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Burch AE, Erath JW, Kutyifa V, Aßmus B, Bonderman D, Russo AM. Decline in physical activity in the weeks preceding sustained ventricular arrhythmia in women. Heart Rhythm O2 2020; 1:283-287. [PMID: 34113882 PMCID: PMC8183853 DOI: 10.1016/j.hroo.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Heightened risk of cardiac arrest following physical exertion has been reported. Among patients with an implantable defibrillator, an appropriate shock for sustained ventricular arrhythmia was preceded by a retrospective self-report of engaging in mild-to-moderate physical activity. Previous studies evaluating the relationship between activity and sudden cardiac arrest lacked an objective measure of physical activity and women were often underrepresented. Objective To determine the relationship between physical activity, recorded by accelerometer in a wearable cardioverter-defibrillator (WCD), and sustained ventricular arrhythmia among female patients. Methods A dataset of female adult patients prescribed a WCD for a diagnosis of myocardial infarction or dilated cardiomyopathy was compiled from a commercial database. Curve estimation, to include linear and nonlinear interpolation, was applied to physical activity as a function of time (days before arrhythmia). Results Among women who received an appropriate WCD shock for sustained ventricular arrhythmia (N = 120), a quadratic relationship between time and activity was present prior to shock. Physical activity increased starting at the beginning of the 30-day period up until day -16 (16 days before the ventricular arrhythmia) when activity begins to decline. Conclusion For patients who received treatment for sustained ventricular arrhythmia, a decline in physical activity was found during the 2 weeks preceding the arrhythmic event. Device monitoring for a sustained decline in physical activity may be useful to identify patients at near-term risk of a cardiac arrest.
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Affiliation(s)
- Ashley E. Burch
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina
- Address reprint requests and correspondence: Dr Ashley E. Burch, Department of Cardiovascular Sciences, East Carolina University, Health Sciences Building, Mail Stop 668, Greenville, NC 27834.
| | - Julia W. Erath
- Department of Cardiology, J.W. Goethe University, Frankfurt am Main, Germany
| | | | - Birgit Aßmus
- Department of Medicine I, Cardiology and Angiology, Justus-Liebig-University, Giessen, Germany
| | - Diana Bonderman
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Andrea M. Russo
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
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Abstract
PURPOSE Ischemic stroke significantly contributes to morbidity and mortality in heart failure (HF). The risk of stroke increases significantly, with coexisting atrial fibrillation (AF). An aggravating factor could be asymptomatic paroxysms of AF (so-called silent AF), and therefore, the risk stratification in these patients remains difficult. This review provides an overview of stroke risk in HF, its risk stratification, and stroke prevention in these patients. RECENT FINDINGS Stroke risk stratification in HF patients remains an important issue. Recently, the CHA2DS2-VASc score, originally developed to predict stroke risk in AF patients, had been reported to be a predictive for strokes in HF patients regardless of AF being present. Furthermore, there are several independent risk factors (e.g., hypertension, diabetes mellitus, prior stroke) described. Based on the current evidence, HF should be considered as an independent risk factor for stroke. The CHA2DS2-VASc score might be useful to predict stroke risk in HF patients with or without AF in clinical routine. However, there is only a recommendation for the oral anticoagulation use in patients with concomitant HF and AF, while in patients with HF and no AF, individualized risk stratification is preferred. Current guidelines recommend to prefer non-vitamin Kantagonist anticoagulants over warfarin.
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Affiliation(s)
- Katja Schumacher
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany
| | - Jelena Kornej
- Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Eduard Shantsila
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
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Tolosana JM, Brugada J. Optimizing Cardiac Resynchronization Therapy Devices in Follow-up to Improve Response Rates and Outcomes. Card Electrophysiol Clin 2019; 11:89-98. [PMID: 30717856 DOI: 10.1016/j.ccep.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although cardiac resynchronization therapy (CRT) will improve symptoms and survival in selected heart failure patients, there still remains a high percentage of CRT recipients who do not obtain benefit from the therapy. During CRT follow-up, an effort should be made to identify and to treat reversible causes of nonresponse to CRT. This effort includes optimization of medical therapy, checking for appropriate and effective biventricular pacing, and treatment of arrhythmias and other reversible causes of CRT malfunction.
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Affiliation(s)
- Jose María Tolosana
- Cardiovascular Institute, Hospital Clínic, Arrhythmia Unit Hospital Clinic, University of Barcelona, Villarroel 170, Barcelona 08036, Spain
| | - Josep Brugada
- Pediatric Arrhythmia Unit, Cardiovascular Institute, Hospital Clínic, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
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Isnard R, Bauer F, Cohen-Solal A, Damy T, Donal E, Galinier M, Hagège A, Jourdain P, Leclercq C, Sabatier R, Trochu JN, Cohen A. Non-vitamin K antagonist oral anticoagulants and heart failure. Arch Cardiovasc Dis 2016; 109:641-650. [PMID: 27836786 DOI: 10.1016/j.acvd.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/14/2016] [Accepted: 08/05/2016] [Indexed: 12/31/2022]
Abstract
Thromboembolism contributes to morbidity and mortality in patients with heart failure (HF), and atrial fibrillation (AF) is one of the main factors promoting this complication. As they share many risk factors, HF and AF frequently coexist, and patients with both conditions are at a particularly high risk of thromboembolism. Non-vitamin K antagonist oral anticoagulants (NOACs) are direct antagonists of thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban and edoxaban), and were designed to overcome the limitations of vitamin K antagonists. Compared with warfarin in non-valvular AF, NOACs demonstrated non-inferiority with better safety, most particularly for intracranial haemorrhages. Therefore, the European Society of Cardiology guidelines recommend NOACs for most patients with non-valvular AF. Subgroups of patients with both AF and HF from the pivotal studies investigating the safety and efficacy of NOACs have been analysed and, for each NOAC, results were similar to those of the total analysis population. A recent meta-analysis of these subgroups has confirmed the better efficacy and safety of NOACs in patients with AF and HF - particularly the 41% decrease in the incidence of intracranial haemorrhages. The prothrombotic state associated with HF suggests that patients with HF in sinus rhythm could also benefit from treatment with NOACs. However, in the absence of clinical trial data supporting this indication, current guidelines do not recommend anticoagulant treatment of patients with HF in sinus rhythm. In conclusion, recent analyses of pivotal studies support the use of NOACs in accordance with their indications in HF patients with non-valvular AF.
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Affiliation(s)
- Richard Isnard
- Department of Cardiology, AP-HP, Pitié-Salpêtrière Hospital, Faculty of Medicine Pierre-et-Marie-Curie, University Paris 6, UMRS Inserm-UPMC 1166 and Institute of Cardiometabolism and Nutrition (ICAN), 75013 Paris, France.
| | - Fabrice Bauer
- Department of Cardiology, Inserm U1096, Rouen University Hospital, 76031 Rouen, France
| | - Alain Cohen-Solal
- Department of Cardiology, Paris Diderot University, Sorbonne Paris Centre, UMRS 942, Lariboisière Hospital, 75013 Paris, France
| | - Thibaud Damy
- UPEC, Mondor Amyloidosis Network, Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Inserm U955, DHU ATVB, 94010 Créteil, France
| | - Erwan Donal
- Department of Cardiology, Rennes University Hospital, University of Rennes 1, LTSI, Inserm UMR 1099, University of Rennes 1, 35033 Rennes, France
| | - Michel Galinier
- Équipe 7 « Obésité et Insuffisance Cardiaque : Approches Moléculaires et Cliniques », Inserm UMR 1048 - I2MC, Faculty of Medicine, University Paul-Sabatier - Toulouse 3, 31432 Toulouse, France
| | - Albert Hagège
- Department of Cardiology, AP-HP, Georges-Pompidou European Hospital, Paris Descartes University, PRES Paris Cité, 75015 Paris, France
| | - Patrick Jourdain
- École du Cœur et des Anticoagulants, UTIC, CHR Dubos, 95300 Pontoise, France
| | - Christophe Leclercq
- Department of Cardiology, Rennes University Hospital, CIC-IT, 35033 Rennes, France
| | - Rémi Sabatier
- Department of Cardiology, Caen University Hospital, 14003 Caen, France
| | - Jean-Noël Trochu
- Department of Cardiology and Vascular Diseases, Inserm UMR 1087, CIC 1413, Nantes University, Institut du Thorax, CHU de Nantes, 44093 Nantes, France
| | - Ariel Cohen
- Faculty of Medicine Pierre-et-Marie-Curie, University Paris 6, Department of Cardiology, AP-HP, Saint-Antoine Hospital, 75012 Paris, France
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Kloosterman M, Maass AH, Rienstra M, Van Gelder IC. Atrial Fibrillation During Cardiac Resynchronization Therapy. Card Electrophysiol Clin 2015; 7:735-748. [PMID: 26596815 DOI: 10.1016/j.ccep.2015.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The landmark trials on cardiac resynchronization therapy (CRT) have focused on patients with sinus rhythm at inclusion. Little data are available on the efficacy of CRT in patients with atrial fibrillation (AF), while AF has a high prevalence (20-40%) among patients receiving CRT. This review focuses on the detrimental effect of AF on CRT response and discusses management of patients with AF during CRT. Uncertainty remains as to which thresholds of AF burden can lead to a reduced response to CRT and every effort should be made in trying to assess and guarantee successful biventricular pacing in patients with AF.
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Affiliation(s)
- Mariëlle Kloosterman
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
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Ghosh S, Stadler RW, Mittal S. Automated detection of effective left-ventricular pacing: going beyond percentage pacing counters. Europace 2015; 17:1555-62. [PMID: 25862307 PMCID: PMC4617370 DOI: 10.1093/europace/euv062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/23/2015] [Indexed: 12/12/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) devices report percentage pacing as a diagnostic but cannot determine the effectiveness of each paced beat in capturing left-ventricular (LV) myocardium. Reasons for ineffective LV pacing include improper timing (i.e. pseudofusion) or inadequate pacing output. Device-based determination of effective LV pacing may facilitate optimization of CRT response. Methods and results Effective capture at the LV cathode results in a negative deflection (QS or QS-r morphology) on a unipolar electrogram (EGM). Morphological features of LV cathode–RV coil EGMs were analysed to develop a device-based automatic algorithm, which classified each paced beat as effective or ineffective LV pacing. The algorithm was validated using acute data from 28 CRT-defibrillator patients. Effective LV pacing and pseudofusion was simulated by pacing at various AV delays. Loss of LV capture was simulated by RV-only pacing. The algorithm always classified LV or biventricular (BV) pacing with AV delays ≤60% of patient's intrinsic AV delay as effective pacing. As AV delays increased, the percentage of beats classified as effective LV pacing decreased. Algorithm results were compared against a classification truth based on correlation coefficients between paced QRS complexes and intrinsic rhythm QRS templates from three surface ECG leads. An average correlation >0.9 defined a classification truth of ineffective pacing. Compared against the classification truth, the algorithm correctly classified 98.2% (3240/3300) effective LV pacing beats, 75.8% (561/740) of pseudofusion beats, and 100% (540/540) of beats with loss of LV capture. Conclusion A device-based algorithm for beat-by-beat monitoring of effective LV pacing is feasible.
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Affiliation(s)
- Subham Ghosh
- Medtronic Inc., 8200 Coral Sea St, Mounds View, MN 55112, USA
| | | | - Suneet Mittal
- Arrhythmia Institute at Valley Hospital, 223 N. Van Dien Avenue, Ridgewood, NJ 07450, USA
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Herz ND, Engeda J, Zusterzeel R, Sanders WE, O'Callaghan KM, Strauss DG, Jacobs SB, Selzman KA, Piña IL, Caños DA. Sex differences in device therapy for heart failure: utilization, outcomes, and adverse events. J Womens Health (Larchmt) 2015; 24:261-71. [PMID: 25793483 DOI: 10.1089/jwh.2014.4980] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiple studies of heart failure patients demonstrated significant improvement in exercise capacity, quality of life, cardiac left ventricular function, and survival from cardiac resynchronization therapy (CRT), but the underenrollment of women in these studies is notable. Etiological and pathophysiological differences may result in different outcomes in response to this treatment by sex. The observed disproportionate representation of women suggests that many women with heart failure either do not meet current clinical criteria to receive CRT in trials or are not properly recruited and maintained in these studies. METHODS We performed a systematic literature review through May 2014 of clinical trials and registries of CRT use that stratified outcomes by sex or reported percent women included. One-hundred eighty-three studies contained sex-specific information. RESULTS Ninety percent of the studies evaluated included ≤ 35% women. Fifty-six articles included effectiveness data that reported response with regard to specific outcome parameters. When compared with men, women exhibited more dramatic improvement in specific parameters. In the studies reporting hazard ratios for hospitalization or death, women generally had greater benefit from CRT. CONCLUSIONS Our review confirms women are markedly underrepresented in CRT trials, and when a CRT device is implanted, women have a therapeutic response that is equivalent to or better than in men, while there is no difference in adverse events reported by sex.
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Affiliation(s)
- Naomi D Herz
- Center for Devices and Radiological Health, United States Food and Drug Administration , Silver Spring, Maryland
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10
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Botto GL, Dicandia CD, Mantica M, La Rosa C, D'Onofrio A, Bongiorni MG, Molon G, Verlato R, Villani GQ, Scaccia A, Raciti G, Occhetta E. Clinical characteristics, mortality, cardiac hospitalization, and ventricular arrhythmias in patients undergoing CRT-D implantation: results of the ACTION-HF study. J Cardiovasc Electrophysiol 2012; 24:173-81. [PMID: 23130781 DOI: 10.1111/jce.12023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The characteristics and outcomes of patients who undergo cardiac resynchronization therapy (CRT) device implantation in current clinical practice may differ from those of reference trial populations. Study objectives were to assess 2-year outcomes in a population implanted with a CRT plus defibrillator device in accordance with the standard of care and to evaluate any independent association between clinical variables and outcome. METHODS AND RESULTS A total of 406 patients enrolled at 35 centers in Italy were followed up prospectively for 2 years. All patient management decisions were left to the treating physician's discretion, in accordance with clinical practice. ACTION-HF patients had a better baseline clinical status than patients enrolled in the COMPANION study: shorter HF history (1 vs 3.5 years, P < 0.01), less advanced NYHA functional class (III-IV: 73% vs 100%, P < 0.01), higher LVEF (26% vs 21%, P < 0.01), higher SBP (122 vs 112 mmHg, P < 0.01), and less diabetes (27% vs 41%, P < 0.01). This status was reflected in lower mortality (11.5% vs 26%) and a lower incidence of appropriate ICD shocks (12.1% vs 19.3%). AF history was an independent predictor of the combination of all-cause mortality and cardiac-cause hospitalization (HR: 3.31; P < 0.001). Recurrent or new atrial arrhythmias were independently associated with the development of ventricular arrhythmias (HR: 3.4; P < 0.001). CONCLUSIONS This population appears clinically less compromised and had a lower incidence of adverse clinical outcomes than those of reference trials. However, we recorded a substantial burden of atrial arrhythmias, which was independently associated with a higher incidence of ventricular arrhythmias.
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Caldwell JC, Mamas MA. Heart failure, diastolic dysfunction and atrial fibrillation; mechanistic insight of a complex inter-relationship. Heart Fail Rev 2012; 17:27-33. [PMID: 21103928 DOI: 10.1007/s10741-010-9204-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Atrial fibrillation (AF) and heart failure (HF) commonly coexist, and their co-presence is associated with adverse outcomes relating to thromboembolic events, HF progression, hospitalisation and death. Diastolic dysfunction (DD) is also frequently present in patients with HF and is an independent predictor of hospitalisation and mortality. The presence of DD is a strong predictor of incident AF in patients with HF. In this review, we provide mechanistic insight into pathophysiological processes that frequently promote the occurrence of AF, HF and DD and outline the yin-yang relationship between AF, DD and HF. More recently, invasive studies have also shown that asymptomatic paroxysmal atrial fibrillation (PAF) is a common phenomenon in HF patients. We examine complex inter-relationships between PAF, HF and DD and speculate upon the possible clinical influence of undiagnosed PAF in HF patients.
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Affiliation(s)
- J C Caldwell
- Manchester Heart Centre, Manchester Royal Infirmary, Biomedical Research Centre, Manchester, UK.
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Boriani G, Gasparini M, Landolina M, Lunati M, Proclemer A, Lonardi G, Iacopino S, Rahue W, Biffi M, DiStefano P, Grammatico A, Santini M. Incidence and clinical relevance of uncontrolled ventricular rate during atrial fibrillation in heart failure patients treated with cardiac resynchronization therapy. Eur J Heart Fail 2011; 13:868-76. [PMID: 21558331 DOI: 10.1093/eurjhf/hfr046] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIMS Uncontrolled ventricular rate (VR) during atrial fibrillation (AF) may cause clinical deterioration in heart failure (HF) patients who need continuous biventricular pacing to achieve cardiac resynchronization therapy (CRT). We aimed at evaluating the association between AF, uncontrolled VR, and sub-optimal CRT, defined as low biventricular pacing percentage (BIVP%). METHODS AND RESULTS All 1404 patients had HF, New York Heart Association (NYHA) ≥II, left ventricular ejection fraction (LVEF) ≤35%, and QRS ≥120 ms, and received an implantable CRT defibrillator (CRT-D). Occurrence of AF, VR during AF and lifetime BIVP% were estimated from device data. Ventricular rate during AF was defined as uncontrolled in patients with mean VR>80 bpm and maximum VR>110 bpm. Over a median follow-up of 18 months, AF was detected in 443 of 1404 patients (32%). In this sub-group of AF patients, VR during AF was uncontrolled in 150 of 443 patients (34%). Multivariate Cox regression analysis showed that age [hazard ratio (HR) = 1.03, 95% confidence interval (CI) = 1.00-1.06, P= 0.028], and uncontrolled VR [HR = 1.69 (CI = 1.01-2.83), P= 0.046] were the only independent predictors of clinical outcome, assessed by HF hospitalizations and death. The median lifetime BIVP% was 95% (25-75 percentile range 91-99%). Biventricular pacing percentage was significantly and inversely correlated to VR, decreasing by 7% for each 10 bpm increase in VR. Sub-optimal CRT, defined as BIVP% <95%, was predicted by the occurrence of persistent or permanent AF [odds ratio (OR) = 3.77, CI = 2.44-5.82, P< 0.001], and uncontrolled VR [OR = 2.25, CI = 1.35-3.73, P= 0.002]. CONCLUSION Uncontrolled VR occurs in one-third of CRT-D patients, who experience AF, and is associated with HF hospitalizations and death and with sub-optimal CRT (lifetime BIVP%<95%).
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Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, University of Bologna and Azienda Ospedaliera S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy.
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Bronzetti G, D'Angelo C, Donti A, Salomone L, Giardini A, Maria Picchio F, Boriani G. Role of atrial fibrillation after transcatheter closure of patent foramen ovale in patients with or without cryptogenic stroke. Int J Cardiol 2011; 146:17-21. [DOI: 10.1016/j.ijcard.2009.05.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 05/11/2009] [Indexed: 11/26/2022]
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Rossi P, Bianchi S, Valsecchi S, Porcelli D, Sgreccia F, Lucifiero A, Canonaco S, Campoli M, Malavasi M, Piccirillo G, Quaglione R, Azzolini P. Endocardial vagal atrioventricular node stimulation in humans: reproducibility on 18-month follow-up. Europace 2010; 12:1719-24. [PMID: 20876272 DOI: 10.1093/europace/euq343] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Control of atrioventricular (AV) node conduction by means of high-frequency stimulation (HFS) of efferent AV node vagal stimulation (AVNS) fibres enables the ventricular rate (VR) to be modulated during atrial fibrillation (AF). The aims of this study were to verify, on 18-month follow-up, the reproducibility of the dromotropic effect obtained on implantation and the long-term reliability of the system in patients who received an implantable cardioverter-defibrillator (ICD) with a standard atrial lead positioned at a location suitable for AVNS. METHODS AND RESULTS We enrolled 12 patients with paroxysmal or persistent AF who were candidates for ICD. The right atrium was mapped to locate the pacing site, and a transvenous screw-in lead was implanted in that region. The voltages required for VR modulation (25% VR reduction) and complete AV block at different pulse durations (from 0.1 to 0.5 ms) were recorded. Eleven out of 12 patients underwent 18-month follow-up examination. Atrial pacing parameters were adequate and did not differ from the baseline values (all P > 0.05): pacing threshold 0.9 ± 0.5 V (0.5 ms pulse duration) and impedance 556 ± 121 Ω, with P-wave amplitude of 1.6 ± 0.7 mV. High-frequency stimulation induced VR modulation in nine patients and complete AV block in eight patients at pulse durations ≥0.3 ms. No differences were observed in the voltages for VR modulation and complete AV block between implantation and 18-month examination (all P > 0.100). CONCLUSION Ventricular rate control during AF was obtained under HFS 18 months after implantation in patients with the atrial lead positioned at a location suitable for AVNS. The pacing outputs needed to achieve the dromotropic effect were comparable to those measured on implantation.
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Affiliation(s)
- Pietro Rossi
- Department of Medicine, Electrophysiology and Pacing Unit, Belcolle Hospital, Viterbo, Italy
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Vagal tone augmentation to the atrioventricular node in humans: Efficacy and safety of burst endocardial stimulation. Heart Rhythm 2010; 7:683-9. [DOI: 10.1016/j.hrthm.2010.01.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 01/21/2010] [Indexed: 11/24/2022]
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What are the Thromboembolic Risks of Heart Failure Combined With Chronic or Paroxysmal AF? J Card Fail 2010; 16:340-7. [DOI: 10.1016/j.cardfail.2009.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 12/02/2009] [Accepted: 12/07/2009] [Indexed: 11/22/2022]
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Leclercq C, Padeletti L, Cihák R, Ritter P, Milasinovic G, Gras D, Paul V, Van Gelder IC, Stellbrink C, Rieger G, Corbucci G, Albers B, Daubert JC. Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics. Europace 2010; 12:71-7. [PMID: 19864311 DOI: 10.1093/europace/eup318] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Little is known about the incidence of paroxysmal atrial tachycardias (PAT) in patients with heart failure (HF). The availability of cardiac resynchronization therapy (CRT) devices with extended diagnostics for AT enables continuous monitoring of PAT episodes. The aim of the study was to assess the incidence over time of PAT in HF patients treated with CRT. METHODS AND RESULTS Consecutive patients in NYHA functional class III or IV despite optimal drug therapy, QRS duration > or = 130 ms, left ventricular ejection fraction < or = 35%, and left ventricular end-diastolic dimension > or = 55 mm were eligible for enrolment. Patients with permanent or persistent atrial fibrillation (AF) were not included in the study. The first follow-up examination was performed 2 weeks after implantation, to optimize atrial sensing and CRT. Subsequent follow-up examinations were carried out 15 and 28 weeks after implantation, to collect the telemetric data. A total of 173 patients (67 +/- 11 years, M 116) were enrolled. Complete arrhythmia monitoring data were available from 120 patients over a mean follow-up of 183 +/- 23 days. Atrial tachycardia episodes were detected through telemetry in 25 of 120 patients (21%) during at least one follow-up examination. Atrial tachycardia episodes were recorded in 29 and 17% (P = NS) of patients with and without previous history of AF, respectively. CONCLUSION More than 20% of the overall HF patient population treated with CRT suffer PAT episodes. Paroxysmal atrial tachycardia may interfere with response to CRT. Therefore, telemetric data may be relevant to drive the appropriate therapy in each patient.
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Affiliation(s)
- C Leclercq
- Hôpital Pôntchaillou CHU, University of Rennes, Rennes, France.
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BORIANI GIUSEPPE, DIEMBERGER IGOR, MANTOVANI VALENTINA, BIFFI MAURO, MARTIGNANI CRISTIAN. Remote Monitoring of Patients with an Implanted Device and Patients’ Outcomes: The Potential for “Win-Win” Dynamics. J Cardiovasc Electrophysiol 2009; 20:1252-4. [DOI: 10.1111/j.1540-8167.2009.01576.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rutjanaprom W, Kanlop N, Charoenkwan P, Sittiwangkul R, Srichairatanakool S, Tantiworawit A, Phrommintikul A, Chattipakorn S, Fucharoen S, Chattipakorn N. Heart rate variability in beta-thalassemia patients. Eur J Haematol 2009; 83:483-9. [DOI: 10.1111/j.1600-0609.2009.01314.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Caldwell JC, Contractor H, Petkar S, Ali R, Clarke B, Garratt CJ, Neyses L, Mamas MA. Atrial fibrillation is under-recognized in chronic heart failure: insights from a heart failure cohort treated with cardiac resynchronization therapy. Europace 2009; 11:1295-300. [PMID: 19648586 DOI: 10.1093/europace/eup201] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with chronic heart failure (CHF). Under-detection of asymptomatic paroxysmal AF (PAF) underestimates the true burden of AF in patients with CHF. We retrospectively studied the prevalence of asymptomatic PAF in 162 CHF patients through analysis of cardiac resynchronization therapy (CRT) device downloads to determine whether these episodes are associated with adverse outcomes. METHODS AND RESULTS An episode of AF was defined by mode switching on CRT devices with an atrial rate >200 for at least 30 s. Of the 101 patients thought to be persistently in sinus rhythm (SR), 27% were found to have significant paroxysms of AF, with the cumulative percentage of time in the 'mode-switch mode' (i.e. the AF burden) of 1.6 +/- 0.9%. Mortality was 19.2% in patients with newly identified PAF with hospitalization and thrombo-embolism rates of 42.3 and 2.1%, respectively, compared with mortality of 10.4% with hospitalization and thrombo-embolism rates of 41.8 and 1.9%, respectively, in patients persistently in SR (P= NS). CONCLUSION Analysis of data from CRT devices in a population of CHF patients with severe left ventricular dysfunction shows that a significant proportion of those perceived to be persistently in SR have undiagnosed paroxysms of AF but with relatively low burden. These episodes appear to be associated with a trend towards increased mortality but no effects on hospitalization or thrombo-embolism rates.
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Affiliation(s)
- Jane C Caldwell
- Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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Marzegalli M, Landolina M, Lunati M, Perego GB, Pappone A, Guenzati G, Campana C, Frigerio M, Parati G, Curnis A, Colangelo I, Valsecchi S. Design of the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study to assess the ability of remote monitoring to treat and triage patients more effectively. Trials 2009; 10:42. [PMID: 19538734 PMCID: PMC2705368 DOI: 10.1186/1745-6215-10-42] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 06/18/2009] [Indexed: 11/10/2022] Open
Abstract
Background Heart failure patients with implantable defibrillators (ICD) frequently visit the clinic for routine device monitoring. Moreover, in the case of clinical events, such as ICD shocks or alert notifications for changes in cardiac status or safety issues, they often visit the emergency department or the clinic for an unscheduled visit. These planned and unplanned visits place a great burden on healthcare providers. Internet-based remote device interrogation systems, which give physicians remote access to patients' data, are being proposed in order to reduce routine and interim visits and to detect and notify alert conditions earlier. Methods The EVOLVO study is a prospective, randomized, parallel, unblinded, multicenter clinical trial designed to compare remote ICD management with the current standard of care, in order to assess its ability to treat and triage patients more effectively. Two-hundred patients implanted with wireless-transmission-enabled ICD will be enrolled and randomized to receive either the Medtronic CareLink® monitor for remote transmission or the conventional method of in-person evaluations. The purpose of this manuscript is to describe the design of the trial. The results, which are to be presented separately, will characterize healthcare utilizations as a result of ICD follow-up by means of remote monitoring instead of conventional in-person evaluations. Trial registration ClinicalTrials.gov: NCT00873899
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Ricci RP, Quesada A, Almendral J, Arribas F, Wolpert C, Adragao P, Zoni-Berisso M, Navarro X, DeSanto T, Grammatico A, Santini M. Dual-chamber implantable cardioverter defibrillators reduce clinical adverse events related to atrial fibrillation when compared with single-chamber defibrillators: a subanalysis of the DATAS trial. Europace 2009; 11:587-93. [DOI: 10.1093/europace/eup072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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