Hon-Wah Chan

New‐Onset Heart Failure After Permanent Right Ventricular Apical Pacing in Patients with Acquired High‐Grade Atrioventricular Block and Normal Left Ventricular Function

Introduction: Emerging data have suggested that right ventricular (RV) apical pacing results in progressive left ventricular (LV) dysfunction and contributes to the development of heart failure (HF). This study aimed to investigate the prevalence and clinical predictors for the development of new‐onset HF after long‐term RV apical pacing in patients with acquired atrioventricular (AV) block who require permanent pacing.

Advances in devices for cardiac resynchronization in heart failure.

Patients with advanced heart failure have a high mortality and morbidity despite medical therapy. Depending on the underlying heart disease and severity of heart failure, 3.7 to 52.8% of patients have a QRS complex ≥120 ms who may have interventricular and intraventricular dyssynchrony correctible by cardiac resynchronization therapy (CRT). The latter is usually achieved with biventiricular pacing, with the left ventricular lead placed in a tributary of the coronary sinus (CS), with a reported success rate between 88–92%. The technical advances for implantation include preformed guide sheaths to canulate the CS, over the wire leads with passive fixation mechanism, and surgical placement methods.Device-specific CRT features include optimizing heart failure through ensurance of a high percentage of pacing, heart failure monitoring, atrioventricular and interventricular timing, and avoiding double ventricular sensing. Furthermore, arrhythmic co-morbidities of heart failure such as atrial fibrillation and ventricular tachyarrhythmias can also be managed. Recent prospective trials suggest that there is a 30% reduction in heart failure hospitalization with CRT, and preliminary results suggest a survival benefit with CRT and implantable cardioverter defibrillator over optimal medical therapy.

Cardiac resynchronization therapy optimization by ultrasonic cardiac output monitoring (USCOM) device

Objectives: We investigated the accuracy and feasibility of a 2D echo‐independent ultrasonic continuous wave Doppler cardiac output monitoring device (USCOM) operated by trained nurse for the atrio‐ventricular interval (AVI) optimization in cardiac resynchronization therapy (CRT).

Long-term clinical outcomes after deployment of femoral vascular closure devices in coronary angiography and percutaneous coronary intervention: an observational single-centre registry follow-up

Objectives There are few data evaluating the long-term effect of femoral vascular closure devices (FCDs) on patients’ clinical outcome. We aim to evaluate the incidence of peripheral vascular disease (PVD) in patients who received FCD following its deployment in coronary angiography and percutaneous coronary intervention (PCI) procedures. Design and setting Observational study of a single-centre registry. Participants From June 2000 to September 2004, 265 patients who received FCD after coronary angiography and PCIs were enrolled on the study. Outcome measures Clinical follow-up (using Rutherfords categories of claudication), ankle brachial index (ABI) and duplex ultrasound of femoral arteries (using the non-accessed side as control) were performed to evaluate the presence of PVD. Results The mean follow-up interval was 3320±628 days. 1 patient (0.4%) suffered from grade 2 claudication and another (0.4%) suffered from grade 1 claudication. The mean ABIs of the accessed side and non-accessed side were 1.06±0.13 and 1.08±0.11, respectively (p=0.17). For duplex ultrasound, the mean common femoral artery peak systolic velocities of the accessed side and non-accessed side were 87.4±22.3 and 87.7±22.1 cm/s, respectively (p=0.73); the mean superficial femoral artery peak systolic velocities of the accessed side and non-accessed side were 81.4±20.1 and 81.31±17.8 cm/s, respectively (p=0.19). Conclusions The use of FCD after a coronary angiogram and PCI is safe and does not increase the long-term risk of PVD.

Dual coronary fistulas complicated with significant left to right heart shunt in an elderly patient

Dual coronary artery fistula is a rare clinical entity and their clinical significance remains unknown. We hereby report a case of right coronary artery and left anterior descending artery fistula to pulmonary artery complicated with clinical significant left to right shunt (1.6:1) who remained clinically well at the age of 85 without percutaneous or surgical closure.