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Usage of active fixation bipolar left ventricular (LV) leads represents an alternative approach to the more commonly used passive fixation quadripolar leads in cardiac resynchronization therapy (CRT). SQ22536 molecular weight We compared a bipolar LV lead with a side screw for active fixation and passive fixation quadripolar LV leads.

Sixty-two patients were before CRT implantations randomly allocated to receive a bipolar (n=31) or quadripolar (n=31) LV leads. Speckle-tracking radial strain echocardiography was used to define the LV segment with latest mechanical activation as the target LV segment. The electrophysiological measurements and the capability to obtain a proximal position in a coronary vein placed over the target segment were assessed.

Upon implantation, the quadripolar lead demonstrated a lower pacing capture threshold than the bipolar lead, but at follow-up, there was no difference. There were no differences in the LV lead implant times or radiation doses. The success rate in reaching the target location was not significantly different between the two LV leads.

The pacing capture thresholds were low, with no significant difference between active fixation bipolar leads and quadripolar leads. Active fixation leads did not promote a more proximal location of the stimulating electrode or a higher grade of concordance to the target segment than passive fixation leads.

The pacing capture thresholds were low, with no significant difference between active fixation bipolar leads and quadripolar leads. Active fixation leads did not promote a more proximal location of the stimulating electrode or a higher grade of concordance to the target segment than passive fixation leads.

Right ventricular (RV) pacing causes left ventricular (LV) dyssynchrony sometimes resulting in pacing-induced cardiomyopathy. However, RV pacing for hypertrophic obstructive cardiomyopathy is one of the treatment options. LV flow energy loss (EL) using vector flow mapping (VFM) is a novel hemodynamic index for assessing cardiac function. Our study aimed to elucidate the impact of RV pacing on EL in normal LV function and hypertrophic cardiomyopathy (HCM) patients.

A total of 36 patients with dual-chamber pacemakers for sick sinus syndrome or implantable cardioverter defibrillators for fatal ventricular tachyarrhythmias were enrolled. All patients were divided into two groups 16 patients with HCM (HCM group) and others (non-HCM group). The absolute changes in EL under AAI (without RV pacing) and DDD (with RV pacing) modes were assessed using VFM on color Doppler echocardiography.

In the non-HCM group, the mean systolic EL significantly increased from the AAI to DDD modes (14.0±7.7 to 17.0±8.6mW/m,

=.003), whereas the mean diastolic EL did not change (19.0±12.3 to 17.0±14.8mW/m,

=.231). In the HCM group, the mean systolic EL significantly decreased from the AAI to DDD modes (26.7±14.2 to 21.6±11.9mW/m,

<.001), whereas the mean diastolic EL did not change (28.7±16.4 to 23.9±19.7mW/m,

=.130).

RV pacing increased the mean systolic EL in patients without HCM. Conversely, RV pacing decreased the mean systolic EL in patients with HCM.

RV pacing increased the mean systolic EL in patients without HCM. Conversely, RV pacing decreased the mean systolic EL in patients with HCM.

Despite the effectiveness of implantable cardioverter defibrillators (ICDs) in the prevention of sudden cardiac death, shock therapy causes patients to experience pain and psychological distress, which contradicts the purpose of palliative care. It is difficult to predict the time course for heart failure (HF) patients, unlike that for cancer patients. The aim of this study was to evaluate the deactivation status of ICD therapy in Japanese patients with end-stage HF.

We retrospectively studied 51 ICD patients who died due to worsening HF at Tokyo Women’s Medical University Hospital from 2010 to 2019. The frequency of ICD therapy delivered before death and information about the discussion of deactivation and do not attempt resuscitation (DNAR) decisions were reviewed using medical charts.

Of 51 patients, 12 (24%) patients deactivated ICD therapy and seven patients underwent deactivation within 24hours of a DNAR order. The median time from deactivation to death was 3days (range, 0-56). Of 39 patients with DNAR orders, 27 (69%) did not undergo deactivation. A relatively high proportion of patients (n=14, 27%) experienced ICD shocks within 1month of death. The frequency of electrical storms within 1month of death was also high (n=12, 24%).

Our study showed that only one-fourth of Japanese patients with end-stage HF underwent deactivation of ICD therapy. A relatively high frequency of shock therapy was observed in the last month before death.

Our study showed that only one-fourth of Japanese patients with end-stage HF underwent deactivation of ICD therapy. A relatively high frequency of shock therapy was observed in the last month before death.

Significant sinus bradycardia (SB) in the context of sinus node dysfunction (SND) has been associated with neurological symptoms. The objective was to evaluate the effect of permanent pacing on the incidence of syncope in patients with rather mild degrees of SB, unexplained syncope, and “positive” invasive electrophysiologic testing.

This was an observational study based on a prospective registry of 122 consecutive mild SB patients (61.90±18.28years, 61.5% male, 57.88±7.73bpm) presenting with recurrent unexplained pre and syncope attacks admitted to our hospital for invasive electrophysiology study (EPS). Τhe implantation of a permanent antibradycardia pacemaker (ABP) was offered to all patients according to the results of the EPS. Eighty patients received the ABP, while 42 denied.

The mean of reported syncope episodes was 2.23±1.29 (or presyncope 2.36±1.20) in the last 12months before they were referred for a combined EP guided diagnostic and therapeutic approach. Over a mean follow-up of approximately 4years (50.39±32.40months), the primary outcome event (syncope) occurred in 18 of 122 patients (14.8%), 6 of 80 (7.5%) in the ABP group as compared to 12 of 42 (28.6%) in the no pacemaker group (

=.002).

Among patients with mild degree of SB and a history of unexplained syncope, a set of positivity criteria for the presence of EPS defined SND after differentiating reflex syncope, identifies a subset of patients who will benefit from permanent pacing.

Among patients with mild degree of SB and a history of unexplained syncope, a set of positivity criteria for the presence of EPS defined SND after differentiating reflex syncope, identifies a subset of patients who will benefit from permanent pacing.