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BackgroundRenal insufficiency is recognized as a predictor of mortality and adverse outcome in heart failure (HF) patients. However, the long-term clinical outcome of cardiac resynchronization therapy (CRT) in Japanese HF patients with renal insufficiency remains uncertain.MethodsWe evaluated 67 consecutive patients who underwent CRT at our hospital. The patients were divided into two groups according to a baseline estimated glomerular filtration rate (e-GFR) cut-off value of 50ml/min, which is defined as the time at which patients should be referred to a nephrologist, by the Japanese Society of Nephrology. Follow-up echocardiographic findings and renal function were examined at 3–6 months after CRT. Then, we compared long-term clinical outcomes between the two groups, and analyzed the effect of CRT on renal function, echocardiographic parameters and cardiac survival.ResultsDuring a mean follow-up period of 30.3 months, patients with advanced renal insufficiency (e-GFR

A 60-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) was implanted dual-chamber ICD for the purpose of both the left ventricular outflow tract (LVOT) gradient reduction by ventricular pacing and the primary prevention of ventricular tachyarrhythmia. Because the LVOT gradient reduction and improvement of symptoms by pacing were insufficient, however, a new pacing lead was inserted in the right ventricular apex at a different position 1.5 cm away from the site of the defibrillation lead, and the LVOT gradient greatly declined from 108 to 30 mmHg. This DDD pacing was continued over seven years. On this occasion, he was referred to our hospital because of battery depletion, and a cardiac catheterization study was performed after ICD replacement. The LVOT gradient was 10 mmHg in sinus rhythm. After administration of isoproterenol (0.02γ), the gradient was increased to 92 mmHg in sinus rhythm. DDD pacing using a newly placed ventricular pacing lead significantly decreased the gradient to 36 mmHg. This case study indicated that DDD pacing from a suitable location in the right ventricular apex caused a marked early reduction in the LVOT gradient, and at long-term follow up a further significant effect was obtained, also in sinus rhythm.

Background: As the indications for catheter ablation of complex arrhythmias has expanded, the radiation exposure to the operator has increased. Recently, a radiation protection cabin (RPC) has been developed. However, the effect of reducing the radiation exposure of the operator has not been fully evaluated. The aim of this study was to evaluate the efficacy the RPC during catheter ablation (CA). Method & Results: Twenty-six patients who underwent CA were included in this study. The patients were divided into two groups, those in which the RPC was used (RPC group; n = 11) and those in which it was not used (no RPC group; n = 15). The radiation dosage was measured with thermoluminescent dosimeters placed on the head and chest. The decrement rates at the unprotected area of not only the operator but also the assistant in the RPC group were significantly higher than those in the no RPC group. There was no significant difference in the decrement rate in the protected areas between the two groups. Conclusion: This study shows that the RPC protects from radiation exposure not only the operator but also the assistant and frees us from using a heavy apron.

Introduction: The high incidence of sleep disorderd breathing (SDB) in patients with congestive heart failure (CHF) is well known. We compared adaptive pressure support servo-ventilation therapy (ASV) with nocturnal oxygen therapy (N-HOT) in patient with SDB from the cardiac resynchronization therapy (CRT) candidates. Methods: Thirty patients (22 men; 69.6±8.5 years old; mean left ventricular ejection fraction 32.6±9.9%) with SDB (apnea-hypopnea index (AHI)>15) who were scheduled for CRT therapy were studied. All patients received polysomnographic evaluations before CRT therapy. After implantation of a biventricular pacemaker, patients received ASV or N-HOT therapy (non-randomised). Cardiac events (cardiac death, and hospitalization due to congestive heart failure) were analysed retrospectively. Results: Mean follow up period was 790±561 day. Mean AHI of all patients was 26.4±10.8. Kaplan-Meier survival analysis showed that there was a significant difference between ASV and N-HOT in cardiac death, and hospitalisation due to congestive heart failure event (P=0.0283). There were no significant differences between ASV and N-HOT in patients’ baseline characteristics. Conclusions: ASV is superior to N-HOT for the SDB in patients who are CRT candidates.