Risk of heart failure- and cardiac death gradually increases with more right ventricular pacing

Background: Right ventricular pacing (RVP) is associated with an increased risk of heart failure (HF) events. However, the extent and shape of this association is hardly assessed. Objective: We quantified whether the undesired effects of RVP are confirmed in an unselected population of first bradycardia pacemaker recipients. Furthermore, we studied the shape of the association between RVP and HF death and cardiac death. Methods: Cumulative percentage RVP (%RVP) was measured in 1395 patients. Using multivariable Cox regression analysis with %RVP as time-dependant co-variate we evaluated the association between % RVP and HF- and cardiac death, both unadjusted and adjusted for confounders, including age, gender, pacemaker-indication, cardiac disease, HF at baseline, diabetes, hypertension, atrio-ventricular synchrony, usage of beta-blocking drugs, antiarrhythmic medication, HF medication, and prior atrial fibrillation/flutter. Non-linear associations were evaluated with restricted cubic splines. Results: During a mean follow-up of 5.8 (SD 1.1) years 104 HF deaths and 144 cardiac deaths were observed. % RVP was significantly associated with HF- and cardiac death in both unadjusted (p <0.001 and p <0.001, respectively) and adjusted analyses (p = 0.046 and p = 0.009, respectively). Our results show a linear association between % RVP and HF- and cardiac death. We observed a constant increase of 8% risk of HF death per 10% increase in RVP. A model incorporating various non-linear transformations of % RVP using restrictive cubic splines showed no improved model fit over linear associations. Conclusion: This long-term, prospective study observed a significant, though linear association between % RVP and risk of HF death and/or cardiac death in unselected bradycardia pacing recipients. (C) 2015 Elsevier Ireland Ltd. All rights reserved

Contribution of body surface mapping to clinical outcome after surgical ablation of postinfarction ventricular tachycardia

This article investigates the influence of body surface mapping on outcome of ventricular antiarrhythmic surgery. Preoperative mapping is advocated to optimize map-guided antiarrhythmic surgery of postinfarction ventricular tachycardia. We sequentially analyzed the results of catheter activation sequence mapping, body surface mapping, and intraoperative multielectrode mapping in 54 patients and made a comparison with 30 control patients (group B) in whom catheter activation sequence mapping was omitted. Endpoints were actuarial survival, freedom of arrhythmia, and comparability of the localisation of sites of ventricular tachycardia origin. A total of 128 morphologically different monomorphic sustained ventricular tachycardias were mapped in group A. In group A, 87 ventricular tachycardias were mapped preoperatively with body surface mapping and 30 ventricular tachycardias with catheter activation sequence mapping. In 19 of 24 ventricular tachycardias (79%) that were localized with both mapping methods the ventricular tachycardia exit site was similar. In-hospital death was 1 of 85 (1.2%). Actuarial freedom from ventricular arrhythmias at 4-year follow-up was 74.1 +/- 6.0% in group A vs. 90.0+/-5.5% in group B (P =.10). In group A 14 of 54 patients died (29.6%), whereas 4 of 30 patients (13.3%) died in group B (P =.09). Arrhythmia freedom and survival is as good in patients mapped with body surface mapping only as in patients mapped with body surface mapping and catheter activation sequence mappin

Poor health-related quality of life of patients with indication for chronic cardiac pacemaker therapy

implantation are scarce, or executed in specific patient subgroups (regarding age or specific cardiac rhythm disorders). The purpose of this study was to systematically assess the HRQoL in a large unselected cohort of patients with a conventional indication for PM therapy.Methods: Pre-PM implantation HRQoL (measured with the SF-36 questionnaire, completed at hospital admission) of 818 consecutive Dutch patients included in the FOLLOWPACE study was compared with the HRQoL in a sample of the general Dutch population, and with several cohorts of patients with other conditions. Linear regression analysis was performed to analyze determinants of this HRQoL.Results: Almost all SF-36 subscale scores, were substantially and significantly lower in the PM patients compared to the general population, with. P-volues &lt;0.001 in all SF-36 subscales except for "pain" and "general health perception." In the P-W patients, presence of comorbidities, gender, and age were significantly associated with the overall physical component summary score (mean 38.8 +/- 27 standard deviation) whereas the overall mental component summaryscore (46.8 +/- 27.0) was associated with gender and age.Conclusion: The HRQoL of patients before first PM implantation is significantly lower than that of a general population and also various other patient populations. Physicians should be aware of this unfavorable condition and keep the time interval between the diagnosis of a cardiac rhythm disorder requiring PM implantation and the implantation procedure as short as possible.</p

Increased amount of atrial fibrosis in patients with atrial fibrillation secondary to mitral valve disease

Objective: Atrial fibrosis is related to atrial fibrillation but may differ in patients with mitral valve disease or lone atrial fibrillation. Therefore, we studied atrial fibrosis in patients with atrial fibrillation + mitral valve disease or with lone atrial fibrillation and compared it with controls. Methods: Left and right atrial appendages amputated during Maze III surgery for lone atrial fibrillation (n = 85) or atrial fibrillation + mitral valve disease (n = 26) were embedded in paraffin, sectioned, and stained with picrosirius red. Atria from 10 deceased patients without a cardiovascular history served as controls. A total of 1048 images (4-mu m sections, 10-fold magnification, 4 images per appendage) were obtained and digitized. The percentage of fibrous tissue was calculated by quantitative morphometry. Results: Irrespective of the presence or absence of atrial fibrillation or mitral valve disease, more fibrous tissue was present in right atrial appendages than in left atrial appendages (12.7% +/- 5.7% vs 8.2% +/- 3.9%; P <.0001). The mean amount of fibrous tissue in the atria was significantly larger in patients with atrial fibrillation + mitral valve disease than in patients with lone AF and controls (13.6% +/- 5.8%, 9.7% +/- 3.2%, and 8.8% +/- 2.4%, respectively; P <.01). No significant differences existed between patients with lone atrial fibrillation and patients without a cardiovascular history (controls). Conclusions: Atria of patients with atrial fibrillation and mitral valve disease have more fibrosis than atria of patients with lone atrial fibrillation. However, patients with lone atrial fibrillation have an equal amount of atrial fibrosis compared with controls. These findings support the notion that fibrosis plays a more important role in the pathogenesis of atrial fibrillation secondary to mitral valve disease than in lone atrial fibrillation and potentially explains the relatively poor success of antiarrhythmic surgery in patients with mitral valve disease. (J Thorac Cardiovasc Surg 2012;144:327-33

Poor health-related quality of life of patients with indication for chronic cardiac pacemaker therapy

implantation are scarce, or executed in specific patient subgroups (regarding age or specific cardiac rhythm disorders). The purpose of this study was to systematically assess the HRQoL in a large unselected cohort of patients with a conventional indication for PM therapy. Methods: Pre-PM implantation HRQoL (measured with the SF-36 questionnaire, completed at hospital admission) of 818 consecutive Dutch patients included in the FOLLOWPACE study was compared with the HRQoL in a sample of the general Dutch population, and with several cohorts of patients with other conditions. Linear regression analysis was performed to analyze determinants of this HRQoL. Results: Almost all SF-36 subscale scores, were substantially and significantly lower in the PM patients compared to the general population, with. P-volues <0.001 in all SF-36 subscales except for "pain" and "general health perception." In the P-W patients, presence of comorbidities, gender, and age were significantly associated with the overall physical component summary score (mean 38.8 +/- 27 standard deviation) whereas the overall mental component summaryscore (46.8 +/- 27.0) was associated with gender and age. Conclusion: The HRQoL of patients before first PM implantation is significantly lower than that of a general population and also various other patient populations. Physicians should be aware of this unfavorable condition and keep the time interval between the diagnosis of a cardiac rhythm disorder requiring PM implantation and the implantation procedure as short as possible