BACKGROUND: Transcatheter closure of patent foramen ovale (PFO) in patients with a history of cryptogenic stroke is performed with increasing frequency. However, the long-term effects of these closure devices on atrial tachyarrhythmias (ATs) are not known. METHODS AND RESULTS: The study population included 71 patients [31 (44%) men, aged 54 ...

BACKGROUND: Permanent pacemaker implantation usually is contraindicated in patients with systemic infection. The aim of the present study was to compare two different techniques of transvenous temporary pacing to bridge the infectious situation until permanent pacemaker implantation under infection-free conditions is possible. METHODS AND RESULTS: Forty-nine patients with systemic infection ...

The effect of right ventricular restrictive physiology on exercise capacity and arrhythmogenesis after correction of tetralogy of Fallot was assessed in 80 patients aged 7.9 +/- 3.6 years. Right ventricular restrictive physiology was defined as the presence of an A wave across the pulmonary artery on 2-dimensional echocardiography. At the ...

CONTEXT: Limited information exists to direct clinical management after an implantable device has been put under advisory. A better understanding of the risks and benefits of device replacement compared with continued clinical follow-up would be helpful to clinicians. OBJECTIVE: Using the tools of decision analysis, to determine the best management ...

BACKGROUND: Alcohol septal ablation (ASA) decreases the left ventricular (LV) outflow gradient and relieves symptoms in patients with highly symptomatic hypertrophic obstructive cardiomyopathy (HOCM). The aim of this study was to evaluate the early course of hemodynamic, morphologic and clinical changes in younger and elderly patients. METHODS AND RESULTS: Forty-four ...

BACKGROUND: Double-outlet right ventricle encompasses a broad spectrum of anomalies. Heterotaxy syndrome, which is often associated with total anomalous pulmonary venous connection and complete atrioventricular canal defect, has been considered a risk factor for surgical repair of double-outlet right ventricle. METHODS: From January 1992 to May 1999, medical records of ...

OBJECTIVES: This study sought to determine whether the time from diagnosis to randomization was related to outcome in a clinical trial of implantable cardioverter-defibrillator (ICD) insertion in nonischemic cardiomyopathy. BACKGROUND: Whether the duration of nonischemic cardiomyopathy is related to arrhythmic risk and the possible benefit of ICD insertion is unknown. ...

OBJECTIVE: To review a mortality database, and identify all sudden unexpected deaths in patients followed by the cardiac program. DESIGN: Retrospective review of prospectively maintained database. RESULTS: Over 8 years, we identified 80 sudden unexpected deaths, among which there were sufficient data in 69 (24 females). Patients died at a ...

INTRODUCTION: The purpose of this study was to determine predictors of appropriate implantable defibrillator (ICD) therapy among patients with heart failure who are treated with a cardiac resynchronization therapy-defibrillator (CRT-D). METHODS AND RESULTS: Patients enrolled in the Ventak CHF/Contak CD study were treated with a CRT-D device and were required ...

BACKGROUND: Congenital heart disease (CHD) that causes right atrial dilatation is commonly associated with atrial flutter and/or fibrillation (AFl/F). To reduce late recurrence of AFl/F in patients undergoing repair of CHD, we utilized a concomitant right-sided maze procedure. METHODS: From 1993 to 2003, 99 patients with CHD and associated AFl/F ...

BACKGROUND: Biventricular repair is often difficult to accomplish in patients with right atrial isomerism because of complex anomalous structures. METHODS: Ten patients with right atrial isomerism underwent biventricular repair. Their ages ranged from 15 months to 21 years. The follow-up period ranged from 1 month to 21 years. The Fontan ...

OBJECTIVES: We sought to evaluate the mid-term outcome of hospital survivors with extracardiac Fontan circulation. BACKGROUND: Few data exist about the mid-term and long-term results of the extracardiac Fontan operation. METHODS: From November 1988 to November 2003, 221 patients underwent an extracardiac Fontan procedure as primary (9 patients) or secondary ...

CONTEXT: Despite there being millions of pacemaker and implantable cardioverter-defibrillator (ICD) generator implants worldwide, little is known about device reliability. OBJECTIVES: To perform a meta-analysis of prospective pacemaker and ICD registries to determine annual rates of pacemaker and ICD malfunction and to identify trends in these rates. DATA SOURCES: MEDLINE ...

OBJECTIVE: The surgical results for the repair of interrupted aortic arch (IAA) have evolved in recent years. We report our results for staged repair of this complex congenital malformation. METHODS: Sixty-five patients (mean age, 16.9+/-41.7 days) were diagnosed with IAA and referred for surgical therapy. The surgical management strategy at ...

We report on our experience with transhepatic access for catheter interventions in six children (age range 2.5 months-9 years). Three had systemic venous anomalies, and one infant a femoral venous occlusion. In two further patients with bradyarrhythmia after a Fontan operation with an intraatrial Gore-Tex tunnel, transhepatic access was chosen ...

The objective of this meta-analysis of individual patients' data was to compare the immediate outcomes of anatomic and physiologic repair of congenitally corrected transposition of the great arteries. Eleven nonrandomized studies, involving 124 patients, met the inclusion criteria for this review. The Rastelli type anatomic repair and the era of ...

BACKGROUND: Conventional surgical atrial septal defect (ASD) closure requires cardiopulmonary bypass, whereas percutaneous transcatheter closure is limited by maximal defect size of 34 mm and access to the neck. We describe a new minimally invasive approach using a right minithoracotomy to deploy an occluder without cardiopulmonary bypass. METHODS: Between October ...

Alcohol septal ablation (ASA) causes remodeling of the upper septum and left ventricular outflow tract (LVOT) and reduction in the LVOT gradient. The time course of gradient reduction early after ASA has not been established. This study characterized the time course of gradient response early after ASA. Patients underwent clinical ...

BACKGROUND: The value of an implantable cardioverter defibrillator (ICD) for primary prevention in dilated cardiomyopathy (DCM) is unclear, as randomized trials could not show a survival benefit compared to drug therapy. It has not been investigated if patients with a very poor left ventricular function (LVEF) could profit from an ...

BACKGROUND: Despite the increasingly widespread use of active-fixation leads, long-term clinical follow-up of pacing lead outcomes is lacking. The aim was to analyze pacing parameters over a 2-year follow-up. We performed a prospective observational study of consecutive new pacemaker implants using the 1488T St. Jude (100) and the Medtronic 5076 ...

BACKGROUND: Normotensive hemodialysis patients may still have left ventricular hypertrophy in the absence of significant pressure or volume overload. We examined the hypothesis that treatment with an angiotensin-converting enzyme inhibitor could be beneficial in the reversal of left ventricular hypertrophy in these patients. METHODS: Forty-six normotensive patients with end-stage renal ...

The present study was undertaken to evaluate the safety and release of nickel after implantation of a nickel device (Amplatzer occluder) in patients with an atrial septal defect (ASD) receiving antiplatelet therapy. METHODS: Blood and urine samples were obtained from 24 patients with ASD before occluder implantation (baseline) and during ...

BACKGROUND: There are no international guidelines indicating how long a patient should stay strictly in bed after pacemaker implantation. In the present study, we tested a new protocol concerning the mobilization of patients 3 h after receiving a single or a dual-chamber pacemaker. METHODS: Consecutive patients who underwent single or ...

Theoretically, replacement of a VDD device requires using a similar pacemaker to provide the best match between the filtering characteristics of the pacemaker and the atrial dipole of the lead. This study evaluated the performance of newly implanted Vitatron VDD pacemakers connected to dedicated leads and compared the results with ...

We report the first experience obtained with the new Intrasept device. We attempted to treat 35 patients with a mean age of 43 +/- 21 years. The mean size of the defect was 17/15 mm. It was successfully closed in 31 patients. In the remaining four the device could not ...

AIM: The purpose of this study was to evaluate the outcome after one-stage repair of tetralogy of Fallot (TOF). METHODS: Between May 1997 and December 2002, 240 patients with a median age of 9 months (1 month-48 years) underwent one-stage repair of TOF. Closure of ventricular septal defect (VSD) was ...

Fenestration is still widely used in right heart bypass operations. Our study was conducted to assess its need in the most recent modification, the completion of a total cavopulmonary connection with an extracardiac tube. The extracardiac approach was introduced at our institution in January, 1999. Since June of 2000, no ...

BACKGROUND: Because of venous occlusion, intracardiac shunting, previous surgery, or small size placement of implantable cardioverter-defibrillator (ICD) leads may not be possible using traditional methods. The purpose of this study was to evaluate and describe innovative methods of placing ICD leads. METHODS: The records of all patients undergoing ICD implantation ...

BACKGROUND: Since 1987, anatomic biventricular repair using the double-switch operations has been our principal choice for patients with atrioventricular discordance. These alternative procedures have the theoretical advantage of using the anatomic left ventricle to support the systemic circulation. METHODS: A total of 45 patients underwent the double-switch operation. Their ages ...

OBJECTIVES: This phase I study attempted to report the initial safety and efficacy results of transcatheter closure of perimembranous ventricular septal defects (PmVSDs) using the new Amplatzer Membranous VSD Occluder (AGA Medical Corp., Golden Valley, Minnesota) in the U.S. BACKGROUND: The most common congenital heart disease is PmVSD. Surgical repair ...

AIMS: This study assesses short- and long-term performance of the S80TB ventricular lead manufactured by Sorin Biomedica, Italy. METHODS AND RESULTS: Three hundred and thirty leads were implanted and had complete follow-up with us for a minimum of 60 months or up to failure, removal, and/or patient death (mean 40 ...

OBJECTIVE: To evaluate the incidence of reoperation due to complications or battery depletion in patients who underwent endocardial permanent pacemaker implantation during an 8-year period. METHODS: All pacemaker implantation and related procedures from January 1996 to June 2003 were retrospectively collected and entered into a database. During this time period ...

BACKGROUND: The implantable cardioverter defibrillators (ICDs) are increasingly being used as a treatment modality for life threatening tachyarrhythmia. The purpose of this study was to compare the frequency of complications and mortality between single-chamber and dual-chamber ICD implantation in Shahid Rajaie cardiovascular center. METHODS AND RESULTS: Between January 2000 and ...

BACKGROUND: The surgical management of tetralogy of Fallot (TOF) has continued to evolve and there are now generally excellent early and long-term results following complete repair. OBJECTIVE: To investigate the early results of the authors' current surgical management of TOF by assessing the perioperative and early to intermediate follow-up period. ...

BACKGROUND: Although psychological stress is known to favor ventricular arrhythmic events, there is no evidence that stress management intervention decreases ventricular electrical instability in implantable cardioverter-defibrillator (ICD) patients. The aim of the study was to determine whether cognitive behavioral therapy (CBT) results in a decrease of arrhythmic events requiring ICD ...

Transcatheter closure of septal defects has become a widely used alternative to surgery or life-long anticoagulant therapy especially in patients with atrial septal defects (ASD) and patent foramen ovale (PFO). Post-procedural complications include thrombus formation on the occluder in about 0-10% of all cases. Therefore antithrombotic prophylaxis after device implantation ...

OBJECTIVE: This study was undertaken to investigate the intermediate outcomes after the Fontan operation in the current era. METHODS: A cross-sectional analysis was performed by using data gathered between October 13, 2003, and February 22, 2005, on all 310 survivors of the Fontan procedure between January 1, 1992, and December ...

INTRODUCTION: Implantable cardioverter-defibrillator (ICD) therapy has been shown to improve survival in patients with structural heart disease and at high risk for life threatening ventricular arrhythmias. Whether elderly patients benefit from device therapy in a similar way as younger patients is largely unknown. METHODS: We retrospectively analyzed data from 375 ...

BACKGROUND: Early correction is regarded as the treatment of choice for patients with tetralogy of Fallot or pulmonary atresia with ventricular septal defect. Nevertheless, some of these patients reach adulthood without early correction. This study sought to assess risk factors for operative mortality and determine the benefit of total correction ...

OBJECTIVE: To determine the incidence and prognosis of peripartum cardiomyopathy (PPCM) in rural Haiti. PATIENTS AND METHODS: Prospectively identified patients with PPCM treated at the Hospital Albert Schweitzer (HAS), Deschapelles, Haiti, were included in this study. Patients who presented to HAS from February 1, 2000, to January 31, 2005, were ...

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 ...

OBJECTIVE: The purpose of this study was to examine the influence of caudal anesthesia on outcomes (pediatric intensive care unit [PICU] length of stay, hospital length of stay, ventilatory time, early extubation rate) in pediatric patients undergoing congenital heart disease repair requiring cardiopulmonary bypass (CPB). DESIGN: Retrospective. SETTING: University teaching ...

OBJECTIVE: To investigate survival and risk factors influencing intermediate outcome after the Fontan procedure. METHODS: Retrospective analysis of 122 patients operated between April 1991 and September 2002. Poor outcome was defined as late death or poor functional status (intractable supraventricular arrhythmias/NYHA 3-4) necessitating revision surgery. RESULTS: 64(52%) patients had an ...

BACKGROUND: Cardiac resynchronization therapy (CRT) reduces mortality in selected patients with heart failure. However, this result may not be entirely related to the beneficial hemodynamic effects of CRT. OBJECTIVES: The purpose of this study was to assess retrospectively the effect of CRT on the incidence of appropriate therapy in patients ...

BACKGROUND: Sinus venosus atrial septal defect (SVASD) differs from secundum atrial septal defect by its atrial septal location and its association with anomalous pulmonary venous connection (APVC). Data on long-term outcome after surgical repair are limited. METHODS AND RESULTS: We reviewed outcomes of 115 patients (mean age+/-SD 34+/-23 years) with ...

OBJECTIVE: Despite a continuous improvement in operative outcome the optimal timing for the repair of tetralogy of Fallot (TOF) remains controversial. The purpose of this study was to evaluate the results following neonatal repair of TOF and the need for reintervention associated with this strategy. METHODS: Retrospective review of 66 ...

BACKGROUND: The Ventricular Capture Management (VCM) of Medtronic Kappa 700 series pacemakers (PM) performs automatic threshold detection and optimization of pacing output that may enhance generator longevity. We evaluated efficacy and safety of this algorithm in children. METHODS: The study was prospective, non-randomized, involving 50 consecutive patients (mean age 5.6 ...

BACKGROUND: The purpose of this study is to assess the current management of atrial septal defect closure in an era of increasing feasibility of transcatheter device occlusion. METHODS: Atrial septal defect (ASD) closure was performed surgically through complete sternotomy in 165 patients (group 1) and through partial inferior sternotomy in ...

PURPOSE: Radiation therapy (RT) for left-sided breast cancer has been associated with cardiac dysfunction. We herein assess the temporal nature and volume dependence of RT-induced left ventricular perfusion defects and whether these perfusion defects are related to changes in cardiac wall motion or alterations in ejection fraction. METHODS: From 1998 ...

Baseline and long-term follow-up 2-dimensional echocardiograms were obtained in 160 patients with automatic implantable cardioverter-defibrillators without indications for antibradycardia pacing, who had backup ventricular pacing at a rate of 40/minute (VVI-40) or dual-chamber rate-responsive pacing at a rate of 70/minute (DDDR-70). At 37 months of follow-up for 80 patients treated ...