A 65-year-old man with a history of coronary artery bypass grafting was admitted because of severe heart failure. Echocardiography showed diffuse severe hypokinesis of the left ventricle (ejection fraction 25%) and severe mitral regurgitation caused by tethering of the leaflet secondary to left ventricular (LV) dilation. He underwent mitral valve annuloplasty and LV papillary muscle imbrication...

T he number of patients with chronic heart failure has increased substantially during the last few decades. The use of drugs such as the converting enzyme inhibitors, angiotensin II receptor blockers, ‚-blockers and spironolactone has led to significant reduction of the mortality and morbidity associated with this disabling syndrome. Despite this, the prognosis of patients with drug-resistant h...

Objective: To quantify ventricular resynchronisation by biventricular pacing using colour tissue Doppler velocity imaging (c-TVI). Design and patients: c-TVI shows regional tissue velocity profiles with a very high time resolution (10 ms). Eighteen patients were studied from an apical four chamber view at baseline and after a one month follow up of biventricular pacing. Regional left ventricula...

OBJECTIVES We sought to assess the efficacy of biventricular pacing with respect to both peak and submaximal measures of exercise in patients with New York Heart Association class III heart failure (HF) and intraventricular conduction delay in a randomized, blinded study. BACKGROUND Submaximal and maximal changes in exercise capacity need evaluating in this patient population with this novel ...

BACKGROUND Pulmonary-vein isolation is increasingly being used to treat atrial fibrillation in patients with heart failure. METHODS In this prospective, multicenter clinical trial, we randomly assigned patients with symptomatic, drug-resistant atrial fibrillation, an ejection fraction of 40% or less, and New York Heart Association class II or III heart failure to undergo either pulmonary-vein...

OBJECTIVE To quantify ventricular resynchronisation by biventricular pacing using colour tissue Doppler velocity imaging (c-TVI). DESIGN AND PATIENTS c-TVI shows regional tissue velocity profiles with a very high time resolution (10 ms). Eighteen patients were studied from an apical four chamber view at baseline and after a one month follow up of biventricular pacing. Regional left ventricula...

We examined the effectiveness of combination therapy for biventricular pacing after cardiac surgery. We performed biventricular pacing in seven patients until April 2003. The diagnosis of the patients was ischemic cardiomyopathy (ICM) in four patients and dilated cardiomyopathy (DCM) in three patients. The implantation method of biventricular pacing was performed with a myocardial electrode thr...

BACKGROUND Conventional right ventricular (RV) apex pacing can lead to adverse clinical outcome associated with asynchronous activation and reduced left ventricular (LV) pump function. We investigated to what extent alternate RV (septum) and LV (septum, apex) pacing sites improve LV electric activation, mechanics, hemodynamic performance, and efficiency over 4 months of pacing. METHODS AND RE...

BACKGROUND The mechanoenergetic effects of atrioventricular delay optimization during biventricular pacing ("cardiac resynchronization therapy", CRT) are unknown. METHODS Eleven patients with heart failure and left bundle branch block (LBBB) underwent invasive measurements of left ventricular (LV) developed pressure, aortic flow velocity-time-integral (VTI) and myocardial oxygen consumption (...