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1.
Circ Arrhythm Electrophysiol ; 16(6): e011714, 2023 06.
Article in English | MEDLINE | ID: mdl-37183700

ABSTRACT

BACKGROUND: The role of atrioventricular optimization (AVO) to improve cardiac resynchronization therapy outcomes remains controversial. Previous post hoc analyses of a multicenter trial showed that measures of electrical dyssynchrony (right ventricular-left ventricular [LV] or LV electrical delay durations) are associated with patients who benefit from AVO. METHODS: This was a global, multicenter, prospective, randomized trial of de novo cardiac resynchronization therapy implant patients with an right ventricular-LV duration ≥70 ms to determine whether AVO results in greater reverse remodeling. Patients were randomized 1:1 for either an AVO algorithm (SmartDelay) that determines atrioventricular delay and pacing chamber, biventricular or LV only, or a fixed atrioventricular delay of 120 ms with biventricular pacing. Paired echocardiograms performed at baseline and 6 months were evaluated. The primary end point was echocardiographic cardiac resynchronization therapy response, defined dichotomously as a >15% reduction in LV end-systolic volume. RESULTS: A total of 310 patients (n=120 women) were randomized and had completed 6 months of follow-up. The echocardiographic cardiac resynchronization therapy response rate did not statistically differ between the groups (SmartDelay, 74.8%; fixed, 67.7%; P=0.17). Analyses of prespecified secondary end points demonstrated significant improvements in the absolute (median: SmartDelay, -41.0 mL; fixed, -33.0 mL; P=0.01) and relative change in LV end-systolic volume (SmartDelay, -38.3%; fixed, -27.8%; P=0.03) for patients with SmartDelay optimization. Similar results were observed for the relative improvement in LV ejection fraction (SmartDelay, 46.7%; fixed, 32.1%; P=0.050); absolute improvement in LV ejection fraction trended to be higher with SmartDelay (P=0.06). CONCLUSIONS: Analysis of reverse remodeling parameters demonstrated that AVO via SmartDelay, relative to the nonoptimized fixed atrioventricular delay comparator group, improved absolute and relative changes in LV function in patients with longer right ventricular-LV duration. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03089281.


Subject(s)
Cardiac Resynchronization Therapy , Heart Failure , Humans , Female , Cardiac Resynchronization Therapy/methods , Prospective Studies , Treatment Outcome , Heart Failure/diagnosis , Heart Failure/therapy , Ventricular Function, Left/physiology , Ventricular Remodeling/physiology
2.
J Cardiovasc Electrophysiol ; 24(10): 1125-9, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23889767

ABSTRACT

BACKGROUND: While continuation of oral anticoagulation (OAC) with warfarin may be preferable to interruption and bridging with heparin for patients undergoing cardiovascular implantable electronic device (CIED) implantation, it is uncertain whether the same strategy can be safely used with dabigatran. OBJECTIVE AND METHODS: To determine the risk of bleeding and thromboembolic complications associated with uninterrupted OAC during CIED implantation, replacement, or revision, the outcomes of patients receiving uninterrupted dabigatran (D) were compared to those receiving warfarin (W). RESULTS: D was administered the day of CIED implant in 48 patients (age 66 ± 12.4 years, 13 F and 35 M, 21 ICDs and 27 PMs), including new implant in 25 patients, replacement in 14 patients, and replacement plus lead revision in 9 patients. D was held the morning of the procedure in 14 patients (age 70 ± 11 years, 4 F and 10 M, 5 ICDs and 9 PMs). W was continued in 195 patients (age 60 ± 14.4 years, 54 F, and 141 M), including new implant in 122 patients, replacement in 33 patients, and replacement plus lead revision or upgrade in 40 patients. Bleeding complications occurred in 1 of 48 patients (2.1%) with uninterrupted dabigatran (a late pericardial effusion), 0 of 14 with interrupted D, and 9 of 195 patients (4.6%) on W (9 pocket hematomas), P = 0.69. Fifty percent of bleeding complications were associated with concomitant antiplatelet medications. CONCLUSIONS: The incidence of bleeding complications is similar during CIED implantation with uninterrupted D or W. The risks are higher when OAC is combined with antiplatelet drugs.


Subject(s)
Anticoagulants/administration & dosage , Benzimidazoles/administration & dosage , Cardiac Pacing, Artificial , Defibrillators, Implantable , Electric Countershock/instrumentation , Warfarin/administration & dosage , beta-Alanine/analogs & derivatives , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Benzimidazoles/adverse effects , Cardiac Pacing, Artificial/adverse effects , Dabigatran , Device Removal/adverse effects , Drug Administration Schedule , Electric Countershock/adverse effects , Female , Hemorrhage/chemically induced , Humans , International Normalized Ratio , Male , Middle Aged , Pacemaker, Artificial , Platelet Aggregation Inhibitors/adverse effects , Prosthesis Implantation/adverse effects , Reoperation , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Warfarin/adverse effects , beta-Alanine/administration & dosage , beta-Alanine/adverse effects
5.
Int Heart J ; 50(2): 259-62, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19367035

ABSTRACT

A 23-year-old woman with pre-excitation who was resuscitated from ventricular fibrillation underwent electrophysiologic testing. Successful catheter ablation of a left posteroseptal accessory pathway was achieved. Though the JT and JTc intervals as well as QT and QTc intervals were prolonged before and one day after the ablation, they normalized within about 5 hours after the ablation. This case demonstrated that in a patient with pre-excitation and long QT syndrome (LQTs), the JTc interval was useful for diagnosing LQTs and a longer follow-up of the JTc interval after the ablation was necessary in order not to miss the diagnosis of LQTs.


Subject(s)
Catheter Ablation , Heart Septum/surgery , Long QT Syndrome/surgery , Pre-Excitation Syndromes/surgery , Ventricular Fibrillation/surgery , Adult , Electrocardiography , Female , Heart Conduction System/physiopathology , Humans , Long QT Syndrome/complications , Long QT Syndrome/congenital , Long QT Syndrome/diagnosis , Long QT Syndrome/physiopathology , Pre-Excitation Syndromes/complications , Pre-Excitation Syndromes/diagnosis , Pre-Excitation Syndromes/physiopathology , Treatment Outcome , Ventricular Fibrillation/complications , Ventricular Fibrillation/diagnosis , Ventricular Fibrillation/physiopathology
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