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MitraClip or Ventricular Assist Device?

The patient was a 59-year-old female with advanced heart failure and severe functional mitral regurgitation who was classified as INTERMACS profile 4 with repeated hospitalizations despite guideline-directed medical therapy. She was also listed for heart transplantation. After comparing the two major therapeutic strategies: (1) durable left ventricular assist device (LVAD) implantation and (2) percutaneous MitraClip procedure (Abbott Vascular, Abbott Park, IL, USA), we eventually decided to proceed with MitraClip, given her relatively lower B-type natriuretic peptide, lower MAGGIC Heart Failur

Bundled Payments for Care Improvement and Quality of Care and Outcomes in Heart Failure.

IMPORTANCE: The Centers for Medicare & Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) program was launched in 2013 wit … ptor-neprilysin inhibitors at discharge, receiving an aldosterone antagonist at discharge, having a cardiac resynchronization therapy (CRT)-defibrillator or CRT pacemaker placed or prescribed at discharge, having implantable cardioverter-defibrillator (ICD) counseling or an ICD placed or prescribed at discharge, heart failure education being provided among eligible patients, or ha …

INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) Profiling Identifies Ambulatory Patients at High Risk on Medical Therapy After Hospitalizations for Heart Failure.

BACKGROUND: INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles provide important prognostic information for patients with advanced heart failure (HF) receiving mechanical support. The value of INTERMACS profiling has not been shown for patients followed on medical therapy for advanced HF at centers that also offer mechanical circulatory support. METHODS AND RESULTS: This prospective, observational study enrolled 166 patients with chronic New York Heart Association class III-IV HF, ejection fraction ≤30%, and ≥1 HF hospitalization in the previous year, excl

Influence of predictive modeling in implementing optimal heart failure therapy.

INTRODUCTION: A gap remains between evidence-based guidelines in the treatment of heart failure (HF) and current pharmacologic and device therapy. The Seattle Heart Failure Model (SHFM) is an accurate predictive tool that allows the clinician to quantitatively assess the influence of pharmacologic and device therapy on HF. The authors hypothesized that graphically demonstrating the improvement in survival using such a tool may well modify physician practice behavior. METHODS: The authors examined 50 randomly selected patients from 10 primary care physicians having HF with a left ventricular e

Utility of cardiac magnetic resonance imaging, echocardiography and electrocardiography for the prediction of clinical response and long-term survival following cardiac resynchronisation therapy.

Cardiac resynchronisation therapy (CRT) can reduce symptoms, hospitalisations, and mortality in patients with severe left ventricular (LV) systolic dysfunction and electro-mechanical dyssynchrony. Unfortunately, approximately 30 % of eligible patients fail to respond to CRT. This study prospectively compared electrocardiography (ECG), echocardiography, and cardiac magnetic resonance (CMR) imaging for the prediction of response to CRT. We performed ECG, echocardiography and CMR on 46 patients prior to planned CRT implantation. Patients were divided into predicted responder and non-responder gro

Feasibility, safety and outcomes of contrast-free cardiac resynchronisation therapy device implantation: a retrospective cohort comparison.

BACKGROUND: Left ventricular lead (LVL) implantation can be challenging in Cardiac Resynchronization Therapy (CRT). Therefore, contrast is commonly used to visualize the coronary venous system. However, contrast use is correlated with substantial risks such as contrast-induced nephropathy and anaphylactic reaction. Case studies suggest feasibility of LVL implantation without coronary sinus (CS) venography. PURPOSE: We aimed to compare the procedure characteristics, outcome, and safety of contrast-free and contrast-aided LVL implantation. METHODS: 346 LVL implantations performed between 2017 an…

Heart failure with reduced ejection fraction: comparison of patient characteristics and clinical outcomes within Asia and between Asia, Europe and the Americas.

AIMS: Nearly 60% of the world's population lives in Asia but little is known about the characteristics and outcomes of Asian patients with heart failure with reduced ejection fraction (HFrEF) compared to other areas of the world. METHODS AND RESULTS: We pooled two, large, global trials, with similar design, in 13 174 patients with HFrEF (patient distribution: China 833, India 1390, Japan 209, Korea 223, Philippines 223, Taiwan 199 and Thailand 95, Western Europe 3521, Eastern Europe 4758, North America 613, and Latin America 1110). Asian patients were younger (55.0-63.9 years) than in Western

The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries.

Heart failure is a global pandemic affecting an estimated 26 million people worldwide and resulting in more than 1 million hospitalizations annually in both the United States and Europe. Although the outcomes for ambulatory HF patients with a reduced ejection fraction (EF) have improved with the discovery of multiple evidence-based drug and device therapies, hospitalized heart failure (HHF) patients continue to experience unacceptably high post-discharge mortality and readmission rates that have not changed in the last 2 decades. In addition, the proportion of HHF patients classified as having

Arrhythmic Risk Stratification in Cardiac Amyloidosis: A Review of the Current Literature.

Cardiac amyloidosis is the most frequent infiltrative disease caused by the deposition of misfolded proteins in the cardiac tissue, leading to heart failure, brady- and tachyarrhythmia and death. Conduction disorders, atrial fibrillation (AF) and ventricular arrhythmia (VA) significantly impact patient outcomes and demand recognition. However, several issues remain unresolved regarding early diagnosis and optimal management. Extreme bradycardia is the most common cause of arrhythmic death, while fast and sustained VAs can be found even in the early phases of the disease. Risk stratification an

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… Anti-Bradycardia Pacing and Cardiac Resynchronization Therapy The preventive effect of pacemaker (PM) implantation on mortality has been a subject of discussion [ 18 , 40 ]. … Brignole M. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA) Eur. …

Cardiac Interventions in Patients With Active, Advanced Solid and Hematologic Malignancies: JACC: CardioOncology State-of-the-Art Review.

Invasive cardiac interventions are recommended to treat ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndromes, multivessel coronary disease, severe symptomatic aortic stenosis, and cardiomyopathy. These recommendations are based on randomized controlled trials that historically included few individuals with active, advanced malignancies. Advanced malignancies represent a significant competing risk for mortality, and there is limited evidence to inform the risks and benefits of invasive cardiac interventions in affected patients. We review the benefit con

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… resynchronization therapy (CRT). … Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy Several cancer therapies are associated with left ventricular dysfunction, which in some cases may result in heart failure. …

Outcomes in patients hospitalized for heart failure and chronic obstructive pulmonary disease: differences in clinical profile and treatment between 2002 and 2009.

AIMS: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently co-exist, and each is a major public health issue. In a large cohort of hospitalized HF patients, we evaluated: (i) the impact of COPD on clinical outcomes; (ii) whether outcomes and treatments changed from 2002 to 2009; and (iii) the relationship between outcomes and treatments focusing on beta-blockers (BBs) and bronchodilators (BDs). METHODS AND RESULTS: From linkable Lombardy administrative health databases, we selected individuals with a discharge diagnosis of HF with or without concomitant COPD (HF yesC

Stereotactic arrhythmia radioablation for intramural basal septal ventricular tachycardia originating near the His bundle.

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… resynchronization therapy defibrillator device was implanted. … Discussion STAR offers a noninvasive strategy for treatment of refractory VT. 2 In our case, STAR offered a palliative option for recurrent, symptomatic, intramural VT originating from the interventricular basal septum without adverse effects to a newly implanted cardiac resynchronization therapy defibrillator …

Novel Therapeutics for Anthracycline Induced Cardiotoxicity.

Anthracyclines remain an essential component of the treatment of many hematologic and solid organ malignancies, but has important implications on cardiovascular disease. Anthracycline induced cardiotoxicity (AIC) ranges from asymptomatic LV dysfunction to highly morbid end- stage heart failure. As cancer survivorship improves, the detection and treatment of AIC becomes more crucial to improve patient outcomes. Current treatment modalities for AIC have been largely extrapolated from treatment of conventional heart failure, but developing effective therapies specific to AIC is an area of growing

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… Moderate to end stage therapy considerations include cardiac resynchronization therapy, mechanical circulatory support, and orthotopic heart transplantation. … Cardiac Resynchronization Therapy In patients with AIC and standard guideline indications for cardiac resynchronization therapy (CRT), CRT has been found to be safe and effective. …

Arrhythmias and Device Therapies in Cardiac Amyloidosis.

Cardiac amyloidosis is caused by amyloid fibrils that deposit in the myocardial interstitium, causing restrictive cardiomyopathy and eventually death. The electromechanical, inflammatory, and autonomic changes due to amyloid deposition result in arrhythmias. Atrial fibrillation is by far the most common arrhythmia. The rate control strategy is generally poorly tolerated due to restrictive filling physiology and heart rate dependance, favoring adoption of the rhythm control strategy. Anticoagulation for stroke prophylaxis is warranted, irrespective of CHA2DS2-VASc score in patients with a favor

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… On the other hand, most patients met the standard criteria for cardiac resynchronization therapy, which resulted in improvement in the ejection fraction, systemic congestion, and mitral regurgitation severity [ 72 ]. … In another retrospective study from the Cleveland Clinic, cardiac resynchronization therapy was associated with improved survival among patients with ATTR and also resulted in improvements in heart failure symptoms and the left ventricular ejection fraction [ 73 ]. …

Heart Failure in Older Patients: An Update.

Heart failure (HF) is a clinical syndrome with high incidence and prevalence and high morbidity and death rate, even in the short term, representing a serious public health issue, mainly in older people. It is a growing cause for hospital admission in this age group, being frequently associated with several comorbidities, further aggravating the disease's course. Moreover, older HF patients are usually affected by clinical conditions, like frailty, malnutrition, and cachexia, which significantly impact the overall management of HF and need to be properly identified and treated. Diagnosing and

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… Cardiac Resynchronization Therapy and Implantable Cardioverter-Defibrillator Cardiac resynchronization therapy (CRT) is recommended to improve symptoms and reduce morbidity and mortality in symptomatic HF patients in sinus rhythm who have a QRS duration ≥150 ms with left bundle branch block morphology … Deactivating the resynchronization component in CRT-Ps (cardiac resynchronization therapy pacemakers) should be avoided since this could worsen HF-related symptoms (breathlessness, asthenia, and so on). …

Standard Poster Abstracts for the 17th Asia Pacific Heart Rhythm Society (APHRS) Scientific Sessions

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… QT interval in individuals with broad QRS complexes to calculate QTc following cardiac resynchronization therapy (CRT). … Twenty‐eight (19.2%) patients underwent device implantation such as ICD and cardiac resynchronization therapy defibrillator (CRT‐D). …

An unexpected cause of a swollen pacemaker pocket: a case report.

BACKGROUND: A complication originating from the pacemaker pocket after device implantation can most often be explained by a post-operative pocket haematoma, or, less frequently, by a pocket infection. Both conditions need immediate assessment, dedicated treatment, and specialized follow-up. In rare cases, however, a swollen pacemaker pocket has an alternative diagnosis, which is exemplified by the following case. CASE SUMMARY: A 70-year-old male patient had a-specific symptoms of fatigue, dyspnoea, and coughing for some weeks. He also noted an evident, new swelling of his pacemaker pocket sev

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… Ward Heggermont is a board certified cardiologist, specialized in chronic heart failure, and device implantations, especially cardiac resynchronization therapy. … resynchronization therapy. …

Abstracts

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… The role of LV mechanical dyssynchrony assessment with gated single-photon emission computed tomography in selection and response assessment of patients, who undergo cardiac resynchronization therapy, is widely discussed. …

The Arrhythmic Burden of Cardiac Amyloidosis: A Comprehensive Review.

Cardiac amyloidosis (CA) represents a growing etiology of heart failure (HF) and arrhythmogenesis, driven by the intramyocardial deposition of aberrantly folded proteins, notably immunoglobulin light chains (AL) and transthyretin (ATTR). This infiltrative process compromises myocardial compliance and disrupts the cardiac conduction system, leading to a diverse spectrum of dysrhythmias. The escalating prevalence of CA, particularly within geriatric demographics and individuals with plasma cell dyscrasias, underscores the imperative for refined diagnostic and therapeutic paradigms. The considera

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… resynchronization therapy (CRT) also presents unique issues in CA. … Cardiac resynchronization therapy: Current status and near-future prospects. J Cardiol. 2022;79:352–7. doi: 10.1016/j.jjcc.2021.10.021. 109. Cheung CC, Olgin JE, Lee BK. Wearable cardioverter-defibrillators: A review of evidence and indications. …

Malignant Neoplasms Arising in the Cardiac Pacemaker Cavity: A Systematic Review.

Cancer is the abnormal proliferation of physiologically inadequate cells. Studies have identified the cardiac pacemaker pocket as a site of rare neoplasms. To evaluate the clinical outcomes, treatment, prognosis, and individualized management of tumors originating in the cardiac pacemaker pocket, a systematic review was conducted using case reports and case series available in the PubMed/Medline, Science Direct, Cochrane Central, LILACS, and Scientific Electronic Library Online (Scielo) databases. Pacemaker pocket tumors affected patients with a mean age of 72.9 years, with a higher incidence

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… Corrigendum to: 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC): With the special contribution of the European Heart Rhythm Association (EHRA) EP …