual cardiac anatomy and repolarization strain, the surface electrocardiogram (ECG) is frequently abnormal, potentially increasing the screen failure rate.

Methods and results: We prospectively screened 100 adult CHD patients regardless of the presence of clinical indication for ICD utilizing a standard left sternal lead placement, as well as a right parasternal position.

Outcomes After Implantable Cardioverter-Defibrillator Generator Replacement for Primary Prevention of Sudden Cardiac Death.

Background: The effectiveness of implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death in patients with an ejection fraction (EF) ≤ 35% and clinical heart failure is well established. However, outcomes after replacement of the ICD generator in patients with recovery of EF to >35% and no previous therapies are not well characterized.

Methods And Results: Between 2001 and 2011, generator replacement was performed at 2 tertiary medical centers in 253 patients (mean age, 68.

Effects of tricuspid valve regurgitation on outcome in patients with cardiac resynchronization therapy.

Cardiac resynchronization therapy (CRT) has a symptomatic and survival benefit for patients with heart failure (HF), but the percentage of nonresponders remains relatively high. The aims of this study were to assess the clinical significance of baseline tricuspid regurgitation (TR) or worsening TR after implantation of a CRT device on the response to therapy. This is a multicenter retrospective analysis of prospectively collected databases that includes 689 consecutive patients who underwent implantation of CRT.

Effects of atrioventricular conduction delay on the outcome of cardiac resynchronization therapy.

Background And Purpose: First-degree atrioventricular (AV) block in relation to the outcome of cardiac resynchronization therapy (CRT) has not been well examined.

Methods: Patients who received a CRT defibrillator or pacemaker between January 2002 and September 2010 at Mayo Clinic were classified into 2 groups: normal PR interval and prolonged PR interval. Standard sensed (100 milliseconds) and paced (130 milliseconds) AV delay was programmed after CRT.

Predictors and outcomes of "super-response" to cardiac resynchronization therapy.

Background: Cardiac resynchronization therapy (CRT) has been shown to improve heart failure (HF) symptoms and survival. We hypothesized that a greater improvement in left-ventricular ejection fraction (LVEF) after CRT is associated with greater survival benefit.

Methods And Results: In 693 patients across 2 international centers, the improvement in LVEF after CRT was determined.

Features and outcomes of patients who underwent cardiac device deactivation.

Importance: Little is known about patients who undergo cardiovascular implantable electronic device deactivation.

Objective: To describe features and outcomes of patients who underwent cardiovascular implantable electronic device deactivation.

Design, Setting, And Participants: Retrospective review of medical records of 150 patients at a tertiary academic medical center (Mayo Clinic, Rochester, Minnesota).

Outcomes of cardiac resynchronization therapy in the elderly.

Background: Octogenarians (>80 years) have been underrepresented in clinical trials of cardiac resynchronization therapy (CRT).

Objective: To determine the benefit of CRT with or without a defibrillator in older elderly patients.

Methods: We retrospectively studied consecutive patients who received CRT at our institution from 2002 through 2008.

Left ventricular lead position for cardiac resynchronization: a comprehensive cinegraphic, echocardiographic, clinical, and survival analysis.

Aims: We sought to determine the clinical and survival outcomes of cardiac resynchronization therapy (CRT) associated with left ventricular (LV) lead location. The lateral left ventricle has been considered the optimal LV lead location for CRT.

Methods And Results: Left ventricular lead cinegrams taken in 30° right and left anterior oblique views were evaluated in 457 recipients of CRT with a pacemaker or a defibrillator from 1 January 2002 to 31 December 2008 in this retrospective study.

Cardiac resynchronization therapy: do women benefit more than men?

Introduction: Women are underrepresented in cardiac resynchronization therapy (CRT) trials. Whether there is a gender difference in the benefit derived from CRT has not been well studied.

Methods: This study included 728 consecutive CRT recipients at our institution who met guidelines for placement of a CRT device.

Definition of performance metrics and methods for screening for sudden cardiac arrest risk at a tertiary care medical center.

Purpose: The purpose of this study is to describe the results of manual and automatic electronic medical record-based screening of patients at risk of sudden cardiac arrest (SCA) based on measurements of left ventricular ejection fraction (LVEF).

Methods: Counseling regarding SCA risk and implantable cardioverter defibrillator (ICD) therapy is underutilized in patients with reduced LVEF. We developed and implemented an electronic medical record (EMR)-based system for screening of such patients to improve care.

Cardiac sympathetic reserve and response to cardiac resynchronization therapy.

Background: The objective of the present study was to investigate the effect of cardiac resynchronization therapy (CRT) on cardiac autonomic function.

Methods And Results: This prospective study included 45 consecutive patients with heart failure who received CRT devices with defibrillator and 20 age-matched, healthy control subjects. At baseline and 3 months and 6 months after CRT, we assessed New York Heart Association (NYHA) class, 6-minute walk distance, plasma sympathetic biomarker nerve growth factor, echocardiography, heart rate variability and cardiac presynaptic sympathetic function determined by iodine 123 metaiodobenzylguanidine scintigraphy.

Differential outcome of cardiac resynchronization therapy in ischemic cardiomyopathy and idiopathic dilated cardiomyopathy.

Background: Cardiac resynchronization therapy (CRT) is a therapy of proven benefit in patients with advanced heart failure. Identifying potential responders remains challenging, and whether the etiology of the heart failure is related to the potential hemodynamic benefit and long-term outcome of CRT is unclear.

Objective: The purpose of this study was to evaluate whether heart failure etiology (ischemic cardiomyopathy [ICM] vs nonischemic dilated cardiomyopathy [DCM]) was associated with CRT outcome and implantable cardioverter-defibrillator (ICD) shocks.

Implantable cardioverter defibrillator therapy for congenital long QT syndrome: a single-center experience.

Background: Long QT syndrome's (LQTS) marked heterogeneity necessitates both evidence-based and individualized therapeutic approaches.

Objective: This study sought to analyze a single LQTS specialty center's experience regarding the relationship between risk factors and appropriate ventricular fibrillation (VF)-terminating therapies among LQTS patients treated with an implantable cardioverter-defibrillator (ICD).

Methods: An internal review board-approved, retrospective analysis of the electronic medical records of 459 patients with genetically confirmed LQTS including the 51 patients (14 LQT1, 22 LQT2, and 15 LQT3) who received an ICD from 2000 to 2010 was performed.

Atrioventricular nodal ablation predicts survival benefit in patients with atrial fibrillation receiving cardiac resynchronization therapy.

Background: Cardiac resynchronization therapy (CRT) benefits patients with advanced heart failure. The role of atrioventricular nodal (AVN) ablation in improving CRT outcomes, including survival benefit in CRT recipients with atrial fibrillation, is uncertain.

Objective: The purpose of this study was to assess the impact of AVN ablation on clinical and survival outcomes in a large atrial fibrillation and heart failure population that met the current indication for CRT and to determine whether AVN ablation is an independent predictor of survival in CRT recipients.

Long-term stability of endocardial left ventricular pacing leads placed via the coronary sinus.

Background: Left ventricular endocardial pacing leads placed via the coronary sinus (CS) are increasingly implanted to achieve cardiac resynchronization therapy (CRT); however, the long-term stability of these leads is unknown. We sought to determine the implant success and long-term stability of CS leads in our single center experience.

Methods: All consecutive patients who underwent CRT via implantation of the CS lead between January 1999 and December 2005 were included.

Upgrade and de novo cardiac resynchronization therapy: impact of paced or intrinsic QRS morphology on outcomes and survival.

Background: Cardiac resynchronization therapy (CRT) improves outcomes in patients with left bundle branch block (LBBB), but the benefits of CRT in patients with other QRS morphologies or previous pacing are uncertain.

Objective: The purpose of this study was to describe outcomes in patients with prior right ventricular pacing and non-LBBB morphologies.

Methods: We studied 505 patients who underwent de novo CRT (n = 338) or CRT upgrade (n = 167).