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Long-Term Survival in Patients Treated with Cardiac Resynchronization Therapy: A 3-Year Follow-Up Study from the InSync/InSync ICD Italian Registry

Background: Studies reporting the long‐term survival of patients treated with cardiac resynchronization therapy (CRT) outside the realm of randomized controlled trials are still lacking. The aim of this study was to quantify the survival of patients treated with CRT in clinical practice and to investigate the long‐term effects of CRT on clinical status and echocardiographic parameters.

Proportion of patients needing an implantable cardioverter defibrillator on the basis of current guidelines: impact on healthcare resources in Italy and the USA. Data from the ALPHA study registry

AIMS Implantable cardioverter defibrillators (ICD) improve survival in selected patients with left ventricular dysfunction or heart failure (HF). The objective is to estimate the number of ICD candidates and to assess the potential impact on public health expenditure in Italy and the USA. METHODS AND RESULTS Data from 3513 consecutive patients (ALPHA study registry) were screened. A model based on international guidelines inclusion criteria and epidemiological data was used to estimate the number of eligible patients. A comparison with current ICD implant rate was done to estimate the necessary incremental rate to treat eligible patients within 5 years. Up to 54% of HF patients are estimated to be eligible for ICD implantation. An implantation policy based on guidelines would significantly increase the ICD number to 2671 implants per million inhabitants in Italy and to 4261 in the USA. An annual increment of prophylactic ICD implants of 20% in the USA and 68% in Italy would be necessary to treat all indicated patients in a 5-year timeframe. CONCLUSION Implantable cardioverter defibrillator implantation policy based on current evidence may have significant impact on public health expenditure. Effective risk stratification may be useful in order to maximize benefit of ICD therapy and its cost-effectiveness in primary prevention.

Validation of Seattle Heart Failure Model for mortality risk prediction in patients treated with cardiac resynchronization therapy

Survival prediction by the Seattle Heart Failure Model (SHFM) of patients treated with cardiac resynchronization therapy (CRT) remains ill defined. The performance of the SHFM in this clinical setting was therefore evaluated.

Iterative atrial tachycardia originating from the coronary sinus musculature.

Coronary Sinus Atrial Tachycardia. A case of iterative atrial tachycardia leading to dilated cardiomyopathy is reported. During electrophysiologic study, the tachycardia showed a markedly irregular cycle length associated with changes in atrial activation breakthrough as demonstrated by coronary sinus (CS) recordings and frequently degenerated into self‐terminating atrial fibrillation. Left atrial transseptal mapping demonstrated the earliest endocardial atrial activation close to the posterolateral mitral annulus, but this was invariably later than that recorded within the CS, where low‐energy radiofrequency applications eliminated the tachycardia. No acute vessel damage was observed at postablation CS angiography. In accordance with previously published experimental data, we hypothesized that the muscular sleeves surrounding the CS might be involved in the genesis of this tachycardia. During 6‐month follow‐up, the patient remained asymptomatic without tachycardia recurrences and with complete recovery of left ventricular function, confirming the reversible nature of the tachycardia‐induced cardiomyopathy.

Predictors of mortality and hospitalization for cardiac causes in patients with heart failure and nonischemic heart disease: a subanalysis of the ALPHA study.

Background: Several studies have searched for predictors of clinical outcome in patients with heart failure (HF). However, since they were collected in clinical trials, most data were subject to selection biases and do not specifically apply to patients with nonischemic heart disease. This study examined the impact of several variables on combined all‐cause mortality and hospitalization for cardiac causes, in consecutive ambulatory patients with HF included in the ALPHA registry.

Successful Selective Ablation of Fast Atrioventricular Node Pathway by Cryothermal Energy Application

This paper reports the experience of successful cryoablation of fast atrioventricular nodal pathway in a patient with recurrent atrioventricular nodal reentrant tachycardia after previous unsuccessful attempts of slow pathway ablation. Slow formation of a permanent lesion by cryothermal energy application allowed precise modulation of atrioventricular nodal conduction until the endpoints of complete fast pathway ablation were met with long‐term cure of the arrhythmia.

Comparison of single premature versus continuous overdrive stimulation for identification of a protected isthmus in macro-reentrant atrial tachycardia circuits

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Unusual Resetting Patterns in Response to Single Atrial Extrastimuli During AV Junctional Reentrant Tachycardia

Unusual Resetting Patterns in AV Junctional Reentry. Introduction: Two unusual resetting patterns were observed in two patients with slow‐fast AV junctional reentrant tachycardia (AVJRT) submitted to an electrophysiologic study.

Remote monitoring in cardiology: Clinical overview

Telemedicine can change the modern medicine. Studies, reviews and meta-analysis analysed remote monitoring in patients with cardiovascular diseases. The results of these researches are promising but not yet conclusive. Some aspects should be addressed, particularly the suitable technology for each patient and the patient risk stratification, to understand how remote monitoring could impact on routine clinical management in cardiology. The paper would focus on these nodal aspects of remote monitoring in cardiology.

Complex Supraventricular Tachycardia Ablation: What Is the Role of Alternative Technology?

Radiofrequency catheter ablation is a safe and effective treatment for curing supraventricular tachycardias (SVT), including those related to different forms of atrioventricular (AV) nodal reentry and to the Wolff-Parkinson-White syndrome. Although this treatment is largely considered as a first-line therapy for these tachycardias, under some circumstances the safety and/or the effectiveness of the procedure might be endangered. This review will focus on the difficulties that can be met during SVT catheter ablations, and on the role of special tools and new technologies in improving the success rate and reducing the complications.