Genesis Health System

About: Genesis Health System is a healthcare organization based out in Davenport, Iowa, United States. It is known for research contribution in the topics: Cardiac resynchronization therapy & Nursing Outcomes Classification. The organization has 89 authors who have published 81 publications receiving 2885 citations.

Prevention of chronic atrial fibrillation by pacing in the region of Bachmann's bundle: results of a multicenter randomized trial.

Abstract: Bachmann's Bundle Pacing for AF Prevention. Introduction: Atrial pacing locations that decrease atrial activation and recovery time may be preferable in patients with a history of atrial arrhythmias. This multicenter prospective randomized study compared the efficacy of Bachmann's bundle (BB) region pacing to right atrial appendage (RAA) pacing in patients with recurrent paroxysmal atrial fibrillation (AF). Methods and Results: Patients with standard pacing indications (n = 120, 70 ± 11 years) were randomized to atrial pacing in either the RAA (n = 57) or BB region (n = 63). Implantation time was similar between groups (88 ± 36 min[n = 38] for BB vs 83 ± 34 min [n = 34] for RAA). No differences in pacing threshold, impedance, or sensing between BB and RAA groups were observed at implantation or after the 6-week, 6-month, and 1-year follow-up periods. Average length of follow-up was 12.6 ± 7.4 months for the BB group and 11.8 ± 8.0 months for the RAA pacing group. The percentage of atrial pacing was similar between groups (61% ± 34% RAA vs 65% ± 31% BB at 2 weeks after implant). BB atrial pacing significantly (P < 0.05) shortened p wave duration compared with sinus rhythm (123 ± 21 msec vs 132 ± 21 msec, n = 50) 2 weeks after implant. In contrast, p wave duration was longer during atrial pacing from the RAA position compared with sinus rhythm (148 ± 23 msec vs 123 ± 23 msec, n = 37). Additionally, p wave duration was shorter during BB pacing than during RAA pacing. Patients with BB pacing had a higher (P < 0.05) rate of survival free from chronic AF (75%) compared with patients with RAA pacing (47%) at 1 year. Conclusion: BB region pacing is safe and effective for attenuating the progression of AF.

Intrathoracic Impedance vs Daily Weight Monitoring for Predicting Worsening Heart Failure Events: Results of the Fluid Accumulation Status Trial (FAST)

Abstract: The relative sensitivity and unexplained detection rate of changes in intrathoracic impedance has not been compared with standard heart failure (HF) monitoring using daily weight changes. The Fluid Accumulation Status Trial (FAST) prospectively followed 156 HF patients with implanted cardioverter-defibrillator or cardiac resynchronization therapy defibrillator devices modified to record daily changes in intrathoracic impedance in a blinded fashion for 537±312 days. Daily impedance changes were used to calculate a fluid index that could be compared with a prespecified threshold. True positives were defined as adjudicated episodes of worsening HF occurring within 30 days of a fluid index above threshold or an acute weight gain. Unexplained detections were defined as threshold crossings or acute weight gains not associated with worsening HF. Impedance measurements were performed on >99% of follow-up days, compared with only 76% of days for weight measurements. Sixty-five HF events occurred during follow-up (0.32/patient-year). Forty HF events were detected by impedance but not weight, whereas 5 were detected by weight but not impedance. Sensitivity was greater (76% vs 23%; P<.0001) and unexplained detection rate was lower (1.9 vs 4.3/patient-year; P<.0001) for intrathoracic impedance monitoring at the threshold of 60Ω days compared with acute weight increases of 3 lbs in 1 day or 5 lbs in 3 days and also over a wide range of fluid index and weight thresholds. The sensitivity and unexplained detection rate of intrathoracic impedance monitoring was superior to that seen for acute weight changes. Intrathoracic impedance monitoring represents a useful adjunctive clinical tool for managing HF in patients with implanted devices.

Correlation of back extensor strength with thoracic kyphosis and lumbar lordosis in estrogen-deficient women.

Abstract: Aging and osteoporosis have been associated with skeletal changes. Back extensor strengthening exercises are highly recommended for management of back pain, especially back pain related to osteoporosis. To our knowledge, the correlation of thoracic kyphosis, lumbar lordosis, and sacral inclination with back extensor strength, physical activity, and bone mineral density has not been critically studied in healthy, active, estrogen-deficient women. In a study of 65 such women (ages 48-65 yr), back extensor strength, bone mineral density, and physical activity score were evaluated and measured. These factors were then correlated with radiographic factors: (1) vertebral body ratios (anterior/posterior height) calculated for each vertebra from T-4 through L-5; (2) kyphosis index determined by adding the anterior heights of each vertebral body, T-4 through T-12, and then dividing the total by the corresponding sum of the posterior heights of each vertebral body; (3) thoracic kyphosis; (4) lumbar lordosis; and (5) sacral inclination. Back extensor strength had a significant negative correlation with thoracic kyphosis (r = -0.30, P = 0.019) and a positive correlation with lumbar lordosis (r = 0.26, P = 0.048) and sacral inclination (r = 0.34, P = 0.009). However, bone mineral density and physical activity score did not show any significant correlations with the radiographic factors. The results indicate that the stronger the back extensor, the smaller the thoracic kyphosis and the larger the lumbar lordosis and sacral inclination. We conclude that back extensor strength is an important determinant of posture in healthy women. However, prescribing back extensor strengthening exercises alone may also increase lumbar lordosis, which is not desirable.

Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR trial (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis).

Abstract: Objectives: The purpose of this study was to evaluate the safety and efficacy of excimer laser atherectomy (ELA) with adjunctive percutaneous transluminal angioplasty (PTA) versus PTA alone...