Should all dysfunctional high-voltage leads be extracted? Results of a single-centre long-term registry.

Aims: A considerable number of lead defects occurs during long-term cardioverter defibrillator therapy. Evidence-based strategies for the handling of chronically implanted, non-functional high-voltage (HV) leads are mandatory.

Methods And Results: Patient outcome after abandonment of HV leads was retrospectively compared with patient outcome following other lead revision strategies and following primary implantation.

AV interval optimization using pressure volume loops in dual chamber pacemaker patients with maintained systolic left ventricular function.

Background: Atrioventricular (AV) interval optimization is often deemed too time-consuming in dual-chamber pacemaker patients with maintained LV function. Thus the majority of patients are left at their default AV interval.

Objective: To quantify the magnitude of hemodynamic improvement following AV interval optimization in chronically paced dual chamber pacemaker patients.

The effect of biventricular pacing on cardiac function after weaning from cardiopulmonary bypass in patients with reduced left ventricular function: a pressure-volume loop analysis.

Objective: Patients with severely reduced left ventricular function undergoing coronary artery bypass grafting have increased complication rates. We hypothesized that temporary postoperative atrial synchronous biventricular pacing would improve left ventricular function after cardiopulmonary bypass.

Methods: A left ventricular pressure-volume catheter was placed in 21 patients undergoing coronary artery bypass grafting (ejection fraction 29% +/- 5%).

The effect of biventricular pacing after coronary artery bypass grafting: a prospective randomized trial of different pacing modes in patients with reduced left ventricular function.

Objectives: Biventricular pacing acutely improves left ventricular function in patients with heart failure and left ventricular dyssynchrony. Pressure-volume loop analysis has shown acute perioperative hemodynamic benefits of biventricular pacing immediately after weaning from cardiopulmonary bypass in patients undergoing coronary artery bypass grafting, but whether these effects can be maintained for the early postoperative period is unclear. We hypothesized that biventricular pacing is superior to atrioventricular universal pacing at right ventricular outflowtract and atrial inhibited pacing in patients undergoing coronary artery bypass grafting.

Evolution of cardiac autonomic nervous activity indices in patients presenting with transient left ventricular apical ballooning.

Background: Transient left ventricular (LV) apical ballooning (AB) is characterized by a rapidly reversible, acute LV systolic dysfunction, triggered by physical or emotional stress. Despite observations strongly suggesting catecholamine-mediated myocardial stunning due to enhanced sympathetic activity, the early time course of heart rate variability (HRV) has not been described.

Methods: We prospectively enrolled 39 consecutive patients (median age = 68 years, range 35-85 years, 38 women) with LV AB.

The effects of facilitated primary PCI by guide wire on procedural and clinical outcomes in acute ST-segment elevation myocardial infarction.

Background: Reperfusion of the infarct related artery (IRA) prior to PCI is prognostically important in patients with acute ST segment elevation myocardial infarction (STEMI). Reperfusion is either achieved spontaneously, facilitated by GP IIb/ IIIa inhibitors, or mechanically by crossing the guide wire beyond the lesion. In order to test the hypothesis that a visible coronary anatomy is independently associated with procedural and clinical outcomes, we evaluated the frequency and prognostic impact of guide wire facilitated reperfusion of the IRA before primary PCI.

Feasibility of temporary biventricular pacing in patients with reduced left ventricular function after coronary artery bypass grafting.

Background And Methods: Biventricular pacing improves hemodynamics after weaning from cardiopulmonary bypass in patients with severely reduced left ventricular (LV) function undergoing coronary artery bypass grafting (CABG). We examined the feasibility of temporary biventricular pacing for 96 hours postoperatively. Unipolar epicardial wires were placed on the roof of the right atrium (RA), the right ventricular (RV) outflow tract, and the LV free lateral wall and connected to an external pacing device in 51 patients (mean LV ejection fraction 35 +/- 4%).

Modulation of cardiac autonomic nervous activity early after cardioversion of atrial fibrillation by biphasic waveform.

Background: Imbalance of cardiac autonomic nervous modulation might prominently contribute to early relapses of atrial fibrillation (AF) after cardioversion (CV). The biphasic (Bi) waveform is more effective than the monophasic (Mo) waveform in CV of AF. Whether these waveforms have different effects on autonomic modulation early after CV is unknown.

Modulation of ventricular repolarization in patients with transient left ventricular apical ballooning: a case control study.

Objective: Even though diffuse T wave inversion and prolongation of the QT interval in the surface electrocardiogram (ECG) have been consistently reported in patients with transient stress-induced left ventricular apical ballooning (AB), ventricular repolarization has not yet been systematically investigated in this clinical entity.

Background: AB, an emerging syndrome that mimics acute ST-segment elevation myocardial infarction (MI), is characterized by reversible left ventricular wall motion abnormalities in the absence of obstructive coronary heart disease and significant QT interval prolongation.

Methods: We prospectively enrolled 22 consecutive patients (21 women, median age 65 years) with transient left ventricular AB.

Inadequate ICD discharges due to diaphragmatic electromyopotential oversensing as the first sign of right ventricular lead perforation.

Right ventricular lead perforation, when acute, is a rare but potentially life-threatening complication of implantable cardioverter defibrillator (ICD) therapy. We report about a patient with early lead perforation presenting with repetitive ICD discharges due to oversensing of diaphragmatic electromyopotentials and describe the management of this complication.

Ventricular fibrillation induced by stretch pulse: implications for sudden death due to commotio cordis.

Introduction: Nonpenetrating chest wall impact (commotio cordis) may lead to sudden cardiac death due to the acute initiation of ventricular fibrillation (VF). VF may result from sudden stretch during a vulnerable window, which is determined by repolarization inhomogeneity.

Methods: We examined action potential morphologies and VF inducibility in response to sudden myocardial stretch in the left ventricle (LV).

Atrial near-field and ventricular far-field analysis by automated signal processing at rest and during exercise.

Introduction: Sophisticated monitoring of atrial activity is a prerequisite for modern pacemaker therapy. Ideally, near-fields and ventricular far-fields ought to be distinguished by beat-to-beat template analysis of the atrial signal. A prerequisite is that atrial signals are stable under different conditions.

Effect of adjunctive treatment with tirofiban on troponin T elevation during stenting of critically stenosed aortocoronary saphenous vein grafts.

In this pilot study, we show that periprocedural administration of tirofiban during stenting of critically stenosed saphenous vein grafts, significantly reduces the occurrence of postprocedural minor myocardial necroses.

Very early cardiac magnetic resonance imaging for quantification of myocardial tissue perfusion in patients receiving tirofiban before percutaneous coronary intervention for ST-elevation myocardial infarction.

Background: Assessment of myocardial blood flow is important for identification and monitoring of microvascular effects of glycoprotein IIb/IIIa inhibitors. Magnetic resonance imaging is a novel noninvasive method providing complementary information on myocardial blood flow and cardiac function.

Methods And Results: Patients (n = 53) admitted within 12 (mean, 5.

Accelerated idioventricular rhythm in the post-thrombolytic era: incidence, prognostic implications, and modulating mechanisms after direct percutaneous coronary intervention.

Background: In the thrombolytic era, the occurrence of accelerated idioventricular rhythm (AIR) has been proposed to be a specific marker for successful reperfusion. The incidence, prognostic implications, and potential modulating mechanisms of AIR after successful restoration of antegrade flow by means of modern reperfusion therapy (i.e.

Changes in heart rate, heart rate variability, and heart rate turbulence during evolving reperfused myocardial infarction.

Depressed cardiac parasympathetic activity is associated with electrical instability and adverse outcomes after myocardial infarction (MI). Heart rate turbulence (HRT), reflecting reflex vagal activity, and heart rate variability (HRV), reflecting tonic autonomic variations are both reduced in the subacute phase of MI. However, the evolution of these components of cardiac autonomic control between subacute and chronic phase of MI has not been defined.

Carvedilol versus metoprolol in the acute phase of myocardial infarction:

Beta-adrenergic blockers provide significant cardioprotection during acute ischemia and reperfusion. To further explore the effects of additional alpha-1-adrenoceptor blockade on autonomic modulation in acute myocardial infarction (AMI), carvedilol was compared with metoprolol in the setting of primary percutaneous coronary interventions (PCI). In a prospective study, 100 consecutive patients (61.

Carvedilol versus metoprolol in patients undergoing direct percutaneous coronary interventions for myocardial infarction: effects on QT dynamicity.

Beta-adrenergic blockers exert significant antiarrhythmic activity during ischemia and reperfusion. To further explore the beneficial effects conferred by alpha-1-adrenoceptor blockade on ventricular repolarization dynamicity in the acute phase of myocardial infarction (AMI), we compared carvedilol with metoprolol in the setting of primary percutaneous coronary intervention (PCI). In a prospective study, 100 consecutive patients undergoing primary PCI for AMI were randomized to metoprolol 200 mg/day versus carvedilol 25 mg/day.

Left ventricular malposition of pacemaker lead in Chagas' disease.

A 52-year-old Argentinian woman presented with third-degree AV block due to seropositive chronic stage of Chagas' disease. Subsequently, a DDD pacemaker was implanted. Interestingly, a postoperative chest X ray suggested left ventricular lead misplacement, an ECG showed a paced RBBB.