A health economic evaluation of using N-terminal pro brain natriuretic peptide for the management of acute heart failure: A pilot study in an Indonesian tertiary referral hospital

Heart failure represents a major health problem and economic burden also in development countries such as Indonesia. Based on current guidelines, the use of natriuretic peptides can improve diagnosis, risk stratification, and decrease in hospital length of stay. However, mostly due to the related high costs, many Indonesian physicians currently do not routinely use these biomarkers in their daily clinical practice. By comparing the results of guidance with N-terminal pro brain natriuretic peptide (NT-proBNP) and without NT-proBNP, this pilot study was aimed to determine the clinical effectiveness and costs of using natriuretic peptides in the management of acute heart failure (AHF) patients admitted at National Cardiovascular Center Harapan Kita Hospital, a tertiary referral hospital in Jakarta, Indonesia. This was a health economic evaluation using a single-blind, randomized controlled trial. AHF patients adjudicated following European Society of Cardiology guidelines were randomly assigned to the 2 groups: NT-proBNP group (group A) and control group (group B). In the group A, NT-proBNP level was obtained at admission and pre-discharge, with the target of achieving a decrease of ≥30%. Randomised patients were followed up to 90 days post-discharge to assess short-term outcomes and costs. In total, one hundred and twelve patients were enrolled, of whom 56 were randomized in group A and 56 patients in group B. Compared to Group B, in Group A the total costs of patients management resulted to be significantly higher (P<0.05), while no significant difference between the 2 groups was observed for inhospital length of stay, total mortality rate, rehospitalization, and emergency department visits within 90 days post-discharge. In this pilot study for the management of AHF at an Indonesian National Cardiovascular Center, the routine use of NT-proBNP compared to the non use, at hospital admission and discharge resulted into a significant increase of medical cost without any evident favourable impact on patients outcomes. Larger study in greater Asia Pacific populations should be performed to confirm these preliminary results.

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Abstract 320: Follow Through Heart Failure

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.320 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Ishan Kamat ◽

Alexander Harvey ◽

Ali Ghergherehchi ◽

Emily Podany ◽

Kim-Trang Ho ◽

...

Keyword(s):

Heart Failure ◽

Nurse Practitioner ◽

Hospital Admissions ◽

Referral Hospital ◽

Inpatient Setting ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Post Discharge ◽

Initial Intervention

Heart failure decompensations accounts for over one million hospitalizations annually and are the most common cause of US hospital admission in patients over 65. While this results in a reduced quality of life for patients, hospital admissions within 30 days of discharge for heart failure are not reimbursed, making this patient population incredibly expensive for hospitals to treat. US expenditure on heart failure exceeds $30 billion annually and is projected to rise by 127% to nearly $70 billion by 2030 as the population ages. Scheduling a follow up appointment within one week of discharge has been shown to reduce rates of readmission. This quality improvement initiative is aimed at improving post-discharge follow up rates in a tertiary referral hospital. The affiliated follow up clinic uses a different electronic medical record (EMR) system, so a system of cross-communication is key. The initial intervention introduced an EMR order that, once placed in the inpatient setting, created an appointment request in the follow up clinic. The cardiology consult nurse practitioner was assigned and educated about the task of entering this follow up order. With this intervention, an increase the number of confirmed follow up appointments scheduled by discharge for patients admitted with acute decompensated heart failure was expected. The initial intervention of introducing an EMR order resulted in a median of 18 patient referrals per month over a period of 5 months. The intervention of introducing a dedicated nurse practitioner the task of placing the order resulted in an increase to 25 orders in the next month. Similarly, the percentage of completed referrals increased from 29% over 5 months to 44% in the last month when a dedicated nurse practitioner was tasked with placing the order for follow up. In recognizing the delicate process of discharging patients with heart failure decompensations, a unified process to organize follow up in a tertiary referral hospital was necessary to communicate with the affiliated clinic. This initial intervention shows promise that continuity of care can be established in an intricate medical system. Further interventions include better equipping the cardiology clinic with personnel to accommodate for the bolus of new post-discharge follow up appointments.

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Total Endoscopic Perichondrium Reinforced Cartilage Myringoplasty for Anterior Perforation

Ear Nose & Throat Journal ◽

10.1177/0145561320946908 ◽

2020 ◽

pp. 014556132094690

Author(s):

Dipesh Shakya ◽

Ajit Nepal

Keyword(s):

Reliable Method ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Hearing Results ◽

Group A ◽

Group B ◽

Hearing Outcomes ◽

Lost To Follow Up ◽

Anterior Perforation

Objectives: To investigate the outcomes of graft uptake and hearing results in the repair of anterior perforation via a total endoscopic transcanal approach using a single or double perichondrium reinforced cartilage underlay technique. Study Design: Retrospective study. Setting: Tertiary referral hospital. Materials and Methods: We analyzed 65 patients who underwent surgery for anterior perforation. All surgeries were done via an endoscopic transcanal approach using tragal cartilage as graft, underlay technique reinforced with single or double perichondrium. Two groups were created in which group A had single perichondrium reinforcement and group B had double perichondrium. Graft uptake and hearing outcomes were evaluated between the two groups. Results: During the study period, 65 patients were included, of which 3 were lost to follow-up, and thus, only 62 patients were assessed. As for the surgical outcome, graft uptake was observed in 95.2% (n = 59) of patients, 6 months after the intervention. Graft uptake was not statistically significantly different between groups A and B and was 95% in both. There was a statistically significant improvement in hearing across the series overall, with no significant differences seen between group A and group B. Conclusions: The endoscopic approach for myringoplasty offers superior visualization, especially for anterior perforation avoiding postaural approach and canaloplasty. Endoscopic single or double perichondrium reinforced cartilage underlay technique is a reliable method for repair of anterior perforation. There is no difference in using single or double perichondrium reinforcement. Thus, we recommend using single or double perichondrium reinforcement depending on the need during the surgery.

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A pilot study comparing two physiotherapy techniques in patietnts with cystic fibrosis

South African Journal of Physiotherapy ◽

10.4102/sajp.v60i2.183 ◽

2004 ◽

Vol 60 (2) ◽

Cited By ~ 7

Author(s):

S. M. Milne ◽

C. J. Eales

Keyword(s):

Cystic Fibrosis ◽

Pilot Study ◽

Lung Function ◽

Statistical Difference ◽

Positive Pressure ◽

Lung Function Tests ◽

Bronchial Secretions ◽

Group A ◽

Group B ◽

Minimal Research

The flutter is a simple hand held device designed to facilitate the mobilisation of excess bronchial secretions by means of oscillating positive pressure. Traditionally patients at the Johannesburg Hospital Cystic Fibrosis clinic used the active cycle of breathing technique as a means of facilitating secretion mobilisation and clearance. When the flutter became available in South Africa in 1999 many cystic fibrosis patients wanted to change to this technique. Minimal research has been conducted comparing these two techniques. The aim of this pilot study was therefore to determine which technique is more effective in the mobilisation of secretions in cystic fibrosis patients. The pilot study was conducted on seven cystic fibrosis patients (mean age 28 years, range 16-42 years) admitted to the Johannesburg Hospital for antibiotic therapy. The study lasted four days and consisted of two treatment days separated by a washout day on which no physiotherapy was performed. Patients randomised into Group A performed the flutter technique on day two and the active cycle of breathing technique on day four. Group B performed the active cycle of breathing technique on day two and the flutter on day four. The techniques were performed twice a day for 15 minutes. The measurements taken were daily 24-hour sputum samples and daily lung function tests. A questionnaire to determine patient preference to a technique concluded the study. The results showed no statistical difference between the two techniques with regard to sputum weight or lung function (p<0.05). The questionnaire indicated that on a whole, patients had no preference for a technique.

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Demographic and clinical characteristics of individuals’ Intentions to attend cardiac rehabilitation following hospitalization for heart failure: a descriptive analysis

10.32920/ryerson.14648007.v1 ◽

2021 ◽

Author(s):

Kristen Cunningham

Keyword(s):

Heart Failure ◽

Pilot Study ◽

Cardiac Rehabilitation ◽

Clinical Characteristics ◽

Descriptive Analysis ◽

Future Research ◽

Post Discharge ◽

Convenience Sample ◽

Rehabilitation Centers ◽

Quantitative Descriptive

There is limited literature available that addresses heart failure patient attendance at cardiac rehabilitation centers. This quantitative descriptive pilot study used a convenience sample (n=30) to determine differences in socio-demographic and clinical characteristics and complications among individuals with heart failure who intended or did not intend to attend cardiac rehabilitation six weeks post-discharge. Findings suggest those intending to attend were significantly (p<0.05) older, unemployed/retired, received an income >$50,000, were able to drive, had lower functional classification scores, and experienced fewer complications over six weeks post-discharge. This descriptive pilot study provides an understanding of factors associated with intention to attend cardiac rehabilitation as well as the feasibility of the study design and procedures. Implications focus on strategies to increase potential attendance at cardiac rehabilitation in the heart failure population at the health care provider, organizational and policy levels as well as areas for future research.

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Abstract 17296: Arrhythmia Recurrence and Subsequent Heart Failure Hospitalization in Atrial Fibrillation Patients Undergoing Catheter Ablation: A Landmark Analysis From the Kansai Plus Atrial Fibrillation (KPAF) Registry

Circulation ◽

10.1161/circ.142.suppl_3.17296 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Nobuaki Tanaka ◽

KOICHI INOUE ◽

Atsushi Kobori ◽

Kazuaki Kaitani ◽

Takeshi Morimoto ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Large Scale ◽

Multicenter Observational Study ◽

History Of ◽

Group A ◽

Group B ◽

Af Recurrence

Background: Heart failure (HF) is the leading cause of death in patients with atrial fibrillation (AF). Radiofrequency catheter ablation (RFCA) of AF is effective for maintaining sinus rhythm though its impact on heart failure still remains controversial. Purpose: We sought to elucidate whether AF recurrence following RFCA was associated with subsequent HF hospitalizations. Methods: We conducted a large-scale, prospective, multicenter, observational study. A total of 4931 consecutive patients who underwent an initial RFCA for AF with longer than 1-year of follow-up in 26 centers were enrolled (average age, 64±10 years; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. The primary endpoint was an HF hospitalization more than 1-year after the index RFCA. We compared the patients without AF recurrences (group A) to those with AF recurrences within 1-year post RFCA (group B). Results: The 1-year cumulative incidence of AF recurrences after a single procedure was 30.7% (group A=3418, group B=1513 patients). Group B had a lower body mass index (group A vs. group B,24.1±3.6 vs. 23.8±3.4 kg/m 2 , p=0.014), longer history of AF (1.9 vs. 3.1 years, p<0.0001), higher prevalence of non-paroxysmal AF (32.1% vs. 33.9%, p<0.0001), and valvular heart disease (5.9% vs. 7.8%, p=0.013). They also had a lower ejection fraction (63.7±9.4% vs. 62.8±9.6%, p=0.0043) and larger left atrial dimeter (39.7±6.6 vs. 40.6±7.0 mm, p<0.0001) on echocardiography. Hospitalizations for HF were observed in 57 patients (1.14%) more than 1-year after the RFCA and were significantly higher in group B than group A (group A vs. group B, 0.91% vs 1.72%, log-rank p=0.019). Conclusions: Among AF patients receiving RFCA, those with AF recurrences were at a greater risk of subsequent heart failure hospitalizations than those without AF recurrences. Recognition that AF recurrence following RFCA is a risk factor for a subsequent HF-related hospitalization is appropriate in clinical practice.

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Dose-intensive cyclophosphamide with etoposide and vincristine for pediatric solid tumors: a phase I/II pilot study by the Australia and New Zealand Childhood Cancer Study Group.

Journal of Clinical Oncology ◽

10.1200/jco.1994.12.3.522 ◽

1994 ◽

Vol 12 (3) ◽

pp. 522-531 ◽

Cited By ~ 18

Author(s):

L White ◽

G McCowage ◽

G Kannourakis ◽

V Nayanar ◽

L Colnan ◽

...

Keyword(s):

New Zealand ◽

Pilot Study ◽

Childhood Cancer ◽

Solid Tumors ◽

Hematologic Toxicity ◽

Study Group ◽

Cancer Study ◽

Cancer Study Group ◽

Group A ◽

Group B

PURPOSE This pilot study of the Australia and New Zealand Childhood Cancer Study Group investigated the effectiveness and toxicity of a regimen incorporating vincristine (VCR), etoposide, and divided-dose, escalating cyclophosphamide (CPA) (VETOPEC) in 23 patients aged 1 to 20 years with solid tumors. PATIENTS AND METHODS Seventeen patients (group A) had recurrent or refractory tumors after prior multiagent therapy, and six patients (group B) with adverse prognostic indicators were treated at initial presentation. Treatment cycles were 21 to 28 days and consisted of vincristine (0.05 mg/kg) on days 1 and 14, with etoposide (2.5 mg/kg/d) plus escalating CPA on days 1, 2, and 3. The CPA dosage was escalated from 30 mg/kg/d in cycle no. 1 by 5 mg/kg/d in each cycle to a maximum of 55 mg/kg/d in cycle no. 6. RESULTS Of 20 patients assessable for tumor response, 19 (95%) responded after two to six cycles of VETOPEC: seven complete responses (CRs); eight very good partial responses (VGPRs); and four partial responses (PRs). In group A, 13 of 14 (93%) assessable patients responded (five CRs, four VGPRs, four PRs), and in group B, five stage IV and one stage III patient achieved two CRs and four VGPRs. The principal toxicity was myelosuppression. Grade IV neutropenia occurred after 98% of cycles, and the incidence of grade IV thrombocytopenia increased from 37% after cycle no. 1 to 91% after cycle no. 6 (P = .002). A total of 115 cycles delivered were followed by 62 febrile admissions (54%), and showed a significant rise with increasing cycles (P = .001). One patient died of septicemia. CONCLUSION This combination and scheduling produced a high response rate in patients with recurrent, refractory, or advanced solid tumors of childhood. Further studies of this regimen and of strategies to reduce hematologic toxicity are warranted.

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Comparison of In-Hospital Outcomes Between Patients With or Without Acute Kidney Injury Developed After Hospitalization Following Acute Coronary Syndrome

University Heart Journal ◽

10.3329/uhj.v16i1.44815 ◽

2020 ◽

Vol 16 (1) ◽

pp. 3-10

Author(s):

Md Sajjad Safi ◽

Msi Tipu Chowdhury ◽

Tanjima Parvin ◽

Khurshed Ahmed ◽

Md Ashraf Uddin Sultana ◽

...

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Serum Creatinine ◽

Cardiogenic Shock ◽

Hospital Stay ◽

Kidney Injury ◽

Duration Of Hospital Stay ◽

Group A ◽

Hospital Stays ◽

Group B

Background: Acute Kidney Injury (AKI), a common complication of acute coronary syndromes (ACS), is associated with higher mortality and longer hospital stays. ACS patients with renal impairment during hospitalization are associated with adverse in-hospital outcomes in the form of heart failure, cardiogenic shock, arrhythmia, dialysis requirement and mortality. Objective: To compare the in-hospital adverse outcomesof patients with ACS with or without AKI. Materials and Methods: This prospective comparative study was conducted in the Department of Cardiology, BSMMU, Dhaka, during the period of August 2017 to July 2018. A total of 70 eligible patients were included in this study of which 35 patients were included in group A (ACS with AKI) and 35 patients were included in group B (ACS without AKI). AKI was diagnosed, on the basis of increased serum creatinine level 0.3mg/dL from baseline within 48 hours after hospitalization. They were subjected to electrocardiography, blood test for serum creatinine (on admission, 12 hours, 48 hours and at the time of discharge), lipid profile, 2-D echocardiography along with serum troponin, CK MB and electrolytes. Results: It was observed that mean age was 58.0±8.5 years in group A and 55.6±12.3 years in group B. Heart failure was more common in group A than in Group B (74.3% vs 34.2% p=0.001 respectively) and arrhythmia was more common in group A than in Group B (100% vs 74.2% respectively). 7(20%) patients of group A required dialysis. The mean duration of hospital stay was significantly higher in Group A than in the Group B (9.4±2.3 vs 7.2±0.6; p=0.001) days. Multiple logistic regression analysis revealed that heart failure, cardiogenic shock, duration of hospital stay were found to be the independently significant predictors of outcome of the patients with AKI with odds ratio being 5.53 (p=0.001), 4.353 (p=0.001) and 6.92 (p=0.001) Conclusion: This study shows that, heart failure, cardiogenic shock, arrhythmia, dialysis requirement, were more common in the patients with AKI (group A) than in the patients without AKI (group B). The duration of hospital stays were longer in patients with AKI (group A) than in the patients without AKI (group B). Therefore, an important research target is the identification of high-risk patients with ACS experiencing AKI, thereby appropriate medication and follow-up should be implemented. University Heart Journal Vol. 16, No. 1, Jan 2020; 3-10

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Effectiveness and Safety of Peritoneal Dialysis Treatment in Patients with Refractory Congestive Heart Failure due to Chronic Cardiorenal Syndrome

BioMed Research International ◽

10.1155/2018/6529283 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Qiuyuan Shao ◽

Yangyang Xia ◽

Min Zhao ◽

Jing Liu ◽

Qingyan Zhang ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Peritoneal Dialysis ◽

Survival Time ◽

Heart Function ◽

Cardiorenal Syndrome ◽

Term Survival ◽

Group A ◽

Group B

Aims. To evaluate the effectiveness and safety of peritoneal dialysis (PD) in treating refractory congestive heart failure (RCHF) with cardiorenal syndrome (CRS).Methods. A total of 36 patients with RCHF were divided into type 2 CRS group (group A) and non-type 2 CRS group (group B) according to the patients’ clinical presentations and the ratio of serum urea to creatinine and urinary analyses in this prospective study. All patients were followed up till death or discontinuation of PD. Data were collected for analysis, including patient survival time on PD, technique failure, changes of heart function, and complications associated with PD treatment and hospitalization.Results. There were 27 deaths and 9 patients quitting PD program after a follow-up for 73 months with an average PD time of22.8±18.2months. A significant longer PD time was found in group B as compared with that in group A (29.0±19.4versus13.1±10.6months,p=0.003). Kaplan–Meier curves showed a higher survival probability in group B than that in group A (p<0.001). Multivariate regression demonstrated that type 2 CRS was an independent risk factor for short survival time on PD. The benefit of PD on the improvement of survival and LVEF was limited to group B patients, but absent from group A patients. The impairment of exercise tolerance indicated by NYHA classification was markedly improved by PD for both groups. The technique survival was high, and the hospital readmission was evidently decreased for both group A and group B patients.Conclusions. Our data suggest that PD is a safe and feasible palliative treatment for RCHF with type 2 CRS, though the long-term survival could not be expected for patients with the type 2 CRS. Registration ID Number isChiCTR1800015910.

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Outcome of Albumin Infusion in Heart Failure Patients

University Heart Journal ◽

10.3329/uhj.v15i2.42646 ◽

2019 ◽

Vol 15 (2) ◽

pp. 47-53

Author(s):

Ashaduzzaman Talukder ◽

Mohamed Mausool Siraj ◽

Md Noornabi Khondokar ◽

SM Ahsan Habib ◽

Md Abu Salim ◽

...

Keyword(s):

Heart Failure ◽

Serum Albumin ◽

Nyha Class ◽

Class Ii ◽

Class I ◽

Class Iii ◽

Albumin Infusion ◽

Group A ◽

Group B ◽

Class Iv

Background: Heart Failure (HF) is a major public health burden worldwide. Approximately 5 million Americans, 0.4–2% of the general European population and over 23 million people worldwide are living with heart failure. Like few other chronic disease, low serum albumin is common in patients with heart failure (HF). However, very few studies evaluated the outcome of albumin infusion in different stages of HF. Therefore, the objective of this study is to assess the outcome of albumin infusion in heart failure patients. Methods: It was a cross-sectional study. A total of 50 cases of chronic heart failure with reduced ejection fraction and NYHA class III or IV with serum albumin level <2.5g/dl who were admitted in CCUwere selected by purposive sampling, from September 2017 to August 2018. 100ml of 20% albumin was infused and serum albumin was measured after 3 days. Then the patients were divided into two groups, Patients who failed to attain serum albumin of 3g/dl(Group A) or Patients who attained serum albumin of ≥3g/dl (Group B). Analysis and comparison for symptomatic improvement of heart failure by NHYA classification and LVEF was done at 10th day after infusion between group A and B. Result: Among the 50 patients, mean age of patients was 53.64 ± 13.44 years (age range: 26-84 years) with a male-female ratio of 3:2 (60%-male vs 40%- female). Majority patients were previously re-admitted at least two times (40%), 28% were re-admitted once, 16% were re-admitted three times and 4% were re-admitted for four times. Of all, 56% patients presented NYHA class IV and AHA stage D heart failure (56%) and 44% patients presented with NYHA class III and AHA stage C. At day 10 follow up following albumin infusion, overall frequency of following ten days of albumin therapy, in group B, 8 patients (72.7%) among Class III improved to Class I and 3 patients (27.3%) improved to class II. Also, 7 patients (50%), 5 patients (35.7%) and 2 patients (14.3%) among class IV improved to respectively class I, class II and class III. In group A, 3 patients (27.3%) among class III improve to class II and 8 patients (72.7%) remain in class III. Also, 2 patients (14.3%), 5 Patients (35.7%) and 7 patients (50%) among class IV improve to respectively class I, class II and class III. Moreover, statistically significant improvement was noted in ejection fraction of patents irrespective of initial class of heart failure (p<0.001) in group B patients compare to group A (p<0.09). Conclusion: In this study, the improvement of heart failure was more in patients who attained albumin level of ≥3g/dl.Therefore, in can be concluded that albumin infusion improves both subjective and objective improvement of patients with heart failure. University Heart Journal Vol. 15, No. 2, Jul 2019; 47-53

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P1239His-bundle pacing in CHF-patients with narrow QRS and chronic AF using dual-chamber ICD

European Heart Journal ◽

10.1093/eurheartj/ehz748.0197 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Slawuta ◽

K Boczar ◽

A Zabek ◽

A Ciesielski ◽

J Hiczkiewicz ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Congestive Heart Failure ◽

Dual Chamber ◽

His Bundle ◽

His Bundle Pacing ◽

Narrow Qrs ◽

Group A ◽

Group B

Abstract The heart rate regularization is crucial for proper treatment of patients with atrial fibrillation and congestive heart failure. The standard resynchronization can be applied, but in patients with narrow QRS this procedure is of no use. The aim of our study is to assess the efficacy of direct His-bundle pacing in patients with congestive heart failure and chronic atrial fibrillation using dual chamber ICD implanted for prevention of sudden cardiac death. Methods The study population included 78 patients with CHF and chronic AF: group A - 56 pts treated with direct His-bundle pacing using atrial port of dual chamber ICD and group B - 22 patients implanted with single chamber ICD as recommended by the guidelines. The patients in group B constituting clinical controls were derived from the Heart Failure Outpatients Clinic with established clinical status and pharmacotherapy. Results The demographic data, clinical characteristics and echocardiography measurements at baseline and during follow-up were presented in the table: Table 1 Group A Group B P value Age (years) 69.7±6.9 66.7±11.3 n.s. Sex (% of male sex) 84.0 86.4 n.s. Ventricular pacing (%) – 46.3±31.2 – His-bundle pacing (%) 81.7±9.2 – – pre post pre post pre vs. post LVEDD (mm) 66.9±4.9 59.9±4.7 64.8±8.0 64.7±8.1 <0.01 n.s. EF (%) 29.6±3.8 43.6±5.9 28.1±6.1 28.8±7.3 <0.01 n.s. NYHA class 2.7±0.6 1.4±0.6 2.5±0.6 2.0±0.2 <0.05 n.s. B-blocker dose (metoprolol equivalent dose) 104.6±41.6 214.3±82.6 78.3±56.6 103.1±49.2 <0.001 <0.05 During 12-months of follow-up the mean values of NYHA functional class, EF and LV dimensions did not change in group B but significantly improved in group A. The physiological His-bundle based pacing enabled optimal beta-blocker dosing. The studied groups had no tachyarrhythmia at baseline so the presumable atrial fibrillation-related harm depends on the rhythm irregularity. Conclusions His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process. The CHF-patients with narrow QRS and chronic AF benefit from substantially higher beta-blockade which can be instituted in His-bundle pacing group.

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