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4. P756Use of anti-arrhythmic drug therapy in patients treated with Cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation: data from a multicenter observational project

Author

Landolina, M, primary, Arena, G, additional, Iacopino, S, additional, Verlato, R, additional, Pieragnoli, P, additional, Tondo, C, additional, Curnis, A, additional, Lunati, M, additional, Rahue, W, additional, Senatore, G, additional, Sciarra, L, additional, and Padeletti, L, additional

Published
2018
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8. Impact of mitral regurgitation on the outcome of patients treated with CRT-D: Data from the InSync ICD Italian registry

Author

Giuseppe, Boriani, M. D., H. D., P, Maurizio, Gasparini, † MAURIZIO LANDOLINA, ‡ MAURIZIO LUNATI, MAURO BIFFI, Massimo, Santini, LUIGI PADELETTI, Giulio, Molon, †† GIANLUCA BOTTO, ‡‡ TIZIANA DE SANTO, B. S., and SERGIO VALSECCHI, Gasparini, M., Galimberti, P., Regoli, F., Ceriotti, C., Istituto Clinico Humanitas, Rozzano-, Milano, Lunati, M., Cattafi, G., Magenta, G., Paolucci, M., Vecchi, R., Niguarda, Hospital, Milano, Santini, M., Ricci, R., San Filippo Neri, Roma, Gaita, F., Bocchiardo, M., Didonna, P., Caponi, D., Civile, Hospital, Asti, Tavazzi, L., Landolina, M., Rordorf, R., Petracci, B., Vicentini, A., Savastano, S., Matteo, Pol. S., Pavia, Padeletti, L., Pieragnoli, P., Careggi, Firenze, Vincenti, A., Deceglia, S., Cir ` o, A., Gerardo Dei Tintori, S., Monza(MI), Curnis, A., Mascioli, G., Spedali, Civili, Brescia, Puglisi, A., Bianchi, S., Peraldo, C., Fatebenefratelli, Roma, Sassara, M., Achilli, A., Turreni, F., Rossi, P., Belcolle, Hospital, Viterbo, Perego, Gb., Luca Auxologico, S., Ravazzi, P. A., Diotallevi, P., Antonio e Biagio, Ss., Alessandria, Tritto, M., Mater, Domini, Castellanza, (VA), Carboni, A., Ardissino, D., Gonzi, G., Serra, V., Civile, Parma, Vergara, G., Maria Del Carmine, S., Rovereto, (TN), Boriani, G., Biffi, M., Martignani, C., Diemberger, I., Orsola-Mailpighi, S., Bologna, Luzzi, G., Policlinico, Bari, Laurenzi, F., Camillo, S., Pistis, G., Mauriziano, Torino, Cesario, A., Grassi, G. B., Ostia, (RM), Zanotto, G., Civile, Verona, Orazi, S., Rieti, Ometto, R., Bonanno, C., Bortolo, S., Vicenza, Molon, G., Barbieri, E., Cuore, S., Negrar, (VR), Raviele, A., Gasparini, G., Umbertoi, Mestre, (VE), Botto, G., Luzi, M., Sagone, A., Anna, S., Como, Vado, A., Croce, S., Cuneo, Montenero, A., Multimedica, Giovanni (MI), Sestos., Inama, G., Maggiore, Crema, Sassone, B., Civile, Bentivoglio, (BO), Briedda, M., Zardo, F., Maria, S., Pordenone, E. Bertaglia, Mirano (VE), Proclemer, A., Udine, Zanon, F., Civile, Rovigo, Disertori, M., Gramegna, L., Delgreco, M., Dallafior, D., Chiara, S., Trento, Tomasi, C., Maresta, A., Piancastelli, M., Maria Croci, S., Ravenna, Bridda, A., Martino, S., Belluno, Mantovan, R., C`afoncello, Treviso, Fusco, A., Pederzoli, Peschiera, (VR), Baraldi, P., Agostino, S., Modena, G. Lonardi, Legnago (VR), Rahue, W., Maurizio, S., Bolzano, P. Delise, Conegliano (TV), Menozzi, C., Marianuova, S., Reggioemilia, Babudri, P., Borgoroma, Verona, Marconi, R., Mazzoni, Ascolipiceno, Alfano, G. DeFabrizio F., Moscati, G., Avellino, Barbato, G., Maggiore, Bologna, P. Gelmini, Desenzano (BS), Disabato, Leopoldo, S., Merate, (LC), Ricci, S., Ramazzini, Carpi, (MO), Aulerio, M. D., Biagio, S., Domodossola, (VB), Morgagni, G. L., Latini, R., Macerata, Bardelli, G., Fornaroli, Magenta, (MI), R. Paulichl, F. Tappeiner Merano (BZ), Bernasconi, M., Marzegalli, M., Carlo, S., Neri, G., Montebelluna, Treviso, E. Occhetta, Novara, Bocconcelli, P., Salvatore, S., Pesaro, A. Capucci, Piacenza, Campana, A., Giovanni, S., Salerno, N. Dibelardino, Velletri (RM), Vaglio, A., Giovanni, e Paolo, Venezi, A., Boriani G, Gasparini M, Landolina M, Lunati M, Biffi M, Santini M, Padeletti L, Molon G, Botto G, de Santo T, Valsecchi S, and InSync/InSync ICD Italian Registry Investigators.

Subjects
Male, Mitral Valve Insufficiency, Socio-culturale, heart failure, Comorbidity, CARDIAC RESYNCHRONIZATION THERAPY, mitral regurgitation, Risk Assessment, Survival Analysis, Survival Rate, Treatment Outcome, Italy, Risk Factors, Prevalence, Humans, Female, Registries, Aged
Abstract

We assessed the influence of clinically significant mitral regurgitation (MR) on clinical-echocardiographic response and outcome in heart failure (HF) patients treated with a biventricular defibrillator (cardiac resynchronization therapy defibrillator [CRT-D]). METHODS AND RESULTS: A total of 659 HF patients underwent successful implantation of CRT-D and were enrolled in a multicenter prospective registry (median follow-up of 15 months). Following baseline echocardiographic evaluation, patients were stratified into two groups according to the severity of MR: 232 patients with more than mild MR (Group MR+: grade 2, 3, and 4 MR) versus 427 patients with mild (grade 1) or no functional MR (Group MR-). On 6- and 12-month echocardiographic evaluation, MR was seen to have improved in the vast majority of MR+ patients, while it remained unchanged in most MR- patients. On 12-month follow-up evaluation, a comparable response to CRT was observed in the two groups, in terms of the extent of left ventricular reverse remodeling and combined clinical and echocardiographic response. During long-term follow-up, event-free survival did not differ between MR+ and MR- patients, even when subpopulations of patients with ischemic heart disease and with dilated cardiomyopathy were analyzed separately. On multivariate analysis, the only independent predictor of death from any cause was the lack of β-blocker use. CONCLUSIONS: This observational analysis supports the use of CRT-D in HF patients with clinically significant MR; MR had no major influence on patient outcome.

Published
2012

9. Effectiveness of cardiac resynchronization therapy in heart failure patients with valvular heart disease: comparison with patients affected by ischaemic heart disease or dilated cardiomyopathy. The InSync/InSync ICD Italian Registry

Author

Boriani, G, Gasparini, M, Landolina, M, Lunati, M, Biffi, M, Santini, M, Padeletti, L, Molon, G, Botto, G, De Santo, T, Valsecchi, S, Galimberti, P, Regoli, F, Ceriotti, C, Cattafi, G, Magenta, G, Paolucci, M, Vecchi, R, Ricci, R, Gaita, F, Bocchiardo, M, Didonna, P, Caponi, D, Tavazzi, L, Rordorf, R, Petracci, B, Vicentini, A, Savastano, S, Matteo, Ps, Pieragnoli, P, Vincenti, A, Deceglia, S, Ciró, A, Gerardo Dei Tintori, S, Curnis, A, Mascioli, G, Puglisi, A, Bianchi, S, Peraldo, C, Sassara, M, Achilli, A, Turreni, F, Rossi, P, Perego, Gb, Ravazzi, Pa, Diotallevi, P, Antonio, e Biagio SS, Tritto, M, Carboni, A, Ardissino, D, Gonzi, G, Serra, V, Vergara, G, Maria Del Carmine, S, Martignani, C, Frabetti, L, Orsola-Mailpighi, S, Luzzi, G, Laurenzi, F, Camillo, S, Pistis, G, Cesario, A, Grassi, Gb, Zanotto, G, Orazi, S, Ometto, R, Bonanno, C, Bortolo, S, Barbieri, E, Cuore, S, Raviele, A, Gasparini, G, Luzi, M, Sagone, A, Anna, S, Vado, A, Croce, S, Montenero, A, Giovanni, Ss, Inama, G, Sassone, B, Briedda, M, Zardo, F, Maria, S, Bertaglia, E, Proclemer, A, Zanon, F, Disertori, M, Gramegna, L, Delgreco, M, Dallafior, D, Chiara, S, Tomasi, C, Maresta, A, Piancastelli, M, Maria Croci, S, Bridda, A, Martino, S, Mantovan, R, Fusco, A, Baraldi, P, Agostino, S, Lonardi, G, Rahue, W, Maurizio, S, Delise, P, Menozzi, C, Marianuova, S, Babudri, P, Marconi, R, Defabrizio, G, Alfano, F, Moscati, G, Barbato, G, Gelmini, P, Disabato, Leopoldo, S, Ricci, S, Aulerio, Md, Biagio, S, Morgagni, Gl, Latini, R, Bardelli, G, Paulichl, R, Tappeiner Merano, F, Bernasconi, M, Marzegalli, M, Carlo, S, Neri, G, Occhetta, E, Bocconcelli, P, Salvatore, S, Capucci, A, Campana, A, Giovanni, S, Dibelardino, N, Vaglio, A, Boriani G, Gasparini M, Landolina M, Lunati M, Biffi M, Santini M, Padeletti L, Molon G, Botto G, De Santo T, and Valsecchi S

Subjects
Cardiomyopathy, Dilated, Male, medicine.medical_specialty, Pacemaker, Artificial, medicine.medical_treatment, Cardiac resynchronization therapy, Cardiomyopathy, Heart Valve Diseases, Myocardial Ischemia, Socio-culturale, Heart failure, Aged, Atrial Fibrillation, Defibrillators, Implantable, Female, Heart Failure, Humans, Middle Aged, Registries, Treatment Outcome, Ventricular Remodeling, Cardiac Pacing, Artificial, Clinical Research, Internal medicine, medicine, cardiovascular diseases, Remodelling, Valvular heart disease, Heart transplantation, Ejection fraction, business.industry, valvular heart disease, Atrial fibrillation, Dilated cardiomyopathy, medicine.disease, Cardiology, cardiovascular system, Cardiology and Cardiovascular Medicine, business
Abstract

Aims To analyse the effectiveness of cardiac resynchronization therapy (CRT) in patients with valvular heart disease (a subset not specifically investigated in randomized controlled trials) in comparison with ischaemic heart disease or dilated cardiomyopathy patients. Methods and results Patients enrolled in a national registry were evaluated during a median follow-up of 16 months after CRT implant. Patients with valvular heart disease treated with CRT ( n = 108) in comparison with ischaemic heart disease ( n = 737) and dilated cardiomyopathy ( n = 635) patients presented: (i) a higher prevalence of chronic atrial fibrillation, with atrioventricular node ablation performed in around half of the cases; (ii) a similar clinical and echocardiographic profile at baseline; (iii) a similar improvement of LVEF and a similar reduction in ventricular volumes at 6–12 months; (iv) a favourable clinical response at 12 months with an improvement of the clinical composite score similar to that occurring in patients with dilated cardiomyopathy and more pronounced than that observed in patients with ischaemic heart disease; (v) a long-term outcome, in term of freedom from death or heart transplantation, similar to patients affected by ischaemic heart disease and basically more severe than that of patients affected by dilated cardiomyopathy. Conclusion In ‘real world’ clinical practice, CRT appears to be effective also in patients with valvular heart disease. However, in this group of patients the outcome after CRT does not precisely overlap any of the two other groups of patients, for which much more data are currently available.

Published
2009

10. Heart rate variability monitored by the implanted device predicts response to CRT and long-term clinical outcome in patients with advanced heart failure

Author

Landolina, M, Gasparini, M, Lunati, M, Santini, M, Rodorf, R, Vincenti, A, Montenero AS, Diotallevi P., Bonanno, C, Desanto, T, Valsecchi, S, Padeletti, L, Galimberti, P, Regoli, F, Gronda, E, Cattafi, G, Magenta, G, Paolucci, M, Vecchi, R, Niguarda, Ricci, R, Gaita, F, Bocchiardo, M, Didonna, P, Caponi, D, Tavazzi, L, Rordorf, R, Petracci, B, Vicentini, A, Savastano, S, Pieragnoli, P, Deceglia, S, Cirò, A, Curnis, A, Mascioli, G, Puglisi, A, Bianchi, S, Peraldo, C, Sassara, M, Achilli, A, Turreni, F, Rossi, P, B Perego, G, A Ravazzi, P, Diotallevi, P, Carboni, A, Ardissino, D, Gonzi, G, Serra, V, Boriani, G, Biffi, M, Martignani, C, Frabetti, L, Luzzi, G, Laurenzi, F, Pistis, G, Cesario, A, Zanotto, G, Orazi, S, Ometto, R, Molon, G, Barbieri, E, Raviele, A, Gasparini, G, Botto, G, Luzi, M, Sagone, A, Vado, A, Montenero, A, Inama, G, Sassone, B, Briedda, M, Zardo, F, Bertaglia, E, Proclemer, A, Zanon, F, Disertori, M, Gramegna, L, Delgreco, M, Dallafior, D, Tomasi, C, Maresta, A, Piancastelli, M, Bridda, A, Mantovan, R, Fusco, A, Baraldi, P, Lonardi, G, Rahue, W, Delise, P, Menozzi, C, Babudri, P, Marconi, R, G De Fabrizio, Alfano, F, Barbato, G, Gelmini, P, Disabato, Ricci, S, D Aulerio, M, L Morgagni, G, Latini, R, Bardelli, G, Paulichl, R, Bernasconi, M, Marzegalli, M, Neri, G, Occhetta, E, Bocconcelli, P, Capucci, A, Campana, A, Dibelardino, N, Vaglio, A, Landolina M, Gasparini M, Lunati M, Santini M, Rordorf R, Vincenti A, Diotallevi P, Montenero AS, Bonanno C, De Santo T, Valsecchi S, Padeletti L, and InSync/InSync ICD Italian Registry Investigators [.., Boriani G,..]

Subjects
Male, medicine.medical_specialty, Time Factors, Cardiac pacing, medicine.medical_treatment, Socio-culturale, Heart Rate, Internal medicine, Heart rate variability, Medicine, Humans, In patient, Implanted device, Aged, Monitoring, Physiologic, Retrospective Studies, Heart transplantation, Heart Failure, Ventricular Remodeling, business.industry, Follow up studies, Cardiac Pacing, Artificial, Retrospective cohort study, Equipment Design, medicine.disease, Prognosis, Survival Rate, Heart failure, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
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

Published
2008

11. Follow-up of CRT-ICD: implications for the use of remote follow-up systems. Data from the InSync ICD italian Registry

Author

Lunati, M, Gasparini, M, Santini, M, Landolina, M, Perego, Gb, Pappone, C, Galimberti, P, Regoli, F, Gronda, E, Cattafi, G, Magenta, G, Paolucci, M, Vecchi, R, Ricci, R, Gaita, F, Bocchiardo, M, Didonna, P, Caponi, D, Tavazzi, L, Rordorf, R, Petracci, B, Vicentini, A, Deceglia, S, Cirò, A, Curnis, A, Mascioli, G, Puglisi, A, Bianchi, S, Sassara, M, Achilli, A, Turreni, F, Rossi, P, B Perego, G, A Ravazzi, P, Diotallevi, P, Tritto, M, Carboni, A, Ardissino, D, Gonzi, G, Serra, V, Vergara, G, Boriani, G, Biffi, M, Martignani, C, Frabetti, L, Orsola, S, Luzzi, G, Laurenzi, F, Pistis, G, Cesario, A, Zanotto, G, Orazi, S, Ometto, R, Bonanno, G, Molon, G, Barbieri, E, Raviele, A, Gasparini, G, Botto, G, Luzi, M, Sagone, A, Vado, A, Montenero, A, Inama, G, Sassone, B, Briedda, M, Zardo, F, Bertaglia, E, Proclemer, A, Zanon, F, Disertori, M, Gramegna, L, Delgreco, M, Dallafior, D, Tomasi, C, Maresta, A, Piancastelli, M, Bridda, A, Mantovan, R, Fusco, A, Baraldi, P, Lonardi, G, Rahue, W, Delise, P, Menozzi, C, Babudri, P, Marconi, R, De Fabrizio, F Alfano, Moscati, G, Barbato, G, Gelmini, P, Disabato, Ricci, S, D Aulerio, M, L Morgagni, G, Latini, R, Bardelli, G, Paulichl, R, Bernasconi, M, Marzegalli, M, Vicedomini, G, Augello, G, Paglino, G, Neri, G, Occhetta, E, Bocconcelli, P, Capucci, A, Campana, A, Dibelardino, N, and Vaglio, A

Subjects
Socio-culturale
Published
2008

13. Clinical and arrhythmic outcomes of patients with post- myocardial infarction cardiomyopathy treated with implantable defibrillators for primary prevention of sudden death: the Search-MI Registry. Abstract XIII World Congress on Cardiac Pacing and Electrophysiology

Author

Boriani, Giuseppe, Santini, M., Russo, M., Botto, M. LUNATI G., Proclemer, A., Erdogan, A., Shmidt, B., Rahue, W., Desaga, M., Santi, E., Messier, M., Biffi, M., G.Boriani, M.Santini, M.Russo, M. Lunati G. Botto, A. Proclemer, A. Erdogan, B. Shmidt, W. Rahue, M. Desaga, E.Santi, M.Messier, and M.Biffi.

Published
2007

16. Primary prevention of sudden cardiac death: can we afford the cost of cardioverter-defibrillators? Data from the Search-MI Registry-Italian Sub-study.

Author

Boriani G, Biffi M, Russo M, Lunati M, Botto G, Proclemer A, Vergara G, Rahue W, Martignani C, Ricci R, and Santini M

Abstract

Background: Large randomized trials show that in appropriately selected patients with left ventricular dysfunction, implantable cardioverter-defibrillators (ICDs) can improve overall survival at 2-5 years. Since direct implementation of the criteria used in the MADIT II and SCD-HeFT will lead to a marked rise in ICD implants, there is a growing fear that increased use of ICDs may cause a dramatic burden to health care systems. The ICD has traditionally been seen as an expensive form of treatment, which is difficult to accept at the first look. This is mainly due to the nonlinear character of the ICD investment, characterized by high initial expenditure, followed by a deferred pay-off in terms of clinical benefits. Cost-effectiveness analysis may help provide a different perspective on the problem of ICD cost, as may estimation of the daily cost of ICD treatment, assuming a time horizon of 5-7 years-a particularly interesting subject for further registry studies. Methods and Results: Based on real expenditure data from 2002 to 2005, as recorded in the Search-MI Registry-Italian Sub-study of patients implanted on MADIT II indications, we estimated the daily costs associated with the device and leads. Over a 5-7 year time horizon, the average daily cost was estimated to be 4.60-6.70. Translation of these figures into U.S. market conditions suggests a daily cost of around $7.90-$11.40. Conclusions: These findings appear useful to help evaluate the affordability of ICD in comparison with other therapeutic options in a context of limited available economic resources. [ABSTRACT FROM AUTHOR]

Published
2006
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17. 20. ICD: Primary Prevention, Utilization & Costs.

Author

Bertaglia, E., Santini, M., Boriani, G., Proclemer, A., Lunati, M., Rahue, W., Vergara, G., Botto, G., Rizzo, V., and Santi, E.

Abstract

In July 2002 the European Registry Search-MI (SMI) was started with the purpose to follow patients in clinical practice, treated with ICD on the base of MADIT II (MII) indication.Methods In 48 Italian centers 444 patients (pts) with MII indication were enrolled after implant of an ICD (VVIR 53%, DDDR 26%, CRT 21%). Results The baseline characteristics compared with MII population are reported in the table. In comparison to MII pts, SMI pts were less often in NYHA class I; were more affected by AF and LBBB; and higher intake of Amiodarone and lower intake of Statins was documented. The average follow-up was 11 months and 38/303(12.5%) pts had appropriate device intervention, 23 pts (7.6%) treated with at least 1 shock and 24 pts (7.9%) with ATP. One year total mortality regarded 16 pts (5.7%): 10 cardiac (6 not sudden, 4 sudden but 2 not arrhythmic), 4 not cardiac, 2 not classified. Conclusion despite several baseline clinical differences, mortality rate in clinical practice seems to be comparable to the ICD arm of MII study, also in terms of classification. [ABSTRACT FROM PUBLISHER]

Published
2005

18. Primary prevention of sudden cardiac death: can we afford the cost of cardioverter-defibrillators? Data from the Search-MI Registry-Italian sub-study

Author

Giuseppe Boriani, Maurizio Lunati, Cristian Martignani, Mauro Biffi, Massimo Santini, Giuseppe Vergara, Gianluca Botto, Renato Pietro Ricci, Maurizio Russo, W. Rahue, Alessandro Proclemer, Boriani G, Biffi M, Russo M, Lunati M, Botto G, Proclemer A, Vergara G, Rahue W, Martignani C, Ricci R, and Santini M

Subjects
Male, medicine.medical_specialty, Cost effectiveness, Cost-Benefit Analysis, Electric Countershock, Context (language use), Time horizon, law.invention, Sudden cardiac death, Randomized controlled trial, law, Health care, medicine, Humans, Registries, Intensive care medicine, Aged, Estimation, Death, Sudden, Cardiac, Female, Health Care Costs, Italy, Primary Prevention, Cost–benefit analysis, business.industry, General Medicine, medicine.disease, Medical emergency, Cardiology and Cardiovascular Medicine, business
Abstract

Background: Large randomized trials show that in appropriately selected patients with left ventricular dysfunction, implantable cardioverter-defibrillators (ICDs) can improve overall survival at 2–5 years. Since direct implementation of the criteria used in the MADIT II and SCD-HeFT will lead to a marked rise in ICD implants, there is a growing fear that increased use of ICDs may cause a dramatic burden to health care systems. The ICD has traditionally been seen as an expensive form of treatment, which is difficult to accept at the first look. This is mainly due to the nonlinear character of the ICD investment, characterized by high initial expenditure, followed by a deferred pay-off in terms of clinical benefits. Cost-effectiveness analysis may help provide a different perspective on the problem of ICD cost, as may estimation of the daily cost of ICD treatment, assuming a time horizon of 5–7 years—a particularly interesting subject for further registry studies. Methods and Results: Based on real expenditure data from 2002 to 2005, as recorded in the Search-MI Registry-Italian Sub-study of patients implanted on MADIT II indications, we estimated the daily costs associated with the device and leads. Over a 5–7 year time horizon, the average daily cost was estimated to be €4.60–€6.70. Translation of these figures into U.S. market conditions suggests a daily cost of around $7.90–$11.40. Conclusions: These findings appear useful to help evaluate the affordability of ICD in comparison with other therapeutic options in a context of limited available economic resources.

Published
2006

19. INCIDENCE AND CLINICAL RELEVANCE OF UNCONTROLLED VENTRICULAR RATE DURING ATRIAL FIBRILLATION IN HEART FAILURE PATIENTS TREATED WITH CARDIAC RESYNCHRONIZATION THERAPY

Author

Gabriele Lonardi, Alessandro Proclemer, Saverio Iacopino, Giuseppe Boriani, Andrea Grammatico, Mauro Biffi, W. Rahue, Maurizio Lunati, Paola DiStefano, Maurizio Landolina, Maurizio Gasparini, Massimo Santini, Boriani G, Gasparini M, Landolina M, Lunati M, Proclemer A, Lonardi G, Iacopino S, Rahue W, Biffi M, DiStefano P, Grammatico A, and Santini M

Subjects
Male, medicine.medical_specialty, ATRIAL FIBRILLATION, CARDIAC RESYNCHRONIZATION THERAPY, CLINICAL OUTCOMES, medicine.medical_treatment, Heart Ventricles, Cardiac resynchronization therapy, Comorbidity, Cardiac Resynchronization Therapy, QRS complex, Internal medicine, Atrial Fibrillation, medicine, Humans, cardiovascular diseases, Aged, Heart Failure, Ejection fraction, business.industry, Incidence, Hazard ratio, Cardiac Pacing, Artificial, Atrial fibrillation, Arrhythmias, Cardiac, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Heart failure, Cardiology, cardiovascular system, Female, Cardiology and Cardiovascular Medicine, business, circulatory and respiratory physiology
Abstract

Aims Uncontrolled ventricular rate (VR) during atrial fibrillation (AF) may cause clinical deterioration in heart failure (HF) patients who need continuous biventricular pacing to achieve cardiac resynchronization therapy (CRT). We aimed at evaluating the association between AF, uncontrolled VR, and sub-optimal CRT, defined as low biventricular pacing percentage (BIVP%). Methods and results All 1404 patients had HF, New York Heart Association (NYHA) ≥II, left ventricular ejection fraction (LVEF) ≤35%, and QRS ≥120 ms, and received an implantable CRT defibrillator (CRT-D). Occurrence of AF, VR during AF and lifetime BIVP% were estimated from device data. Ventricular rate during AF was defined as uncontrolled in patients with mean VR>80 bpm and maximum VR>110 bpm. Over a median follow-up of 18 months, AF was detected in 443 of 1404 patients (32%). In this sub-group of AF patients, VR during AF was uncontrolled in 150 of 443 patients (34%). Multivariate Cox regression analysis showed that age [hazard ratio (HR) = 1.03, 95% confidence interval (CI) = 1.00–1.06, P= 0.028], and uncontrolled VR [HR = 1.69 (CI = 1.01–2.83), P= 0.046] were the only independent predictors of clinical outcome, assessed by HF hospitalizations and death. The median lifetime BIVP% was 95% (25–75 percentile range 91–99%). Biventricular pacing percentage was significantly and inversely correlated to VR, decreasing by 7% for each 10 bpm increase in VR. Sub-optimal CRT, defined as BIVP%

20. Pulmonary fluid overload monitoring in heart failure patients with single and dual chamber defibrillators.

Author

Molon G, Zanotto G, Rahue W, Facchin D, Leoni L, Morani G, Calvi V, Catanzariti D, Costa A, Zago L, Comisso J, Varbaro A, and Santini M

Subjects
Aged, Cardiography, Impedance methods, Disease Progression, Emergency Service, Hospital statistics & numerical data, Female, Follow-Up Studies, Heart Failure therapy, Hospitalization statistics & numerical data, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Monitoring, Physiologic methods, Prospective Studies, Pulmonary Edema etiology, Defibrillators, Implantable, Heart Failure complications, Pulmonary Edema diagnosis
Abstract

Aims: Heart failure has a relevant healthcare impact. Monitoring of pulmonary fluid overload (PFO), measured by intrathoracic impedance, has been proposed to alert to heart failure worsening before symptoms become patent. The aim of our research was to evaluate whether PFO diagnostics reduce heart failure hospitalizations in heart failure patients receiving single-chamber or dual-chamber implantable cardioverter-defibrillator (ICD) for primary prevention of sudden death., Methods: Twenty-five Italian cardiological centers prospectively followed 221 ICD patients (86% men, 66 ± 11 years, 79% New York Heart Association II and left ventricular ejection fraction 28 ± 5%), of whom 123 received an ICD with PFO monitoring (diagnostics group) and 98 an ICD without such a diagnostics (control group). The association of each patient to a group was assigned a priori, independently of patients' characteristics but based on regional device allocation policies., Results: Patient clinical characteristics and observation period were similar between groups. In a mean follow-up of 17 ± 11 months, heart failure hospitalizations or emergency-room admissions occurred in eight (7%) patients of the diagnostics group and in 16 of the control group (16%; P = 0.02), with an incidence, measured by Kaplan-Meier analysis, of 23% at 2 years and 34% at 3 years in patients of the control group compared with 8% at 2 and 3 years in patients of the diagnostics group (Log rank test P = 0.044)., Conclusion: Our data show that in heart failure patients receiving single-chamber or dual-chamber ICD, the use of intrathoracic impedance monitoring is associated with a significant reduction of heart failure hospitalizations. Our results support the hypothesis that PFO diagnostics improve the likelihood of timely detection of heart failure worsening.

Published
2014
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