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(Circulation. 2007;115:1.)
© 2007 American Heart Association, Inc.

Issue Highlights

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	IS DUAL-CHAMBER PROGRAMMING INFERIOR TO SINGLE-CHAMBER PROGRAMMING IN AN IMPLANTABLE CARDIOVERTER- DEFIBRILLATOR? RESULTS OF THE INTRINSIC RV (INHIBITION OF UNNECESSARY RV PACING WITH AVSH IN ICDs) STUDY, by Olshansky et al.

 
Although implantable cardioverter defibrillators reduce sudden death in high risk patients with depressed ventricular function, the impact on mortality is blunted by progressive heart failure. Implantable cardioverter defibrillators also provide bradycardia pacing that can vary from continuous to rare back-up pacing. A previous study found that dual-chamber (DDD) pacing increased mortality, likely due to adverse effects of unnecessary right ventricular pacing. Yet DDD pacing systems offer desirable atrial pacing and arrhythmia classification. In this issue of Circulation, Olshansky and coworkers conducted a noninferiority trial comparing single-chamber VVI pacing to a DDD pacing algorithm in patients for whom the algorithm minimized right ventricular pacing. DDD pacing did not increase the combined end point of mortality and hospitalizations for heart failure and showed a favorable trend toward benefit. Thus, with attention to pacing programming, DDD pacing can be safely employed in selected implantable cardioverter defibrillator recipients for whom atrial sensing and pacing is desirable. See p 9.

	SILDENAFIL IMPROVES EXERCISE HEMODYNAMICS AND OXYGEN UPTAKE IN PATIENTS WITH SYSTOLIC HEART FAILURE, by Lewis et al.

 
The type 5 phosphodiesterase inhibitor sildenafil has been shown to lower pulmonary vascular resistance and pressures in patients with heart failure by augmenting an important determinant of exercise function in heart failure. Lewis and colleagues administered a single oral dose of sildenafil (50 mg) to 13 patients with New York Heart Association class III heart failure. They found that sildenafil lowered pulmonary resistance and pressures and improved exercise capacity in those patients with a pulmonary arterial pressure greater than 25 mm Hg. The Lewis et al study thus provides support for the utility . . . [Full Text of this Article]

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