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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses some of the open issues in implantable cardioverter-defibrillator and cardiac resynchronization therapy.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EProfessor Pangiotis Vardas, MD, Heraklion University Hospital, Crete, Greece, discussed some of the open issues in implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT). Commenting on the concern about the high number of patients who must be treated (NNT) to save 1 life with ICD implantation and CRT, Prof. Vardas reminded the audience that \u201cthis number is highly dependent on the time window over which the benefit is assessed.\u201d Pointing to the MADIT-II trial, he noted that while the NNT in Year 1 was 133 patients, it was only 17 in Year 2 and 11 in Year 3. Another important issue for ICDs and CRT therapy is the criteria for patient evaluation, which Prof. Vardas believes should be updated with a particular need for additional, more reliable markers. Technical issues that he believes need to be addressed include device longevity, inappropriate shocks, lead reliability, and follow-up for ICDs and lead stability, easier device programming, and follow-up for CRT. In concluding, Prof. Vardas suggested that existing guidelines need to be modified, particularly for patients with mild heart failure (HF), in light of the recent study results.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EHF is the most common cause of hospitalization due to cardiovascular disease in patients aged over 65 years, and it has a considerable impact on health care costs (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [AHA. \u003Cem\u003EHeart and Stroke Statistical Update\u003C\/em\u003E 2006], noted Professor Luigi Tavazzi, MD, GVM Care and Research, Cotignola, Italy.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/32\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Impact of HF Hospitalizations in Patients Aged Over 65 Years on Health Care Costs.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-749294820\u0022 data-figure-caption=\u0022Impact of HF Hospitalizations in Patients Aged Over 65 Years on Health Care Costs.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/32\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/32\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/32\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11394\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EImpact of HF Hospitalizations in Patients Aged Over 65 Years on Health Care Costs.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission by L. Tavazzi.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EProf. Tavazzi discussed some of the recent technological advancements that raise the possibility that remotely acquired physiological data from permanently implanted CRT\/ICD devices may contribute to the management of HF patients by allowing for timely treatment. Several devices are currently being tested in clinical trials, including the PARADYM\u2122-8770 sonR\u2122 cardiac resynchronization therapy defibrillator (CRT-D), which is designed to adjust CRT delivery based on hemodynamic response. Another device in testing is the InSync Sentry, a CRT-D device with automatic intrathoracic fluid status monitoring (OptiVol\u2122 Fluid Status Monitoring) that assesses a patient\u0027s fluid status by measuring, tracking, and reporting intrathoracic impedance. Prof. Tavazzi said that the combination of multiple diagnostics is feasible and may increase the clinical utility of device monitoring.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EResults from the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00180271\u0026amp;atom=%2Fspmdc%2F9%2F4%2F32.atom\u0022\u003ENCT00180271\u003C\/a\u003E) study, presented by Arthur J. Moss, MD, University of Rochester, Rochester, NY, showed that asymptomatic or mildly symptomatic cardiac patients who are treated with CRT-D have a significant 34% (p=0.001) lower risk of HF or death than those who receive a standard ICD only.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EMADIT-CRT was a randomized, multicenter, international trial that comprised 1820 patients (\u223c53% aged \u226565 years; 75% men) with New York Heart Association Class I or II (no or mild symptoms) who had either ischemic or nonischemic heart disease with LVEF \u0026lt;30% and QRS duration of \u0026gt;130 ms on ECG. Subjects were randomized to receive either CRT-D (n=1089) or ICD (n=731) along with optimal medical therapy. Subjects were followed for an average of 24 months. The primary study endpoint was all-cause mortality or an HF event, whichever occurred first.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ECRT-Dtherapywas superior on the primary endpoint (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) and in all patient subgroups. The benefit was driven by a 41% reduction in HF events. CRT-D was more effective in women (HR, 0.37; 95% CI, 0.22 to 0.61) versus men (HR, 0.76; 95% CI, 0.59 to 0.97) and in subjects who had wider (HR, 0.48; 95% CI, 0.37 to 0.64) versus narrower (HR, 1.06; 95% CI, 0.74 to 1.52) QRS complexes. Full article: \u003Ca href=\u0022http:\/\/content.nejm.org\/cgi\/content\/full\/NEJMoa0906431v1\u0022\u003Ehttp:\/\/content.nejm.org\/cgi\/content\/full\/NEJMoa0906431v1\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/32\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Kaplan-Meier Estimates of the Probability of Survival Free of HF.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-749294820\u0022 data-figure-caption=\u0022Kaplan-Meier Estimates of the Probability of Survival Free of HF.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/32\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/32\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/32\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11398\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EKaplan-Meier Estimates of the Probability of Survival Free of HF.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003ECopyright \u00a9 2009 Massachusetts Medical Society. 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