Long-term survival with Cardiac Contractility Modulation in patients with NYHA II or III symptoms and normal QRS duration.

AIMS: Cardiac Contractility Modulation (CCM) is a treatment for heart failure based on electrical signals applied during the absolute refractory period. CCM improves myocardial molecular and biochemical characteristics of heart failure and improves exercise tolerance and quality of life. However, the long term impact on survival has not been described. METHODS AND RESULTS: Survival was determined retrospectively from a cohort of 68 consecutive heart failure cases with NYHA II or III symptoms and QRS duration ≤130ms, implanted with a CCM device between May 2002 and July 2013 in either Bochum or Ludenscheid, Germany. Results were compared with predicted survival (Seattle Heart Failure Model; SHFM) pre-implant for each patient. Mean follow-up was 4.5years (range 0.25-10.3years). Baseline characteristics were as follows: mean age 61years, 88% male, 68% with ischemic heart disease, 78% with an ICD, mean NYHA class 2.9±0.3, LVEF 26%±6% (range 15-40%) and mean QRS duration 106±11ms. Mortality rates (Kaplan-Meier analysis) at 1-, 2- and 5-years were lower with CCM than predicted by SHFM for the cohort (0% with CCM vs. 6.1% per SHFM, 3.5% vs. 11.8%, and 14.2% vs. 27.7%, respectively, p=0.007). CONCLUSIONS: Long-term mortality rates in heart failure patients with NYHA (II-III) and QRS≤130ms are lower when treated by CCM than predicted for the cohort. These findings warrant substantiation in a prospective study.

A comparison of chronaxies for ventricular fibrillation induction, defibrillation, and cardiac stimulation: unexpected findings and their implications.

INTRODUCTION: A low-energy (

How good are experienced interventional cardiologists at predicting the functional significance of intermediate or equivocal left main coronary artery stenoses?

BACKGROUND: Decisions for coronary revascularisation are frequently based on visual assessment of the severity of a stenosis. In patients with intermediate left main stem lesions clinical decision making based on FFR is safe and feasible. This study was performed to assess the accuracy of visual angiographic assessment of intermediate or equivocal left main coronary artery (LMCA) stenoses by experienced interventional cardiologists when taking fractional flow reserve (FFR) measurements as the gold standard. METHODS: Fifty-one patients with intermediate (40-80% diameter stenosis by angiography) or equivocal LMCA disease were evaluated by FFR. Angiograms were then reviewed by 4 experienced interventionalists from different university hospitals blinded to FFR results. Lesions were visually assessed and their significance classified as 'significant', 'not significant', or 'unsure' if the observer was unable to make a decision regarding lesion significance based on the angiogram. RESULTS: Results were compared with two different FFR cutoff values (< 0.75 and < or = 0.80) for hemodynamic significance. The 4 reviewers achieved correct lesion classification in no more than approximately 50% of cases each, regardless of FFR threshold. The interobserver agreement between two reviewers in excess of the agreement expected due to chance was outperformed on average by only 16%. Furthermore, interobserver variability was large resulting in unanimously correct lesion classification in only 29% of all cases. CONCLUSIONS: The functional significance of intermediate and equivocal LMCA stenoses should not be based solely on angiographic assessment even by experienced interventional cardiologists.