Current cardiology reports
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This article reviews controversies in cardiac pacing in four areas: methods to prevent unnecessary right ventricular pacing and optimal ventricular pacing sites in the bradycardia population, pacing for prevention of atrial fibrillation (AF), a novel pacing technique for the treatment of heart failure, and pacing for the treatment of sleep apnea. Frequent right ventricular pacing has been reported to increase the incidence of AF and congestive heart failure. However, many patients with pacemakers for bradycardia have intrinsic atrioventricular conduction most of the time. ⋯ Atrial antitachycardia pacing has been shown to reduce the burden of atrial tachyarrhythmias in selected patients. Cardiac contractility modulation has recently been reported to be a promising new approach to the treatment of heart failure. Some pacing techniques may be effective in the treatment of sleep apnea but larger, long-term clinical trials are required to demonstrate a significant clinical benefit.
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Heart failure (HF) complicating acute coronary syndromes (ACS) is a heterogeneous clinical syndrome characterized by varying degrees of pulmonary congestion, and in its severest form, by profound organ hypoperfusion (cardiogenic shock). The occurrence of HF in patients with ACS has long been recognized as a strong predictor of increased morbidity and mortality. As such, there is increased interest in better understanding the epidemiology and management of this common clinical syndrome. This manuscript reviews recent insights from work in this area, including recent important trials evaluating the impact of renin-angiotensin system inhibition, early beta-blockade, and aggressive reperfusion strategies.
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Heart failure (HF) and pulmonary hypertension (PH) coexist frequently and contribute to each other. Because PH often is an insidious disease, the cornerstone of management is the early identification and treatment of its underlying causes, such as left-sided heart disease, left to right shunts, and pulmonary disorders. ⋯ Recent studies using vasodilators such as prostacyclins and endothelin antagonists give new hope in the otherwise poor prognosis of idiopathic pulmonary arterial hypertension and its related conditions. Despite optimum medical management, transplantation (lung/heart-lung) remains the choice in severely symptomatic patients.