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Purkayastha S, Reynbakh O, Krishnan S, Guttenplan N. Safety and efficacy of orthodromic snare technique in left ventricular lead delivery in cardiac resynchronization implantation. Pacing Clin Electrophysiol 2024; 47:1317-1325. [PMID: 39210617 DOI: 10.1111/pace.15066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 08/09/2024] [Accepted: 08/11/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves ventricular function, but a positive response to CRT is often limited due to left ventricular (LV) lead placement in a suboptimal position. Complex coronary venous anatomy can hinder the placement of an LV lead in the target vessel, leading to poor CRT response. OBJECTIVE To report experience with snare-assisted LV lead delivery in CRT and compare outcomes with the conventional LV lead delivery. METHODS This is a single-center retrospective case-control study of CRT implants between 2016 and 2021. Snare-assisted lead delivery was performed in cases where conventional lead placement failed or when a preferred target vessel had anatomy amenable to the technique. Safety and outcomes were compared to conventional LV lead placement cases. RESULTS Among 180 CRT cases, 33 were snare-assisted, and 147 were conventional LV lead placements. Median follow-up was 924 days in the snare and 618.5 days in the control group. The lead placement was successful in 28/33 snare and 138/147 control cases. A mid-vessel segment was attained in 89.3% of snare and 72.5% of control cases(p = .03). The apical position was more frequently observed in the control group (26.8% vs. 7.1%, p = .03). All-cause mortality trended lower in the snare group (6.1%) compared to (17.1%) in the control group (p = .13). CONCLUSION Snare-assisted LV lead delivery is a safe and effective technique that can be utilized for overcoming complex venous anatomy.
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Affiliation(s)
- Sutopa Purkayastha
- Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Olga Reynbakh
- Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Suraj Krishnan
- Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nils Guttenplan
- Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York, USA
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2
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Shaik SA, Oruganti SS. Relationship of echocardiographic left ventricular dyssynchrony with QRS width on surface electrocardiogram in patients with systolic heart failure: An observational study. Indian Heart J 2021; 73:664-666. [PMID: 34627591 PMCID: PMC8551543 DOI: 10.1016/j.ihj.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to evaluate left ventricular dyssynchrony with QRS width on ECG in patients with systolic heart failure. 100 study patients were classified into two groups. Narrow QRS group-N- QRS (80-119 msec) and Wide QRS group-W- QRS (120-160 msec). Out of each 50 patients in W- QRS group, 38(76%) had LV dyssynchrony and 18 (36%) in N- QRS group had ventricular dyssynchrony. Dyssynchrony in narrow QRS patients with heart failure also needs attention as a therapeutic target in future studies.
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Affiliation(s)
- Shabbir Ali Shaik
- Department of Cardiology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, 500082, Telangana, India
| | - Sai Satish Oruganti
- Department of Cardiology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, 500082, Telangana, India.
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3
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Gellér L, Salló Z, Molnár L, Tahin T, Özcan EE, Kutyifa V, Osztheimer I, Szilágyi S, Szegedi N, Ábrahám P, Apor A, Nagy KV, Kosztin A, Becker D, Herczeg S, Zima E, Merkely B. Long-term single-centre large volume experience with transseptal endocardial left ventricular lead implantation. Europace 2020; 21:1237-1245. [PMID: 31168608 PMCID: PMC6680368 DOI: 10.1093/europace/euz116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/15/2019] [Indexed: 11/29/2022] Open
Abstract
Aims The aim of our study was to investigate the long-term efficacy and safety of transseptal endocardial left ventricular lead implantation (TELVLI). Methods and results Transseptal endocardial left ventricular lead implantation was performed in 54 patients (44 men, median age 69, New York Heart Association III–IV stage) between 2007 and 2017 in a single centre. In 36 cases, the transseptal puncture (TP) was performed via the femoral vein, and in 18 cases, the TP and also the left ventricular (LV) lead placement were performed via the subclavian vein. An electrophysiological deflectable catheter was used to reach the LV wall through the dilated TP hole. The LV lead implantation was successful in all patients. A total of 54 patients were followed up for a median of 29 months [interquartile range (IQR) 8–40 months], the maximum follow-up time was 94 months. Significant improvement in the LV ejection fraction was observed at the 3-month visit, from the median of 27% (IQR 25–34%) to 33% (IQR 32–44%), P < 0.05. Early lead dislocation was observed in three cases (5%), reposition was performed using the original puncture site in all. The patients were maintained on anticoagulation therapy with a target international normalized ratio between 2.5 and 3.5. Four thromboembolic events were noticed during follow-up. A total of 27 patients died, with a median survival of 15 months (IQR 6–40). Conclusion The TELVLI is an effective approach for cardiac resynchronization therapy (CRT) however it is associated with a substantial thromboembolic risk (7%).
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Affiliation(s)
- László Gellér
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Zoltán Salló
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Levente Molnár
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Tamás Tahin
- Department of Cardiology, St. Rafael Hospital, Zrínyi street 1, Zalaegerszeg H, Hungary
| | - Emin Evren Özcan
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, Kültür Mahallesi, Cumhuriyet Blv No: 144, İzmir, Turkey
| | - Valentina Kutyifa
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary.,University of Rochester Medical Center, 265 Crittenden Boulevard, Box 653, Rochester, NY, USA
| | - István Osztheimer
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Szabolcs Szilágyi
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Nándor Szegedi
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Pál Ábrahám
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Astrid Apor
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Klaudia Vivien Nagy
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Annamária Kosztin
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Dávid Becker
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Szilvia Herczeg
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Endre Zima
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
| | - Béla Merkely
- Department of Cardiology, The Heart and Vascular Center of Semmelweis University, Városmajor street 68, Budapest H, Hungary
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4
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Ogawa K, Igarashi M, Nogami A, Yamamoto M, Sugano A, Sekiguchi Y, Aonuma K, Ieda M. The Usefulness and Limitations of Impedance Cardiography for Cardiac Resynchronization Therapy Device Optimization. Int Heart J 2020; 61:896-904. [PMID: 32999195 DOI: 10.1536/ihj.19-620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Identifying the optimal atrioventricular (AV) or interventricular (VV) delay is beneficial for patients using cardiac resynchronization therapy (CRT) devices. Ultrasonic echocardiography (UCG) has been the most commonly used method; however, it requires high technical knowledge. Impedance cardiography (ICG) can calculate stroke volume by measuring changes in transthoracic electric impedance. This study sought to assess the clinical utility of ICG in comparison with that of UCG for the optimization of CRT devices.Patients who underwent CRT device implantation were retrospectively analyzed. One week after implantation, optimization of AV delay (AVD) was performed in every patient with ICG (AVD-ICG) and UCG (AVD-UCG). VV delay (VVD) was then determined according to the optimal AVD using these two methods.Forty-two patients were enrolled. Average AVD-ICG was significantly shorter than AVD-UCG (128 ± 49 versus 146 ± 41 milliseconds, P = 0.018). Five patients (12%) had the same optimized AVD with two methods, and the difference between AVD-ICG and AVD-UCG was ≤ 20 milliseconds in 19 patients (45%). In the multivariate analysis, the presence of postoperative mitral regurgitation (MR) was an independent predictor of AVD-ICG/AVD-UCG mismatch, defined as a difference over 20 milliseconds (odds ratio = 10.71; 95% confidence interval = 1.72 to 66.72; P = 0.018). The results of optimized VVD were similar using both methods.ICG might be a promising tool for the rapid optimization of CRT devices. However, in patients with moderate-to-severe MR, ICG may not be able to optimize AVD.
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Affiliation(s)
- Kojiro Ogawa
- Department of Cardiology, Faculty of Medicine, University of Tsukuba.,Department of Cardiology, Hitachi General Hospital
| | - Miyako Igarashi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Akinori Sugano
- Department of Cardiology, Faculty of Medicine, University of Tsukuba.,Department of Cardiology, Tsukuba Medical Center Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba.,Department of Internal Medicine (Cardiology), Kasumigaura Medical Center
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
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5
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Antoniou CK, Manolakou P, Magkas N, Konstantinou K, Chrysohoou C, Dilaveris P, Gatzoulis KA, Tousoulis D. Cardiac Resynchronisation Therapy and Cellular Bioenergetics: Effects Beyond Chamber Mechanics. Eur Cardiol 2019; 14:33-44. [PMID: 31131035 PMCID: PMC6523053 DOI: 10.15420/ecr.2019.2.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cardiac resynchronisation therapy is a cornerstone in the treatment of advanced dyssynchronous heart failure. However, despite its widespread clinical application, precise mechanisms through which it exerts its beneficial effects remain elusive. Several studies have pointed to a metabolic component suggesting that, both in concert with alterations in chamber mechanics and independently of them, resynchronisation reverses detrimental changes to cellular metabolism, increasing energy efficiency and metabolic reserve. These actions could partially account for the existence of responders that improve functionally but not echocardiographically. This article will attempt to summarise key components of cardiomyocyte metabolism in health and heart failure, with a focus on the dyssynchronous variant. Both chamber mechanics-related and -unrelated pathways of resynchronisation effects on bioenergetics – stemming from the ultramicroscopic level – and a possible common underlying mechanism relating mechanosensing to metabolism through the cytoskeleton will be presented. Improved insights regarding the cellular and molecular effects of resynchronisation on bioenergetics will promote our understanding of non-response, optimal device programming and lead to better patient care.
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Affiliation(s)
| | - Panagiota Manolakou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | - Nikolaos Magkas
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | - Konstantinos Konstantinou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | - Christina Chrysohoou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | - Konstantinos A Gatzoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
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6
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Ojo A, Tariq S, Harikrishnan P, Iwai S, Jacobson JT. Cardiac Resynchronization Therapy for Heart Failure. Interv Cardiol Clin 2017; 6:417-426. [PMID: 28600094 DOI: 10.1016/j.iccl.2017.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cardiac resynchronization therapy (CRT) has emerged as a valued nonpharmacologic therapy in patients with heart failure, reduced ejection fraction (EF), and ventricular dyssynchrony manifest as left bundle branch block. The mechanisms of benefit include remodeling of the left ventricle leading to decreased dimensions and increased EF, as well as a decrease in the severity of mitral regurgitation. This article reviews the rationale, effects, and indications for CRT, and discusses the patient characteristics that predict response and considerations for nonresponders.
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Affiliation(s)
- Amole Ojo
- Division of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Sohaib Tariq
- Division of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Prakash Harikrishnan
- Division of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Sei Iwai
- Division of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Jason T Jacobson
- Division of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA.
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7
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Abstract
Aging of the population and prolongation of the lives of patients with heart failure (HF) by advanced therapeutic innovations has led to an elevating number of patients who live with HF. The American Heart Association estimated that 5.1 million Americans were affected with HF in 2013 and approximately 23 million individuals were affected worldwide. Despite the improved management approaches, the mortality rate is still high; less than half of the patients with HF remain alive after 5 years of HF diagnosis and less than a quarter of them after 10 years. HF costs the nation a huge amount of money. The total cost comprises $34.4 billion each year, including the health care services, medications, and loss of productivity. Hospitalization is a common issue in HF, estimated as primary diagnosis in more than 1 million each year. Readmission after initial hospitalization is another concern in patients with HF. Around 25% will be readmitted in the next 30 days after hospital discharge, out of which only one-third is due to HF. It also costs the government an exhausting amount of money. The report of Medicare Payment Advisory Commission that was provided to the congress in 2008 showed that the expenses on HF readmissions were about $903. In this review, we intended to demonstrate the different strategies that could improve the readmission rates in patients with HF and ultimately decrease the health care payments. These strategies include evidence-based management programs, surgical therapy, risk factors adjustment, and disease monitoring.
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8
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Belardinelli R, Capestro F, Misiani A, Scipione P, Georgiou D. Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy. ACTA ACUST UNITED AC 2016; 13:818-25. [PMID: 17001224 DOI: 10.1097/01.hjr.0000230104.93771.7d] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to determine the effects of a moderate exercise training program on functional capacity, quality of life, and hospital readmission rate in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy. METHODS AND RESULTS We studied 52 men (mean age 55+/-10 years, ejection fraction 31+/-7%) in chronic heart failure II (n=29) and III (n=23) NYHA functional class with ischemic cardiomyopathy who received implantable cardioverter defibrillators with or without cardiac resynchronization therapy. Patients were randomized into two groups. Group T (n=30 patients, 15 implantable cardioverter defibrillator, 15 implantable cardioverter defibrillator+cardiac resynchronization therapy) underwent a supervised exercise training program at 60% of peak VO2 three times a week for 8 weeks. Group C (n=22 patients, 12 implantable cardioverter defibrillator, 10 implantable cardioverter defibrillator+cardiac resynchronization therapy) avoided physical training. At 8 weeks, only trained patients had improvements in peak VO2 (P<0.01 versus C), endothelium-dependent dilatation of the brachial artery (P<0.001 versus C) and quality of life (P<0.001 versus C). Among trained patients, those with cardiac resynchronization therapy had greater improvements in peak VO2 and quality of life. During the follow-up (24+/-6 months), eight controls had sustained ventricular tachycardia requiring hospital readmission, while no trained patients had adverse events (log rank 8.56; P<0.001). The improvement in peak VO2 was correlated with the improvement in endothelium-dependent dilatation (r=0.65). CONCLUSION Moderate exercise training is safe and has beneficial effects after implantable cardioverter defibrillator implantation, especially when cardiac resynchronization therapy is present. These effects are associated with improvement in quality of life and outcome.
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9
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CURCIO ANTONIO, DE ROSA SALVATORE, SABATINO JOLANDA, DE LUCA SIMONA, BOCHICCHIO ANGELA, POLIMENI ALBERTO, SANTARPIA GIUSEPPE, RICCI PIETRANTONIO, INDOLFI CIRO. Clinical Usefulness of a Mobile Application for the Appropriate Selection of the Antiarrhythmic Device in Heart Failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:696-702. [DOI: 10.1111/pace.12872] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/29/2016] [Accepted: 04/07/2016] [Indexed: 01/15/2023]
Affiliation(s)
- ANTONIO CURCIO
- Division of Cardiology, Department of Medical and Surgical Sciences, University Magna Graecia; Campus di Germaneto; Catanzaro Italy
| | - SALVATORE DE ROSA
- Division of Cardiology, Department of Medical and Surgical Sciences, University Magna Graecia; Campus di Germaneto; Catanzaro Italy
| | - JOLANDA SABATINO
- Division of Cardiology, Department of Medical and Surgical Sciences, University Magna Graecia; Campus di Germaneto; Catanzaro Italy
| | - SIMONA DE LUCA
- Division of Cardiology, Department of Medical and Surgical Sciences, University Magna Graecia; Campus di Germaneto; Catanzaro Italy
| | - ANGELA BOCHICCHIO
- Division of Cardiology, Department of Medical and Surgical Sciences, University Magna Graecia; Campus di Germaneto; Catanzaro Italy
| | - ALBERTO POLIMENI
- Division of Cardiology, Department of Medical and Surgical Sciences, University Magna Graecia; Campus di Germaneto; Catanzaro Italy
| | - GIUSEPPE SANTARPIA
- Division of Cardiology, Department of Medical and Surgical Sciences, University Magna Graecia; Campus di Germaneto; Catanzaro Italy
| | - PIETRANTONIO RICCI
- Institute of Forensic Medicine, University Magna Graecia; Campus di Germaneto; Catanzaro Italy
| | - CIRO INDOLFI
- Division of Cardiology, Department of Medical and Surgical Sciences, University Magna Graecia; Campus di Germaneto; Catanzaro Italy
- U.R.T.-C.N.R; Catanzaro Italy
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10
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Reddy YM, Gunda S, Vallakati A, Kanmanthareddy A, Pillarisetti J, Atkins D, Bommana S, Emert MP, Pimentel R, Dendi R, Berenbom LD, Lakkireddy D. Impact of Tricuspid Regurgitation on the Success of Atrioventricular Node Ablation for Rate Control in Patients With Atrial Fibrillation: The Node Blast Study. Am J Cardiol 2015; 116:900-3. [PMID: 26174606 DOI: 10.1016/j.amjcard.2015.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 06/14/2015] [Accepted: 06/14/2015] [Indexed: 11/13/2022]
Abstract
Atrioventricular node (AVN) ablation is an effective treatment for symptomatic patients with atrial arrhythmias who are refractory to rhythm and rate control strategies where optimal ventricular rate control is desired. There are limited data on the predictors of failure of AVN ablation. Our objective was to identify the predictors of failure of AVN ablation. This is an observational single-center study of consecutive patients who underwent AVN ablation in a large academic center. Baseline characteristics, procedural variables, and outcomes of AVN ablation were collected. AVN "ablation failure" was defined as resumption of AVN conduction resulting in recurrence of either rapid ventricular response or suboptimal biventricular pacing. A total of 247 patients drug refractory AF who underwent AVN ablation at our center with a mean age of 71 ± 12 years with 46% being males were included. Ablation failure was seen in 11 (4.5%) patients. There were no statistical differences between patients with "ablation failure" versus "ablation success" in any of the baseline clinical variables. Patients with moderate-to-severe tricuspid regurgitation (TR) were much more likely to have ablation failure than those with ablation success (8 [73%] vs 65 [27%]; p = 0.003). All 11 patients with ablation failure had a successful redo procedure, 9 with right and 2 with the left sided approach. On multivariate analysis, presence of moderate-to-severe TR was found to be the only predictor of failure of AVN ablation (odds ratio 9.1, confidence interval 1.99 to 42.22, p = 0.004). In conclusion, moderate-to-severe TR is a strong and independent predictor of failure of AVN ablation.
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Affiliation(s)
- Yeruva Madhu Reddy
- Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas
| | - Sampath Gunda
- Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas
| | - Ajay Vallakati
- Division of Cardiovascular medicine, Case Western Reserve University, Metrohealth Campus, Cleveland, Ohio
| | | | - Jayasree Pillarisetti
- Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas
| | - Donita Atkins
- Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas
| | - Sudharani Bommana
- Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas
| | - Martin P Emert
- Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas
| | - Rhea Pimentel
- Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas
| | - Raghuveer Dendi
- Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas
| | - Loren D Berenbom
- Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular medicine, University of Kansas Hospitals and Medical Center, Kansas City, Kansas.
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11
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Rocha EA, Pereira FTM, Abreu JS, Lima JWO, Monteiro MDPM, Rocha Neto AC, Quidute ARP, Goés CVA, Rodrigues Sobrinho CRM, Scanavacca MI. Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy. Arq Bras Cardiol 2015; 105:552-9. [PMID: 26351981 PMCID: PMC4693658 DOI: 10.5935/abc.20150108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/01/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders. OBJECTIVE To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT. METHOD Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre‑implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping. RESULTS There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6‑12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78. CONCLUSION EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options.
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12
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Rocha EA, Pereira FTM, Abreu JS, Lima JWO, Monteiro MDPM, Rocha Neto AC, Goés CVA, Farias AGP, Rodrigues Sobrinho CRM, Quidute ARP, Scanavacca MI. Development and Validation of Predictive Models of Cardiac Mortality and Transplantation in Resynchronization Therapy. Arq Bras Cardiol 2015; 105:399-409. [PMID: 26559987 PMCID: PMC4633004 DOI: 10.5935/abc.20150093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/06/2015] [Indexed: 01/04/2023] Open
Abstract
Background 30-40% of cardiac resynchronization therapy cases do not achieve favorable
outcomes. Objective This study aimed to develop predictive models for the combined endpoint of cardiac
death and transplantation (Tx) at different stages of cardiac resynchronization
therapy (CRT). Methods Prospective observational study of 116 patients aged 64.8 ± 11.1 years,
68.1% of whom had functional class (FC) III and 31.9% had ambulatory class IV.
Clinical, electrocardiographic and echocardiographic variables were assessed by
using Cox regression and Kaplan-Meier curves. Results The cardiac mortality/Tx rate was 16.3% during the follow-up period of 34.0
± 17.9 months. Prior to implantation, right ventricular dysfunction (RVD),
ejection fraction < 25% and use of high doses of diuretics (HDD) increased the
risk of cardiac death and Tx by 3.9-, 4.8-, and 5.9-fold, respectively. In the
first year after CRT, RVD, HDD and hospitalization due to congestive heart failure
increased the risk of death at hazard ratios of 3.5, 5.3, and 12.5, respectively.
In the second year after CRT, RVD and FC III/IV were significant risk factors of
mortality in the multivariate Cox model. The accuracy rates of the models were
84.6% at preimplantation, 93% in the first year after CRT, and 90.5% in the second
year after CRT. The models were validated by bootstrapping. Conclusion We developed predictive models of cardiac death and Tx at different stages of CRT
based on the analysis of simple and easily obtainable clinical and
echocardiographic variables. The models showed good accuracy and adjustment, were
validated internally, and are useful in the selection, monitoring and counseling
of patients indicated for CRT.
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Derval N, Bordachar P, Lim HS, Sacher F, Ploux S, Laborderie J, Steendijk P, Deplagne A, Ritter P, Garrigue S, Denis A, Hocini M, Haissaguerre M, Clementy J, Jaïs P. Impact of pacing site on QRS duration and its relationship to hemodynamic response in cardiac resynchronization therapy for congestive heart failure. J Cardiovasc Electrophysiol 2014; 25:1012-1020. [PMID: 24891271 DOI: 10.1111/jce.12464] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/14/2014] [Accepted: 04/17/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Recent studies have demonstrated that left ventricular (LV) pacing site is a critical parameter in optimizing cardiac resynchronization therapy (CRT). The present study evaluates the effect of pacing from different LV locations on QRS duration (QRSd) and their relationship to acute hemodynamic response in congestive heart failure patients. METHODS AND RESULTS Thirty-five patients with nonischemic dilated cardiomyopathy and left bundle branch block referred for CRT device implantation were studied. Eleven predetermined LV pacing sites were systematically assessed in random order: epicardial: coronary sinus (CS); endocardial: basal and mid-cavity (septal, anterior, lateral, and inferior), apex, and the endocardial site facing the CS pacing site. For each patient QRSd and +dP/dtmax during baseline (AAI) and DDD LV pacing at 2 atrioventricular delays were compared. Response to CRT was significantly better in patients with wider baseline QRSd (≥150 milliseconds). Hemodynamic response was inversely correlated to increase of QRSd during LV pacing (short atrioventricular [AV] delay: r = 0.44, P < 0.001; long AV delay: r = 0.59, P < 0.001). Compared to baseline, LV pacing at the site of shortest QRSd significantly improved +dP/dtmax (+18 ± 25%, P < 0.001) but was not superior to other conventional strategy (lateral wall, CS pacing, and echo-guided) and was inferior to a hemodynamically guided strategy. CONCLUSIONS In our study, we have demonstrated that changes of QRSd during LV pacing correlated with acute hemodynamic response and that LV pacing location was a primary determinant of paced QRSd. Although QRSd did not predict the maximum hemodynamic response, our results confirm the link between electrical activation and hemodynamic response of the LV during CRT.
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Affiliation(s)
- Nicolas Derval
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Pierre Bordachar
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Han S Lim
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Frederic Sacher
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Sylvain Ploux
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | | | - Paul Steendijk
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antoine Deplagne
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Philippe Ritter
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | | | - Arnaud Denis
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Mélèze Hocini
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | | | - Jacques Clementy
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Pierre Jaïs
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
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Rademakers LM, van Gelder BM, Scheffer MG, Bracke FA. Mid-term follow up of thromboembolic complications in left ventricular endocardial cardiac resynchronization therapy. Heart Rhythm 2014; 11:609-13. [DOI: 10.1016/j.hrthm.2014.01.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Indexed: 12/01/2022]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 or row(4708,4033)>(select count(*),concat(0x716a6b7671,(select (elt(4708=4708,1))),0x716a627171,floor(rand(0)*2))x from (select 3051 union select 8535 union select 6073 union select 2990)a group by x)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 8965=8965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (1210=1210) then null else ctxsys.drithsx.sn(1,1210) end) from dual) is null-- xobr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (1664=1487) then null else cast((chr(122)||chr(70)||chr(116)||chr(76)) as numeric) end)) is null-- irzn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 8965=8965-- hjno] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 9453=6189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 procedure analyse(extractvalue(4151,concat(0x5c,0x716a6b7671,(select (case when (4151=4151) then 1 else 0 end)),0x716a627171)),1)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 2863=6232-- jate] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 order by 1-- drbf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (4057=3733) then null else ctxsys.drithsx.sn(1,4057) end) from dual) is null] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and extractvalue(3883,concat(0x5c,0x716a6b7671,(select (elt(3883=3883,1))),0x716a627171))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 3474=cast((chr(113)||chr(106)||chr(107)||chr(118)||chr(113))||(select (case when (3474=3474) then 1 else 0 end))::text||(chr(113)||chr(106)||chr(98)||chr(113)||chr(113)) as numeric)-- crum] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 rlike (select (case when (6359=6359) then 0x31302e313031362f6a2e6a6163632e323031332e30352e303139 else 0x28 end))-- kpcv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 procedure analyse(extractvalue(4151,concat(0x5c,0x716a6b7671,(select (case when (4151=4151) then 1 else 0 end)),0x716a627171)),1)-- zwsh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 order by 1#] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 3529=(select upper(xmltype(chr(60)||chr(58)||chr(113)||chr(106)||chr(107)||chr(118)||chr(113)||(select (case when (3529=3529) then 1 else 0 end) from dual)||chr(113)||chr(106)||chr(98)||chr(113)||chr(113)||chr(62))) from dual)-- fhnu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (1210=1210) then null else ctxsys.drithsx.sn(1,1210) end) from dual) is null] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 order by 1-- gmoi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 4949=utl_inaddr.get_host_address(chr(113)||chr(106)||chr(107)||chr(118)||chr(113)||(select (case when (4949=4949) then 1 else 0 end) from dual)||chr(113)||chr(106)||chr(98)||chr(113)||chr(113))-- ktgp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (8036=8036) then null else cast((chr(109)||chr(65)||chr(84)||chr(72)) as numeric) end)) is null-- zkzl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 3409=concat(char(113)+char(106)+char(107)+char(118)+char(113),(select (case when (3409=3409) then char(49) else char(48) end)),char(113)+char(106)+char(98)+char(113)+char(113))-- diyj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (5528=2881) then null else ctxsys.drithsx.sn(1,5528) end) from dual) is null-- xppw] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 3474=cast((chr(113)||chr(106)||chr(107)||chr(118)||chr(113))||(select (case when (3474=3474) then 1 else 0 end))::text||(chr(113)||chr(106)||chr(98)||chr(113)||chr(113)) as numeric)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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