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Effects of implantable cardioverter/defibrillator (ICD) shocks and antitachycardia pacing (ATP) on anxiety and quality of life (QoL) in ICD patients are poorly understood. METHODS: We evaluated changes in QoL from baseline to 9-month follow-up using the EQ-5D questionnaire in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) (n=1,268). We assessed anxiety levels using the Florida Shock Anxiety Scale (1-10 score) in patients with appropriate or inappropriate shocks or ATP compared to those with no ICD therapy during the first 9 months postimplant. The analysis was stratified by number of ATP or shocks (0-1 vs ≥2) and adjusted for covariates. RESULTS: In MADIT-RIT, 15 patients (1%) had ≥2 appropriate shocks, 38 (3%) had ≥2 appropriate ATPs. Two or more inappropriate shocks were delivered in 16 patients (1%); ≥2 inappropriate ATPs, in 70. In multivariable analysis, patients with ≥2 appropriate shocks had higher levels of shock-related anxiety than those with ≤1 appropriate shock (P<.01). Furthermore, ≥2 inappropriate shocks produced more anxiety than ≤1 inappropriate shock (P=.005). Consistently, ≥2 appropriate ATPs resulted in more anxiety than ≤1 (P=.028), whereas the number of inappropriate ATPs showed no association with anxiety levels (P=.997). However, there was no association between QoL and appropriate or inappropriate ATP/shock (all P values > .05). CONCLUSIONS: In MADIT-RIT, ≥2 appropriate or inappropriate ICD shocks and ≥2 appropriate ATPs are associated with more anxiety at 9-month follow-up despite no significant changes in the assessment of global QoL by the EQ-5D questionnaire. Innovative ICD programming reducing inappropriate therapies may help deal with patient concerns about the device.
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Ansiedade/etiologia , Desfibriladores Implantáveis , Qualidade de Vida , Taquicardia Ventricular/terapia , Ansiedade/psicologia , Cardioversão Elétrica/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Taquicardia Ventricular/complicações , Taquicardia Ventricular/psicologia , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Ablation of longstanding persistent atrial fibrillation (LSPAF) is the most challenging procedure in the treatment of AF, either by surgical or by percutaneous approach. OBJECTIVE: We investigated the difference in success and complication rates between combined surgical epicardial and endocardial catheter ablation procedure and our standard endocardial ablation procedure. METHODS AND RESULTS: Twenty-four consecutive patients (group 1) with LSPAF and enlarged left atrium (>4.5 cm) underwent a combined procedure, consisting of surgical, closed-chest, epicardial, radiofrequency ablation (nContact, NC, USA) via pericardial access, and concomitant endocardial ablation (hybrid procedure). Procedural complications and long-term outcomes were compared to those of 35 consecutive patients who refused the hybrid procedure and underwent standard endocardial only ablation (group 2). Baseline characteristics were comparable. In group 1, 1 patient (4.2%) developed post-procedural cardio-embolic stroke and 3 (12.5%) died (1 atrio-esophageal fistula, 1 fatal stroke, 1 of unknown cause in early follow-up), while no strokes or deaths occurred in group 2. Overall complication rates were higher for group 1 (P = 0.036). At 24-month follow-up, 4 (19%) patients in group 1 and 19 (54.3%) in group 2 were arrhythmia-free after a single procedure, on or off antiarrhythmic drugs (P<0.001). Total procedural time (276.9 ± 63.5 vs. 203.15 ± 67.3 minutes) and length of hospital stay (5 [IQR 3-8] vs. 1 [IQR 1-3] days were significantly shorter for group 2 (P <0.001). CONCLUSIONS: In patients with LSPAF and enlarged left atrium, a concomitant combined surgical/endocardial ablation approach increases complication rate and does not improve outcomes when compared to extensive endocardial ablation only.
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Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Endocárdio/cirurgia , Átrios do Coração/cirurgia , Pericárdio/cirurgia , Potenciais de Ação , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Intervalo Livre de Doença , Endocárdio/fisiopatologia , Feminino , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pericárdio/fisiopatologia , Complicações Pós-Operatórias/etiologia , Recidiva , Fatores de Risco , Texas , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: SonR sensor signal correlates well with myocardial contractility expressed in terms of left ventricular (LV) dP/dt max. The aim of our study was to evaluate the changes in myocardial contractility during isometric effort in heart failure patients undergoing cardiac resynchronization therapy (CRT) with right atrial SonR sensor. METHODS: Thirty-one patients (19 men, 65 ± 7 years, LV ejection fraction [LVEF] 28% ± 5%, in sinus rhythm) were implanted with a CRT-defibrillator (CRT-D) device equipped with SonR sensor, which was programmed in VVI mode at 40 beats/min. Twenty-four hours after implantation, each patient underwent a noninvasive hemodynamic evaluation at rest and during isometric effort, including: (1) measurement of beat-to-beat endocavitary SonR signal; (2) echocardiographic assessment; and (3) continuous measurement of blood pressure with Nexfin method (BMEYE, Amsterdam, the Netherlands). The following contractility parameters were considered: (1) mean value of beat-to-beat SonR signal; (2) mean value of LV dP/dt by Nexfin system; and (3) fractional shortening (FS) by echocardiography. RESULTS: At the third minute of the isometric effort, mean value of SonR signal significantly increased from baseline (P < 0.001). Similarly, mean value of both LV dP/dt by Nexfin and FS significantly increased compared to the resting condition (P < 0.001; P < 0.001). While in 27 (88%) patients SonR signal increased at the third minute of the isometric effort, in four (12%) patients SonR signal decreased. In these patients, both LV dP/dt by Nexfin and FS consensually decreased. CONCLUSIONS: In CRT patients, SonR sensor is able to detect changes in myocardial contractility in a consensual way like noninvasive methods such as Nexfin system and echocardiography.
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Balistocardiografia/instrumentação , Dispositivos de Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/prevenção & controle , Insuficiência Cardíaca/fisiopatologia , Sistemas Microeletromecânicos/instrumentação , Contração Miocárdica , Idoso , Terapia de Ressincronização Cardíaca/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Contração Isométrica , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , TransdutoresRESUMO
INTRODUCTION: Premature ventricular complexes (PVCs) and ventricular tachycardia (VT) arising from papillary muscles of both ventricles have recently been described. There is a lack of data on VT originating from the right ventricular papillary (RV PAP) muscles. There have been no prior studies focused on the electrocardiogram (ECG) features and ablation of PVC/VT arising from the septal papillary muscle of the right ventricle. METHODS: Among 155 consecutive patients with normal structural heart who underwent catheter ablation of PVC/VT, 8 patients with PVC/VT from the septal RV PAP muscle were identified. The site of origin of the arrhythmias was identified through activation/pace mapping and intracardiac echocardiography. All patients underwent radiofrequency ablation of the arrhythmia. RESULTS: Data on 8 consecutive patients (2 men, age 42 ± 13 years old) were collected. All patients had a preserved ejection fraction (60 ± 4%). Septal RV PAP arrhythmias had a left superior axis and negative concordance or late R-wave transition in precordial leads. PVCs were spontaneous in 5 cases, were induced by isoprotenerol in 2 cases and by isoproterenol plus phenylephrine in another one. PVCs were never induced with calcium bolus and only rarely with burst pacing. Adenosine never terminated VT or suppressed the VT/PVCs. Radiofrequency, fluoroscopic, and procedural time were, respectively, 10.3 ± 3, 36.4 ±11.3, and 76.3 ± 27.5 minutes. During a mean follow-up of 8 ± 4 months, mean PVC burden was reduced from 14 ± 3% preablation to 0.1 ± 0.2% postablation. CONCLUSION: PVCs and VT originating from septal RV papillary muscle could have a typical ECG pattern due to the site of the muscle involved. Radiofrequency ablation of this anatomic area is feasible and effective.
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Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Músculos Papilares/fisiopatologia , Taquicardia Ventricular/diagnóstico , Função Ventricular Direita , Complexos Ventriculares Prematuros/diagnóstico , Agonistas Adrenérgicos , Adulto , Idoso , Estimulação Cardíaca Artificial , Ablação por Cateter , Ecocardiografia , Estudos de Viabilidade , Feminino , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Papilares/cirurgia , Valor Preditivo dos Testes , Indução de Remissão , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/cirurgia , Fatores de Tempo , Resultado do Tratamento , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/cirurgiaRESUMO
BACKGROUND: Animal studies showed that papillary muscles can be sources of ventricular fibrillation (VF) in both the left and right ventricle, but this occurrence in humans has been described only in patients with ischemic heart disease. OBJECTIVE: To investigate the role of papillary muscle premature ventricular contractions (PVCs) as triggers for VF and the safety and feasibility of catheter ablation in these patients. METHODS: Six patients (2 male; age, 40 ± 11 years; 5 with a normal structural heart and 1 with nonischemic cardiomyopathy) with history of VF resulting in repetitive implantable cardioverter defibrillator shocks, despite antiarrhythmic drug therapy, and a papillary muscle focus of PVCs triggering VF were included and underwent mapping and ablation of PVCs. RESULTS: PVCs were observed to trigger VF and localized by mapping the earliest activation point that matched pace mapping of the same area. In 2 patients, PVCs originated from the left ventricle at the posteromedial papillary muscle; in 4 patients, PVCs originated from the right ventricle, at the posterolateral papillary muscle. Elimination of the triggering PVC was obtained in these areas after 19 ± 12 minutes by radiofrequency application. During a follow-up of 58 ± 11 months using ambulatory monitoring and defibrillator memory interrogation, no patients had recurrence of symptomatic ventricular arrhythmias. CONCLUSION: Papillary muscles from both ventricles represent an anatomic structure potentially involved in the onset of VF, also in normal structural heart. PVCs arising from this area can be successfully eliminated by radiofrequency ablation, resulting in freedom from recurrent VF at long-term follow-up.
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Ablação por Cateter , Músculos Papilares/fisiopatologia , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/fisiopatologia , Adulto , Ablação por Cateter/métodos , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibrilação Ventricular/cirurgia , Complexos Ventriculares Prematuros/cirurgiaRESUMO
BACKGROUND: The clinical impact of smoking on atrial fibrillation (AF) recurrences after pulmonary vein isolation (PVI) have contradictory results in previous studies, performed on Asian populations. METHODS AND AIM: Smoking habit and other cardiovascular risk-factors were assessed in patients who underwent their first radiofrequency PVI for symptomatic AF. The study aims to assess the clinical impact of smoking on AF recurrences after PVI in a contemporary European cohort of patients. RESULTS: The study included 186 consecutive patients (135 males [72.6%]) with a mean age of 63.4 ± 9.7 years. Current smokers resulted 29 (15.7%). No statistically significant baseline differences were detected between current smokers and non-current smokers. After a follow-up of 418 ± 246 days, AF recurrence was higher in currently smoking patients vs. non-currently smoker patients, the latter intended as a combination between previous smokers and never smokers (34.5% vs. 14% p = 0.01). A previous smoking habit was not associated with increased risk of AF recurrence when compared with patients who never smoked (13.2% vs. 14.6%, p = 0.23), while a current smoking habit impacted on AF recurrence in comparison with previous smokers (p = 0.01) and never smokers (p = 0.04). The increased incidence of AF recurrence in current smokers was consistent also considering only paroxysmal AF (31.4% vs 9.6%, p = 0.012) or persistent AF (50% vs 31.2%, p = 0.03). Smoking (HR =2.96 95% CI 1.32-6.64) and persistent AF (HR =2.64 95% CI 1.22-5.7) resulted independent predictors of AF recurrence. CONCLUSION: Cigarette smoking is associated with an increased risk of AF recurrences after PVI, both in paroxysmal and in persistent AF.
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BACKGROUND: There are limited real-world data on the extended prognosis of patients with drug-induced type 1 Brugada electrocardiogram (ECG). OBJECTIVE: We assessed the clinical outcomes and predictors of life-threatening arrhythmias in patients with drug-induced type 1 Brugada ECG. METHODS: This multicenter retrospective study, conducted at 21 Italian and Swiss hospitals from July 1997 to May 2021, included consecutive patients with drug-induced type 1 ECG. The primary outcome, a composite of appropriate ICD therapies and sudden cardiac death, was assessed along with the clinical predictors of these events. RESULTS: A total of 606 patients (mean age 49.7 ± 14.7 years; 423 [69.8%] men) were followed for a median of 60.3 months (interquartile range 23.0-122.4 months). Nineteen patients (3.1%) experienced life-threatening arrhythmias, with a median annual event rate of 0.5% over 5 years and 0.25% over 10 years. The SCN5A mutation was the only predictor of the primary outcome (hazard ratio 4.54; P = .002), whereas a trend was observed for unexplained syncope (hazard ratio 3.85; P = .05). In patients who were asymptomatic at presentation, the median annual rate of life-threatening arrhythmias is 0.24% over 5 years and increases to 1.2% if they have inducible ventricular fibrillation during programmed ventricular stimulation. CONCLUSION: In patients with drug-induced type 1 Brugada ECG, the annual risk of life-threatening arrhythmias is low, with the SCN5A mutation as the only independent predictor. Unexplained syncope correlated with worse clinical outcomes. Ventricular fibrillation inducibility at programmed ventricular stimulation significantly increases the median annual rate of life-threatening arrhythmias from 0.24% to 1.2% over 5 years.
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Síndrome de Brugada , Eletrocardiografia , Sistema de Registros , Humanos , Masculino , Síndrome de Brugada/fisiopatologia , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/epidemiologia , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Prognóstico , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Itália/epidemiologia , Seguimentos , Desfibriladores Implantáveis , Suíça/epidemiologia , Fatores de Tempo , Taxa de Sobrevida/tendências , AdultoRESUMO
BACKGROUND: Atrial high-rate episodes (AHREs) are frequent in patients with cardiac implantable electronic devices. A decrease in device-detected P-wave amplitude may be an indicator of periods of increased risk of AHRE. OBJECTIVE: The objective of this study was to assess the association between P-wave amplitude and AHRE incidence. METHODS: Remote monitoring data from 2579 patients with no history of atrial fibrillation (23% pacemakers and 77% implantable cardioverter-defibrillators, of which 40% provided cardiac resynchronization therapy) were used to calculate the mean P-wave amplitude during 1 month after implantation. The association with AHRE incidence according to 4 strata of daily burden duration (≥15 minutes, ≥6 hours, ≥24 hours, ≥7 days) was investigated by adjusting the hazard ratio with the CHA2DS2-VASc score. RESULTS: The adjusted hazard ratio for 1-mV lower mean P-wave amplitude during the first month increased from 1.10 (95% confidence interval [CI], 1.05-1.15; P < .001) to 1.18 (CI, 1.09-1.28; P < .001) with AHRE duration strata from ≥15 minutes to ≥7 days independent of the CHA2DS2-VASc score. Of 871 patients with AHREs, those with 1-month P-wave amplitude <2.45 mV had an adjusted hazard ratio of 1.51 (CI, 1.19-1.91; P = .001) for progression of AHREs from ≥15 minutes to ≥7 days compared with those with 1-month P-wave amplitude ≥2.45 mV. Device-detected P-wave amplitudes decreased linearly during the 1 year before the first AHRE by 7.3% (CI, 5.1%-9.5%; P < .001 vs patients without AHRE). CONCLUSION: Device-detected P-wave amplitudes <2.45 mV were associated with an increased risk of AHRE onset and progression to persistent forms of AHRE independent of the patient's risk profile.
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Fibrilação Atrial , Desfibriladores Implantáveis , Humanos , Feminino , Masculino , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/diagnóstico , Idoso , Incidência , Progressão da Doença , Medição de Risco/métodos , Átrios do Coração/fisiopatologia , Marca-Passo Artificial , Frequência Cardíaca/fisiologia , Fatores de Risco , Pessoa de Meia-Idade , Tecnologia de Sensoriamento Remoto/instrumentação , SeguimentosRESUMO
Cardiac blood cysts are rare findings in clinical practice. They usually involve the valves and are very uncommon in adult age. Their clinical manifestation varies broadly, as they can interfere with intracardiac flow, or even be completely silent. We report a case of a newly developed cyst of the atrial septum, incidentally detected by transthoracic echocardiography in a 69-year-old asymptomatic patient. The diagnosis was confirmed by postsurgery histopathological examination.
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Septo Interatrial/diagnóstico por imagem , Cistos/diagnóstico por imagem , Endocárdio/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Idoso , Humanos , Masculino , UltrassonografiaRESUMO
PURPOSE: Myocardial scar is directly related to the response to CRT after implantation. The extent of myocardial scar can be detected not only by cardiac magnetic resonance but also by two electrocardiographic scores: fragmented QRS (fQRS) and Selvester score (SSc). The aim of our study is to compare the role of baseline SSc and fQRS in predicting response to CRT in a cohort of heart failure patients with true left bundle branch block (LBBB). As a secondary endpoint, we assessed the association of both scores with overall and cardiac mortality, heart failure hospitalizations, ventricular arrhythmias requiring ICD intervention, and major adverse cardiovascular event (MACE). METHODS: We evaluated fQRS and SSc of 178 consecutive HF patients with severe systolic dysfunction (LVEF ≤ 35%), NYHA class II-III despite optimal medical treatment, and true-LBBB. Response to CRT was defined as the improvement of LVEF of at least 10% or as the reduction of LVESV of at least 15% at a 6-month follow-up. Each endpoint was related to fQRS and SSc. RESULTS: SSc ≥7 was significantly associated with the absence of echocardiographic response to CRT (OR: 0.327; 95% C.I. 0.155-0.689; p=0.003), while the presence of fQRS at baseline ECG was not (OR: 1.133; 95% C.I. 0.539-2.381; p=0.742). No correlation was found between SSc and overall mortality, cardiac death, ventricular arrhythmias, hospitalizations due to heart failure, or for MACE. Similar results were observed between fQRS and all secondary endpoints. CONCLUSION: In HF patients with true-LBBB and LVEF ≤35% eligible for CRT, myocardial scar assessed by calculating the SSc on preimplant ECG is an independent predictor of nonresponse after multiple adjustments. Neither SSc nor fQRS is associated with overall and cardiac death, ventricular arrhythmias, or hospitalization for heart failure at a 24-month follow-up.
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Population aging and broader indications for the implant of cardiac implantable electronic devices (CIEDs) are the main reasons for the continuous increase in the use of pacemakers (PMs), implantable cardioverter-defibrillators (ICDs) and devices for cardiac resynchronization therapy (CRT-P, CRT-D). The growing burden of comorbidities in CIED patients, the greater complexity of the devices, and the increased duration of procedures have led to an augmented risk of infections, which is out of proportion to the increase in implantation rate. CIED infections are an ominous condition, which often implies the necessity of hospitalization and carries an augmented risk of in-hospital death. Their clinical presentation may be either at pocket or at endocardial level, but they can also manifest themselves with lone bacteremia. The management of these infections requires the complete removal of the device and subsequent, specific, antibiotic therapy. CIED failures are monitored by competent public authorities, that require physicians to alert them to any failures, and that suggest the opportune strategies for their management. Although the replacement of all potentially affected devices is often suggested, common practice indicates the replacement of only a minority of devices, as close follow-up of the patients involved may be a safer strategy. Implantation of a PM or an ICD may cause problems in the patients' psychosocial adaptation and quality of life, and may contribute to the development of affective disorders. Clinicians are usually unaware of the psychosocial impact of implanted PMs and ICDs. The main difference between PM and ICD patients is the latter's dramatic experience of receiving a shock. Technological improvements and new clinical evidences may help reduce the total burden of shocks. A specific supporting team, providing psychosocial help, may contribute to improving patient quality of life.
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AIM: We evaluated the predictive value of echo/Doppler derived indices, which reflect the duration of the isovolumic phases of the cardiac cycle, in identifying cardiac resynchronization therapy (CRT) responders. METHODS AND RESULTS: In 105 patients before and 6 months after CRT the following echo/Doppler parameters were evaluated: myocardial performance index (MPI) as the sum of isovolumic contraction time (IVCT) and isovolumic relaxation time (IVRT) divided by ejection time; total isovolumic time (t-IVT) as the sum of IVCT and IVRT divided by the RR interval; and standard deviation of the time to systolic peak velocity (Ts-SD) as asynchrony index. After 6 months, patients were defined responders according to 15% left ventricle (LV) end-systolic volume reduction or more. At baseline, responders (53.3%) had higher t-IVT and MPI than nonresponders (0.30 +/- 0.06 versus 0.22 +/- 0.05, P < 0.0001 and 1.01 +/- 0.27 versus 0.73 +/- 0.19, P < 0.0001, respectively). Receiving operating characteristic curve analysis showed that both t-IVT (80.3% sensitivity and 83.7% specificity, cut-off = 0.263) and MPI (78.6% sensitivity and 81.6% specificity, cut-off = 0.84) could predict CRT response. Baseline t-IVT correlated well to end-systolic volume reduction (r = -0.56, P < 0.00001). CONCLUSION: Echo/Doppler derived indices, describing physiologic abnormalities of the isovolumic contraction and relaxation phase, are able to predict CRT-induced reverse remodeling.
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Estimulação Cardíaca Artificial , Ecocardiografia Doppler , Insuficiência Cardíaca/terapia , Função Ventricular Esquerda , Remodelação Ventricular , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Volume Sistólico , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Although optimization of atrioventricular and interventricular delays has been demonstrated to improve hemodynamics in patients with cardiac resynchronization therapy (CRT), the required time-consuming procedure discourages its use in clinical practice. Recently, a new method for CRT optimization based on the intracardiac electrogram (IEGM) detected by the implanted leads, has been developed. We evaluated the effectiveness of this method in improving left ventricular (LV) asynchrony and performance using real-time 3D echocardiography (RT3DE). METHODS AND RESULTS: Twenty patients with CRT were prospectively studied. RT3DE was performed before and after IEGM optimization. The standard deviation of the time to the regional LV minimum systolic volume (Tmsv) for all 16 segments (Tmsv 16-SD), six basal and six mid segments (Tmsv 12-SD), and the six basal segments (Tmsv 6-SD) were assessed as a asynchrony indexes. LV end-diastolic and end-systolic volumes (EDV, ESV), stroke volume (SV), ejection fraction (EF), myocardial performance index (MPI), ejection time (ET), and filling time (FT), corrected by R-R interval, were also evaluated. After IEGM optimization, as compared with baseline Tmsv 12-SD and Tmsv 16-SD decreased (P = 0.01, P< 0.001, respectively), EF and SV improved (P < 0.001, P = 0.01 respectively), FT/RR and ET/RR increased (P = 0.02 for both), and MPI improved (P < 0.001). Tmsv 6-SD, EDV and ESV did not change. CONCLUSION: A simple IEGM-based method of CRT optimization decreased LV dyssynchrony and improved systolic function.
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Estimulação Cardíaca Artificial/normas , Ecocardiografia Tridimensional , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/terapia , Marca-Passo Artificial , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/terapia , Idoso , Algoritmos , Humanos , Masculino , Estudos Prospectivos , Estatísticas não ParamétricasRESUMO
AIM: Gender related differences in epidemiology, treatment, and prognosis of heart failure (HF) have been reported. We examined the sex influence in patients treated with cardiac resynchronization therapy (CRT). METHODS AND RESULTS: Out of 334 consecutive HF patients (19.7% women) who underwent CRT, 195 patients reached clinical and echocardiographic evaluation at six and 12 months and were selected for analysis. A reduction in left ventricular (LV) end-diastolic volume/m(2) (EDVi) and end systolic volume/m(2) (ESVi) was evident in the overall population at six months (P < 0.001) and from six to 12 months (P < 0.001). Compared to men, women showed significantly greater changes in LV volumes at mid (P < 0.05) and long-term (P < 0.001) follow-up and a significantly higher LV ejection fraction (EF) (40.8 +/- 12.3 vs 34.1 +/- 10.1, P < 0.01) at one year. Multiple regression analysis, including several demographic and clinical parameters, revealed that female gender is independently associated with greater reduction in LV ESVi. At the 12-month follow-up, the proportion of responders (defined in terms of ESV reduction by at least 10%) was higher in women than in men (76.1% vs 59.3%, P < 0.05). CONCLUSIONS: CRT induced a gender specific LV remodeling response.