Women with heart failure and their experiences of sexuality and intimacy: A qualitative content analysis.

AIM AND OBJECTIVE: This study aimed to explore how women with heart failure experience intimacy and sexual activity. BACKGROUND: Knowledge about women diagnosed with heart failure and their sexual activity is scarce. By investigating the experience of sexual activity and intimacy of women diagnosed with heart failure, an alignment between current practice and patients' expectations and needs within this area might be obtained. DESIGN: A qualitative design was used. METHODS: Fifteen women diagnosed with heart failure were recruited from a heart failure outpatient clinic at a university hospital. The study was carried out from January to September 2018. The inclusion criteria were women >18 years, with estimated New York Heart Association Class II or III living together with a partner. Face-to-face semi-structured interviews were undertaken at the hospital. The interviews were organised around a set of predetermined open-ended questions, transcribed verbatim and analysed using a qualitative content analysis. COREQ guidelines were used. RESULTS: The analysis revealed one overarching theme characterises how living with heart failure has an impact on women's sexual relationship. Furthermore, three sub-themes were identified: (1) redefining sexual activity, (2) reducing sexual activity and (3) maintaining sexual activity. CONCLUSION: Women need information about sexual activity and heart failure in order to prevent fear and anxiety. It is important to include partners in patient consultations at heart failure outpatient clinics and in sexual counselling. It is furthermore essential to educate patients about sexual activity in relation to medication and comorbidities. RELEVANCE TO CLINICAL PRACTICE: Findings from this study support that information about sexuality and intimacy is a central part of the consultation in a heart failure outpatient clinic, and highlights the importance of not making assumptions about aging, frailty and interest in sexual expression. PATIENT CONTRIBUTION: Data were collected through face-to-face semi-structured interviews.

Performance of an active fixation bipolar left ventricular lead vs passive fixation quadripolar leads in cardiac resynchronization therapy, a randomized trial.

BACKGROUND: Usage of active fixation bipolar left ventricular (LV) leads represents an alternative approach to the more commonly used passive fixation quadripolar leads in cardiac resynchronization therapy (CRT). We compared a bipolar LV lead with a side screw for active fixation and passive fixation quadripolar LV leads. METHODS: Sixty-two patients were before CRT implantations randomly allocated to receive a bipolar (n = 31) or quadripolar (n = 31) LV leads. Speckle-tracking radial strain echocardiography was used to define the LV segment with latest mechanical activation as the target LV segment. The electrophysiological measurements and the capability to obtain a proximal position in a coronary vein placed over the target segment were assessed. RESULTS: Upon implantation, the quadripolar lead demonstrated a lower pacing capture threshold than the bipolar lead, but at follow-up, there was no difference. There were no differences in the LV lead implant times or radiation doses. The success rate in reaching the target location was not significantly different between the two LV leads. CONCLUSIONS: The pacing capture thresholds were low, with no significant difference between active fixation bipolar leads and quadripolar leads. Active fixation leads did not promote a more proximal location of the stimulating electrode or a higher grade of concordance to the target segment than passive fixation leads.

Clinical outcome of cardiac resynchronization therapy in patients randomized to an active fixation bipolar left ventricular lead versus a passive quadripolar lead.

Objectives: To compare the clinical outcome of cardiac resynchronization therapy (CRT) in patients receiving a bipolar left ventricular (LV) lead with a side helix for active fixation to the outcome in patients receiving a quadripolar passive fixation LV lead.Design: Sixty-two patients (mean age 72 ± 11 years) were blindly and randomly assigned to the active fixation bipolar lead group (n = 31) or to the quadripolar lead group (n= 31). The LV leads were targeted to the basal LV segment in a vein concordant to the LV segment with the latest mechanical contraction chosen on the basis of preoperative radial strain (RS) echocardiography.Results: At the 6-month follow-up (FU), the reduction in LV end-systolic volume and LV reverse remodelling responder rate, defined as LV end-systolic volume reduction >15%, was 77% in the active fixation group and 83% in the quadripolar group, which was not significantly different. At the 12-month FU, the LV ejection fraction (LVEF) did not differ between the groups. There were no significant differences between the two groups in changes in New York Heart Association (NYHA) functional class or Minnesota Living with Heart Failure Questionnaire score. The occurrence of phrenic nerve stimulation (PNS) was 19% in the active fixation group versus 10% in the quadripolar group (p=.30), and all cases were resolved by reprogramming the device. All patients were alive at the 12-month FU. There was no device infection.Conclusions: There were no significant differences between the active fixation group of patients and the quadripolar group of patients concerning improvement in echocardiographic parameters or clinical symptoms.ClinicalTrials.gov number, NCT04632472.

Active fixation of a thin transvenous left-ventricular lead by a side helix facilitates targeted and stable placement in cardiac resynchronization therapy.

AIMS: Suboptimal placement, phrenic nerve stimulation, and dislodgements of left-ventricular (LV) leads are main challenges in cardiac resynchronization therapy. We investigated the handling, performance, safety, and stability for a novel 4Fr LV lead with a small side helix located proximal to the ring electrode for active fixation of the LV lead. METHODS AND RESULTS: The novel LV lead was successfully implanted in 103 of 106 patients. Patients with dislodged LV leads and with demanding coronary vein anatomies were included. The lead body was rotated clockwise to engage the active fixation side helix in the vein wall. The stimulating electrode was located in basal LV segment and middle LV segment in 54 and 46% of the patients, respectively. The lead was targeted to a vein concordant to the LV segment with latest mechanical activation. Concordant LV lead placement was achieved in 73% of the patients and in adjacent segment in 24%. The average pacing capture threshold (PCT) at implantation was 1.04 ± 0.6 V (n = 103) and at an average follow-up at 7 months, the PCT remained low and no dislodgements have been observed. During follow-up, four leads have been explanted without complications. CONCLUSION: Active fixation of this 4Fr LV lead by using a side helix, offers flexibility to place the lead precisely in targeted vein segments over a wide range of vein anatomies. The average LV pacing threshold was low at implantation and follow-ups. The lead seems to be extractable and no late dislodgements have been observed.

Treatment of cardiogenic shock with left ventricular assist device combined with cardiac resynchronization therapy: a case report.

Cardiogenic shock has a poor prognosis with established treatment strategies. We report a 62 years old man with heart failure exacerbating into refractory cardiogenic shock successfully treated with the combination of a percutaneous left ventricular assist device (LVAD) and subacute cardiac resynchronization therapy (CRT) implantable cardioverter-defibrillator device (CRT-D).