NYU Cardiac Newsline
- A Publication of the Department of Cardiothoracic Surgery and Division of Interventional Cardiology, and Electrophysiology
Recent Advances is Electrophysiology-New Treatment for Heart Failure
By Larry Chinitz, MD, Director Electrophysiology Laboratory; Neil Bernstein, Assistant Professor of Medicine and Douglas Holmes, MD; Assistant Professor of Medicine
Biventricular pacing results in resynchronization of left ventricular contraction and is now a treatment option for patients with heart failure. Studies in Europe have demonstrated that patients with symptomatic heart failure can achieve significant functional improvement when they are simultaneously paced from right and left ventricles. This treatment is now being investigated in appropriate patients in the United States. While heart failure is associated with delayed and asymmetric left ventricular contractility, multi-site pacing has been shown to significantly improve hemodynamics. The Division of Clinical Cardiac Electrophysiology at NYU is actively enrolling patients in a number of new studies to expand and define the indications of this therapy. We anticipate that this will make a substantial impact on the enormous morbidity and mortality in patients with heart failure. The following clinical trials are available: VECTOR: Designed for patients without standard pacing indications, biventricular pacing can be recommended if their baseline QRS is greater than 135 ms and they have class II or greater heart failure. MIRACLE ICD: This protocol is for patients with standard indications for ICD implantation and baseline QRS duration greater than 130 ms. Preliminary clinical data suggest that such pacing can result in fewer ICD discharges and improved heart failure status. PAVE (Pacing after AV node ablation): Since right ventricular pacing can compromise hemodynamic function in patients with normal left ventricular function, biventricular pacing will be compared to RV pacing after AV node ablation.
New Diagnostics for Sudden Death
T wave Alternans (TWA) is a powerful new tool for risk, stratifying patients for sudden death. This test examines the beat-to-beat variation of cardiac repolarization and is emerging as an accurate predictor of ventricular arrhythmias. Patients with past myocardial infarction, reduced ejection fraction, and non-sustained ventricular tachycardia on routine screening Holter recordings are the focus of the ABCD trial (Alternans before cardioverter defibrillator). Such patients have shown better survival with ICD therapy if they demonstrated inducible VT during EPS. This study will determine whether people with normal EPS results but abnormal TWA findings will also benefit from ICD placement. Increasing our ability to select and protect patients from sudden death is the major focus of cardiac electrophysiologists and the goal of this prospective study.
In summary, NYU is taking an aggressive approach to the management and risk stratification of patients with impaired left ventricular function and heart failure. We believe that this approach is justified by the enormous mortality in this population and the number of patients at risk.
- A Publication of the Department of Cardiothoracic Surgery and Division of Interventional Cardiology, and Electrophysiology
Recent Advances is Electrophysiology-New Treatment for Heart Failure
By Larry Chinitz, MD, Director Electrophysiology Laboratory; Neil Bernstein, Assistant Professor of Medicine and Douglas Holmes, MD; Assistant Professor of Medicine
Biventricular pacing results in resynchronization of left ventricular contraction and is now a treatment option for patients with heart failure. Studies in Europe have demonstrated that patients with symptomatic heart failure can achieve significant functional improvement when they are simultaneously paced from right and left ventricles. This treatment is now being investigated in appropriate patients in the United States. While heart failure is associated with delayed and asymmetric left ventricular contractility, multi-site pacing has been shown to significantly improve hemodynamics. The Division of Clinical Cardiac Electrophysiology at NYU is actively enrolling patients in a number of new studies to expand and define the indications of this therapy. We anticipate that this will make a substantial impact on the enormous morbidity and mortality in patients with heart failure. The following clinical trials are available: VECTOR: Designed for patients without standard pacing indications, biventricular pacing can be recommended if their baseline QRS is greater than 135 ms and they have class II or greater heart failure. MIRACLE ICD: This protocol is for patients with standard indications for ICD implantation and baseline QRS duration greater than 130 ms. Preliminary clinical data suggest that such pacing can result in fewer ICD discharges and improved heart failure status. PAVE (Pacing after AV node ablation): Since right ventricular pacing can compromise hemodynamic function in patients with normal left ventricular function, biventricular pacing will be compared to RV pacing after AV node ablation.
New Diagnostics for Sudden Death
T wave Alternans (TWA) is a powerful new tool for risk, stratifying patients for sudden death. This test examines the beat-to-beat variation of cardiac repolarization and is emerging as an accurate predictor of ventricular arrhythmias. Patients with past myocardial infarction, reduced ejection fraction, and non-sustained ventricular tachycardia on routine screening Holter recordings are the focus of the ABCD trial (Alternans before cardioverter defibrillator). Such patients have shown better survival with ICD therapy if they demonstrated inducible VT during EPS. This study will determine whether people with normal EPS results but abnormal TWA findings will also benefit from ICD placement. Increasing our ability to select and protect patients from sudden death is the major focus of cardiac electrophysiologists and the goal of this prospective study.
In summary, NYU is taking an aggressive approach to the management and risk stratification of patients with impaired left ventricular function and heart failure. We believe that this approach is justified by the enormous mortality in this population and the number of patients at risk.