John F. Beshai

2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management

2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure : implant and follow-up recommendations and management

Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery.

Background: Pacemakers and implanted cardioverter defibrillator (ICD) infection rates are rising. Renal insufficiency impairs immune function and is known to increase the risk of infection following implantation of orthopedic hardware. The purpose of the current study is to characterize the risk factors for pacemaker and ICD infection and to evaluate the role of renal insufficiency in this complication.

Implantable Cardioverter Defibrillator Therapy in Patients with Cardiac Sarcoidosis

ICD Shocks in Cardiac Sarcoidosis. Background: An implantable cardioverter defibrillator (ICD) is indicated for some patients with cardiac sarcoidosis (CS) for prevention of sudden death. However, there are little data regarding the event rates of ICD therapies in these patients. We sought to identify the incidence and characteristics of ICD therapies in this patient population.

Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure.

OBJECTIVES The goal of this study was to identify better predictors of early death in patients with chronic left ventricular heart failure (CHF). Potential predictors, derived from cardiopulmonary exercise testing, were compared with other commonly used cardiovascular measurements. BACKGROUND The prediction of early death in patients with CHF remains challenging. METHODS Five hundred eight patients with CHF due to systolic dysfunction underwent resting cardiovascular measurements, 6-min walking tests, and cardiopulmonary exercise testing. The peak oxygen uptake (.VO(2)), peak oxygen pulse, anaerobic threshold, ratio of ventilation to carbon dioxide output (.VE/.VCO(2)), slope of .VE versus .VCO(2), and presence or absence of a distinctive oscillatory breathing pattern (OB) were ascertained. Outcomes were 6-month mortality and morbidity, the latter a sum of cardiac hospitalizations and deaths. RESULTS The single best predictor of mortality was an elevated lowest .VE/.VCO(2) (> or =155% predicted). Adding OB on the basis of stepwise regression (optimal 2-predictor model), the odds ratio for mortality increased from 9.4 to 38.9 (p < 0.001). The slope of .VE versus .VCO(2) slope, peak .VO(2), peak oxygen pulse, and anaerobic threshold combined with OB were also strong predictors. OB also increased the odds ratio 2- to 3-fold for each of these (p < 0.01). Kaplan-Meier survival curves and area under the receiver-operating characteristic curve confirmed that lowest .VE/.VCO(2) and OB were superior. For morbidity, elevated lowest .VE/.VCO(2) or lower peak .VO(2) with OB were the best predictors. No nonexercise measurements discriminated mortality and morbidity. CONCLUSIONS Cardiopulmonary exercise testing parameters are powerful prognosticators of early mortality and morbidity in patients with CHF, especially the optimal 2-predictor model of a combination of elevated lowest .VE/.VCO(2) and OB.

Myocardial damage in patients with sarcoidosis and preserved left ventricular systolic function: an observational study

Late gadolinium enhanced cardiovascular magnetic resonance (LGE‐CMR) is a valuable test to detect myocardial damage in patients with sarcoidosis; however, the clinical significance of LGE in sarcoidosis patients with preserved left ventricular ejection fraction (LVEF) is not defined. We aim to characterize the prevalence of LGE, its associated cardiac findings, and its clinical implications in sarcoidosis patients with preserved LVEF.

Individual patient data network meta-analysis of mortality effects of implantable cardiac devices

Objective Implantable cardioverter defibrillators (ICD), cardiac resynchronisation therapy pacemakers (CRT-P) and the combination therapy (CRT-D) have been shown to reduce all-cause mortality compared with medical therapy alone in patients with heart failure and reduced EF. Our aim was to synthesise data from major randomised controlled trials to estimate the comparative mortality effects of these devices and how these vary according to patients’ characteristics. Methods Data from 13 randomised trials (12 638 patients) were provided by medical technology companies. Individual patient data were synthesised using network meta-analysis. Results Unadjusted analyses found CRT-D to be the most effective treatment (reduction in rate of death vs medical therapy: 42% (95% credible interval: 32–50%), followed by ICD (29% (20–37%)) and CRT-P (28% (15–40%)). CRT-D reduced mortality compared with CRT-P (19% (1–33%)) and ICD (18% (7–28%)). QRS duration, left bundle branch block (LBBB) morphology, age and gender were included as predictors of benefit in the final adjusted model. In this model, CRT-D reduced mortality in all subgroups (range: 53% (34–66%) to 28% (−1% to 49%)). Patients with QRS duration ≥150 ms, LBBB morphology and female gender benefited more from CRT-P and CRT-D. Men and those <60 years benefited more from ICD. Conclusions These data provide estimates for the mortality benefits of device therapy conditional upon multiple patient characteristics. They can be used to estimate an individual patients expected relative benefit and thus inform shared decision making. Clinical guidelines should discuss age and gender as predictors of device benefits.

HRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection: Developed in partnership between the Heart Rhythm Society (HRS) and the American College of Cardiology Foundation (ACCF) and in collaboration with the Society of Thoracic Surgeons

Anne M. Gillis, MD, FHRS, Andrea M. Russo, MD, FHRS, FACC, Kenneth A. Ellenbogen, MD, FHRS, FACC, Charles D. Swerdlow, MD, FHRS, CCDS, FACC, Brian Olshansky, MD, FHRS, CCDS, FACC, Sana M. Al-Khatib, MD, MHS, FHRS, CCDS, FACC, John F. Beshai, MD, FHRS, FACC, Janet M. McComb, MD, FHRS, Jens Cosedis Nielsen, MD, Jonathan M. Philpott, MD, Win-Kuang Shen, MD, FHRS, FACC From University of Calgary, Libin Cardiovascular Institute of Alberta, Alberta, Canada, Cooper Medical School of Rowan University, Cooper University Hospital, New Jersey, USA, Virginia Commonwealth University Medical Center, irginia, USA, David Geffen School of Medicine at UCLA, California, USA, University of Iowa Hospital, Iowa, USA, Duke University Medical Center, North Carolina, USA, University of Chicago Hospitals, Illinois, USA, Freeman ospital, Newcastle-upon-Tyne, United Kingdom, Skejby Hospital, Aarhus, Denmark, Mid-Atlantic Cardiothoracic Surgeons, Virginia, USA, Mayo Clinic College of Medicine, Arizona, USA. Representing the Society of Thoracic Surgeons

Prognosis of Myocardial Damage in Sarcoidosis Patients With Preserved Left Ventricular Ejection Fraction: Risk Stratification Using Cardiovascular Magnetic Resonance.

Background—Cardiac sarcoidosis is associated with an increased risk of heart failure and sudden death, but its risk in patients with preserved left ventricular ejection fraction is unknown. Using cardiovascular magnetic resonance in patients with extracardiac sarcoidosis and preserved left ventricular ejection fraction, we sought to (1) determine the prevalence of cardiac sarcoidosis or associated myocardial damage, defined by the presence of late gadolinium enhancement (LGE), (2) quantify their risk of death/ventricular tachycardia (VT), and (3) identify imaging-based covariates that predict who is at greatest risk of death/VT. Methods and Results—Parameters of left and right ventricular function and LGE burden were measured in 205 patients with left ventricular ejection fraction >50% and extracardiac sarcoidosis who underwent cardiovascular magnetic resonance for LGE evaluation. The association between covariates and death/VT in the entire group and within the LGE+ group was determined using Cox proportional hazard models and time-dependent receiver–operator curves analysis. Forty-one of 205 patients (20%) had LGE; 12 of 205 (6%) died or had VT during follow-up; of these, 10 (83%) were in the LGE+ group. In the LGE+ group (1) the rate of death/VT per year was >20× higher than LGE− (4.9 versus 0.2%, P<0.01); (2) death/VT were associated with a greater burden of LGE (14±11 versus 5±5%, P<0.01) and right ventricular dysfunction (right ventricular EF 45±12 versus 53±28%, P=0.04). LGE burden was the best predictor of death/VT (area under the receiver-operating characteristics curve, 0.80); for every 1% increase of LGE burden, the hazard of death/VT increased by 8%. Conclusions—Sarcoidosis patients with LGE are at significant risk for death/VT, even with preserved left ventricular ejection fraction. Increased LGE burden and right ventricular dysfunction can identify LGE+ patients at highest risk of death/VT.

News from the Heart Rhythm SocietyHRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection: Developed in partnership between the Heart Rhythm Society (HRS) and the American College of Cardiology Foundation (ACCF) and in collaboration with the Society of Thoracic Surgeons

Anne M. Gillis, MD, FHRS, Andrea M. Russo, MD, FHRS, FACC, Kenneth A. Ellenbogen, MD, FHRS, FACC, Charles D. Swerdlow, MD, FHRS, CCDS, FACC, Brian Olshansky, MD, FHRS, CCDS, FACC, Sana M. Al-Khatib, MD, MHS, FHRS, CCDS, FACC, John F. Beshai, MD, FHRS, FACC, Janet M. McComb, MD, FHRS, Jens Cosedis Nielsen, MD, Jonathan M. Philpott, MD, Win-Kuang Shen, MD, FHRS, FACC From University of Calgary, Libin Cardiovascular Institute of Alberta, Alberta, Canada, Cooper Medical School of Rowan University, Cooper University Hospital, New Jersey, USA, Virginia Commonwealth University Medical Center, irginia, USA, David Geffen School of Medicine at UCLA, California, USA, University of Iowa Hospital, Iowa, USA, Duke University Medical Center, North Carolina, USA, University of Chicago Hospitals, Illinois, USA, Freeman ospital, Newcastle-upon-Tyne, United Kingdom, Skejby Hospital, Aarhus, Denmark, Mid-Atlantic Cardiothoracic Surgeons, Virginia, USA, Mayo Clinic College of Medicine, Arizona, USA. Representing the Society of Thoracic Surgeons

HRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection

The most recent American College of Cardiology Foundation/American Heart Association/Heart Rhythm Society (ACCF/AHA/HRS) guidelines related to pacemaker implantation were published as part of a larger document related to device-based therapy ([1][1]). While this document provides some comments on