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3 years ago
Dear Sir,
We read Dr Zografos’ response to our article1 with interest. He agrees with the findings of our review but highlights two important issues for further discussion, which we address below.
Right ventricular lead position
Dr Zografos points out that randomised comparisons of different right ventricular lead positions have not shown superiority of septal pacing over apical pacing.2 This…
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3 years ago
Recurrent ventricular tachycardia (VT) in patients who have an implantable cardioverter-defibrillator (ICD) with subsequent shocks is associated with reduced quality of life and an adverse prognosis. Pharmacological treatments are associated with significant side-effects. Catheter ablation has been used to reduce the number of ICD therapies in patients with ischaemic and non-ischaemic…
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3 years ago
Ventricular tachycardia (VT) is a significant cause of morbidity and mortality in patients with structural heart disease (SHD). While implantable cardioverter-defibrillators (ICDs) have been shown to be effective in preventing sudden death due to ventricular arrhythmias, they are not able to prevent recurrent VT episodes. Antiarrhythmic drugs (AADs) have some demonstrated efficacy in preventing…
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3 years ago
Heart failure (HF) and AF share common pathophysiologic pathways and often coexist.1 Indeed, HF has been identified as the strongest predictor of AF in a Framingham Heart study population-based cohort.2 Moreover, HF and AF are involved in a vicious pathophysiological interplay. HF promotes AF mainly through raised atrial filling pressures, abnormal calcium handling, neurohormonal activation and…
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3 years ago
AF is the most common rhythm disorder. It is estimated AF will affect 6–12 million Americans by 2050 and 17.9 million Europeans by 2060.1–4 AF is responsible for significant morbidity, mortality and healthcare costs.5–7 Heart failure with reduced ejection fraction (HFrEF) is also a rising epidemic that will afflict over 8 million Americans by 2030.8 AF is common in patients with HFrEF9,10 and…
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3 years ago
Ventricular arrhythmias are a therapeutic challenge. They occur frequently in clinical practice, are found in patients with and without structural heart disease, and most importantly, are unpredictable and potentially deadly. Patients with a history of sustained ventricular tachycardia (VT) and VF or those at high risk for such arrhythmias, may require an ICD to prevent sudden cardiac arrest…
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3 years ago
CRT is an essential treatment for patients with heart failure and reduced ejection fraction as it can restore left ventricular (LV) electrical and mechanical synchrony. It has been shown to increase quality of life, improve functional status, reduce hospitalisation, improve LV systolic function and reduce mortality in properly selected patients.1,2 While CRT is an effective therapy, approximately…
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3 years ago
Since the introduction of CRT more than 20 years ago, its role in mild to severe systolic heart failure has become well established. CRT has been shown to decrease mortality, reduce heart failure hospitalisations and improve functional status in patients with NYHA class II–IV heart failure and QRS prolongation, most commonly with LBBB pattern.1 One of the major limitations of CRT implementation…
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3 years ago
Despite the fact that more than 20 years have passed since the clinical introduction of cardiac resynchronisation therapy (CRT), one of the key questions – do we need an ICD for primary prevention of sudden cardiac death (SCD) in CRT patients? – is still unanswered.
Prospective Randomised Controlled Trials
Multiple prospective randomised controlled trials have been conducted to establish the…
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3 years ago
Ivabradine is a pure heart rate-lowering agent best characterised by its negative chronotropic effect on the sinoatrial node.1 Its unique mechanism selectively blocks the pacemaker funny (If) channels, which are responsible for spontaneous depolarisation in the sinoatrial node that regulates heart rate during sinus rhythm (Figure 1).2 Since 1980, it has been well established that controlling the…
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