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Implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death may be underused in patients with heart failure and reduced ejection fraction (HFrEF). Aim was to investigate predictors of ICD non-use in a contemporary HFrEF cohort. Patients from the Swedish Heart Failure

When, in October 1958, the Swedish patient Arne Larsson was expected to die in a desperate scenario of progressive atrioventricular (AV) conduction block with accelerating Stokes-Adams attacks and resuscitation attempts, a team of courageous scientists ventured to implant a pacemaker device to

When Willem Einthoven gave his Nobel Lecture in 1925, he presented the case of a 79-year-old patient. The laureate had been puzzled by a capillary electrometer tracing taken back in 1894, showing a shape that was “markedly diverging from curves up till then recorded.” Investigating the same

Objectives This study examined the characteristics of continuously measured right ventricular (RV) hemodynamic information derived from an implantable hemodynamic monitor (IHM) in heart failure patients. Background Hemodynamic monitoring might improve the day-to-day management of patients with chronic heart failure (CHF). Little is known about the characteristics of long-term hemodynamic information in patients with CHF or how such information relates to meaningful clinical events. Methods Thirty-two patients with CHF received a permanent RV IHM system similar to a single-lead pacemaker. Right ventricular systolic and diastolic pressures, heart rate, and pressure derivatives were continuously measured for nine months without using the data for clinical decision-making or management of patients. Data were then made available to clinical providers, and the patients were followed up for 17 months. Pressure characteristics during optimal volume, clinically determined volume-overload exacerbations, and volume depletion events were examined. The effect of IHM on hospitalizations was examined using the patients’ historical controls. Results Long-term RV pressure measurements had either marked variability or minimal time-related changes. During 36 volume-overload events, RV systolic pressures increased by 25 ± 4% (p Conclusions Long-term ambulatory pressure measurements from an IHM may be helpful in guiding day-to-day clinical management, with a potentially favorable impact on CHF hospitalizations.

Objectives The main objective of this study was to assess if the benefits of biventricular (BiV) pacing observed during the crossover phase were sustained over 12 months. Background MUltisite STimulation In Cardiomyopathies (MUSTIC) is a randomized controlled study intended to evaluate the effects of BiV pacing in patients with New York Heart Association (NYHA) class III heart failure and intraventricular conduction delay. Methods Of 131 patients included, 42/67 in sinus rhythm (SR) and 33/64 in atrial fibrillation (AF) were followed up longitudinally at 9 and 12 months by 6-min walked distance, peak oxygen uptake (peak VO2), quality of life by the Minnesota score, NYHA class, echocardiography, and left ventricular ejection fraction by radionuclide technique. Results At 12 months, all SR and 88% of AF patients were programmed to BiV pacing. Compared with baseline, the 6-min walked distance increased by 20% (SR) (p = 0.0001) and 17% (AF) (p = 0.004); the peak VO2by 11% (SR) and 9% (AF); quality of life improved by 36% (SR) (p = 0.0001) and 32% (AF) (p = 0.002); NYHA class improved by 25% (SR) (p = 0.0001) and 27% (AF) (p = 0.0001). The ejection fraction improved by 5% (SR) and 4% (AF). Mitral regurgitation decreased by 45% (SR) and 50% (AF). Conclusions The clinical benefits of BiV pacing appeared to be significantly maintained over a 12-month follow-up period.

We aimed at testing the hypothesis that spinal cord stimulation (SCS) reduces cardiac sympathetic nerve activity in patients with heart failure (HF). Patients with HF (NYHA -class III, EF ≤35%, QRS < 120 ms) were randomly assigned to SCS ON for 6 weeks followed by a 6-week OFF period, or vice

This study examined the characteristics of continuously measured right ventricular (RV) hemodynamic information derived from an implantable hemodynamic monitor (IHM) in heart failure patients.Hemodynamic monitoring might improve the day-to-day management of patients with chronic heart failure (CHF). Little is known about the characteristics of long-term hemodynamic information in patients with CHF or how such information relates to meaningful clinical events.Thirty-two patients with CHF received a permanent RV IHM system similar to a single-lead pacemaker. Right ventricular systolic and diastolic pressures, heart rate, and pressure derivatives were continuously measured for nine months without using the data for clinical decision-making or management of patients. Data were then made available to clinical providers, and the patients were followed up for 17 months. Pressure characteristics during optimal volume, clinically determined volume-overload exacerbations, and volume depletion events were examined. The effect of IHM on hospitalizations was examined using the patients' historical controls.Long-term RV pressure measurements had either marked variability or minimal time-related changes. During 36 volume-overload events, RV systolic pressures increased by 25 +/- 4% (p0.05) and heart rate increased by 11 +/- 2% (p0.05). Pressure increases occurred in 9 of 12 events 4 +/- 2 days before the exacerbations requiring hospitalization. Hospitalizations before using IHM data for clinical management averaged 1.08 per patient year and decreased to 0.47 per patient-year (57% reduction, p0.01) after hemodynamic data were used.Long-term ambulatory pressure measurements from an IHM may be helpful in guiding day-to-day clinical management, with a potentially favorable impact on CHF hospitalizations.

Contrary to the trivializing label “frequent flyer,” which conjures analogies to rewards from airline bonus programs, recurrent hospital stays for heart failure (HF) constitute a truly malignant condition that has a detrimental impact on patient prognosis and health care consumption. Patients