10 research outputs found
Low cardiovascular event rate and high atrial fibrillation recurrence rate one year after electrical cardioversion
Publisher Copyright: © 2017 The Czech Society of CardiologyBackground: Electrical cardioversion is widely used to restore sinus rhythm in patients with atrial fibrillation. However, the long term clinical event and sinus rhythm maintenance rates following electrical cardioversion still remains unclear. This study evaluated one year incidence and risk factors for cardiovascular events and atrial fibrillation recurrence in a single center clinical practice. Methods: In a prospective study 188 patients with atrial fibrillation who underwent electrical cardioversion were enrolled. Patients and their primary care physicians were followed up one year after cardioversion and patient clinical and arrhythmic event rate was evaluated. Data obtained from patients and general practitioners were combined and the results were analyzed with PSPP 0.8.5 software. Results: Electrical cardioversion success rate was 90.4%. Within a year after cardioversion one patient (0.6%) suffered myocardial infarction, three patients (1.9%) had a stroke/transitory ischemic attack (TIA), three patients (1.6%) died and three patients (1.9%) had a bleeding event that required hospitalization. The presence of diabetes mellitus was the only factor with a tendency to increase the risk of combined event of myocardial infarction, stroke/TIA and bleeding (P = 0.096). At follow up 30.0% of patients reported having atrial fibrillation and within a year 62.2% had suffered at least one atrial fibrillation paroxysm. The proportion of patients who underwent additional cardioversions after the initial hospitalization was 32.5%. The factors that significantly increased the risk of atrial fibrillation recurrence were history of stroke/TIA (P = 0.014) and increased left atrial volume index on echocardiography (P = 0.039). Greater left atrial diameter had a tendency toward an increased risk (P = 0.087). Conclusions: Cardiovascular event rate one year after electrical cardioversion was low. Electrical cardioversion had a high immediate success rate, however, maintenance of stable sinus rhythm in the long term was low.publishersversionPeer reviewe
Assessment of Cardiac Resynchronisation Therapy Efficacy Determining Factors for Patients with Moderate and Severe Heart Failure in the Population of Latvia in a 12 and 24 Month Study
Publisher Copyright: © 2018 Maija Vikmane et al.The aim of this study was to evaluate treatment of patients with moderate and severe heart failure (HF) who were resistant to pharmacotherapy in Latvia and to assess the cardiac resynchronisation therapy (CRT) by exploring the predisposing factors which provides CRT efficacy. We accomplished prospective analysis of left ventricle ejection fraction (LVEF) and other parameter changes 12 and 24 months after CRT device implantation, dividing the population into two groups: responders - to whom LVEF improvement was ≥10% and non-responders where ≥ 10% LVEF improvement was not achieved. The study included 50 chronic HF patients with preserved sinus rhythm, who underwent CRT device implantation in Latvia at the Pauls Stradiņš Clinical University Hospital from June 2009 to March 2012. In the group of patients where 12 and 24 months after CRT device implantation LVEF improvement ≥10% was achieved, there were statistically significantly more patients with left bundle branch block (LBBB) QRS morphology, wider QRS complex, nonischemic genesis of HF, and normal systolic blood pressure. Patients with LVEF improvement had more pronounced ventricular dyssynchrony measured by Echo before CRT device implantation and, accordingly, the CRT mode was programmed as left ventricle paced before right ventricle and close to 100% biventricular pacing was achieved and the patient was female.publishersversionPeer reviewe
Lead-related infective endocarditis in latvia : A single centre experience
Publisher Copyright: © 2019 by the authors. Licensee MDPI, Basel, Switzerland. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.Background and Objectives: Over the last five decades cardiac implantable electronic devices (CIED) have become established as the mainstay for the treatment of permanent bradycardias, chronic heart failure and dangerous heart rhythm disturbances. These devices improve survival and quality of life in many patients. However, infections associated with CIED implantation, particularly lead-related infective endocarditis (LRIE), can offset all benefits and make more harm than good for the patient. To date, there are no other studies in Latvia, addressing patients with lead-related infective endocarditis. The objective of this study was to identify the most common pathogens associated with LRIE and their antimicrobial resistance and to identify possible risk factors of patients who present with LRIE. Materials and Methods: The study was performed retrospectively at Pauls Stradins Clinical University Hospital (PSCUH). The study included patients who were referred to PSCUH due to LRIE for lead extraction. Patients were identified from procedural journals. Information about isolated microorganisms, patient comorbidities and visual diagnostics data was taken from patient records. Results: Forty-nine patients with CIED related infective endocarditis were included in the study, 34 (69.4%) were male, median age of all patients was 65.0 (50.5–73.0) years, median hospital stay was 15.5 (22.0–30.5) days. Successful and complete lead extraction was achieved in all patients. Thirty-two (65.3%) had received antibiotics prior to blood sample. Only in 31 (63.3%) positive culture results were seen. The most common isolated pathogens were Staphylococcus aureus (23.5%) and coagulase negative staphylococci (23.5%). Other bacteria were isolated considerably less often. The atrial lead was most common location for lead vegetations, seen in 50.0% of cases. Five (10.2%) patients have died due to the disease. Conclusions: Lead-related infective endocarditis is a major complication of cardiac implantable electronic devices with considerable morbidity and mortality, which in our study was as high as 10.2%.Peer reviewe
Second European Cardiac Resynchronisation Therapy Survey (Crt Survey II): Latvian Data Compared to Europe
The cardiac resynchronisation therapy (CRT) survey II is a joint initiative between the European Heart Rhythm Association and the Heart Failure Association. It compiles real world data about cardiac resynchronisation therapy in European Society of Cardiology member states. 11 088 patients assigned to implantation of CRT with pacemaker function (CRT-P) or CRT with an incorporated defibrillator (CRT-D) were enrolled in the survey starting 1 October 2015 till 31 December 2016 and for each patient, an electronic case report form (eCRF) was completed. Each participating country had each eCRF data-point benchmarked against the total cohort. In total, 79 patients were included from Latvia. The mean age of patients was 68.1, similar to the total cohort of other ESC member states, and 21.8% of patients were female. Latvian patients compared to other countries more often had permanent atrial fibrillation, NYHA class III and IV, ejection fraction 35 %. CRT-Ds and multipolar lead implantation rates were higher. Peri-procedural complication rates were similarly low in both groups. At discharge, prescribed medication rates were similar but more frequently MRAs, ivabradine and calcium channel blockers were prescribed and slightly less frequently ACE inhibitors/ARBs were prescribed. The CRT survey II is a valuable resource that describes ongoing practice of cardiac resynchronisation therapy around Europe and benchmarking against the total cohort is nationally significant for each participating country.publishersversionPeer reviewe
Pacemaker-Mediated Programmable Hypertension Control Therapy
BACKGROUND: Many patients requiring a pacemaker have persistent hypertension with systolic blood pressures above recommended levels. We evaluated a pacemaker-based Programmable Hypertension Control (PHC) therapy that uses a sequence of variably timed shorter and longer atrioventricular intervals. METHODS AND RESULTS: Patients indicated for dual-chamber pacing with office systolic blood pressure (oSBP) >150 mm Hg despite stable medical therapy were implanted with a Moderato™ pulse generator that delivers PHC therapy. Patients were followed for 1 month (Run-In period) with conventional pacing; those with persistent oSBP >140 mm Hg were included in the study and had PHC therapy activated. The co-primary efficacy end points were changes in 24-hour ambulatory systolic blood pressure and oSBP between baseline and 3 months. Safety was assessed by tracking adverse events. Thirty-five patients met the initial inclusion criteria and underwent Moderato implantation. At 1 month, oSBP was <140 mm Hg in 7 patients who were excluded. PHC was activated in the remaining 27 patients with baseline office blood pressure 166±11/80±10 mm Hg despite an average of 3.2 antihypertensive medications. During the Run-In period, oSBP and 24-hour ambulatory systolic blood pressure decreased by 8±13 and 5±12 mm Hg (P<0.002), respectively. Compared with pre-PHC activation measurements, oSBP decreased by another 16±15 mm Hg and 24-hour ambulatory systolic blood pressure decreased by an additional 10±13 mm Hg (both P<0.01) at 3 months. No device-related serious adverse effects were noted. CONCLUSIONS: In pacemaker patients with persistent hypertension despite medical therapy, oSBP and 24-hour ambulatory systolic blood pressure are decreased by PHC therapy. Initial indications are that this therapy is a safe and promising therapy for such patients. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02282033
Treatment of Heart Failure With Associated Functional Mitral Regurgitation Using the ARTO System
Pacemaker-Mediated Programmable Hypertension Control Therapy
BACKGROUND: Many patients requiring a pacemaker have persistent hypertension with systolic blood pressures above recommended levels. We evaluated a pacemaker-based Programmable Hypertension Control (PHC) therapy that uses a sequence of variably timed shorter and longer atrioventricular intervals. METHODS AND RESULTS: Patients indicated for dual-chamber pacing with office systolic blood pressure (oSBP) >150 mm Hg despite stable medical therapy were implanted with a Moderato™ pulse generator that delivers PHC therapy. Patients were followed for 1 month (Run-In period) with conventional pacing; those with persistent oSBP >140 mm Hg were included in the study and had PHC therapy activated. The co-primary efficacy end points were changes in 24-hour ambulatory systolic blood pressure and oSBP between baseline and 3 months. Safety was assessed by tracking adverse events. Thirty-five patients met the initial inclusion criteria and underwent Moderato implantation. At 1 month, oSBP was <140 mm Hg in 7 patients who were excluded. PHC was activated in the remaining 27 patients with baseline office blood pressure 166±11/80±10 mm Hg despite an average of 3.2 antihypertensive medications. During the Run-In period, oSBP and 24-hour ambulatory systolic blood pressure decreased by 8±13 and 5±12 mm Hg (P<0.002), respectively. Compared with pre-PHC activation measurements, oSBP decreased by another 16±15 mm Hg and 24-hour ambulatory systolic blood pressure decreased by an additional 10±13 mm Hg (both P<0.01) at 3 months. No device-related serious adverse effects were noted. CONCLUSIONS: In pacemaker patients with persistent hypertension despite medical therapy, oSBP and 24-hour ambulatory systolic blood pressure are decreased by PHC therapy. Initial indications are that this therapy is a safe and promising therapy for such patients. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02282033
Navigating between Scylla and Charybdis : challenges and strategies for implementing guideline‐directed medical therapy in heart failure with reduced ejection fraction
Guideline-directed medical therapy (GDMT) has the potential to reduce the risks of mortality and hospitalisation in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data indicate that many patients with HFrEF do not receive optimised GDMT, which involves several different medications, many of which require up-titration to target doses. There are many challenges to implementing GDMT, the most important being patient-related factors (comorbidities, advanced age, frailty, cognitive impairment, poor adherence, low socioeconomic status), treatment-related factors (intolerance, side-effects) and healthcare-related factors that influence availability and accessibility of HF care. Accordingly, international disparities in resources for HF management and limited public reimbursement of GDMT, coupled with clinical inertia for treatment intensification combine to hinder efforts to provide GDMT. In this review paper, authors aim to provide solutions based on available evidence, practical experience, and expert consensus on how to utilise evolving strategies, novel medications, and patient profiling to allow the more comprehensive uptake of GDMT. Authors discuss professional education, motivation, and training, as well as patient empowerment for self-care as important tools to overcome clinical inertia and boost GDMT implementation. We provide evidence on how multidisciplinary care and institutional accreditation can be successfully used to increase prescription rates and adherence to GDMT. We consider the role of modern technologies in advancing professional and patient education and facilitating patient–provider communication. Finally, authors emphasise the role of novel drugs (especially sodium–glucose co-transporter 2 inhibitors), and a tailored approach to drug management as evolving strategies for the more successful implementation of GDMT
Pacemaker-Mediated Programmable Hypertension Control Therapy
Background-Many patients requiring a pacemaker have persistent hypertension with systolic blood pressures above recommended levels. We evaluated a pacemaker-based Programmable Hypertension Control (PHC) therapy that uses a sequence of variably timed shorter and longer atrioventricular intervals. Methods and Results-Patients indicated for dual-chamber pacing with office systolic blood pressure (oSBP) > 150 mm Hg despite stable medical therapy were implanted with a Moderato (TM) pulse generator that delivers PHC therapy. Patients were followed for 1 month (Run-In period) with conventional pacing; those with persistent oSBP > 140 mm Hg were included in the study and had PHC therapy activated. The co-primary efficacy end points were changes in 24-hour ambulatory systolic blood pressure and oSBP between baseline and 3 months. Safety was assessed by tracking adverse events. Thirty-five patients met the initial inclusion criteria and underwent Moderato implantation. At 1 month, oSBP was <140 mm Hg in 7 patients who were excluded. PHC was activated in the remaining 27 patients with baseline office blood pressure 166 +/- 11/80 +/- 10 mm Hg despite an average of 3.2 antihypertensive medications. During the Run-In period, oSBP and 24-hour ambulatory systolic blood pressure decreased by 8 +/- 13 and 5 +/- 12 mm Hg (P <0.002), respectively. Compared with pre-PHC activation measurements, oSBP decreased by another 16 +/- 15 mm Hg and 24-hour ambulatory systolic blood pressure decreased by an additional 10 +/- 13 mm Hg (both P <0.01) at 3 months. No device-related serious adverse effects were noted. Conclusions-In pacemaker patients with persistent hypertension despite medical therapy, oSBP and 24-hour ambulatory systolic blood pressure are decreased by PHC therapy. Initial indications are that this therapy is a safe and promising therapy for such patient