Background-Recent trials have shown that intracoronary infusion of bone marrow cells (BMCs) improves functional recovery after acute myocardial infarction. However, whether this treatment is effective in heart failure as a consequence of remodeling after organized infarcts remains unclear. In this randomized trial, we assessed the hypothesis that direct intramyocardial injection of autologous mononuclear bone marrow cells during coronary artery bypass graft (CABG) could improve global and regional left ventricular ejection fraction (LVEF) at 4-month follow-up. Methods and Results-Twenty patients (age 64.8Ϯ8.7; 17 male, 3 female) with a postinfarction nonviable scar, as assessed by thallium (Tl) scintigraphy and cardiac magnetic resonance imaging (MRI), scheduled for elective CABG, were included. They were randomized to a control group (n ϭ10, CABG only) or a BMC group (CABG and injection of 60.10 6 Ϯ31.10 6 BMC). Primary end points were global LVEF change and wall thickening changes in the infarct area from baseline to 4-month follow-up, as measured by MRI. Changes in metabolic activity were measured by Tl scintigraphy and expressed as a score with a range from 0 to 4, corresponding to percent of maximal myocardial Tl uptake (4 indicates Ͻ50%, nonviable scar; 3, 50% to 60%; 2, 60% to 70%; 1, 70% to 80%; 0Ͼ80%). Global LVEF at baseline was 39.5Ϯ5.5% in controls and 42.9Ϯ10.3% in the BMC group (Pϭ0.38). At 4 months, LVEF had increased to 43.1Ϯ10.9% in the control group and to 48.9Ϯ9.5% in the BMC group (Pϭ0.23). Systolic thickening had improved from Ϫ0.6Ϯ1.3 mm at baseline to 1.8Ϯ2.6 mm at 4 months in the cell-implanted scars, whereas nontreated scars remained largely akinetic (Ϫ0.5Ϯ2.0 mm at baseline compared with 0.4Ϯ1.7 mm at 4 months, Pϭ0.007 control versus BMC-treated group at 4 months). Defect score decreased from 4 to 3.3Ϯ0.9 in the BMC group and to 3.7Ϯ0.4 in the control group (Pϭ0.18). Conclusions-At 4 months, there was no significant difference in global LVEF between both groups, but a recovery of regional contractile function in previously nonviable scar was observed in the BMC group.

A Caucasian female patient with repetitive attacks of ventricular tachycardia and fibrillation caused by annular submitral left ventricular aneurysm is reported. During a follow-up period of six years after aneurysmectomy, the patient remained symptom-free.

Objective Outcome data on exercise capacity following atrio-ventricular (AV) optimization of dual-chamber pacing are sparse. Pacemaker settings are often left at manufacturers' nominal values upon implantation. We studied the short-term effect of AV optimization on exercise capacity in patients with a dual-chamber pacemaker. Methods and resultsTwenty-eight patients (mean age 73 ± 14 y) with a dual-chamber pacemaker, were randomized towards either nominal AV settings (group 1) or echo-guided AV optimization using the iterative mitral inflow VTI (velocity time integral) method (group 2) at baseline. At 4 weeks, patients were crossed-over to AV optimization in group 1 and returned to nominal AV settings in group 2 for another period of 4 weeks.Oxygen uptake efficiency slope improved significantly after AV optimization (by 126.7 mL/logL ± 190.7 mL/logL; P = 0.003).Conclusions AV optimization in dual-chamber pacing significantly improved functional capacity after 4 weeks. These data provide the background for further validation studies. Keywords AV optimization -interatrial conduction delay -interatrial mechanical delay -dual-chamber pacemaker.contraction of the left atrium can compromise left ventricular filling, leading to an early increase in atrial filling pressures and a limitation in functional exercise capacity 2 . Oxygen uptake efficiency slope (OUES) is a validated marker of exercise capacity in healthy subjects and in patients with heart failure 3 .Resolution of left AV asynchrony in DDD pacing can be obtained by AV delay optimization and has been shown to improve acute haemodynamics in patients with an important IACD 4,5 . Several validated methods for AV optimization exist 6 . However, data on the effects of this intervention on short-and long-term clinical end points as exercise capacity, morbidity and mortality, are sparse.The aim of this pilot study was to investigate the short-term effect of AV optimization on functional [ Original article ]

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