Peter Buser

2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA).

2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy : The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA)

2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy

### Abbreviationsnn1st AVn: First-degree atrioventricular blocknAFn: atrial fibrillationnATn: atrial tachyarrhythmianATPn: Anti-tachycardia pacingnAVn: atrioventricularnBBBn: bundle branch blocknCHFn: congestive heart failurenCIn: confidence intervalnCPGn: Committee for Practice GuidelinesnCRTn: cardiac resynchronization therapynCRT-Dn: cardiac resynchronization therapy and defibrillatornCRT-Pn: cardiac resynchronization therapy and pacemakernECGn: electrocardiogramnEDMDn: Emery-Dreifuss muscular dystrophynEFn: ejection fractionnEPSn: electrophysiological studynESCn: European Society of CardiologynHCMn: hypertrophic cardiomyopathynHFn: heart failurenHRn: hazard rationHVn: His-ventricularnICDn: implantable cardioverter defibrillatornILRn: implantable loop recordernIVCDn: intraventricular conduction delaynLBBBn: left bundle branch blocknLQTSn: long QT syndromenLVn: left ventricularnLVEFn: left ventricular ejection fractionnLVSDn: left ventricular systolic dysfunctionnMRn: mitral regurgitationnMRIn: magnetic resonance imagingnNYHAn: New York Heart AssociationnPMn: pacemakernORn: odds rationQALYn: quality-adjusted life yearnRBBBn: right bundle branch blocknRCTn: randomized controlled trialnRVn: right ventricularnSBn: sinus bradycardianSNRTn: sinus node recovery timenSRn: sinus rhythmnSSSn: sick sinus syndromenTAVIn: transcatheter aortic valve implantationnVFn: ventricular fibrillationnVTn: ventricular tachycardianVVn: interventricular (delay)nn### Acronyms of the trials referenced in the recommendations or reported in the tablesnnADEPTn: ADvanced Elements of Pacing Randomized Controlled TrialnADOPTn: Atrial Dynamic Overdrive Pacing TrialnAOPSn: Atrial Overdrive Pacing StudynAPAFn: Ablate and Pace in Atrial FibrillationnASSERTn: ASymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing TrialnATTESTn: ATrial Therapy Efficacy and Safety TrialnAVAIL CLS/CRTn: AV Node Ablation with CLS and CRT Pacing Therapies for Treatment of AF trialnB4n: Bradycardia detection in Bundle Branch BlocknBELIEVEn: Bi vs. Left Ventricular Pacing: an International Pilot Evaluation on Heart Failure Patients with Ventricular ArrhythmiasnBIOPACEn: Biventricular pacing for atrioventricular block to prevent cardiac desynchronizationnBLOCK-HFn: Biventricular versus right ventricular pacing in patients with AV blocknB-LEFTn: Biventricular versus LEFT Univentricular Pacing with ICD Back-up in Heart Failure PatientsnCARE-HFn: CArdiac REsynchronization in Heart FailurenCLEARn: CLinical Evaluation on Advanced ResynchronizationnCOMBATn: COnventional vs. Biventricular Pacing in Heart Failure and BradyarrhythmianCOMPANIONn: COmparison of Medical Therapy, Pacing and Defibrillation in Heart FailurenDANPACEn: DANish Multicenter Randomized Trial on Single Lead Atrial PACing vs. Dual Chamber Pacing in Sick Sinus SyndromenDECREASE-HFn: The Device Evaluation of CONTAK RENEWAL 2 and EASYTRAK 2: Assessment of Safety and Effectiveness in Heart FailurenFREEDOMn: Optimization Study Using the QuickOpt MethodnGREATER-EARTHn: Evaluation of Resynchronization Therapy for Heart Failure in Patients with a QRS Duration GREATER Than 120 msnLESSER-EARTHn: Evaluation of Resynchronization Therapy for Heart Failure in Patients with a QRS Duration Lower Than 120 msnHOBIPACEn: HOmburg BIventricular PACing EvaluationnIN-CHFn: Italian Network on Congestive Heart FailurenISSUEn: International Study on Syncope of Unexplained EtiologynMADITn: Multicenter Automatic Defibrillator TrialnMIRACLEn: Multicenter InSync RAndomized CLinical EvaluationnMOSTn: MOde Selection Trial in Sinus-Node DysfunctionnMUSTICn: MUltisite STimulation In CardiomyopathiesnOPSITEn: Optimal Pacing SITEnPACEn: Pacing to Avoid Cardiac EnlargementnPAVEn: Left Ventricular-Based Cardiac Stimulation Post AV Nodal Ablation EvaluationnPATH-CHFn: PAcing THerapies in Congestive Heart Failure II Study GroupnPIPAFn: Pacing In Prevention of Atrial Fibrillation StudynPIRATn: Prevention of Immediate Reinitiation of Atrial TachyarrhythmiasnPOTn: Prevention Or Termination StudynPREVENT-HFn: PREventing VENTricular Dysfunction in Pacemaker Patients Without Advanced Heart FailurenPROSPECTn: PRedictors Of Response to Cardiac Resynchronization TherapynRAFTn: Resynchronization–Defibrillation for Ambulatory Heart Failure TrialnRethinQn: Cardiac REsynchronization THerapy IN Patients with Heart Failure and Narrow QRSnREVERSEn: REsynchronization reVErses Remodelling in Systolic left vEntricular dysfunctionnSAFARIn: Study of Atrial Fibrillation ReductionnSCD HeFTn: Sudden Cardiac Death in Heart Failure TrialnSMART-AVn: The SMARTDelay Determined AV Optimization: a Comparison with Other AV Delay Methods Used in Cardiac Resynchronization TherapynSYDITn: The SYncope DIagnosis and TreatmentnSYNPACEn: Vasovagal SYNcope and PACingnTARGETn: TARgeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization TherapynTHEOPACEn: Effects of Oral THEOphylline and of Permanent PACEmaker on the Symptoms and Complications of Sick Sinus SyndromenVASIS-PMn: VAsovagal Syncope International Study on PaceMaker therapynV-HeFTn: Vasodilator in HEart Failure TrialnVPSIIn: Second Vasovagal Pacemaker Study (VPS II)nnAdditional references are mentioned with ‘w’ in the main text and can be found on the online addenda along with 5 figures (1, 6, 7, 9, 11, 12) and 10 tables (3, 4, 5, 9, 11, 12, 19, 21, 22, 23). They are available on the ESC website only at http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/cardiac-pacing-and-cardiac-resynchronisation-therapy.aspxnnGuidelines summarize and evaluate all available evidence, at the time of the writing process, on a particular issue, with the …

The future of cardiovascular imaging and non-invasive diagnosis A joint statement from the European Association of Echocardiography, the Working Groups on Cardiovascular Magnetic Resonance, Computers in Cardiology, and Nuclear Cardiology of the European Society of Cardiology, the European Association of Nuclear Medicine and the Association for European Paediatric Cardiology

Advances in medical imaging now make it possible to investigate any patient with cardiovascular disease using multiple methods which vary widely in their technical requirements, benefits, limitations, and costs. The appropriate use of alternative tests requires their integration into joint clinical diagnostic services where experts in all methods collaborate. This statement summarises the principles that should guide developments in cardiovascular diagnostic services.

The future of cardiovascular imaging and non-invasive diagnosis: A joint statement from the European Association of Echocardiography, the Working Groups on Cardiovascular Magnetic Resonance, Computers in Cardiology, and Nuclear Cardiology, of the European Society of Cardiology, the European Association of Nuclear Medicine and the Association for European Paediatric Cardiology

Advances in medical imaging now make it possible to investigate any patient with cardiovascular disease using multiple methods which vary widely in their technical requirements, benefits, limitations, and costs. The appropriate use of alternative tests requires their integration into joint clinical diagnostic services where experts in all methods collaborate. This statement summarizes the principles that should guide developments in cardiovascular diagnostic services.

Effects of Morphologic Restenosis, Defined by MRI After Coarctation Repair, on Blood Pressure and Arm-Leg and Doppler Gradients

Ten years after coarctation repair, 36 adolescents and young adults were studied in order to evaluate the relationship of anatomy at the resection site to blood pressure and arm- leg and Doppler gradients. The patients underwent magnetic resonance imaging (MRI), exercise testing, and continuous wave (CW) Doppler echocardiography. On MRI, residual narrowing at the resection site was measured as 1-(ø anastomosis/ ø descending aorta) and expressed as percent stenosis. Residual stenosis on MRI was negatively correlated with the leg pressure at rest (P=0.0003) and during exercise (P=0.002). Residual stenosis correlated positively with the arm-leg gradient at rest (P<0.0001) and during exercise (P<0.0001) and with the peak CW Doppler gradient across the anastomosis (P<0.0001). However, residual stenosis was not related to the systolic blood pressure of the arm at rest or during exercise. The systolic arm pressures did not differ between patients with residual stenosis of less than 30% (group I), patients with residual stenosis of equal to or greater than 30% but less than 45% (group II), and patients with residual stenosis of equal to or greater than 45% (group III). In conclusion residual anatomic stenosis influences blood pressure in the legs, the arm-leg gradient, and the Doppler gradient across the anastomosis. Arm hypertension late after coarctation repair seems not to be related to residual stenosis, and the benefit of reintervention in these patients remains questionable.

Different effects of sevoflurane, desflurane, and isoflurane on early and late left ventricular diastolic function in young healthy adults

BACKGROUNDnKnowledge on the effects of volatile anaesthetics on left ventricular (LV) diastolic function in humans in vivo is limited. We tested the hypothesis that sevoflurane, desflurane, and isoflurane do not impair LV diastolic function in young healthy humans.nnnMETHODSnSixty otherwise healthy subjects (aged 18-48 yr) undergoing minor procedures under general anaesthesia were studied. After randomization for the anaesthetic, transthoracic echocardiographic examinations were performed at baseline and under anaesthesia with 1 minimum alveolar concentration (MAC) of the volatile anaesthetics during spontaneous breathing and intermittent positive pressure ventilation (IPPV). Peak early (E) and late (A) diastolic velocities of the mitral annulus were studied as the main echocardiographic indicators of diastolic function.nnnRESULTSnDuring anaesthesia with 1 MAC under spontaneous breathing, E increased with desflurane (P<0.001), was not significantly different with isoflurane (P=0.030), and decreased with sevoflurane (P=0.006). During IPPV, E was similar to baseline with desflurane (P=0.550), insignificantly decreased with isoflurane (P=0.029), and decreased with the sevoflurane group (P<0.001). In contrast, A was similarly reduced in all groups during spontaneous breathing without further changes during IPPV. Haemodynamic changes were comparable in all study groups.nnnCONCLUSIONSnThe findings of this in vivo study indicate that desflurane and isoflurane, and most likely sevoflurane, have no relevant direct negative effect on early diastolic relaxation in young healthy humans. In contrast, all three volatile anaesthetics appear to impair late diastolic LV filling during atrial contraction.

Remifentanil does not impair left ventricular systolic and diastolic function in young healthy patients

BACKGROUNDnExperimental studies and investigations in patients with cardiac diseases suggest that opioids at clinical concentrations have no important direct effect on myocardial relaxation and contractility. In vivo data on the effect of remifentanil on myocardial function in humans are scarce. This study aimed to investigate the effects of remifentanil on left ventricular (LV) function in young healthy humans by transthoracic echocardiography (TTE). We hypothesized that remifentanil does not impair systolic, diastolic LV function, or both.nnnMETHODSnTwelve individuals (aged 18-48 yr) without any history or signs of cardiovascular disease and undergoing minor surgical procedures under general anaesthesia were studied. Echocardiographic examinations were performed in the spontaneously breathing subjects before (baseline) and during administration of remifentanil at a target effect-site concentration of 2 ng ml(-1) by target-controlled infusion. Analysis of systolic function focused on fractional area change (FAC). Analysis of diastolic function focused on peak early diastolic velocity of the mitral annulus (e) and on transmitral peak flow velocity (E).nnnRESULTSnRemifentanil infusion at a target concentration of 2 ng ml(-1) did not affect heart rate or arterial pressure. There was no evidence of systolic or diastolic dysfunction during remifentanil infusion, as the echocardiographic measure of systolic function (FAC) was similar to baseline, and measures of diastolic function remained unchanged (e) or improved slightly (E).nnnCONCLUSIONnContinuous infusion of remifentanil in a clinically relevant concentration did not affect systolic and diastolic LV function in young healthy subjects during spontaneous breathing as indicated by TTE.

Intra-operative myocardial ischaemia cannot be detected by analysis of transmitral inflow patterns in patients undergoing off-pump coronary surgery

Background and objective: Transmitral inflow patterns have been used for detection of myocardial ischaemia. However, its diagnostic value has not been tested in anaesthetized and mechanically ventilated patients undergoing coronary artery bypass graft surgery. Methods: Transmitral inflow patterns were studied by transoesophageal Doppler echocardiography in 43 patients undergoing coronary artery bypass graft surgery without cardiopulmonary bypass after opening of the sternum (baseline) and during grafting of the left anterior descending artery. Peak early (E) and peak late (A) transmitral velocities and their ratio (E/A) were recorded. Myocardial ischaemia was defined by standard criteria using two‐dimensional echocardiography and seven‐lead electrocardiogram. Results: Thirty‐one patients (64 ± 8 yr, 9 women) fulfilled the predefined inclusion criteria for analysis. During distal revascularization, 16 patients showed myocardial ischaemia and 15 did not. The use of vasoactive drugs, haemodynamic findings and transmitral inflow patterns were similar in both groups at baseline and during grafting. In the ischaemic group, E was 67.1 ± 13.9 cm s−1 at baseline and 69.5 ± 23.2 cm s−1 during grafting, and the E/A ratios were 1.3 ± 0.3 and 1.4 ± 0.9, respectively. In the non‐ischaemic group, E was 64.0 ± 17.1 cm s−1 at baseline and 60.9 ± 14.8 cm s−1 during grafting, and the E/A ratios were 1.4 ± 0.7 and 1.2 ± 0.3, respectively. Conclusions: Analysis of Doppler findings of transmitral inflow patterns did not allow for detection of myocardial ischaemia during surgical revascularization of the myocardium.

1503 Estimating Sample Size of Eligible Patient for a Heart Failure RCT: Discrepancy Between Literature Data and Actual Recruited Patients in the SWIM-HF Trial

1503 Estimating sample size of eligible patient for a heart failure RCT: discrepancy between literature data and actual recruited patients in the SWIM-HF trial Antoinette Conca, Marcia Leventhal, Arlette Bernasconi, Brigitte Jenni, Lyn Lindpainter, Nicole Zigan, Evelyn Haegi-Rieder, Hans Peter Brunner-La Rocca, Peter Buser, Stefano Muzzarelli, Sabina De Geest Institute of Nursing Science, University of Basel, CH; University Hospital of Basel, CH Corresponding author. Sabina De Geest, RN, PhD, University of Basel, Institute of Nursing Science, Bernoullistr. 28, CH-4056 Basel, Switzerland. E-mail: sabina.degeest@ unibas.ch