Circulation. Arrhythmia and electrophysiology
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Circ Arrhythm Electrophysiol · Jun 2014
Observational StudyThe epidemic of inadequate biventricular pacing in patients with persistent or permanent atrial fibrillation and its association with mortality.
We classified patients' atrial fibrillation (AF), assessed its impact on biventricular pacing (BIVP%), and determined whether AF classification or BIVP% independently correlate with mortality in cardiac resynchronization therapy defibrillator patients. ⋯ High BIVP% was not achieved in two thirds of 8686 patients with persistent or permanent AF, and these patients had an increased risk of death. A shift toward more aggressive rate control and more pacing may be necessary in patients with AF to maximize the benefits of cardiac resynchronization therapy.
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Circ Arrhythm Electrophysiol · Jun 2014
Determination of the longest intrapatient left ventricular electrical delay may predict acute hemodynamic improvement in patients after cardiac resynchronization therapy.
One of the reasons for patient nonresponse to cardiac resynchronization therapy is a suboptimal left ventricular (LV) pacing site. LV electric delay (Q-LV interval) has been indicated as a prognostic parameter of cardiac resynchronization therapy response. This study evaluates the LV delay for the optimization of the LV pacing site. ⋯ Pacing the LV at the latest activated site is highly predictive of the maximum increase in contractility, expressed as LV dP/dtmax. A positive correlation between Q-LV interval and hemodynamic improvement was found in all patients at every pacing site, a value of 95 ms corresponding to an increase in LV dP/dtmax of ≥10%.
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Circ Arrhythm Electrophysiol · Jun 2014
Pulmonary veins to left atrium cycle length gradient predicts procedural and clinical outcomes of persistent atrial fibrillation ablation.
Rapid pulmonary vein (PV) activity has been shown to maintain paroxysmal atrial fibrillation (AF). We evaluated in persistent AF the cycle length (CL) gradient between PVs and the left atrium (LA) in an attempt to identify the subset of patients where PVs play an important role. ⋯ The PV to LA CL gradient may identify the subset of patients in whom persistent AF is likely to terminate after PV isolation or limited substrate ablation and better long-term outcomes are achieved.
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Circ Arrhythm Electrophysiol · Apr 2014
Multicenter Study Observational StudyArrhythmogenic right ventricular dysplasia/cardiomyopathy and cardiac sarcoidosis: distinguishing features when the diagnosis is unclear.
Cardiac sarcoidosis (CS) may show overlap in the clinical presentation with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). We sought to investigate patients with CS who were misdiagnosed with ARVD/C and identify clinical features to distinguish these 2 groups. ⋯ The 2010 diagnostic criteria for ARVD/C have limited discrimination in distinguishing between ARVD/C and CS. Despite the overlay in clinical presentation, older age of symptom onset, presence of cardiovascular comorbidities, nonfamilial pattern of disease, PR interval prolongation, high-grade atrioventricular block, significant left ventricular dysfunction, myocardial delayed enhancement of the septum, and mediastinal lymphadenopathy should raise the suspicion for CS.