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Objective Outcome data on exercise capacity following atrio-ventricular (AV) optimization of dual-chamber pacing are sparse. Pacemaker settings are often left at manufacturers’ nominal values upon implantation. We studied the short-term effect of AV optimization on exercise capacity in patients with a dual-chamber pacemaker.Methods and results Twenty-eight patients (mean age 73 ± 14 y) with a dual-chamber pacemaker, were randomized towards either nominal AV settings (group 1) or echo-guided AV optimization using the iterative mitral inflow VTI (velocity time integral) method (group 2) at baseline. At 4 weeks, patients were crossed-over to AV optimization in group 1 and returned to nominal AV settings in group 2 for another period of 4 weeks.Oxygen uptake efficiency slope improved significantly after AV optimization (by 126.7 mL/logL ± 190.7 mL/logL; P= 0.003).Conclusions AV optimization in dual-chamber pacing significantly improved functional capacity after 4 weeks. These data provide the background for f...

Acute heart attacks are a major healthcare problem with continuing high mortality and morbidity rates. The major goal in the treatment of acute myocardial infarction (AMI) is the rapid restoration of blood flow and myocardial perfusion in the infarct zone. This can be achieved by either a pharmacological approach (fibrinolysis) or by a mechanical approach (immediate coronary angiography and coronary dilatation of the occluded infarct artery, the so-called primary percutaneous coronary intervention or PCI). A timely application of reperfusion therapy has been shown to influence favourably shortand long-term patient outcome. Data from several large registries have, however, shown that reperfusion therapy is insufficiently implemented in many countries1. A considerable number of patients with ST-segment elevation myocardial infarction (STEMI) do not receive any reperfusion therapy, for a wide variety of reasons, despite its availability and the absence of any contra-indication. In addition, for patients who do have access to reperfusion, preor in-hospital delays can adversely influence the outcome. In this context, a policy conference was organised in Brussels on 30 September 2006 to review the status quo of reperfusion strategies, taking into account existing guidelines and data from registries. In addition, strategies to optimize reperfusion therapy were discussed in regional meetings during 2007. This policy statement presents a summary of the topics discussed at the policy conference and subsequent regional meetings and also refers to the recently published European Society of Cardiology (ESC) guidelines on the management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. This document has been reviewed and approved by the board members of the Belgian Society of Cardiology and its working groups on acute cardiology and interventional cardiology.

Objective The aim of this paper was to assess the determinants of and variations in length of hospital stay (LOS) in Belgium after ST-elevation myocardial infarction (STEMI). Methods and results Data on LOS were collected from 2079 STEMI patients who were discharged alive from 33 Belgian hospitals (21 with PCI facilities) during 2010-2011. Early discharge was defined as hospital discharge within 4 days after admission, and the hospitals were clustered according to their LOS for low-risk patients. Determinants of LOS were calculated by means of a negative binomial regression model. LOS was, on average, 6.5 days with a median of 5 days (IQR 4). Baseline risk profiles and reperfusion treatment explained only 13% of the LOS variation. Additional analysis revealed major in-hospital variations independent of the case mix of patients. For comparable baseline risk profiles, the average LOS in a cluster of 11 hospitals with short discharge policies was 5.3 +/- 5.6 days, with an early discharge rate of 58%, while in the cluster of 11 hospitals with long discharge policies, the average LOS was 7.9 +/- 8.5 days with an early discharge rate of 22% (P < 0.0001). Among the clustered hospitals, there were no differences with regard to logistics (PCI facility, academic affiliation) or volume of STEMI patients. The 1-month mortality rate was less than 0.5% in the different clusters of hospitals (p=NS). Conclusions Length of hospital stay is not only determined by baseline risk profiles of patients but is also highly dependent on hospital discharge policy, which seems to be unrelated to medical or logistical factors.

We report on a 65-year-old patient who underwent a semi-urgent percutaneous coronary intervention (PCI) for a very late stent subthrombosis (13 months) in a paclitaxel-eluting stent (PES) while still on dual antiplatelet therapy.The procedure was complicated by a retrograde embolization into the circumflex artery (CFX). We will focus on the risk of distal embolization after primary PCI for acute stent thrombosis and its prevention.