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  • 1
    Electronic Resource
    Electronic Resource
    Validation of ECG Indices of Ventricular Repolarization Heterogeneity: A Computer Simulation Study (2005)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 16 (2005), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: Repolarization heterogeneity (RH) is functionally linked to dispersion in refractoriness and to arrhythmogenicity. In the current study, we validate several proposed electrocardiogram (ECG) indices for RH: T-wave amplitude, -area, -complexity, and -symmetry ratio, QT dispersion, and the Tapex-end interval (the latter being an index of transmural dispersion of the repolarization (TDR)). Methods and Results: We used ECGSIM, a mathematical simulation model of ECG genesis in a human thorax, and varied global RH by increasing the standard deviation (SD) of the repolarization instants from 20 (default) to 70 msec in steps of 10 msec. T-wave amplitude, -area, -symmetry, and Tapex-end depended linearly on SD. T-wave amplitude increased from 275 ± 173 to 881 ± 456 μV, T-wave area from 34 × 103± 21 × 103 to 141 × 103± 58 × 103μV msec, T-wave symmetry decreased from 1.55 ± 0.11 to 1.06 ± 0.23, and Tapex-end increased from 84 ± 17 to 171 ± 52 msec. T-wave complexity increased initially but saturated at SD = 50 msec. QT dispersion increased modestly until SD = 40 msec and more rapidly for higher values of SD. TDR increased linearly with SD. Tapex-end increased linearly with TDR, but overestimated it. Conclusion: T-wave complexity did not discriminate between differences in larger RH values. QT dispersion had low sensitivity in the transitional zone between normal and abnormal RH. In conclusion, T-wave amplitude, -area, -symmetry, and, with some limitations, Tapex-end and T-wave complexity reliably reflect changes in RH.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2005.40758.x
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  • 2
    Electronic Resource
    Electronic Resource
    Long-Term Follow-Up of Cardiac Resynchronization Therapy in Patients with End-Stage Heart Failure (2005)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 16 (2005), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: Cardiac resynchronization therapy (CRT) has been introduced to treat patients with end-stage heart failure, and results of this technique are promising. The aim of our study was to assess the sustained benefit of CRT in a large patient cohort with end-stage heart failure at long-term follow-up. In addition, the prognosis of responders and nonresponders was evaluated. Methods and Results: 125 patients with end-stage heart failure, NYHA class III or IV, LVEF 〈35%, QRS duration 〉120 msec and left bundle branch block morphology received a biventricular device. At baseline and 6 months after implantation the following parameters were evaluated: NYHA class, Minnesota Quality of life score, QRS duration on surface ECG, 6-minute walking distance and LVEF. Follow-up was obtained up to 3 years. After 6 months, patients were divided in clinical responders and nonresponders according to improvement in NYHA class. All clinical parameters improved significantly at 6-month follow-up. Hospitalization for heart failure was 3.8 ± 4.9 days/year before and 0.7 ± 1.6 days/year after CRT. Survival at 1-, 2-, and 3-year follow-up was 93%, 88%, and 85%, respectively. Responders (78%) showed a significantly better survival than nonresponders at 2- and 3-year follow-up (96% and 93% for responders versus 81% and 73% for nonresponders, P 〈 0.05). Conclusion: The improvement in functional status and symptoms after CRT is maintained at long-term follow-up (up to 3 years). The clinical improvement was associated with a significant reduction in hospitalization rate which was also maintained over the years. Preimplantation selection of responders may result in even better long-term survival.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2005.40685.x
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  • 3
    Electronic Resource
    Electronic Resource
    Determinants of Recurrent Ventricular Arrhythmia or Death in 300 Consecutive Patients with Ischemic Heart Disease Who Experienced Aborted Sudden Death: Data from the Leiden Out-of-Hospital Cardiac Arrest Study (2005)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 16 (2005), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective: Evaluation of the relation between clinical characteristics and incidence of recurrent ventricular arrhythmias (VAs) or death during long-term follow-up in a cohort of 300 consecutive ischemic heart disease (IHD) patients who had survived an episode of sudden cardiac arrest (SCA). Background: Survivors of life-threatening VA are at high risk for recurrent events. Methods: A total of 300 consecutive survivors of SCA with IHD were included in a standardized screening and evaluation protocol. Multivariable Cox regression analysis was performed to determine the relation between clinical variables at baseline and the incidence of recurrent VA, all-cause mortality and the composite of both (composite endpoint). Results: The presenting arrhythmia was VT in 156 (52%) patients and VF in 144 (48%) patients. Revascularization was performed in 78 (26%) patients and an ICD was implanted in 216 (72%) patients. During follow-up (mean 30 ± 21 months) 37 (12%) patients died and 88 (29%) patients experienced a recurrence. Advanced age (adjusted hazard ratio (HR) 2.0; 1.2–3.3), history of heart failure (HR 1.8; 1.2–2.6), and amiodarone use (HR 3.1; 2.1–4.6) were independent predictors for the composite endpoint. VT as presenting arrhythmia was an independent predictor for all-cause mortality only (HR 2.4; 1.2–4.8). A decreased risk of recurrences was determined by beta-blocker use (HR 0.5; 0.4–0.8) and coronary revascularization (HR 0.3; 0.2–0.6). Conclusion: In a cohort of 300 consecutive survivors of SCA the incidence of recurrent VA and death is dependant on patient age, history of heart failure, and use of amiodarone. In contrast, use of beta-blockers and aggressive coronary revascularization improve the outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2005.50006.x
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  • 4
    Electronic Resource
    Electronic Resource
    Relationship Between QRS Duration and Left Ventricular Dyssynchrony in Patients with End-Stage Heart Failure (2004)
    350 Main Street , Malden , MA 02148 , USA , and 9600 Garsington Road , Oxford OX4 2XG , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 15 (2004), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: Patients with end-stage heart failure and a wide QRS complex are considered candidates for cardiac resynchronization therapy (CRT). However, 20% to 30% of patients do not respond to CRT. Lack of left ventricular dyssynchrony may explain the nonresponse. Accordingly, we evaluated the presence of left ventricular dyssynchrony using tissue Doppler imaging (TDI) in 90 consecutive patients with heart failure. Methods and Results: Ninety patients with severe heart failure (left ventricular ejection fraction 〈35%, New York Heart Association class III–IV) were prospectively evaluated. Based on QRS duration, 30 consecutive patients with a narrow QRS complex were included (QRS duration ≤120 ms), 30 patients with an intermediate QRS duration (120–150 ms), and 30 patients with a wide QRS complex (〉150 ms). All patients underwent TDI to assess left ventricular dyssynchrony. Extensive left ventricular dyssynchrony was defined as an electromechanical delay on TDI between the septum and lateral wall, the so-called septal-to-lateral delay, of 〉60 ms. Severe dyssynchrony was observed in 27% of patients with narrow QRS complex, 60% with intermediate QRS duration, and 70% with wide QRS complex. No relation existed between QRS duration and septal-to-lateral delay. Conclusion: From 30% to 40% of heart failure patients with QRS duration 〉120 ms do not exhibit left ventricular dyssynchrony, which may explain the nonresponse to CRT. Alternatively, 27% of patients with heart failure and a narrow QRS complex show significant left ventricular dyssynchrony and may be candidates for CRT. (J Cardiovasc Electrophysiol, Vol. 15, pp. 544-549, May 2004)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2004.03604.x
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  • 5
    Electronic Resource
    Electronic Resource
    Long-Term Follow-Up After Radiofrequency Catheter Ablation of Ventricular Tachycardia: A Successful Approach? (2002)
    Oxford, UK : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 13 (2002), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: RF Catheter Ablation of VT. Introduction: Radiofrequency ablation (RFCA) of ventricular tachycardia (VT) is a potential curative treatment modality. We evaluated the results of RFCA in patients with VT. Methods and Results: One hundred fifty-one consecutive patients (122 men and 29 women; age 57 ± 16 years) with drug-refractory VT were treated. Underlying heart disease was ischemic heart disease in 89 (59%), arrhythmogenic right ventricular cardiomyopathy (ARVC) in 32 (21%), and idiopathic VT in 30 (20%; left ventricle in 9 [30%]; right ventricle in 21 [70%]). Ablation was performed using standard ablation techniques. Three hundred six different VTs were treated (cycle length 334 ± 87 msec, 2.0 ± 1.4 VTs per patient). Procedural success (noninducibility of VT after RFCA) was achieved in 126 (83%) patients (70 ischemic heart disease [79%]; 28 ARVC [88%]; 27 idiopathic VT [93%]). Procedure-related complications (〈 48 hours) occurred in 11 (7%) patients: death 3 (2.0%), cerebrovascular accident 2 (1.3%), complete heart block 4 (2.6%), and pericardial effusion 3 (2.0%). Thirty-three (22%) patients received an implantable cardioverter defibrillator (because of hemodynamic unstable VT, failure of the procedure, or aborted sudden death). During follow-up (34 ± 11 months), VT recurrences occurred in 38 (26%) patients (recurrence rate: 19% in successfully ablated patients and 64% in nonsuccessfully ablated patients; P 〈 0.001). During follow-up, 12 (8%) patients died (heart failure 8, unknown cause 1, noncardiac cause 3). Conclusion: RFCA of VT can be performed with a high degree of success (83%). The long-term outcome of successfully ablated patients is promising, with a 75% relative risk reduction compared with nonsuccessfully ablated patients. During follow-up, only one patient died suddenly, supporting a selective ICD placement approach in patients with hemodynamically stable VT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2002.00417.x
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  • 6
    Electronic Resource
    Electronic Resource
    Magnetic resonance of the heart and great vessels (1995)
    [s.l.] : Nature Publishing Group
    Nature medicine 1 (1995), S. 711-713 
    Details
    ISSN: 1546-170X
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Medicine
    Notes: [Auszug] Magnetic resonance imaging (MRI) is a non-invasive imaging modality, which provides detailed anatomical and func tional images of the cardiovascular system in any desired imaging plane without the limitations inherent to more traditional techniques like echocardiography and X-ray ventricu-lography. ...
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1038/nm0795-711
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  • 7
    Electronic Resource
    Electronic Resource
    No Gender Differences in Pacemaker Selection in Patients Undergoing Their First Implantation (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Recent studies have indicated that women were less likely to receive sophisticated pacemaker devices than men. These differences could not be fully explained by demographic and clinical variables. The purpose of the present study was to assess whether a gender related difference might exist in pacemaker mode selection in patients undergoing their first implantation in The Netherlands. Records of first implants (n = 39,217) collected from 1988 through 1997 covering 95% of all implantations in The Netherlands. From this population 33,564 (85.6%) patients were included for final analysis. We observed no significant sex differences in pacemaker selection in patients with atrioventricular conduction disorders and bundle branch block. In patients with sick sinus syndrome, only very old women (≤ 85 years) had more atrial systems implanted than men of similar age (6.5% vs 3.5%), whereas men received more double chamber pacemakers (12.3% vs 10.3%) (P = 0.002). However, the relative distribution of physiological versus nonphysiological pacemakers in this subgroup was similar for men and women. In patients with chronic atrial fibrillation/flutter associated with bradycardia, sex differences were only apparent in the age group of 75–85 years; women received more dual chamber pacemakers (8,8% vs 5.3%) whereas men received more single chamber ventricular pacemakers (94.2% vs 89.8%) (P = 0.0011). With increasing age, sex differences in pacemaker selection were absent, but there was a considerable drop in implantation rate of dual chamber systems. Our study showed no major sex differences in the selection of pacemaker devices. Physicians select pacemaker devices by age rather than gender, which might be a rational choice.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2000.tb00936.x
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  • 8
    Electronic Resource
    Electronic Resource
    QRS Duration and Shortening to Predict Clinical Response to Cardiac Resynchronization Therapy in Patients with End-Stage Heart Failure (2004)
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 27 (2004), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Despite current selection criteria (NYHA Class III–IV, LVEF 〈 35%, QRS 〉 120 ms with LBBB), 30% of patients do not benefit from cardiac resynchronization therapy (CRT). The use of QRS duration as selection criteria for CRT has not been evaluated systematically yet. Accordingly, the value of QRS duration at baseline (and reduction in QRS duration after CRT) to predict responders was studied. Patients were evaluated at baseline and after 6 months of CRT for NYHA Class, quality of life score, and 6-minute walk test. QRS duration was evaluated before, directly after implantation, and after 6 months of CRT. Sixty-one patients were included; 45 (74%) patients were classified as responders (improvement of NYHA Class, 6-minute walking distance and quality of life score) and 16 (26%) as nonresponders. QRS duration at baseline was similar between the two groups: 179 ± 30 ms versus 171 ± 32 ms, NS. Directly after implantation, QRS duration was reduced from 179 ± 30 ms to 150 ± 26 ms (P 〈 0.01) in responders; nonresponders did not exhibit this reduction (171 ± 32 ms vs 160 ± 26 ms, NS). After 6 months of CRT, QRS shortening was only observed in responders (from 179 ± 30 ms to 159 ± 25 ms, P 〈 0.01). ROC curve analysis showed that a reduction in QRS duration 〉 10 ms had a high sensitivity (73%) with low specificity (44%); conversely, a 〉 50 ms reduction in QRS duration was highly specific (88%) but not sensitive (18%) to predict response to CRT. No optimal cutoff value could be defined. QRS duration at baseline is not predictive for response to CRT; responders exhibit a significant reduction in QRS duration after CRT, but individual response varies highly, not allowing adequate selection of responders. (PACE 2004; 27:308–313)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2004.00433.x
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  • 9
    Electronic Resource
    Electronic Resource
    Does a Gender Difference in Response to Cardiac Resynchronization Therapy Exist? (2005)
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Pacing and clinical electrophysiology 28 (2005), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Cardiac resynchronization therapy (CRT) has a beneficial effect on clinical symptoms, exercise capacity, and systolic left ventricular (LV) performance in patients with heart failure. The aim of the current study was to evaluate whether a gender difference exists in response to CRT. Methods: Consecutive patients with end-stage heart failure (New York Heart Association, NYHA, class III–IV), LV ejection fraction (LVEF) ≤35%, QRS duration 〉120 ms, and left bundle branch block configuration underwent CRT. At baseline and 6 months post-CRT, clinical and echocardiographic parameters were evaluated; follow-up was obtained up to 5 years. The effects of CRT were compared between women and men. Results: The study population comprised 137 men and 36 women (mean age 66 ± 11 years). No differences in baseline characteristics were observed except that nonischemic cardiomyopathy was more frequent in women than men (67% vs 38%, P 〈 0.05). In all patients, clinical and echocardiographic parameters improved significantly at 6-month follow-up. The magnitude of improvement in different parameters was similar between women and men, e.g., the improvement in NYHA Class was 0.9 ± 0.6 in women and 1.0 ± 0.7 in men (NS) and the increase in LVEF was 8 ± 8% in women as compared to 7 ± 9% in men (NS). The percentage of individual responders was not different between women and men (76% vs 80%, NS) and 2-year survival was comparable for women and men (84% vs 80%, NS). Conclusion: No gender differences were observed in response to CRT and long-term survival after CRT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2005.00267.x
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  • 10
    Electronic Resource
    Electronic Resource
    Cyclic Appropriate Mode Switching and Inappropriate Back Switching of a Biventricular Pacemaker During Atrial Tachyarrhythmia (2004)
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 27 (2004), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In patients with resynchronization devices and intact intrinsic AV conduction, atrial tachyarrhythmias may give rise to high ventricular rates, resulting in inhibition of (bi)ventricular pacing and concomitant lack of therapeutic effects of the device. This report presents a patient with atrial arrhythmias in whom mode switching and back switching of the biventricular pacemaker occurred, due to special timing of the atrial and ventricular deflections. This case report stresses the importance of strenuous treatment of atrial arrhythmias in patients with resynchronization devices. (PACE 2004; 27:249–251)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2004.00420.x
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