Heart rhythm : the official journal of the Heart Rhythm Society
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The aim of this article is to critically review the data accumulated to date on the application of cardiac resynchronization therapy (CRT) via biventricular pacing techniques to manage patients with advanced heart failure. The data from studies evaluating the effects of long-term right ventricular (RV) pacing are also briefly reviewed. ⋯ CRT offers hemodynamic and clinical improvement to patients with moderate-to-advanced heart failure, and it might significantly prolong survival in selected patients, particularly if devices with defibrillation backup are used. Further confirmatory data from randomized mortality trials are needed, and issues of cost efficacy must be resolved before this vital therapeutic alternative is ready for prime time therapy of heart failure patients.
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The aims of this study were to describe the trends of ventricular fibrillation (VF) out-of-hospital cardiac arrest in Rochester, Minnesota, since 1985 and to determine coexistent trends in implantable cardioverter defibrillator (ICD) placement and termination of potentially lethal ventricular arrhythmias that might explain, at least in part, a declining incidence trend. ⋯ The incidence of VF out-of-hospital cardiac arrest is declining. In contrast, the rates of ICD placement and ICD termination of ventricular tachycardia or VF are markedly increasing. Sudden death preventive strategies are multifactorial. These observations suggest that ICD termination of potentially lethal ventricular arrhythmias may contribute to the lower incidence of VF out-of-hospital cardiac arrest.
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To examine outcomes of children with pacemakers over a 22-year period and identify risk factors for lead failure. ⋯ Pediatric pacing patients have a high incidence lead failures. These occur most commonly in younger patients, structural congenital heart disease, and those with epicardial lead systems. Approaches to pacing system implantation and follow-up in these patients need to be individualized, with special attention to minimizing risk of lead failures. Our findings suggest that expanded utilization of transvenous systems in smaller patients seems justified when anatomy permits.