Maximo Rivero-Ayerza

Left ventricular (LV) lead implantation is feasible using remote magnetic navigation of a guidewire (Stereotaxis, St Louis, MO, USA). A novel software that performs a three-dimensional (3D) reconstruction of vessels based on two or more angiographic views has been developed recently (CardiOp-B system, Paeion Inc., Haifa, Israel). The objective of this paper is to evaluate: (i) the performance of the 3D reconstruction software which reproduce the anatomy of the coronary sinus (CS) and (ii) the efficacy of remotely navigating a magnetic guidewire within the CS based on this reconstruction. In patients undergoing cardiac resynchronization therapy implantation, a 3D reconstruction of the CS was performed using the CardiOp-B system. Accuracy of the reconstruction was evaluated by comparing with the CS angiogram. This reconstruction was imported into the Stereotaxis system. On the basis of the reconstruction, magnetic vectors were automatically selected to navigate within the CS and manually adjusted if required. Feasibility of deploying the guidewire and LV lead into the selected side branch (SB), fluoroscopy time (FT) required for cannulation of the target SB, and total FT were also evaluated. Sixteen patients were included. In one case, the software could not reconstruct the CS. The quality of the reconstruction was graded as good in 13 and poor in 2. In 10 cases, manual adjustments to the traced edges of the CS were required to perform the 3D reconstruction, and in 5, no adjustments were required. In 13 patients, the target SB was engaged on the basis of the automatically selected vectors. In two cases, manual modification of the vector was required. Mean total FT was 23 +/- 14 min and the FT required to cannulate the target SB was 1.7 +/- 1.3 min. A 3D reconstruction of the CS can be accurately performed using two angiographic views. This reconstruction allows precise magnetic navigation of a guidewire within the CS.

The prognostic significance of atrial fibrillation (AF) in hospitalized patients with heart failure (HF) remains poorly understood. To evaluate in what way AF and its different modes of presentation affect the in-hospital mortality in patients admitted with HF. The EuroHeart Failure Survey was conducted to ascertain how hospitalized HF patients are managed in Europe. The survey enrolled patients over a 6-week period in 115 hospitals from 24 countries. For this analysis, patients were categorized into three groups according to the type of AF, previous AF (patients known to have had AF prior to admission), new-onset AF (no previous AF with AF diagnosed during hospitalization), and no AF (no previous AF and no AF during hospitalization). Clinical variables, duration of hospitalization, and in-hospital survival status were assessed and compared among groups. Of the 10 701 patients included in the survey; 6027 (57%) had no AF, 3673 (34%) had previous AF, and 1001 (9%) had new-onset AF. Patients with new-onset AF had a longer stay in the intensive care unit (ICU) when compared with previous AF and no AF patients (mean 2.6 ± 5.3, 1.2 ± 3.5, and 1.5 ± 4.1 days, respectively; P < 0.001). In-hospital mortality was higher among patients with new-onset AF when compared with previous AF or no AF patients (12, 7, and 7% respectively; P < 0.001). After adjusting for multiple clinical variables, new-onset AF (not previous AF) was an independent predictor of in-hospital mortality (odds ratio 1.53, 95% CI 1.1–2.0). In hospitalized patients with HF, new-onset AF is an independent predictor of in-hospital mortality and a longer ICU and hospital stay.

A 72-year-old man presented with advanced symptoms of heart failure due to an idiopathic dilated cardiomyopathy was diagnosed. He presented with sinus rhythm and a left bundle branch block pattern on the electrocardiogram. The echocardiogram showed a severely depressed left ventricular (LV) systolic function with evidence of intra- and inter-ventricular dyssynchrony. Symptoms were considered to be refractory to standard medical therapy and the patient was advised to undergo cardiac resynchronization therapy device implantation. The patient underwent trans-venous implantation of a biventricular defibrillator. A magnetic guidewire was remotely steered to the coronary sinus side branch. Due to marked tortuosity of a lateral side branch (the ideal pacing site), positioning of the LV pacing lead was difficult and time-consuming (Figure 1). Aware of the difficulty and the efforts spent in accessing the ideal LV pacing site, the patient considered the peculiar shape described by the LV lead inside his heart as a way of expressing his gratitude. He presented no complications during the procedure and was dismissed uneventfully 48 h after implantation.

Aims Cardiac resynchronization therapy (CRT) has been shown to improve symptoms and exercise tolerance in patients with advanced heart failure (HF). However, studies were underpowered to address its effect on overall mortality. To evaluate whether CRT alone (without a combined defibrillator function) reduces overall mortality as compared with optimal pharmacological therapy, and how it affects the mode of death in patients with advanced HF.