© 2003 by European Society of Cardiology
CARDIOSTIM, SEVILLE
SELECTED ABSTRACTS FROM THE 6th ANNUAL SYMPOSIUM ON HEART FAILURE MANAGEMENT
October 29–31, 2003 – Seville, SPAIN
Chairman of Cardiostim Saint Cloud, France
The 4th Transmediterranean Symposium held in Seville, Spain, on October 29–31, 2003 is strictly dedicated to heart failure and especially to Cardiac Resynchronization Therapy. This is an educational symposium with a large place given to interactive sessions. It has been organised under the auspices of the European Society of Cardiology, la Société Franxaise de Cardiologie, and the French Pacing Working Group of la Société Fra
aise de Cardiologie.
Submitted abstracts were selected by peer review, with a rejection rate of 43%. Abstracts have been organised in six sessions: three sessions for oral presentations, three poster sessions, and two additional oral presentations included in the main programme. Comments have been written about each presented abstract in each of the sessions, and about selected abstracts in the poster sessions. As the author of these comments is a specialist in pacing and electrophysiology, the comments are only about abstracts dealing with cardiac resynchronization therapy (CRT). Selected abstracts are presented in the following sections, and organized in the way they were displayed during the congress. The codes have the following meaning: the .rst number is the session number, and the second number is the abstract number within each session.
Session 3, Wednesday 29, Nervion Room, 8:30–10:00, Abstracts 3-1 to 3-6
Long-term outcome of patients implanted with CRT devices
All teams implanting CRT devices recognise the efficacy of the technique for improving the clinical status of patients selected for this therapy. This treatment is applied when patients remain symptomatic although maximal medical therapy has been prescribed.
Muhyaldeen (3-1) confirms the results obtained with CRT in a population of patients with heart failure and broad QRS complexes. One of the major results of this group, is the huge reduction in hospital admissions (80.1%), and in family doctor visits (58%), that must have a beneficial impact on the cost of management of heart failure in this cohort of patients. These results con.rm those of Curnis who recently performed a similar study in Italy. These observations should prompt Ministries of Health to be less restrictive in the reimbursement of CRT devices.
Medical therapy must frequently be revised a few weeks after implantation of the device. Diuretic dosage becomes too high; ACE inhibitors and/or beta-blockers can be increased in dosage or introduced.
Clémenty (3-2) shows a reduction in the drug regimen, correlated with the improvement in the clinical status of his patient population, whereas Senni (3-3) reports the preliminary results of the pilot phase of the CARIBE-HF study, which demonstrates the possibility to introduce or increase beta-blocker therapy after CRT. This issue is of major importance as the use of beta-blockers is associated with a significant reduction in mortality and cardiovascular events in this category of patients. Thus, once recommendations of good practice in CRT for heart failure are proposed, the principle of revision of medical therapy after CRT application should be included. In the same way, all trials dealing with long-term results of CRT should include the possibility or necessity of revising medical therapy after CRT device implantation: CRT is just a part of the therapeutic strategy for patients with heart failure and impairment of the ventricular mechanical contraction sequence.
Today, nobody discusses the usefulness and reliability of pacemaker memories for the diagnosis and follow-up of atrial arrhythmias. In the early 1990s, when we first revealed the high incidence of such arrhythmias from the analysis of longterm recorded memory data, we had to understand the semiology of this new diagnostic tool before being capable of reliable interpretation. Nowadays, haemodynamic sensors are introduced in CRT devices, and new diagnostic tools are available to provide direct or indirect information on the clinical tolerance of exercise in heart failure patients. These data should help the physician to understand the clinical condition of the patient and to improve the quality of follow-up.
Decision-making concerning strategies of medical therapy should be facilitated. Linde (3-4) shows the usefulness of daily physical activity recording for the analysis of the clinical outcome of patients implanted with a CRT system. The variations in this parameter correlate well with the variations in the New York Heart Association (NYHA) class. Thus, analysis of this type of information could be a reliable tool for the evaluation of outcome, just as we are performing with atrial arrhythmia follow-up in patients implanted with a DDD pacemaker.
The two last abstracts of this session deal with the difficult issue of the prediction of response of patients to CRT. Lamp (3-5) shows, in a large patient population, that the pre-implant clinical data is not sufficient to predict the response, that patients who demonstrate a reduction in left ventricular volume have a more favourable outcome, and that coronary artery disease patients respond less well than dilated cardiomyopathy patients. All these findings confirm thoughts of many colleagues derived from their own experience. Vogt (3-6) brings some more information as he shows that the value of the inter-ventricular delay (left ventricular pre-ejection interval–right ventricular pre-ejection interval), measured prior to implantation of the CRT device, predicts the response of the patient to the therapy, and depends on variable conditions, such as the underlying heart disease. Besides, pulse pressure measurement is a method used by the team at the moment of the implantation procedure, to guide the location of the implanted left ventricular lead, and the choice of the pacing mode. This supports the desire of many CRT system implanters who wish to use a simple, and reliable haemodynamic assessment during implantation to select the optimal pacing sites. However, no one has demonstrated the impact of such an evaluation on long-term results in comparison with absence of haemodynamic investigation at implant.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||