The American journal of cardiology
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A retrospective, transesophageal study of 51 consecutive patients receiving a left ventricular (LV) assist device (AD) over a 2-year period showed that LVAD-associated LV thrombosis (16%) was predicted by acute myocardial infarction, atrial cannulation, and postimplantation bleeding, and was associated with a fourfold increased risk of stroke compared with patients without thrombosis. LV cannulation, when using short-term LVADs, may decrease the incidence of LV thrombosis, and early transition to Heartmate-LVAD support may improve outcome.
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of hemodynamic effects of enhanced external counterpulsation and intra-aortic balloon pumping in patients with acute myocardial infarction.
This study compared the hemodynamic effects of enhanced external counterpulsation and intra-aortic counterpulsation in patients with acute myocardial infarction. Results demonstrated similarity between these 2 methods, except enhanced external counterpulsation had a transient effect of increasing right atrial pressure, pulmonary capillary wedge pressure, and cardiac index.
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Data from 2 decades of clinical electrophysiologic studies have allowed great progress in the evaluation and treatment of patients with sustained ventricular arrhythmias and the appropriate identification of those patients at high risk for subsequent sudden death. The goals of treatment of the patient with ventricular arrhythmias are to suppress symptoms and prevent a fatal event. ⋯ Although low-risk groups may benefit from reassurance or medications such as beta-blockers or verapamil, high-risk groups have been more difficult to treat. Recent randomized trials of implantable cardioverter defibrillators (ICDs) for ventricular arrhythmias suggest that they may provide better protection for high-risk patients than do antiarrhythmic medications.
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Several independent studies suggest that resynchronization therapy--achieved by left- or biventricular pacing--improves hemodynamics in heart failure patients with interventricular conduction disturbances. Delivery of this new therapy in an effective and minimally invasive manner presents technical challenges, as transvenous access to the left ventricle is required. Since 1999, a novel over-the-wire approach combining standard pacing lead and angioplasty technology has been evaluated in several European countries. ⋯ Once the coronary sinus was found, the implant success rate was 92%. One lead dislodgment and 2 cases of phrenic nerve stimulation were reported. We conclude that the new EASYTRAK lead design for transvenous left ventricular lead implantation seems to be a suitable and safe tool for delivering resynchronization therapy to heart failure patients.
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Cardiac pacing remains one of the most effective means for preventing torsade de pointes in patients with long QT syndrome (LQTS). However, fatal arrhythmias may occur despite combined therapy with beta blockers and pacing, and it is possible that failure of cardiac pacing for preventing arrhythmias in the long run is related (at least in part) to suboptimal pacemaker programming. ⋯ Unfortunately, properly functioning pacemakers cannot be expected to prevent postextrasystolic pauses. The use of a pause-prevention pacing algorithm-rate smoothing-for preventing pause-dependent torsade de pointes is described in 12 patients with cardiac arrest or syncope due to congenital LQTS who were followed for 21 +/- 11 months.