Cardiac resynchronization therapy (CRT) is recommended for patients with New York Heart Association (NYHA) class III or IV heart failure and wide QRS complexes. The aim of this study was to compare ...the effects of CRT in patients in NYHA class II with those in NYHA class III or IV. Nine hundred fifty-two patients (188 in NYHA class II) consecutively implanted with biventricular devices and enrolled in a national observational registry were studied. Clinical outcomes were estimated after 12 months of CRT, and long-term survival was assessed. At a median follow-up of 16 months, significantly fewer major cardiovascular events were reported in patients in NYHA class II compared with NYHA class III or IV (rate 13 vs 23 per 100 patient-years of follow-up, p <0.001). The percentage of patients who improved in NYHA class status after 12 months of CRT was lower in those in class II than in those in class III or IV (34% vs 69%, p <0.001), whereas the absolute increase in the ejection fraction was similar (8 ± 9% vs 9 ± 11%, p = NS), as well as the reductions in end-diastolic diameter (−3 ± 8 vs −3 ± 8 mm, p = NS) and end-systolic diameter (−4 ± 10 vs −6 ± 10 mm, p = NS). The NYHA class II group experienced lower all-cause mortality (log-rank test p = 0.018). In the 2 groups, patients with major cardiovascular events during follow-up exhibited less or no reverse remodeling compared with those with better long-term clinical outcomes. In conclusion, the results of this study indicate that CRT induced similar improvements in ventricular function in the 2 groups, whereas the improvement in functional status was significantly lower for patients in NYHA class II than for those in class III or IV. A positive effect of CRT on cardiac dimensions was associated with a long-term beneficial effect on disease progression in patients in NYHA class II.
Abstract Purpose Speckle-tracking echocardiography (STE) is a novel technique that can be used for assessment of left ventricular (LV) longitudinal deformation dynamics. Using cardiac catheterization ...as the reference standard, the aim of this study was to evaluate the relation between LV global longitudinal strain (GLS) assessed by STE and LV stroke volume in patients undergoing assessment for cardiac transplantation. Methods Conventional echocardiography and STE were performed during right-sided cardiac catheterization in 51 patients referred for cardiac transplant assessment. Thermodilution LV stroke volume indexed (LVSVI) was used as the reference standard. Univariate regression analyses and receiver operating characteristics curves were used to test correlations between LVSVI and GLS by STE. Results Global longitudinal strain was obtained successfully in 95.5% of patients. Among all variables analyzed, GLS best predicted the LVSVI ( r = 0.79; P < .0001). Minor correlations with the LVSVI were observed for tissue Doppler–derived systolic mitral annular velocity ( r = 0.51; P < .005) and for LV ejection fraction ( r = 0.32; P < .05). Conclusions In a group of patients referred for cardiac transplant assessment, LV longitudinal deformation analysis by STE closely correlates with LVSVI, suggesting that, in this particular clinical setting, this new parameter may help provide an accurate, noninvasive, and quantitative assessment of LV function.
Surface electrocardiograms, both resting 12-lead electrocardiographs and ambulatory electrocardiograph monitoring, play an essential role in establishing indications for cardiac implantable ...electronic devices (pacemakers, cardiac implantable defibrillators, and cardiac resynchronization therapies), and in the evaluation of patients already implanted. Current devices have prolonged memory capabilities (defined as Holter functions) and remote monitoring functions, to evaluate the electrical properties and the automatic detection of arrhythmias. Nonetheless, surface electrocardiography remains the critical tool to detect device malfunction, evaluate programming and function, verify the automatic arrhythmia analysis and the delivered electric therapy, and prevent inappropriate intervention.
Hemodynamics of HB pacing Alberti, Luca, MD; Pieragnoli, Paolo, MD; Ricciardi, Giuseppe, MD ...
Journal of electrocardiology,
2016
Journal Article
Recenzirano
Abstract This review will focus on the feasibility of long term His bundle pacing and its effects on left ventricle (LV) haemodynamics. Compared with right ventricular pacing, His bundle pacing ...results in a more physiological electro-mechanical activation that contributes to preserve LV function. Moreover some studies showed a similar effect to biventricular pacing in patients with heart failure and left bundle branch block. Recent observations indicate that His bundle pacing should be considered as an optimal site to pace right ventricle in patients candidate to cardiac resynchronization therapy.
Abstract We report a case of non-traumatic splenic rupture in a 57-year-old man on dual antiplatelet therapy (DAPT) with aspirin and ticagrelor, seven months after percutaneous coronary intervention ...and drug-eluting stent implantation for non-ST elevation myocardial infarction. No splenic abnormalities were found at histopathological analysis after splenectomy, and no history of recent trauma was reported. Once restarted, DAPT after splenectomy, assessment of platelet function was performed by light transmittance aggregometry, showing a profound inhibition of platelet function by adenosine diphosphate, arachidonic acid, and collagen. Taking into account the bleeding risk associated with low on-treatment platelet reactivity, and to switch the patient from ticagrelor to a less potent P2Y12 inhibitor such as clopidogrel, cytochrome P450, genetic polymorphisms accounting for clopidogrel response variability were analyzed. The polymorphisms associated with lower response (CYP2C19*2, CYP2C19*3) were absent. Therefore, ticagrelor was withdrawn, and DAPT was continued with aspirin and clopidogrel. Rupture of the spleen may occur in the absence of major trauma or previous splenic diseases, and could be a complication of antithrombotic treatments. Moreover, low on-treatment platelet reactivity during DAPT is emerging as a possible risk factor for bleeding complications, so underlining the usefulness of assessing platelet function in special conditions to ensure that the patient receives the best tailored antiplatelet therapy. < Learning objective: Non-traumatic splenic rupture is a rare event, and is more often associated with pre-existing splenic abnormalities. However, it may be also a complication of medical treatments, especially with antithrombotic drugs. Low on-treatment platelet reactivity is emerging as a possible risk factor for bleeding complications; therefore, assessing platelet function in special conditions could be useful to ensure the patient receives the best-tailored antiplatelet therapy.>
This article describes the different anatomic structures involved in normal atrioventricular conduction and their pathologic states. It defines their effects on the electrocardiogram, and describes ...how to localize the level and evaluate the severity of conduction disease by electrocardiographic analysis. It illustrates the relevance of intracavitary recordings in the diagnosis of level of block.
The common arrhythmia atrial fibrillation (AF) is incompletely understood. The mechanism of initiation and the perpetuation of AF remain speculative. This article summarizes current knowledge of the ...complex relationship between arrhythmias triggering AF and their long-term effects on atrial tissue, leading to perpetuation of tachycardia. It focuses on the role of the electrocardiogram (ECG) from AF diagnosis to identification of sinus P wave abnormalities predicting future occurrences. The role of ambulatory ECG recordings in managing AF and the use of frequency analysis determining degree of organization and identification of AF triggers are discussed.
Abstract Introduction “Cardiac memory” (CM) refers to a change in repolarization induced by an altered pathway of activation, manifested after resumption of spontaneous ventricular activation (SVA). ...Aims To investigate for the first time in humans the effects of left ventricular (LV) pacing on CM development through vectorcardiography (VCG). Methods We studied 28 patients with heart failure (HF) and left bundle branch block (LBBB) treated with cardiac resynchronization therapy (CRT). Fourteen patients underwent biventricular (BIV) stimulation; the other 14 underwent LV stimulation only. VCG was acquired during SVA at baseline and during AAI and DDD pacing immediately after and 7 and 90 days after the implant. Results At baseline, in both groups, the QRS and T vectors angles were those specific of LBBB pattern. During DDD pacing, QRS vector angle changed to the right and upward in BIV patients while no significant differences were observed in LV patients. During AAI pacing, T vector angle changed significantly in BIV patients, following the direction of the paced QRS and amplitude significantly increased. In LV patients no significant differences in T vector angles were observed. Only T vector amplitude significantly increased at 7 days (p = 0.03) and at 90 days (p = 0.008 vs baseline). Conclusion In patients with LBBB, BIV pacing induces cardiac memory development as a significant change in T vector magnitude and angle, while LV pacing doesn’t induce significant modifications in QRS and T vector angles and CM is manifested only as a significant T vector amplitude change.
Abstract Background Over the last 50 years left bundle branch block (LBBB) has been defined as homophasic (concordant: cLBBB) or heterophasic (discordant: dLBBB) when associated with a positive or ...negative T wave in leads I and V5-V6, respectively. LBBB is recognized as an adverse prognostic factor in heart failure (HF). The prevalence and clinical significance of cLBBB and dLBBB in HF patients are unknown. Methods and Results A total of 897 consecutive systolic HF patients (age 65 ± 13 years, left ventricular ejection fraction LVEF, 34 ± 10%) underwent clinical characterization, electrocardiographic evaluation for LBBB diagnosis and classification, and follow-up for cardiac events (median 37 months, range 1-84). LBBB was diagnosed in 232 patients (26%), cLBBB in 71 (31%), and dLBBB in 161 (69%). The dLBBB patients were older than those with cLBBB, and presented with lower LVEF, greater left ventricular telediastolic diameter and left ventricular mass index, higher level of brain natriuretic peptide, N-terminal pro-brain natriuretic peptide, renin activity, and norepinephrine (all P < .05). At Kaplan-Meier analysis, LBBB ( P = .003) and dLBBB ( P = .036) were associated with a worse prognosis when the composite end point of sudden death and implantable cardioverter defibrillator shock was considered. Conclusions In systolic HF, dLBBB is associated with a worse clinical, neurohormonal, and prognostic profile. LBBB classification could represent a useful tool in routine clinical evaluation.
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