Relationship of the implantable cardioverter defibrillator and chronic resynchronization therapy: the perfect marriage?

Background: The two major modes of death in the patient with a reduced ejection fraction (EF) are death due to heart failure and death due to lethal arrhythmia, essentially the two sides of the same coin. Over the last 20 years, two therapies-cardiac resynchronization therapy (CRT) and the implantable cardioverter defibrillator (ICD)-have been developed and tested in clinical trials. They are now, in conjunction with appropriate medical therapy, the mainstays of therapy for these two commonly encountered clinical problems.

Hibernating myocardium: is there evidence for chronic flow reduction?

Myocardial hibernation is defined as a state of chronically reduced contractility in response to a reduction in blood supply and the ability to recover function after revascularization. There is controversy about the chronicity of a reduction in myocardial perfusion for induction of the adaptive mechanisms of hibernation. A search was conducted of the clinical literature for evidence showing that myocardial perfusion is chronically reduced in hibernating myocardium.

Effect of combined K(ATP) channel activation and Na(+)/H(+) exchange inhibition on infarct size in rabbits.

We tested if combining treatment with cariporide, an Na(+)/H(+) exchange inhibitor, and diazoxide, a mitochondrial ATP-sensitive K(+) (K(ATP)) channel opener, would reduce myocardial infarct size (IS) to a greater extent than either intervention alone. Four groups of rabbits were studied (n = 10 each): cariporide (0.3 mg/kg), diazoxide (10 mg/kg), both drugs, and saline control, given 15 min before a 30-min coronary artery occlusion and 3 h reperfusion.