Current Treatment Options In Cardiovascular Medicine[JOURNAL]
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200 papers
Pre and Post Procedure Imaging of the Watchman® Device with Cardiac Computed Tomography Angiography.
Toy D, Naeger DM
Curr Treat Options Cardiovasc Med · 2019 Sep · PMID 31520214 · Publisher ↗
PURPOSE OF REVIEW: Left atrial appendage occlusion with the Watchman® device requires pre and post procedure imaging. Currently, transesophageal echocardiography is the recommended modality, though cardiac computed tomog...
PURPOSE OF REVIEW: Left atrial appendage occlusion with the Watchman® device requires pre and post procedure imaging. Currently, transesophageal echocardiography is the recommended modality, though cardiac computed tomography angiography may be an acceptable alternative. RECENT FINDINGS: Cardiac computed tomography angiography can be used to safely and accurately predict Watchman® device sizing. It can also be used to detect post procedure complications similar to, or better than, transesophageal echocardiography. Cardiac computed tomography angiography is a viable alternative imaging modality for pre and post procedure evaluation for the Watchman device.
The Impact of Pharmacist-Based Services Across the Spectrum of Outpatient Heart Failure Therapy.
West LM, Williams JB, Faulkenberg KD
Curr Treat Options Cardiovasc Med · 2019 Sep · PMID 31506885 · Publisher ↗
PURPOSE OF REVIEW: A multidisciplinary approach is vital to reduce mortality and hospitalizations in patients with heart failure. As members of the multidisciplinary team, pharmacists are uniquely positioned to care for...
PURPOSE OF REVIEW: A multidisciplinary approach is vital to reduce mortality and hospitalizations in patients with heart failure. As members of the multidisciplinary team, pharmacists are uniquely positioned to care for patients across the spectrum of heart failure. This comprehensive review explores the different facets in which pharmacists can be utilized to impact the care for patients with heart failure, including those with cardiac transplant and left ventricular assist devices (LVADs), in the outpatient setting. RECENT FINDINGS: Pharmacists can see heart failure patients in a variety of settings to reduce drug therapy-related issues, increase use of guideline-directed medical therapy (GDMT), and reduce hospitalizations. Although there is limited data available, pharmacists have also been described in aiding the therapeutic drug monitoring of warfarin for patients with LVADs and immunosuppression agents in the transplant population. Through collaborative practice agreements, pharmacists can provide progressive services such as titration of GDMT and lab monitoring, in addition to medication reconciliation, education, and review for potential drug-related problems. Pharmacists can increase access to patient care by providing services through distance-visits, shared medical appointments, and home visits.
Clinical Applications of MRA 4D-Flow.
Sierra-Galan LM, François CJ
Curr Treat Options Cardiovasc Med · 2019 Sep · PMID 31506869 · Publisher ↗
PURPOSE OF REVIEW: Four-dimensional (4D)-Flow cardiovascular magnetic resonance (CMR) is three-dimensional, time-resolved, three-directional velocity-encoded magnetic resonance that provides flow velocity data within a v...
PURPOSE OF REVIEW: Four-dimensional (4D)-Flow cardiovascular magnetic resonance (CMR) is three-dimensional, time-resolved, three-directional velocity-encoded magnetic resonance that provides flow velocity data within a volumetric region across the cardiac cycle (CC). The goals of this paper are to review the current clinical applications of this technique; provide an overview of the general physics; discuss key points from the expert consensus document; and present recent advances in the field. The advantages and disadvantages of 4D-Flow CMR in comparison with the standard and gold standard methods are summarized. RECENT FINDINGS: 4D-Flow CMR offers unique insights into cardiac and circulatory physiology with an ability to quantify advanced hemodynamic parameters in a variety of pathologic entities including aortic and pulmonary artery diseases, valvular heart disease, complex congenital heart disease, and extra-thoracic cardiovascular diseases. Recent large cohort studies highlight how it provides information that has clinical impact beyond a better understanding of the disease and that will permit better and more timely management and prognosis. 4D-Flow CMR provides unique qualitative and quantitative flow dynamics information and its impact on cardiac chambers, vessel walls, and myocardium. As scan acquisition and post-processing of 4D-Flow CMR become faster and simpler, the investigational and clinical opportunities will expand dramatically.
Pulmonary Hypertension in Patients Eligible for Transcatheter Mitral Valve Repair: Prognostic Impact and Clinical Implications.
Yucel E, Al-Bawardy R, Bertrand PB
Curr Treat Options Cardiovasc Med · 2019 Sep · PMID 31506851 · Publisher ↗
PURPOSE OF REVIEW: Transcatheter edge-to-edge mitral valve repair (TMVr) has been increasingly used in the treatment of patients with severe symptomatic mitral regurgitation who are at high or prohibitive risk for surgic...
PURPOSE OF REVIEW: Transcatheter edge-to-edge mitral valve repair (TMVr) has been increasingly used in the treatment of patients with severe symptomatic mitral regurgitation who are at high or prohibitive risk for surgical intervention. Pre-existing pulmonary hypertension is known to pertain worse prognosis for patients who are undergoing surgical intervention. The aim of this review is to discuss the current literature on the effects of pulmonary hypertension on the transcatheter edge-to-edge mitral valve repair outcomes. RECENT FINDINGS: Large registry data in patients undergoing TMVr for treatment of severe mitral regurgitation reveal a significant negative impact of baseline pulmonary hypertension on post-procedural outcomes. Pulmonary hypertension is associated with increased mortality and heart failure readmissions in patients undergoing TMVr using MitraClip. Further prospective studies are needed to determine whether earlier intervention will improve clinical outcomes.
Paclitaxel-Based Devices for the Treatment of PAD: Balancing Clinical Efficacy with Possible Risk.
Krawisz AK, Secemsky EA
Curr Treat Options Cardiovasc Med · 2019 Sep · PMID 31494757 · Publisher ↗
PURPOSE OF REVIEW: Paclitaxel-based endovascular devices have become the standard of care in symptomatic, medication-refractory peripheral artery disease (PAD) and in critical limb ischemia (CLI). This review examines th...
PURPOSE OF REVIEW: Paclitaxel-based endovascular devices have become the standard of care in symptomatic, medication-refractory peripheral artery disease (PAD) and in critical limb ischemia (CLI). This review examines the data on the efficacy and safety of these devices relative to standard balloon angioplasty (PTA) and bare metal stents (BMS). RECENT FINDINGS: Randomized controlled trials (RCTs) have found that peripheral devices coated with paclitaxel result in superior patency rates and decreased target lesion revascularization (TLR) compared with non-drug-coated devices. Recently, a meta-analysis of randomized controlled trials unexpectedly reported an increase in mortality in patients treated with paclitaxel-coated devices (PCDs), resulting in the pausing of ongoing trials and a warning of safety from the FDA. Observational data that has been published since this time has not supported this safety concern. PAD is a common disease that severely impacts quality and length of life. PCDs are a promising therapy for patients with PAD, offering a more effective and durable intervention when compared with traditional PTA/BMS. A meta-analysis of RCTs identified a signal of harm with these devices which has now been replicated by the FDA. However, there is significant missing data from the trials analyzed by the meta-analysis and FDA, no plausible mechanism linking paclitaxel to death, and no correlation between paclitaxel dose and mortality. Analyses in observational data have found no safety signal. An FDA panel evaluating the validity of this late-mortality signal recently adjourned, emphasizing that the available data is incomplete. PCDs will remain on the market, and an active discussion is underway for developing an approach for improved post-market surveillance, device-labeling, and cause of death adjudication.
Approach to Management of Premature Ventricular Contractions.
O'Quinn MP, Mazzella AJ, Kumar P
Curr Treat Options Cardiovasc Med · 2019 Sep · PMID 31487007 · Publisher ↗
PURPOSE OF REVIEW: Premature ventricular contractions (PVCs) are arrhythmias with presentation ranging from asymptomatic and benign to symptomatic, frequent and capable of inducing cardiomyopathy. Work in the late 1970s-...
PURPOSE OF REVIEW: Premature ventricular contractions (PVCs) are arrhythmias with presentation ranging from asymptomatic and benign to symptomatic, frequent and capable of inducing cardiomyopathy. Work in the late 1970s-1980s showed that they could be representative of underlying coronary artery disease, hypertension, or left ventricular hypertrophy. Furthermore, their presence is independently linked to an increased risk of stroke and sudden cardiac death. Since characterization of PVC-induced cardiomyopathy 21 years ago, there has been progressive interest in treating PVCs. This review aims to present an approach that practitioners can use for the treatment of PVCs. RECENT FINDINGS: Recent efforts have focused on optimizing techniques for mapping and ablation of PVCs in patients with symptoms or reduced LVEF. However, an understanding of the medical treatment options is necessary because medical management is still the first line of therapy. The practitioner will need to weigh the risks and benefits of these strategies in order to help the patient determine the best course of action. PVCs are recognized as a clinically significant arrhythmia, and evolving treatment strategies can improve cardiovascular outcomes. This review provides a concise summary of the current state of PVC treatment.
Cardiac Rehabilitation for Secondary Prevention of Cardiovascular Disease: 2019 Update.
Thomas RJ, Huang HH
Curr Treat Options Cardiovasc Med · 2019 Sep · PMID 31486974 · Publisher ↗
PURPOSE OF REVIEW: To provide updated information on the science and practice of cardiac rehabilitation (CR). RECENT FINDINGS: Evidence continues to mount that supports the many benefits of CR as well as the important ga...
PURPOSE OF REVIEW: To provide updated information on the science and practice of cardiac rehabilitation (CR). RECENT FINDINGS: Evidence continues to mount that supports the many benefits of CR as well as the important gap in delivering CR to all eligible patients. Recent studies have identified center-based and home-based strategies to improve the reach and impact of CR. Cardiac rehabilitation is a systematic, evidence-based approach to deliver effective secondary CVD preventive therapies to individuals with cardiovascular conditions. Because of a number of benefits that have been associated with CR, clinical practice guidelines strongly endorse CR services for eligible patients. Research supports CR as a high value service, with evidence of favorable clinical outcomes and costs. Unfortunately, a significant gap exists in CR participation due to a number of patient-, provider-, and system-level barriers. Solutions to most of these barriers have been identified and involve systematic approaches to CR delivery. The future is bright for CR as new strategies, new policies, and new methods of delivery continue to develop to help provide CR services to all eligible patients.
Multimodality Imaging in the Evaluation of Intracardiac Masses.
Wu CM, Bergquist PJ, Srichai MB
Curr Treat Options Cardiovasc Med · 2019 Sep · PMID 31486926 · Publisher ↗
Intracardiac masses are classified as neoplastic or non-neoplastic. Prognosis varies based on the diagnosis of the mass since treatment options differ greatly. As novel imaging techniques emerge, a multimodality approach...
Intracardiac masses are classified as neoplastic or non-neoplastic. Prognosis varies based on the diagnosis of the mass since treatment options differ greatly. As novel imaging techniques emerge, a multimodality approach to the evaluation of intracardiac masses becomes an important part of non-invasive evaluation prior to potential surgical planning or oncological treatment. The purpose of this article is to compare the available imaging modalities-echocardiography, cardiovascular magnetic resonance, cardiac computed tomography, nuclear imaging, and emerging novel hybrid imaging techniques for future clinical applications-and to review the characteristic features seen on those modalities for the most common intracardiac masses.
Leadless Pacemakers: Recent and Future Developments.
Kroman A, Saour B, Prutkin JM
Curr Treat Options Cardiovasc Med · 2019 Sep · PMID 31486925 · Publisher ↗
PURPOSE OF REVIEW: Leadless pacemakers were developed to reduce complications associated with transvenous pacemaker implant and long-term follow-up. Since initial market release, however, there have been registry and sin...
PURPOSE OF REVIEW: Leadless pacemakers were developed to reduce complications associated with transvenous pacemaker implant and long-term follow-up. Since initial market release, however, there have been registry and single-center reports documenting improvements in implant technique, reduced complication rates, and new patient populations studied. RECENT FINDINGS: Most studies have demonstrated a further reduction in complication rates and safe implant in those on continuous anticoagulation. Perforation rates are decreasing but still occur and risk factors include BMI < 20 kg/m2, age ≥ 85 years, females, history of heart failure, indication not including atrial fibrillation, and chronic lung disease. Device infections are exceedingly rare, even in those undergoing infected transvenous devices at the same time. For appropriate patients, leadless pacing is a safe and reasonable option, especially if atrial-based sensing or pacing is not needed. Future iterations may include VDD pacing, atrial pacing, dual-chamber pacing, biventricular pacing, and device-device communication.
Morbid Obesity as a Therapeutic Target for Heart Failure.
Albert CL
Curr Treat Options Cardiovasc Med · 2019 Sep · PMID 31486922 · Publisher ↗
PURPOSE OF REVIEW: This review will define morbid obesity and relationship between morbid obesity and heart failure syndromes. It will delve into unique challenges facing patients with dual diagnoses of heart failure and...
PURPOSE OF REVIEW: This review will define morbid obesity and relationship between morbid obesity and heart failure syndromes. It will delve into unique challenges facing patients with dual diagnoses of heart failure and morbid obesity and examine the data that obesity should be a target in the treatment of heart failure. RECENT FINDINGS: Emerging literature has indicated the safety and efficacy of surgical weight loss in patients with heart failure. Furthermore, bariatric surgery with associated weight loss has been associated with improvements in heart failure symptoms and reverse remodeling on echocardiography. In patients with advanced heart failure, bariatric surgery has led to improvement in heart failure to obviate the need for cardiac transplantation or sufficient weight loss for cardiac transplant eligibility. In heart failure patients who are morbidly obese, treatment of obesity is an effective therapeutic target with a myriad of potential benefits.
Long-Term Prognostic Value of Stress Perfusion Cardiovascular Magnetic Resonance Imaging.
Filev PD, Stillman AE
Curr Treat Options Cardiovasc Med · 2019 Aug · PMID 31473870 · Publisher ↗
PURPOSE OF REVIEW: The purpose of this review is to analyze the long-term prognostic value of stress perfusion cardiovascular magnetic resonance (CMR) in patients with suspected or known coronary artery disease (CAD). RE...
PURPOSE OF REVIEW: The purpose of this review is to analyze the long-term prognostic value of stress perfusion cardiovascular magnetic resonance (CMR) in patients with suspected or known coronary artery disease (CAD). RECENT FINDINGS: Stress perfusion CMR provides high diagnostic accuracy for detection of CAD, with high sensitivity and relatively lower specificity. A normal stress perfusion CMR examination is highly predictive of overall low patient risk. Conversely, abnormal stress perfusion CMR results are associated with mortality and increased risk for adverse cardiac-related events. Stress perfusion CMR is a useful and robust tool for risk reclassification across different CAD risk categories, and most significant for patients of intermediate risk. Stress CMR is reliable for excluding clinically significant coronary artery disease in patients presenting with low-risk acute chest pain. An ischemic burden threshold of less than 1.5 cardiac segments has been found to be most appropriate for safe deferral from revascularization therapy. A stress perfusion CMR-guided strategy has been shown to be noninferior compared to fractional flow reserve (FFR) for revascularization in patients with stable CAD. In clinical practice, CMR offers a multiplicity of useful techniques besides stress perfusion which may add significant prognostic value when combined with the findings of the stress test itself. Stress perfusion CMR is an accurate noninvasive diagnostic test for patients with suspected CAD and provides strong prognostic value across different risk categories.
Clinical Applications of Echo Strain Imaging: a Current Appraisal.
Fava AM, Meredith D, Desai MY
Curr Treat Options Cardiovasc Med · 2019 Aug · PMID 31473859 · Publisher ↗
PURPOSE OF REVIEW: This article reviews recent advances in echocardiographic strain imaging, particularly in its ability to prognosticate in cardiovascular outcomes and impact clinical decision making. RECENT FINDINGS: S...
PURPOSE OF REVIEW: This article reviews recent advances in echocardiographic strain imaging, particularly in its ability to prognosticate in cardiovascular outcomes and impact clinical decision making. RECENT FINDINGS: Strain has been proposed as a sensitive tool in detecting early ventricular dysfunction. Left ventricular global longitudinal strain (LV-GLS) detects subtle changes in myocardial function, often not quantifiable by ejection fraction alone. Thus, LV-GLS provides the opportunity for early decision-making, and the implementation of more effective treatments, improving outcomes in a variety of diseases such as valvular heart diseases, cardio-oncology, ischemic heart disease, cardiomyopathies, heart transplantation, and pericardial diseases and cardiomyopathies. Strain is a promising tool for the early detection of myocardial dysfunction in patients with preserved left ventricular ejection fraction and can prognosticate long-term outcomes.
Recent Updates in the Role of Wearable Cardioverter Defibrillator for Prevention of Sudden Cardiac Death.
Kirolos I, Jones D, Hesterberg K … +3 more , Yarn C, Khouzam RN, Levine YC
Curr Treat Options Cardiovasc Med · 2019 Aug · PMID 31392426 · Publisher ↗
PURPOSE OF REVIEW: The wearable cardioverter defibrillator (WCD) or LifeVest may protect against sudden cardiac death (SCD) in patients awaiting insertion of an implantable cardioverter defibrillator (ICD). The purpose o...
PURPOSE OF REVIEW: The wearable cardioverter defibrillator (WCD) or LifeVest may protect against sudden cardiac death (SCD) in patients awaiting insertion of an implantable cardioverter defibrillator (ICD). The purpose of this communication is to review the rationale behind WCD therapy and to critically analyze recent data regarding its clinical efficacy. We seek to provide evidence-based recommendations regarding the potential role of the WCD in certain populations. RECENT FINDINGS: The only randomized controlled trial that evaluated WCD therapy did not demonstrate a reduced rate of arrhythmic death in patients prescribed the WCD during the first 90-day post-myocardial infarction (MI). However, when considering trial results alongside previous retrospective data, patient noncompliance with WCD therapy-rather than ineffectiveness of WCD therapy-remains an important theme. The uncertainty of data regarding the use of WCD therapy in patients during ICD waiting periods should be considered as part of the shared decision processes between healthcare providers and patients. Higher rates of adherence are needed to ensure efficiency. Well-designed future studies with appropriate cost-effectiveness analyses are indicated to define the clinical efficacy of WCD therapy on arrhythmic and non-arrhythmic morbidity and mortality in patients who are not yet candidates for ICDs.
How to Optimize Patient Selection and Device Performance of the Newest Generation Left Ventricular Assist Devices.
Albert CL, Estep JD
Curr Treat Options Cardiovasc Med · 2019 Aug · PMID 31388835 · Publisher ↗
PURPOSE OF REVIEW: This review will discuss key differences of third-generation left ventricular assist devices (LVADs), identify patient selection considerations to optimize post-implant clinical outcomes, and summarize...
PURPOSE OF REVIEW: This review will discuss key differences of third-generation left ventricular assist devices (LVADs), identify patient selection considerations to optimize post-implant clinical outcomes, and summarize key echocardiographic and hemodynamic parameters to guide device optimization. RECENT FINDINGS: There are major engineering differences between the third-generation LVADs which contribute to unique pump operational characteristics. Improved hemocompatibility has led to reduction in hemocompatibility-related adverse events (HRAEs), particularly for the Heartmate 3 pump. Having an optimal hemodynamic profile compared with not while on LVAD support defined by either echocardiography or right heart catheterization is associated with a more favorable event-free survival. With attentive patient selection, use of current third-generation LVADs, and appropriate use of echocardiography and invasive ramp studies, LVAD therapy will continue to improve survival and quality of life in select patients with advanced heart failure.
Addressing the Gap in Physician Preparedness To Assess Cardiovascular Risk in Women: a Comprehensive Approach to Cardiovascular Risk Assessment in Women.
Isakadze N, Mehta PK, Law K … +2 more , Dolan M, Lundberg GP
Curr Treat Options Cardiovasc Med · 2019 Jul · PMID 31359165 · Publisher ↗
PURPOSE OF REVIEW: Increased recognition of risk factors and improved knowledge of sex-specific presentations has led to improved clinical outcomes for women with cardiovascular disease (CVD) compared to two decades ago....
PURPOSE OF REVIEW: Increased recognition of risk factors and improved knowledge of sex-specific presentations has led to improved clinical outcomes for women with cardiovascular disease (CVD) compared to two decades ago. Yet, CVD remains the leading cause of death for women in the USA. Women have unique risk factors for CVD that continue to go under-recognized by their physicians. RECENT FINDINGS: In a nationwide survey of primary care physicians (PCPs) and cardiologists, only 22% of PCPs and 42% of cardiologists reported being extremely well prepared to assess CVD risk in women. A presidential advisory from the American Heart Association (AHA) and American College of Obstetrics and Gynecologist (ACOG) recommends that cardiologists and obstetricians and gynecologists (Ob/Gyns) collaborate to promote CVD risk identification and reduction throughout a woman's lifetime. We suggest a comprehensive approach to identify unique and traditional risk factors for CVD in women, address the gap in physician knowledge, and improve cardiovascular care for women.
Diagnostic and Therapeutic Approach to Arrhythmias in Adult Congenital Heart Disease.
Guerrier K, Hendrickson B, Waller BR … +1 more , Wetzel GT
Curr Treat Options Cardiovasc Med · 2019 Jul · PMID 31342289 · Publisher ↗
PURPOSE OF REVIEW: Adult survivors of congenital heart disease (CHD) are at increased risk of arrhythmia. The goal of this review is to outline diagnostic and therapeutic approaches to arrhythmia in adult CHD patients. R...
PURPOSE OF REVIEW: Adult survivors of congenital heart disease (CHD) are at increased risk of arrhythmia. The goal of this review is to outline diagnostic and therapeutic approaches to arrhythmia in adult CHD patients. RECENT FINDINGS: Macro-reentrant atrial tachyarrhythmia is the most common arrhythmia encountered in adults with CHD. Approximately 25% of hospitalizations associated with arrhythmia. The risk of ventricular arrhythmia is estimated as high as 25-100 times that for the general population and increased after two decades. Routine ambulatory monitoring is important for arrhythmia risk assessment in adults with CHD. There are limitations, potential adverse effects, and risk of recurrence with antiarrhythmic drugs, catheter ablation, and surgical approaches. Adults with CHD suffer various forms of arrhythmia, are at increased risk of sudden death, and require special consideration for medical and interventional therapy.
Maternal Mortality in the United States and the HOPE Registry.
Grodzinsky A, Florio K, Spertus JA … +9 more , Daming T, Schmidt L, Lee J, Rader V, Nelson L, Gray R, White D, Swearingen K, Magalski A
Curr Treat Options Cardiovasc Med · 2019 Jul · PMID 31342274 · Publisher ↗
PURPOSE OF REVIEW: Maternal mortality in the United States is highest among all developed nations and continues to rise. The leading cause of morbidity and mortality during pregnancy and the postpartum period is cardiova...
PURPOSE OF REVIEW: Maternal mortality in the United States is highest among all developed nations and continues to rise. The leading cause of morbidity and mortality during pregnancy and the postpartum period is cardiovascular disease. While there are large European and Canadian studies exploring the care and outcomes of moms with heart disease in pregnancy, there are no large prospective studies to guide the care of this growing group of patients in the US. We review the current approach to the management of patients with heart disease in pregnancy and the gaps in knowledge thereof. RECENT FINDINGS: Currently, antenatal management and delivery planning are highly variable for patients with heart disease in pregnancy and maternal risk models' application to the US patient population is limited by their derivation from an international cohort of patients and their focus on patients with congenital heart disease. As the need for interdisciplinary care between cardiologists and obstetricians becomes evident, and as broad research efforts within this space are very much needed, we propose a research collaborative called the Heart Outcomes in Pregnancy: Expectations (HOPE) for Mom and Baby Registry. The HOPE Registry aims to address key clinical questions surrounding the preconception period, antenatal care, delivery planning and outcomes, and long-term postpartum care and outcomes of these unique patients. We have made progress in recent years by recognizing the clinical need to address and standardize the management of patients with heart disease in pregnancy. We now must initiate and propel US-based cardio-obstetrics research to address key gaps in knowledge and variability in the care of patients with heart disease in pregnancy.
Impact of Technique and Technology on Mitral Isthmus Ablation.
Naniwadekar A, Koruth J
Curr Treat Options Cardiovasc Med · 2019 Jul · PMID 31342200 · Publisher ↗
PURPOSE OF REVIEW: Mitral isthmus ablation is an established strategy in the treatment of peri-mitral atrial flutter and as an adjunct to pulmonary vein isolation. The objective of this review is to summarize the techniq...
PURPOSE OF REVIEW: Mitral isthmus ablation is an established strategy in the treatment of peri-mitral atrial flutter and as an adjunct to pulmonary vein isolation. The objective of this review is to summarize the techniques and specific strategies that allow for increased success and durability of mitral isthmus ablation. RECENT FINDINGS: Achieving bidirectional block across the mitral isthmus remains a challenge due to the increased thickness in this region, convective cooling as a result of coronary sinus blood flow, and the occurrence of epicardial connections. Several strategies to achieve durable mitral isthmus block, such as coronary sinus ablation, coronary sinus balloon occlusion, ethanol ablation via the vein of Marshall, and using alternate mitral lines in select cases, are described in detail in this review.
CRT Optimization: What Is New? What Is Necessary?
Dauw J, Martens P, Mullens W
Curr Treat Options Cardiovasc Med · 2019 Jul · PMID 31342198 · Publisher ↗
Cardiac resynchronization therapy (CRT) has proven to improve quality of life, reduce heart failure hospitalization, and prolong life in selected heart failure patients with reduced ejection fraction, on optimal medical...
Cardiac resynchronization therapy (CRT) has proven to improve quality of life, reduce heart failure hospitalization, and prolong life in selected heart failure patients with reduced ejection fraction, on optimal medical therapy and with electrical dyssynchrony. To ensure maximal benefit for CRT patients, optimization of care should be implemented. This begins with appropriate referring as well as selecting patients, knowing that the presence of left bundle branch block and QRS ≥ 150 ms is associated with the greatest reverse remodeling. The LV lead, preferably quadripolar, is best targeted in a postero-lateral position. After implantation, optimal device programming should aim for maximal biventricular pacing and in selected cases further electrical delay optimization might be of use. Even as important, is the implementation of thorough multidisciplinary heart failure care with medication uptitration, remote monitoring, rehabilitation, and patient education. The role of newer pacing strategies as endocardial or His-bundle pacing remains the subject of ongoing investigation.
Atrial Fibrillation Ablation: Indications and Techniques.
Patel NJ, Maradey JA, Bhave PD
Curr Treat Options Cardiovasc Med · 2019 Jul · PMID 31342171 · Publisher ↗
PURPOSE OF REVIEW: Atrial fibrillation (AF) predisposes to embolic strokes and reduced quality of life. Ablation (catheter-based or surgically performed) can be employed to promote the maintenance of sinus rhythm in a ca...
PURPOSE OF REVIEW: Atrial fibrillation (AF) predisposes to embolic strokes and reduced quality of life. Ablation (catheter-based or surgically performed) can be employed to promote the maintenance of sinus rhythm in a carefully selected subset of patients with AF. The goal of this review is to discuss the indications and techniques for AF ablation, as well as post-procedural outcomes. RECENT FINDINGS: Atrial fibrillation ablation improves quality of life in patients with atrial fibrillation although no clear reduction in stroke or overall mortality has been shown. Familiarity with the indications for AF ablation is important for all cardiologists, as is having a sound understanding of the efficacy of the procedure and potential complications. Furthermore, acquiring a grasp of the different modalities of AF ablation (including percutaneous endocardial techniques and surgical ablation approaches) will help to facilitate effective and appropriate referrals.
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