Pulmonary diseases frequently coexist in heart failure (HF), thus posing diagnostic and therapeutic challenges to cardiologists evaluating patients with overlapping symptoms and implementing recommended HF treatments. There is a growing body of evidence suggesting that pulmonary function testing might provide useful information for the best management of these patients. The availability of portable devices, allowing the measurement of spirometry and lung diffusion capacity for carbon monoxide outside of hospital-based pulmonary lung function laboratories, provides an opportunity for a more widespread use of these measures in the cardiology community, but their interpretation can be challenging. In this work, after a brief review of the methodologies, we discuss the interpretation of pulmonary function testing in patients with HF alone or associated with pulmonary diseases, and its contribution in differentiating cardiac and pulmonary symptoms and preventing acute cardiac decompensation. In addition, we examined recent evidence suggesting how the use of pulmonary function testing may provide independent prognostic information in HF patients with and without pulmonary disorders, and help therapeutic decisions to fill the treatment gap that still exists in HF patients with concomitant pulmonary diseases.

A 58 year old female underwent orthotopic left lung transplantation for emphysema. She enjoyed rapid recovery from her surgical procedure but developed almost daily episodes of symptomatic palpitations, persisting 32 months following transplant.Electrocardiogram demonstrated atypical atrial flutter, and she reported to the electrophysiology (EP) laboratory for mapping and catheter ablation.At EP study, she was found to have left atrial flutter, cycle length 230 ms, with variable atrioventricular conduction. Entrainment and activation mapping were both consistent with left atrial origin. Transseptal mapping demonstrated high frequency fractionated diastolic atrial electrograms recorded from the site of posterior anastamosis between the grafted pulmonary vein and the left atrium. Post pacing intervals recorded from this site were identical to the tachycardia cycle length. A single radiofrequency lesion terminated the tachycardia, rendering the patient noninducible. She has remained free of symptoms for over six months post ablation. This is the first published report of incisional reentrant atrial tachycardia involving a lung transplant. Standard entrainment mapping and radiofrequency ablation techniques proved satisfactory in curing the arrhythmia.Aim: cavo-tricuspidal isthmus (CTI) block assessment using right ventricular (RV) pacing in pts with ventriculo-atrial conduction.Methods: pts submitted to CTI ablation for typical atrial flutter were studied with a quadruple catheter in RV, a decapolar in the coronary sinus (CS), an eicosapolar around the tricuspidal annulus and an 8 mm ablator. Circumannular activation (CA) was analysed during CS and RV pacing in pts with spontaneous sinus rhythm or cardioverted during ablation. Pts without ventriculo-atrial conduction were excluded. The linear lesion was performed during RV pacing, looking at atrial signals splitting. CTI block was confirmed by analysis of CA during CS and RV pacing.Results: out of 15, 9 (60%) pts were included. Before ablation, during RV stimulation, the collision front of CA shifted counter clockwise with respect to CS pacing, without variation of Halo-like catheter activation time (82±31 ms vs 77±26, p=0.49). After ablation, CA was similar during CS and RV pacing, showing fully descending lateral right atrium activation (115±33 ms vs. 103±29, p=0.09). Double potentials on the ablation line were more splitted during CS pacing than RV pacing (126±24 ms vs. 108±20 ms, p=0.009), but less detached from the V wave. All pts were successfully ablated.Conclusions: in pts with ventriculo-atrial conduction, RV pacing can substitute CS pacing in the assessment of isthmus block.We ablated 26 patients with atrial flutter; in 13, a lateral line (LL) of isthmus block was drawn; in the other with draw a septal line (SPT); we used 8 mm non-irrigated tip catheters (60W power (PW); maximal temperature (TEMP) of 70 ºC -LL). With SPT, same catheters but 40W; 50ºC TEMP). In SPT we interrupted radiofrequency with high rate junctional rhythm (HJR) and looked for another po...