Patient perspective and safety of remote monitoring of implantable cardioverter-defibrillators in the Polish Nationwide Multicenter Registry: the Medtronic CareLink network evaluation.

BACKGROUND: Remote monitoring of cardiovascular implantable electronic devices allows the assessment of system effectiveness, arrhythmia occurrence, and indirectly, clinical changes. Medical interventions can be performed earlier because of a faster transfer of information to the monitoring site, even in the case of asymptomatic arrhythmias or abnormalities in the operation of the system. AIMS: The aim of the study was to assess the effectiveness of remote monitoring of implantable cardioverter-defibrillators and evaluation in an outpatient setting during 12-month follow -up. METHODS: We analyzed 176 patients at 10 sites (men, 84.1%). The mean (SD) age of the patients was 60.7 (12.5) years (range, 20-86 years), and mean (SD) follow -up period was 405 (70) days (range, 131-723 days). RESULTS: A total of 354 outpatient and 514 remote follow -up visits were conducted. Episodes of arrhythmias and device malfunctions were detected with similar frequency in outpatient visits and in remote visits. During the study period, patient sense of safety increased. More patients preferred joined remote and outpatient visits as the optimal healthcare model. As the patient survey showed, the greatest benefit of the CareLink network was fast intervention and an increased sense of safety. CONCLUSIONS: The strategy of remote monitoring appeared to be feasible, safe, and patient friendly, demonstrating that the majority of patients do not require an additional in -person visit within 1 year from the device implantation just to confirm the proper functioning of the implantable cardioverter--defibrillators.

Heart rate variability in the course of ST--segment elevation myocardial infarction treated with primary percutaneous transluminal coronary angioplasty in elderly and younger patients.

BACKGROUND: The aim of the study was to appraise time domain heart rate variability (HRV) parameters in patients with ST-segment elevation myocardial infarction (STEMI) in different age groups. MATERIAL AND METHODS: Retrospective analysis included 357 consecutive patients in sinus rhythm without diabetes, aged 27-87 years (mean age--63.0 +/- 11.8 years, 243 men) treated with primary percutaneous transluminal coronary angioplasty (PTCA) due to first in their life STEMI. Each patient had an echocardiographic examination and 24-hour ECG monitoring results interpreted. Participants were divided in the analysis applying the WHO old age criterion into two groups: group A < 65 years old (n = 188) and B aged > or = 65 years (n = 169). RESULTS: In the whole study group age negatively correlated with SDNN, SDANNI, SDNNI and EF, whereas positive correlation between EF and SDANN, and EF and SDNNI was observed. Elderly patients as compared to the younger individuals had significantly diminished SDNN, SDANN, SDNNI and more often SDNN < 70 ms (33.7% vs 20.7%, p < 0.0001). When the circumflex artery lesion was the cause of myocardial infarction SDNN and SDANN were significantly lower in the group B, whereas in case of PTCA of RCA, apart from decreased SDNN and SDANN, EF was also compromised in this group. CONCLUSIONS: Elderly patients with myocardial infarction with ST-segment elevation treated with primary PTCA, compared to the younger age group, are characterized by increased sympathetic activation assessed by heart rate variability and heart rate in 24-hour ECG monitoring.

Effects of biventricular pacing on right ventricular function assessed by standard echocardiography.

BACKGROUND AND AIM: The aim of this study was to evaluate the short term effect of cardiac resynchronisation therapy (CRT) on right ventricular (RV) function assessed by standard echocardiography. METHODS: Data from 57 patients (54 men, 95%; three women, 5%), aged 66.4 ± 8.7 years with heart failure (HF) was analysed. All patients were in NYHA III-IV functional classes, despite optimal pharmacological treatment according to the current guidelines, had left ventricular ejection fraction ≤ 35% and QRS complex ≥ 120 ms in a standard electrocardiogram. At baseline and three months after CRT implantation the patients' histories were taken, an anthropometrical examination was made, laboratory tests including the level of NT-proBNP and electrocardiogram were performed, and echocardiographic examination was extended by tissue Doppler imaging techniques and complex RV evaluation. RESULTS: Three months after CRT implantation in the whole study group, the average NYHA functional class had decreased from 3.11 ± 0.28 to 2.25 ± 0.68 (p < 0.001), and the six-minute walk test distance had increased from 298.04 ± 107.42 m to 373.12 ± 127.15 m (p < 0.001). CRT improved RV systolic function in the whole study group. Tricuspid annular plane systolic excursion had increased from 13.95 ± 2.80 to 15.79 ± 2.33 mm (p < 0.001), and so likewise had systolic excursion velocity (S'), which rose from 8.84 ± 3.45 to 11.00 ± 3.43 cm/s (p < 0.001). Tricuspid regurgitation grade decreased from 2.02 ± 0.95 to 1.86 ± 0.91 (p = 0.013). RV systolic pressure decreased from 31.07 ± 20.43 to 27.75 ± 17.35 mm Hg (p < 0.001). RV fractional area change rose from 31.35 ± 10.30% to 35.40 ± 10.51% (p < 0.001). CONCLUSIONS: This study showed that CRT improved RV systolic function evaluated with parameters assessed in standard echocardiographic examination three months after therapy initiation. The observed improvement was consistent among all applied echocardiographic parameters reflecting RV systolic function.

[Cryoablation of ventricular arrhythmias originating from septal aspects of mitral and tricuspid annulus]. / Krioablacja arytmii komorowej z przegrodowej czesci pierscienia mitralnego i trójdzielnego.

Two cases of frequent ventricular ectopy are described. Case one: a 49 year-old woman with post myocarditis extrasytoles (34 000/24 h). The ectopic focus was located on the tricuspid annulus - directly in the area of largest and sharpest His bundle potential and where direct His bundle capture was observed during all pace mapping attempts. Case two: a 15 year- -old men with idiopathic, very frequent premature ventricular beats from septal aspect of the mitral annulus. The area of earliest activation during the spontaneous ectopy with 12/12 pace map match showed obvious His bundle potential, moreover, the radiofrequency ablation catheter was unstable in that position (inferoseptal from retrograde aortic approach). In both cases treatment with cryoablation was successfully and uneventful. In conclusion, cryoablation instead of radiofrequency current ablation should be used for ventricular ectopy from septal part of the tricuspid or mitral annuli especially in cases of parahisian localisation and/or catheter instability.

Clinical and classic echocardiographic features of patients with, and without, left ventricle reverse remodeling following the introduction of cardiac resynchronization therapy.

BACKGROUND: The aim of the study was to assess clinical and classic echocardiographic data in patients with different cardiac resynchronization therapy (CRT) outcomes. METHODS: Sixty consecutive patients (aged 66.3 ± 8.7 years, 57 men) with chronic heart failure (CHF) in New York Heart Association (NYHA) classes III-IV despite optimized pharmacotherapy, with left ventricular end-diastolic diameter (LVEDD) > 55 mm, left ventricular ejection fraction £ 35% and wide QRS complex (≥ 120 ms), including individuals with permanent atrial fibrillation (AF) and single- and dual-chamber pacing, were assessed firstly before, and secondly three months after, biventricular heart stimulator implantation (excluding three patients who died during the follow-up). Patients developing ≥ 10% reduction of left ventricular end-systolic volume (LVESV) were classified as responders to CRT. RESULTS: The group of responders (n = 34, 59.7%) and the group of non-responders (n = 23, 40.3%) did not differ regarding baseline echocardiographic parameters or in terms of clinical data of age, gender, concomitant diseases, smoking or pharmacological treatment. The differences involved higher rates of ischemic CHF background, prevalence of hypertension and permanent AF, and a higher concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP) among the non-responders. In the multivariate logistic regression analysis, NT-proBNP, body mass index (BMI) and the presence of permanent AF correlated negatively with the magnitude of LVESV reduction following CRT introduction. CONCLUSIONS: Classic echocardiographic data did not predict left ventricle reverse remodeling. Higher rates of ischemic CHF aetiology, hypertension, permanent AF and higher NT-proBNP concentration were found in the group without at least 10% LVESV reduction at the three month follow-up. NT-proBNP, BMI and the presence of permanent AF had negative effects on the magnitude of LVESV.

Left ventricular lead implantation at a phrenic stimulation site is safe and effective.

AIMS: Phrenic stimulation (PS) is a major limiting factor for both left ventricular (LV) lead placement and cardiac resynchronization therapy (CRT) delivery. We have developed a protocol allowing for LV lead implantation at a PS site based on specific criteria regarding phrenic and LV acute capture thresholds. The present study examined long-term outcomes in patients treated using this protocol. METHODS AND RESULTS: A total of 211 consecutive patients underwent CRT device implantation. The procedure was successful in 201 patients. Leads were implanted at a PS site in 27 patients (PS patients) and a non-PS site in 174 patients (non-PS patients). Left ventricular leads were placed at a PS site only on the following conditions: no PS at ≤3.5 V/0.5 ms, LV threshold ≤1.5 V, and a PS/LV threshold ratio >4. The mean PS threshold decreased (5.1 ± 1.6 vs. 2.8 ± 1.6 V, P < 0.001) and the mean LV threshold remained stable (1.0 ± 0.7 vs. 0.9 ± 0.8 V, P = 0.6) in PS patients over the 16 ± 9 month follow-up. Only one PS patient experienced non-reprogrammable PS and required a re-operation. Seven PS patients required very low LV channel output programming without the usual safety margin of twice the LV threshold amplitude or three times the pulse width. However, 100% LV capture was shown in those patients during daily activity. Non-reprogrammable PS occurred in 2 of the 174 non-PS patients. CONCLUSION: Our strategy for LV lead implantation at a PS site was found to result in long-term safe and effective outcomes.

Baseline tissue Doppler imaging-derived echocardiographic parameters and left ventricle reverse remodelling following cardiac resynchronization therapy introduction.

INTRODUCTION: The aim of the study was to assess the relation of baseline mechanical dyssynchrony with the left ventricular end-systolic volume (LVESV) decrease following cardiac resynchronization (CRT) therapy introduction. MATERIAL AND METHODS: Sixty consecutive patients (aged 66.3 ± 8.7 years; 57 men) with chronic heart failure (71.7% of ischaemic and 28.3% of non-ischaemic origin) and current indications for CRT were assessed before and 3 months after biventricular heart stimulator implantation. Longitudinal movements of twelve segments of the left ventricle (LV) (6 basal and 6 midlevel) and two segments of the right ventricle (RV) were analysed using tissue Doppler imaging (TDI) techniques with time from onset of Q wave in ECG to peak systolic velocity in colour-coded TDI (T(TDI)), time to peak strain (T(strain)) and time to peak strain rate (T(strain) (rate)). Minimal and maximal time differences within LV and between LV and RV walls were calculated. RESULTS: In the study group LVEF and 6-min walk test distance increased, while NYHA class, NT-proBNP level, left ventricular end-diastolic volume and LVESV decreased. Significant correlations between the magnitude of LVESV reduction with maximal time differences between T(strain) of 12 LV segments (r=0.34, p = 0.017) and time differences between T(TDI) basal LV-RV segments (r = -0.29, p=0.041) were found. CONCLUSIONS: Only a few TDI-derived parameters such as maximal time differences between T(strain) of 12 LV segments and T(TDI) difference of LV-RV basal segments can be useful to predict the magnitude of left ventricle reverse remodelling after CRT introduction.

[Inappropriate sinus tachycardia - non-contact mapping and ablation]. / Nieadekwatna tachykardia zatokowa - ablacja z zastosowaniem mapowania przestrzennego bezkontaktowego EnSite Array.

Two cases of inappropriate sinus tachycardia refractory to combined pharmacotherapy (beta-blocker, ivabradine) are described. Both were female patients (28 and 45 years-old) and underwent sinus node modification/ablation using non-contact mapping (EnSite Array). Since ablation had to be performed in both cases very close to the phrenic nerve (captured during 10V pacing at ablation spots) its function was monitored during ablation with constant phrenic nerve pacing from the superior vena cava. One case was successful after single and straightforward ablation session, the other case despite several attempts and initially good result had recurrences; first recurrence two days after cryoablation, and second three weeks after radiofrequency ablation with irrigated tip catheter.

Prospective evaluation of diagnostic work-up in syncope patients: results of the PL-US registry.

AIMS: Syncope is a common problem. Demographic and clinical characteristics of patients admitted to different types of centres may vary, physician's adherence to the guidelines has been examined only in a few studies, and the requirements for implantable loop recorders (ILR) have not been well defined. The aim of this study was to (i) compare demographic and clinical characteristics of patients with syncope diagnosed and treated in tertiary electrophysiology cardiac centres and those attending syncope units or general hospitals, (ii) assess how physicians adhere to the published guidelines, and (iii) calculate the requirement for ILR insertion. METHODS AND RESULTS: In total, 669 consecutive patients with syncope, admitted to 18 electrophysiological cardiac tertiary centres over a mean of 3 months (range 1-10 months), entered a special Internet database called the PL-US (Polish patients with Unexplained Syncope) registry. Detailed demographic and clinical characteristics of the patients, including the results of all diagnostic tests performed, were analysed. Adherence to the guidelines was assessed, based on the published recommendations. The ILR implantation was indicated when (i) all other tests were inconclusive (unexplained syncope) and (ii) syncope associated with injury or presence of organic heart disease or past medical history and ECG suggesting arrhythmic syncope. Syncope of cardiac/arrhythmic origin was the most frequent diagnosis (53%), followed by reflex syncope (33%). Adherence to the guidelines was less than satisfactory-measurement of blood pressure in an upright position, carotid sinus massage, exercise testing, and electrophysiological study were underused, whereas prolonged ECG monitoring and neurological consultations were overused. Unexplained syncope had 58 (9%) patients, and 42 (72%) of them had indication for ILR which accounts for 6% of the whole study population. The calculated need for ILR was 222 implants/million inhabitants/year. CONCLUSION: Patients with syncope admitted to the tertiary electrophysiology cardiac centres are a highly selected group of patients with syncope and differ in their characteristics as well as underlying diseases to those managed at general hospitals, outpatient clinics, or special syncope units. In Poland, the adherence to the published guidelines is far from satisfactory. At least 6% of all consecutive patients with syncope are candidates for ILR insertion.

Effects of cardiac resynchronization therapy on sleep apnea, quality of sleep and daytime sleepiness in patients with chronic heart failure.

BACKGROUND: Sleep-related breathing disorders are common in patients with chronic heart failure (CHF) and contribute to exacerbation of CHF. The effects of biventricular stimulation (CRT) seem to exceed the improvement of mechanical heart performance and are likely to affect other aspects of CHF pathophysiology. The aim of the study was to assess the influence of CRT on subjective and objective sleep features. MATERIAL AND METHODS: Twenty seven consecutive patients (aged 67.7 +/- 8.7 years, 23 men - 85%) with chronic heart failure (62.9% with ischaemic background and 37.1% of non-ischaemic etiology) in stable for at least 3 months NYHA class III - IV despite optimized pharmacotherapy, with left ventricular end-diastolic diameter (LVEDd) > 55 mm, left ventricular ejection fraction (LVEF) < or = 35% and wide QRS complex (> or = 120 ms) were appraised before and 12-16 weeks after CRT introduction clinically (including 6-minute walk test--6-MWT), echocardiographically and in polisomnography. The apnea-hypopnea index (AHI) and apnea indexes (AI) of central, obstructive and mixed types were calculated. The sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness with the Epworth Sleepiness Scale (ESS). RESULTS: LVEF increased, 6-MWT distance rose. Left ventricular diameters and left ventricular end-systolic volume decreased. PQSI and ESS fell (9.3 +/- 4.2 vs 6.2 +/- 3.2, p < 0.001 and 8.4 +/- 4.1 vs 7.0 +/- 3.4, p < 0.001, respectively). AHI, obstructive AL and mixed AL did not alter but significant reduction of central AL was noted (9.6 +/- 13.0 vs 3.7 +/- 6.2, p = 0.023). CONCLUSIONS: CRT decreases central sleep apnea and improves quality of sleep and daytime sleepiness in patients with CHF.

Different response rates to cardiac resynchronization therapy (CRT) according to the applied definition.

BACKGROUND: Solid evidence shows that cardiac resynchronization therapy (CRT) improves prognosis, physical capacity and quality of life in selected groups of patients with chronic heart failure (CHF). Nonetheless, marked percentage of patients seem not to benefit from CRT. MATERIAL AND METHODS: Sixty consecutive patients (aged 66.3 +/- 8.7 years, 57 men - 95%, 3 women - 5%) with CHF (71.7% with ischaemic and 28,3% with non-ischaemic origin) of stable for > or = 3 months NYHA III or IV class despite optimized pharmacotherapy, with left ventricle end-diastolic diameter (LVEDd) > or = 55 mm, left ventricular ejection fraction (EF) < or = 35% and QRS > 130 ms were evaluated before and 3 months after CRT implementation (biventricular stimulation BiV) echocardiographically and clinically. RESULTS: EF increased (21.7% vs 26,6%, p<0,0001), 6-minute walk distance (6-MWT) rose (298.0 m vs 373.1 m, p<0,0001), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) decreased (244.3 ml vs 226,4 ml, p=0.0002; 192.8 ml vs 168,7 ml, p<0,0001 respectively). Mean NYHA class dropped from 3.1 to 2.2 (p<0.0001). Absolute increase in EF of > or = 4%, > or = 5%, > or = 6% was observed in 63.2%, 52.6%, and 35.7% respectively; relative increase of > or = 25% presented 21.1%, > or = 10% reduction of LVESV--59.7%, > or = 15% reduction of LVESV--43.8%, decrease in NYHA class--78.3%, > or = 10% reduction of 6-MWT--66.7%, no death and no hospitalization due to heart failure--78.3%. CONCLUSIONS: Response to CRT rate differs markedly according to the applied definition.

[Focal atrial tachycardia originating in the right atrial appendage]. / Czestoskurcz ogniskowy z uszka prawego przedsionka.

We present a case of 14-year-old boy with incessant atrial tachycardia from right atrial appendage, resistant to pharmacotherapy and with early signs of the left ventricle tachyarrhythmic dysfunction. The P-wave was positive in leads I, II, III, aVF, negative in aVR, aVL. Moreover, P waves configuration specific for this localization: negative in V1-V2 that become positive in V3-V6 was present. After first ablation session a recurrence was observed after 3 weeks, due to inadequate power delivery resulting from trabeculation/anatomy that limited conventional ablation catheter cooling. Second ablation session with the use of an active electrode cooling and 3D mapping system was successful.

Repetitive monomorphic ventricular tachycardia originating from the inferior tricuspid annulus.

We report a case of an otherwise healthy 63-year-old male with incessant, highly symptomatic ventricular arrhythmia that displayed over 60,000 premature ventricular contractions and 499 runs of non-sustained ventricular tachycardia (VT) during 24 hours of ECG monitoring. The ventricular ectopy had a QRS morphology of the left bundle branch block (LBBB), however, with a superior axis. Structural heart disease was absent and the history was negative. Therefore the arrhythmia was considered to be atypical idiopathic repetitive monomorphic VT. Radiofrequency catheter ablation in an inferior region of the tricuspid ring at a site with good pacemap was successful. We conclude that idiopathic repetitive monomorphic VT may originate from uncommon locations and that QRS morphology (superior axis, LBBB, notching in inferior leads, transition at V4, duration > or = 160 ms) can help diagnose inferior free wall tricuspid location.

[Atrioventricular nodal reentrant tachycardia triggering atrial fibrillation--a case report]. / Nawrotny czestoskurcz wezlowy wyzwalajacy migotanie przedsionków--opis przypadku.

We describe a case of an otherwise healthy 50-year-old man with frequent attacks of heart palpitations. During electrophysiological study two episodes of atrial fibrillation (AF) were induced. In both cases AF was preceded by a few seconds of atrioventricular nodal reentrant tachycardia (AVNRT). Ablation of atrioventricular node slow pathway successfully eliminated both tachyarrhythmias during 6 months follow-up. Since during AVNRT a few short coupled atrial ectopic beats appeared, we hypothesized that AVNRT did not trigger AF directly but by inducing ectopic beats form a pulmonary vein or an atrial focus that became a direct trigger of AF.

Physical training in patients with chronic heart failure of ischemic origin: effect on exercise capacity and left ventricular remodeling.

BACKGROUND: Physical training is a well-known complementary treatment for chronic heart failure (CHF); however, many aspects require further studies. One of them is the impact on remodeling of the left ventricle (LV). The purpose of this study was to evaluate the effect of 6 months of training on LV, exercise capacity and safety issues in patients with ischemic CHF. METHODS: Fifty patients (mean age 60.1+/-9.2 years) with ischemic CHF, New York Heart Association (NYHA) classification class II and III and left ventricular ejection fraction (LVEF)

[Variant Brugada syndrome--mild ST segment elevation in inferior leads and aborted sudden cardiac death]. / Wariant zespolu Brugadów--chory z uniesieniem odcinka ST w zakresie sciany dolnej i naglym zatrzymaniem krazenia.

We describe a case of an otherwise healthy 48-year-old man who survived aborted sudden cardiac death (SCD). His ECG showed ST segment elevation in inferior leads, therefore an acute coronary syndrome was suspected. However, serial troponin T and CPK-MB were negative, echocardiogram was unremarkable and exercise test was negative. On the basis of electrophysiological study, positive ajmaline test, persistent ST segment elevation in inferior leads and other clinical features (PQ interval of 240 ms, family history of SCD) a diagnosis of variant Brugada syndrome was made. Persistent ST segment elevations in inferior leads can be a marker of variant Brugada syndrome.

Electrophysiological study in a patient with Fabry disease and a short PQ interval.

A short PQ interval is a common finding in patients with Fabry disease. However, there have been few electrophysiological studies in Fabry disease, and it is not clear whether the short PQ interval that is present in this disease results from preexcitation or enhanced atrioventricular nodal conduction. We present a case of a 43-year-old man with syncope, sick sinus syndrome, a PQ interval of 80 ms, and palpitations. Electrophysiological study showed PA, AH, and HV intervals of 24, 32, and 34 ms, respectively, and features of enhanced atrioventricular nodal conduction. The presence of an atrioventricular accessory pathway was excluded. We conclude that the short PQ interval in Fabry disease can result from accelerated conduction in the atrioventricular node.

[Massive myocardial hypertrophy in hypertrophic cardiomyopathy: a risk factor for sudden death and high defibrillation threshold during cardioverter-defibrillator implantation]. / Masywne pogrubienie scian serca w kardiomiopatii przerostowej - zagrozenie naglym zgonem i wysoki próg defibrylacji podczas implantacji kardiowertera-defibrylatora.

Two cases of hypertrophic cardiomyopathy with massive hypertrophy and high defibrillation threshold (DFT) are described. A 14-year-old boy, whose single risk factor for sudden death was extreme hypertrophy with maximum interventricular septum (IVS) thickness of 43 mm, survived an episode of ventricular fibrillation. During ICD implantation DFT testing showed energy requirements >30 J and the procedure was aborted. Amiodarone and verapamil treatment was discontinued and treatment with oral sotalol was instituted. After a period of amiodarone washout the procedure was repeated and DFT of 24 J was encountered. An 18-year-old female with massive hypertrophy (IVS thickness=35 mm) and other risk factors for sudden death underwent ICD implantation for primary prevention. During the procedure DFT=20 J and ICD with 30 J maximal output was implanted. An increase in DFT to more than 20 J was encountered during pre-discharge test. Lack of 10 J safety margin warranted ICD system revision and upgrade; during the second procedure DFT was 24 J and ICD with 35 J maximal output was implanted. In summary, in both cases ICDs with 35 J maximal output were successfully implanted.

Effect of physical training on quality of life and oxygen consumption in patients with congestive heart failure.

AIM: To assess changes in quality of life (QoL) and oxygen consumption produced by two different patterns of physical training in patients with congestive heart failure (CHF). MATERIAL AND METHODS: 42 men (mean age 55.9+/-8.1 years) with ischaemic CHF lasting 3.1+/-1.0 years. Patients were randomised into three groups each consisting of 14 men: group A--with constant workload, group B-with progressive/increasing workload, each trained up to 6 months and group C--not trained. QoL was assessed at baseline and at 6 months by means of the Psychological General Well-being Index (PGWB) and the Subjective Symptoms Assessment Profile (SSA-P). Cardiopulmonary exercise test and echocardiography were performed twice. RESULTS: At 6 months improvement in PGWB total index was observed, both in groups A and B (p<0.01). Men from groups A and B reported less cardiac symptoms (p<0.01), emotional distress (p<0.01), peripheral circulatory symptoms (p<0.01) and dizziness (p<0.01) in SSA-P. Improvement in sexual life was observed only in group B (p<0.01). Overall improvement of QoL was greater in group B than in group A as well as oxygen uptake (p<0.01). Higher QoL correlated positively with peak VO2 only in group B (r=0.56, p<0.05). CONCLUSIONS: Physical training improves QoL in men with CHF, but only progressive/increasing workload seems to markedly improve oxygen uptake. Improvement of QoL is related to psychological well-being and physical complaints associated with CHF.