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BackgroundThere’s scarce evidence about cardiovascular events (CV) in patients with hospitalization for acute heart failure (HF) and no indication for immediate device implant. ObjectiveThe CARdiac RhYthm monitorING after acute decompensatiON for Heart Failure study was designed to assess the incidence of prespecified clinical and arrhythmic events in this patient population. MethodsIn this pilot study, 18 patients (12 (67%) male; age 72±10; 16 (89%) NYHA II-III), who were hospitalized for HF with low left ventricular ejection fraction (LVEF) (

Abstract: Background: Few data exist on the long-term changes and the prognostic value of heart rate variability (HRV) assessed by implanted devices in heart failure (HF) patients treated with resynchronization therapy (CRT). Aims: To analyze the long-term changes in the standard deviation of 5-minute median atrial–atrial sensed intervals (SDANN), and assess its role in predicting CRT efficacy and major cardiovascular events. Methods and results: We included 509 consecutive patients implanted with CRT devices. At 12-month follow-up, 44 patients had died and 86 patients had at least one HF hospitalisation. A significant increase in SDANN occurred after 4 weeks of CRT (from 69±22 ms to 82±27 ms, p <0.001). A further increase in SDANN was observed 6 months after implantation. Multivariable analysis identified SDANN as the sole predictor of major cardiovascular events (p =0.03) among several baseline parameters. SDANN≤65 ms at the first week and SDANN≤76 ms after 4 weeks of CRT yielded the best prediction of all-cause mortality and urgent heart transplantation on Kaplan–Meier analysis (log-rank test p =0.015 and p =0.011, respectively for week 1 and 4 values). Moreover, relative reduction in LVESV after CRT significantly correlated with SDANN at week 1 (r =−0.596, p =0.012), and week 4 (r =−0.703, p =0.001). Conclusions: Device-monitored HRV is a useful tool to identify, early after implantation, patients with a low likelihood of long-term benefits from CRT and at high risk for cardiovascular events. [Copyright &y& Elsevier]

ELLERY, S.,et al.: A New Endocardial“Over-the-Wire” or Stylet-Driven Left Ventricular Lead: First Clinical Experience. Transvenous left ventricular (LV) leads are primarily inserted“over-the-wire” (OTW). However, a stylet-driven (SD) approach may be a helpful alternative. A new polyurethane-coated, unipolar LV lead can be placed either by a stylet or a guide wire, which can be inserted into the lead body from both ends. The multicenter OVID study evaluates the clinical performance of this new steroid- and nonsteroid eluting lead. The primary endpoint is the LV lead implant success rate after identification of the coronary sinus (CS). Secondary endpoints include complication rate, short- and long-term lead characteristics, overall procedure and LV lead placement duration, total fluoroscopy time, and lead handling characteristics ratings. To date, 96 patients with heart failure (68± 9 years old, 76% men) are enrolled. The CS was identified in 95 patients and, in 85 (88.5%), the LV lead was successfully implanted. The final lead positioning was lateral in 41%, posterolateral in 35%, anterolateral in 18%, and great cardiac vein in 6% of patients. In 70%, the 85 successful implantations, both stylet-driven and guide-wire techniques were used, a stylet only was used in 22%, and a guide wire only in 8%. Mean overall duration of 85 successful procedures was 112± 40 minutes, total fluoroscopy time 28± 15 minutes, and the duration of LV lead placement was 35± 29 minutes. During a 3-month follow-up, the loss of LV capture occurred in three and phrenic nerve stimulation in six patients. The mean long-term pacing threshold is 0.8 V/0.5 ms and pacing impedance is 550Ω. The OVID data suggest that these new leads are safe and effective. The choice of both OTW and SD techniques during lead implantation offers greater procedural flexibility.(PACE 2005; 28:S31–S35) [ABSTRACT FROM AUTHOR]

Purpose: To assess the diagnostic value of early signs of ischaemic cerebral infarction detected by unenhanced CT in the first 6-10 hours., Material and Methods: We reviewed the CT examinations of 42 patients (mean age: 61 years, range: 35-79) with suspected ischaemic stroke. We assessed CT findings at 6-10 hours of the onset of stroke for hemilateral evidence of main cerebral artery hyperdensity, sulcal effacement, liquoral space asymmetry, hypodensity of grey matter. The CT scans were performed without contrast medium., Results: The topographic pattern of cerebral infarctions was: middle cerebral artery territory in 25 patients, anterior cerebral in 9, striatal lacunar infarction in 2, posterior junctional infarction in 5, anterior junctional infarction in 1. Early signs of infarction were present in 24 patients (57%). CT scans showed early signs in 20 cases (80%) of middle cerebral infarctions; 8 (32%) had middle cerebral artery hyperdensity; 3 (12%) had middle cerebral artery hyperdensity and sulcal effacement; 4 (16%) had sulcal effacement; 2 (8%) had liquoral space asymmetry; 3 (12%) had hypodensity of grey matter and liquoral space asymmetry. CT scans showed early signs in 4/9 (44%) of anterior cerebral infarctions. Sensitivity and specificity of early CT to cerebral infarction was 57% and 100%. The three cases with both hyperdense middle cerebral artery and sulcal effacement died of transtentorial herniation within the 10th day. The seven other deaths occurred in patients without early signs or particular patterns appearing in subsequent CT., Discussion: In the management of ischaemic stroke the aim of neuroradiologic methods is to provide exact direction to immediate therapy by early diagnosis. In such cases the use of CT scanning aims at detecting signs of two main alterations of infarction: vascular occlusion and brain oedema. Middle cerebral artery hyperdensity, showing steady correspondence to infarction site and frequent disappearance on the follow-up CT, is indicative of embolic occlusion. Signs of "mass effect" are evident from the early stages in relation to the substantial concomitance of various types of brain oedema. The semeiology discussed in this study is more clearly detectable in middle cerebral artery infarction because this territory is the main site of embolic occlusion, and its larger size increases the "mass effect" due to oedema. The sensitivity obtained in this study is among the lowest values reported, which likely relates to our choice to use short scan times.