|
1
|
Kitai T, Kohsaka S, Kato T, Kato E, Sato K, Teramoto K, Yaku H, Akiyama E, Ando M, Izumi C, Ide T, Iwasaki YK, Ohno Y, Okumura T, Ozasa N, Kaji S, Kashimura T, Kitaoka H, Kinugasa Y, Kinugawa S, Toda K, Nagai T, Nakamura M, Hikoso S, Minamisawa M, Wakasa S, Anchi Y, Oishi S, Okada A, Obokata M, Kagiyama N, Kato NP, Kohno T, Sato T, Shiraishi Y, Tamaki Y, Tamura Y, Nagao K, Nagatomo Y, Nakamura N, Nochioka K, Nomura A, Nomura S, Horiuchi Y, Mizuno A, Murai R, Inomata T, Kuwahara K, Sakata Y, Tsutsui H, Kinugawa K. JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure. J Card Fail 2025:S1071-9164(25)00100-9. [PMID: 40155256 DOI: 10.1016/j.cardfail.2025.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2025]
|
|
2
|
Sapp JL, Sivakumaran S, Tang ASL. Long-Term Outcomes of Resynchronization-Defibrillation for Heart Failure. Reply. N Engl J Med 2024; 390:1343-1345. [PMID: 38598810 DOI: 10.1056/nejmc2402048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
|
|
3
|
Borgquist R, Marinko S, Platonov PG, Wang L, Chaudhry U, Brandt J, Mörtsell D. Maximizing QRS duration reduction in contemporary cardiac resynchronization therapy is feasible and shorter QRS duration is associated with better clinical outcome. J Interv Card Electrophysiol 2023; 66:1799-1806. [PMID: 36629961 PMCID: PMC10570164 DOI: 10.1007/s10840-022-01463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND We aimed to evaluate if optimization by maximizing QRS duration (QRSd) reduction is feasible in an all-comer cardiac resynchronization therapy (CRT) population, and if reduced, QRSd is associated with a better clinical outcome. METHODS Patients with LBBB receiving CRT implants during the period 2015-2020 were retrospectively evaluated. Implants from 2015-2017 were designated as controls. Starting from 2018, an active 12-lead electrogram-based optimization of QRSd reduction was implemented (intervention group). QRSd reduction was evaluated in a structured way at various device AV and VV settings, aiming to maximize the reduction. The primary endpoint was a composite of heart failure hospitalization or death from any cause. RESULTS A total of 254 patients were followed for up to 6 years (median 2.9 [1.8-4.1]), during which 82 patients (32%) reached the primary endpoint; 53 deaths (21%) and 58 (23%) heart failure hospitalizations. Median QRS duration pre-implant was 162 ms [150-174] and post-implant 146ms [132-160]. Mean reduction in QRS duration was progressively larger for each year during the intervention period, ranging from - 9.5ms in the control group to - 24 in the year 2020 (p = 0.005). QRS reduction > 14 ms (median value) was associated with a lower risk of death or heart failure hospitalization (adjusted HR 0.54 [0.29-0.98] (p = 0.04). CONCLUSIONS Implementing a general strategy of CRT device optimization by aiming for shorter QRS duration is feasible in a structured clinical setting and results in larger reductions in QRS duration post-implant. In patients with a larger QRS reduction, compared to those with a smaller QRS reduction, there is an association with a better clinical outcome.
Collapse
Affiliation(s)
- Rasmus Borgquist
- Arrhythmia section, Skane University Hospital, Entrégatan 7, 222 42, Lund, Sweden.
| | - Sofia Marinko
- Cardiology section, Department of clinical sciences, Lund University, Lund, Sweden
- Arrhythmia section, Skane University Hospital, Entrégatan 7, 222 42, Lund, Sweden
| | - Pyotr G Platonov
- Cardiology section, Department of clinical sciences, Lund University, Lund, Sweden
- Arrhythmia section, Skane University Hospital, Entrégatan 7, 222 42, Lund, Sweden
| | - Lingwei Wang
- Cardiology section, Department of clinical sciences, Lund University, Lund, Sweden
- Arrhythmia section, Skane University Hospital, Entrégatan 7, 222 42, Lund, Sweden
| | - Uzma Chaudhry
- Cardiology section, Department of clinical sciences, Lund University, Lund, Sweden
- Arrhythmia section, Skane University Hospital, Entrégatan 7, 222 42, Lund, Sweden
| | - Johan Brandt
- Cardiology section, Department of clinical sciences, Lund University, Lund, Sweden
- Arrhythmia section, Skane University Hospital, Entrégatan 7, 222 42, Lund, Sweden
| | - David Mörtsell
- Cardiology section, Department of clinical sciences, Lund University, Lund, Sweden
- Arrhythmia section, Skane University Hospital, Entrégatan 7, 222 42, Lund, Sweden
| |
Collapse
|
|
4
|
Menezes Junior AS, Rivera A, Ayumi Miyawaki I, Gewehr DM, Nascimento B. Long-Term Remote vs. Conventional Monitoring of Pacemakers: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Curr Cardiol Rep 2023; 25:1415-1424. [PMID: 37751037 DOI: 10.1007/s11886-023-01963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE OF REVIEW Remote monitoring (RM) is the standard of care for patients with cardiac implantable electronic devices (CIEDs), particularly pacemakers. However, the long-term outcomes of RM versus conventional monitoring (CM) of pacemakers and its effectiveness in reducing in-office (IO) visits for device reprogramming require elucidation. This systematic review and meta-analysis aimed to compare the RM and CM of pacemakers over a long-term follow-up. RECENT FINDINGS We systematically searched the PubMed/MEDLINE, Embase, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing RM and CM of pacemakers with at least 12 months of follow-up. Binary endpoints were pooled with risk ratios (RRs), whereas continuous outcomes were computed using mean differences (MDs) or standardized MDs (SMDs). Heterogeneity was assessed using I2 statistics. Among the eight included RCTs, 2159 (48.9%) of 4063 patients underwent RM. Follow-up periods ranged from 12 to 24 months. There were no significant between-group differences in all-cause mortality (RR = 1.19; 95% confidence interval [CI], 0.90-1.57; p = 0.22; I2 = 0%), stroke (RR = 0.90; 95% CI, 0.43-1.91; p = 0.79; I2 = 23%), hospitalizations for cardiovascular and/or device-related adverse events (RR = 0.95; 95% CI, 0.75-1.21; p = 0.70; I2 = 0%), and quality of life (SMD = - 0.06; 95% CI, - 0.22 to 0.10; p = 0.473; I2 = 0%). RM was associated with fewer IO visits/patient/year (MD = 0.98; 95% CI, - 1.64 to - 0.33; p = 0.08; I2 = 98%) and higher rates of atrial tachyarrhythmia (ATA) detection (RR = 1.22; 95% CI, 1.01-1.48; p = 0.04; I2 = 0%) than was CM. This meta-analysis suggests that RM of pacemakers leads to higher rates of ATA detection and fewer IO visits/patient/year, without compromising patient safety.
Collapse
Affiliation(s)
| | - André Rivera
- Department of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil
| | | | - Douglas Mesadri Gewehr
- Curitiba Heart Institute, Curitiba, Brazil
- Science, and Technology, Denton Cooley Institute of Research, Curitiba, Brazil
| | - Bárbara Nascimento
- Department of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
|
5
|
Knijnik L, Wang B, Cardoso R, Shanafelt C, Lloyd MS. Clinical outcomes of automatic algorithms in cardiac resynchronization therapy: Systematic review and meta-analysis. Heart Rhythm O2 2023; 4:618-624. [PMID: 37936674 PMCID: PMC10626183 DOI: 10.1016/j.hroo.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Algorithms to automatically adjust atrioventricular (AV) and interventricular (VV) intervals in cardiac resynchronization therapy (CRT) devices are common, but their clinical efficacy is unknown. Objective The purpose of this study was to evaluate automatic CRT algorithms in patients with heart failure for the reduction of mortality, heart failure hospitalizations, and clinical improvement. Methods We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) in patients with CRT using automatic algorithms that change AV and VV intervals dynamically without manual input, on a beat-to-beat basis. We performed a subgroup analysis including intracardiac electrogram-based (EGM) algorithms and contractility-based algorithms. Results Nine RCTs with 8531 participants were included, of whom 4275 (50.1%) were randomized to automatic algorithm. Seven of the 9 trials used EGM-based algorithms, and 2 used contractility sensors. There was no difference in all-cause mortality (10.3% vs 11.3%; odds ratio [OR] 0.90; 95% confidence interval [CI] 0.71-1.03; P = .13; I2 = 0%) or heart failure hospitalizations (15.0% vs 16.1%; OR 0.924; 95% CI 0.81-1.04; P = .194; I2 = 0%) between the automatic algorithm group and the control group. Study-defined clinical improvement was also not significantly different between groups (66.6% vs 63.3%; risk ratio 1.01; 95% CI 0.95-1.06; P = .82; I2 = 50%). In the contractility-based subgroup, there was a trend toward greater clinical improvement with the use of the automatic algorithm (75% vs 68.3%; OR 1.45; 95% CI 0.97-2.18; P = .07; I2 = 40%), which did not reach statistical significance. The overall risk of bias was low. Conclusion Automatic algorithms that change AV or VV intervals did not improve mortality, heart failure hospitalizations, or cardiovascular symptoms in patients with heart failure and CRT.
Collapse
Affiliation(s)
- Leonardo Knijnik
- Emory University Adult Congenital Heart Center, Atlanta, Georgia
| | - Bo Wang
- Emory University Adult Congenital Heart Center, Atlanta, Georgia
| | - Rhanderson Cardoso
- Heart and Vascular Center, Brigham and Women’s Hospital, Boston Massachusetts
| | - Colby Shanafelt
- Emory University Adult Congenital Heart Center, Atlanta, Georgia
| | - Michael S. Lloyd
- Emory University Adult Congenital Heart Center, Atlanta, Georgia
| |
Collapse
|
|
6
|
Sami A, Mustafa B, Butt HA, Ashraf Z, Ullah A, Babar F, Asad M, Awais M, Zaidi SMJ, Fakhar T, Mehmoodi A, Adnan N, Malik J. Echocardiography- versus intracardiac electrocardiogram-based optimization of cardiac resynchronization therapy: A systematic review. Ann Noninvasive Electrocardiol 2023; 28:e13040. [PMID: 36606676 PMCID: PMC10023891 DOI: 10.1111/anec.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE This systematic review aimed to evaluate the performance of echocardiography-based programming in comparison with the intracardiac electrocardiogram (IEGM)-based method for the optimization of cardiac resynchronization therapy (CRT). METHODS A literature review was conducted using digital databases to systematically identify the studies reporting CRT optimization through echocardiography compared with IEGM. Detailed patient-level study characteristics including the type of study, sample size, therapy, the New York Heart Classification (NYHA) status, lead placement, and other parameters were abstracted. Finally, postprogramming outcomes were extracted for each article. RESULTS In a total of 11 studies, 919 patients were recruited for the final analysis. Overall, 692 (75.29%) were males. The mean duration of the QRS complex in our study population ranged from 145.2 ± 21.8 ms to 183 ± 19.9 ms. There was an equal improvement in the NYHA class between the two methods while the left ventricular ejection fraction (LVEF) demonstrated an improvement by IEGM. Many studies supported IEGM to increase the 6-minute walk test and left ventricular outflow tract velocity time interval (LVOT VTI) when compared to echocardiography. The mean time for echocardiography-based optimization was 60.15 min while that of IEGM-based optimization was 6.65 min. CONCLUSION IEGM is an alternative method for CRT optimization in improving the NYHA class, LVEF, and LVOT VTI, and is less time-consuming when compared to the echocardiography-based methods.
Collapse
Affiliation(s)
- Abdul Sami
- Department of CardiologyDHQ Teaching HospitalKohatPakistan
| | - Bilal Mustafa
- Department of CardiologyAkbar Niazi Teaching HospitalIslamabadPakistan
| | | | - Zainab Ashraf
- Department of MedicineCMH Lahore Medical CollegeLahorePakistan
| | - Asif Ullah
- Department of CardiologyKhyber Medical University Institute of Medical SciencesKohatPakistan
| | | | - Muhammad Asad
- Department of CardiologyBenazir Bhutto HospitalRawalpindiPakistan
| | - Muhammad Awais
- Department of ElectrophysiologyArmed Forces Institute of CardiologyRawalpindiPakistan
| | | | - Tehniat Fakhar
- Department of MedicineShifa Tameer e Millat UniversityIslamabadPakistan
| | - Amin Mehmoodi
- Department of MedicineIbn e Seena HospitalKabulAfghanistan
| | - Nawal Adnan
- Department of MedicineJinnah Sindh Medical UniversityKarachiPakistan
| | - Jahanzeb Malik
- Department of ElectrophysiologyArmed Forces Institute of CardiologyRawalpindiPakistan
- Cardiovascular Analytics GroupHong KongChina
| |
Collapse
|
|
7
|
Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
| | | |
Collapse
|
|
8
|
Gasparini M, Biffi M, Landolina M, Cattafi G, Rordorf R, Botto GL, Battista Forleo G, Morani G, Santini L, Dello Russo A, Rossillo A, Meloni S, Grammatico A, Vitolo M, Boriani G. The Interplay of PR Interval and AV Pacing Delays Used for Cardiac Resynchronization Therapy in Heart Failure Patients: Association with Clinical Response in a Retrospective Analysis of a Large Observational Study. J Pers Med 2022; 12:1512. [PMID: 36143297 PMCID: PMC9501597 DOI: 10.3390/jpm12091512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF) patients with prolonged QRS and impaired left ventricular (LV) systolic function. We aim to evaluate how the baseline PR interval is associated with outcomes (all-cause death or HF hospitalizations) and LV reverse remodeling (>15% relative reduction in LV end-systolic volume). Methods. Among 2224 patients with CRT defibrillators, 1718 (77.2%) had a device programmed at out-of-the-box settings (sensed AV delay: 100 ms and paced AV delay: 130 ms). Results. In this cohort of 1718 patients (78.7% men, mean age 66 years, 71.6% in NYHA class III/IV, LVEF = 27 ± 6%), echocardiographic assessment at 6-month follow-up showed that LV reverse remodeling was not constant as a function of the PR interval; in detail, it occurred in 56.4% of all patients but was more frequent (76.6%) in patients with a PR interval of 160 ms. In a median follow-up of 20 months, the endpoint of death or HF hospitalizations occurred in 304/1718 (17.7%) patients; in the multivariable regression analysis it was significantly less frequent when the PR interval was between 150 and 170 ms (hazard ratio = 0.79, 95% confidence interval (CI): 0.63−0.99, p = 0.046). The same PR range was associated with higher probability of CRT response (odds ratio = 2.51, 95% CI: 1.41−4.47, p = 0.002). Conclusions. In a large population of CRT patients, with fixed AV pacing delays, specific PR intervals are associated with significant benefits in terms of LV reverse remodeling and lower morbidity. These observational data suggest the importance of optimizing pacing programming as a function of the PR interval to maximize CRT response and patient outcome.
Collapse
Affiliation(s)
- Maurizio Gasparini
- Electrophysiology and Pacing Unit, Humanitas Clinical and Research Hospital, IRCCS, 20089 Rozzano, Italy
| | - Mauro Biffi
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy
| | | | | | - Roberto Rordorf
- Cardiology Department, Policlinico San Matteo Pavia Fondazione, IRCCS, 27100 Pavia, Italy
| | | | | | - Giovanni Morani
- Cardiology Department, Ospedale Civile Maggiore, 37126 Verona, Italy
| | - Luca Santini
- Cardiology Department, Ospedale G.B. Grassi, 00122 Rome, Italy
| | | | - Antonio Rossillo
- Cardiology Department, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Sarah Meloni
- Medtronic Core Clinical Solutions, 00165 Rome, Italy
| | - Andrea Grammatico
- Medtronic Core Clinical Solutions, 00165 Rome, Italy
- Abbott EMEA Medical Affairs, 1931 Brussels, Belgium
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Modena University Hospital, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Modena University Hospital, University of Modena and Reggio Emilia, 41125 Modena, Italy
| |
Collapse
|
|
9
|
Rickard J. Case Studies of Cardiac Resynchronization Therapy "Nonresponders". Card Electrophysiol Clin 2022; 14:273-282. [PMID: 35715085 DOI: 10.1016/j.ccep.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Outcomes following cardiac resynchronization therapy (CRT) vary widely, with some patients experiencing normalization of left ventricular function to some who seem to be harmed by biventricular pacing. The care of CRT patients postoperatively is complex and requires input from physicians specializing in electrophysiology, heart failure, and often cardiac imaging. In this section, cases of apparent CRT suboptimal response from a dedicated CRT optimization clinic are presented.
Collapse
Affiliation(s)
- John Rickard
- Section of Cardiac Electrophysiology, Department of Cardiovascular Medicine, Heart, and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/J2-2, Cleveland, OH 44195, USA.
| |
Collapse
|
|
10
|
Orthodromic and Antidromic Snare Techniques for Left Ventricular Lead Implantation in Cardiac Resynchronization Therapy. J Clin Med 2022; 11:jcm11082133. [PMID: 35456225 PMCID: PMC9024966 DOI: 10.3390/jcm11082133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 02/04/2023] Open
Abstract
The snare technique can be used to overcome unsuitable cardiac venous anatomies for left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) procedures. However, limited data exist regarding performance of the snare technique. We classified 262 patients undergoing CRT procedure into the snare (n = 20) or conventional group (n = 242) according to the LV lead implantation method. We compared the safety, efficacy, and composite outcome (all-cause death and heart failure readmission) at 3 years post-implant between the snare and conventional groups. In the snare group, all LV leads were implanted safely using orthodromic (n = 15) or antidromic (n = 5) techniques, and no immediate complications occurred including vessel perforation, tamponade, and lead dislodgement. During follow-up, LV lead threshold and impedance remained stable without requiring lead revision in the snare group. There were no significant between-group differences regarding LV ejection fraction increase (12 ± 13% vs. 12 ± 13%, p = 0.929) and LV end-systolic volume reduction (18 ± 48% vs. 28 ± 31%, p = 0.501). Both groups exhibited comparable CRT-response rates (62.5% vs. 60.6%, p = 1.000). The risk of primary outcome was not significantly different between the two groups (25.9% vs. 30.9%, p = 0.817). In patients who failed conventional LV lead implantation for CRT, the snare technique could be a safe and effective solution to overcome difficult coronary venous anatomy.
Collapse
|
|
11
|
Wang Z, Li P, Zhang B, Huang J, Chen S, Cai Z, Qin Y, Fan J, Tang W, Qin Y, Li R, Zhao X. Improvement of LV Reverse Remodeling Using Dynamic Programming of Fusion-Optimized Atrioventricular Intervals in Cardiac Resynchronization Therapy. Front Cardiovasc Med 2021; 8:700424. [PMID: 34490369 PMCID: PMC8417774 DOI: 10.3389/fcvm.2021.700424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/20/2021] [Indexed: 12/04/2022] Open
Abstract
Background: The patient-tailored SyncAV algorithm shortens the QRS duration (QRSd) beyond what conventional biventricular (BiV) pacing can. However, evidence of the ability of SyncAV to improve the cardiac resynchronization therapy (CRT) response is lacking. The aim of this study was to evaluate the impact of CRT enhanced by SyncAV on echocardiographic and clinical responses. Methods and Results: Consecutive heart failure (HF) patients from three centers treated with a quadripolar CRT system (Abbott) were enrolled. The total of 122 patients were divided into BiV+SyncAV (n = 68) and BiV groups (n = 54) according to whether they underwent CRT with or without SyncAV. Electrocardiographic, echocardiographic, and clinical data were assessed at baseline and during follow-up. Echocardiographic response to CRT was defined as a ≥15% decrease in left ventricular end-systolic volume (LVESV), and clinical response was defined as a NYHA class reduction of ≥1. At the 6-month follow-up, the baseline QRSd and LVESV decreased more significantly in the BiV+SyncAV than in the BiV group (QRSd −36.25 ± 16.33 vs. −22.72 ± 18.75 ms, P < 0.001; LVESV −54.19 ± 38.87 vs. −25.37 ± 36.48 ml, P < 0.001). Compared to the BiV group, more patients in the BiV+SyncAV group were classified as echocardiographic (82.35 vs. 64.81%; P = 0.036) and clinical responders (83.82 vs. 66.67%; P = 0.033). During follow-up, no deaths due to HF deterioration or severe procedure related complications occurred. Conclusion: Compared to BiV pacing, BiV combined with SyncAV leads to a more significant reduction in QRSd and improves LV remodeling and long-term outcomes in HF patients treated with CRT.
Collapse
Affiliation(s)
- Zhongkai Wang
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Pan Li
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bili Zhang
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jingjuan Huang
- Department of Cardiology, Shanghai Chest hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shaoping Chen
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhuhong Cai
- Department of Ultrasound, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yingyi Qin
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Jihai Fan
- Department of Cardiology, 455th Hospital of Nanjing Military Command, Shanghai, China
| | - Wendong Tang
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yongwen Qin
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xianxian Zhao
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
|
12
|
Herweg B, Welter-Frost A, Vijayaraman P. The evolution of cardiac resynchronization therapy and an introduction to conduction system pacing: a conceptual review. Europace 2021; 23:496-510. [PMID: 33247913 DOI: 10.1093/europace/euaa264] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Indexed: 01/14/2023] Open
Abstract
In chronic systolic heart failure and conduction system disease, cardiac resynchronization therapy (CRT) is the only known non-pharmacologic heart failure therapy that improves cardiac function, functional capacity, and survival while decreasing cardiac workload and hospitalization rates. While conventional bi-ventricular pacing has been shown to benefit patients with heart failure and conduction system disease, there are limitations to its therapeutic success, resulting in widely variable clinical response. Limitations of conventional CRT evolve around myocardial scar, fibrosis, and inability to effectively simulate diseased tissue. Studies have shown endocardial stimulation in closer proximity to the specialized conduction system is more effective when compared with epicardial stimulation. Several observational and acute haemodynamic studies have demonstrated improved electrical resynchronization and echocardiographic response with conduction system pacing (CSP). Our objective is to provide a systematic review of the evolution of CRT, and an introduction to CSP as an intriguing, though experimental physiologic alternative to conventional CRT.
Collapse
Affiliation(s)
- Bengt Herweg
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, South Tampa Center, 2 Tampa General Circle, Tampa, FL 33606, USA.,Tampa General Hospital, USF Health South Tampa Center, 1 Tampa General Circle, Tampa, FL 33606, USA
| | - Allan Welter-Frost
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, South Tampa Center, 2 Tampa General Circle, Tampa, FL 33606, USA.,Tampa General Hospital, USF Health South Tampa Center, 1 Tampa General Circle, Tampa, FL 33606, USA
| | - Pugazhendhi Vijayaraman
- Division of Cardiology, Geisinger Commonwealth School of Medicine, Geisinger Heart Institute, MC 36-10, 1000 E Mountain Blvd, Wilkes-Barre, PA 18711, USA
| |
Collapse
|
|
13
|
Abstract
Cardiac resynchronization therapy (CRT) is an important and effective therapy for end-stage heart failure. Non-response to CRT is one of the main obstacles to its application in clinical practice. There is no uniform consensus or definition of CRT “response.” Clinical symptoms, ventricular remodeling indices, and cardiovascular events have been reported to be associated with non-responders. To prevent non-response to CRT, three aspects should be thoroughly considered: preoperative patient selection, electrode implantation, and postoperative management. Preoperative selection of appropriate patients for CRT treatment is an important step in preventing non-response. Currently, the CRT inclusion criteria are mainly based on the morphology of QRS waves in deciding ventricular dyssynchrony. Echocardiography and cardiac magnetic resonance are being explored to predict nonresponse to CRT. The location of left ventricular electrode implantation is a current hot spot of research; it is important to identify the location of the latest exciting ventricular segment and avoid scars. Cardiac magnetic resonance and ultrasonic spot tracking are being progressively developed in this field. Some new techniques such as His Bundle pacing, endocardial electrodes, and novel sensors are also being investigated. Postoperative management of patients is another essential step towards preventing non-response; it mainly focuses on the treatment of the disease itself and CRT program control optimization. CRT treatment is just one part of the overall treatment of heart failure, and multidisciplinary efforts are needed to improve the overall outcome.
Collapse
|
|
14
|
Covino G, Volpicelli M, Ciardiello C, Capogrosso P. Usefulness of Hemodynamic Device-Based Optimization in Heterogeneous Patients Implanted with Cardiac Resynchronization Therapy Defibrillator. J Cardiovasc Transl Res 2020; 13:938-943. [PMID: 32385806 DOI: 10.1007/s12265-020-10004-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
Optimization of the atrioventricular (AV) and interventricular (VV) timings of the CRT is the most supposed correctable variable to improve the rate of CRT responder. The aim of the present study has been to evaluate if there is a specific subgroup of patients who can actually benefit the most from a hemodynamic optimization of AV. This is a prospective, observational single-center study that enrolled consecutive patients with clinical indication for CRT; all patients were implanted with CRT-D devices with SonR technology, able to automatically adjust AV and VV delay on a weekly basis. Among 57 patients, 39 (69%) showed a LVESV reduction > 15%. The SonR was able to modify the pacing parameters, but an increase of left atrial diameter was associated to a reduced AV variability, suggesting that an impaired left atrial function could potentially reduce the ability of the SonR algorithm to adjust the correct timing of pacing. Graphical abstract Patients with respectively a high (A) and low (B) AV timing variability, among several parameters that could potentially influence the AV timing, only left atrial dimensions demonstrated a significant impact. In fact an increase of left atrial diameter was associated to a reduced AV variability, suggesting that an impaired left atrial function could potentially reduce the ability of the SonR algorithm to adjust the correct timing of pacing.
Collapse
Affiliation(s)
- Gregorio Covino
- Ospedale San Giovanni Bosco, Via Filippo Maria Briganti, 255, 80144, Naples, Italy
| | - Mario Volpicelli
- Ospedale San Giovanni Bosco, Via Filippo Maria Briganti, 255, 80144, Naples, Italy
| | | | - Paolo Capogrosso
- Ospedale San Giovanni Bosco, Via Filippo Maria Briganti, 255, 80144, Naples, Italy
| |
Collapse
|
|
15
|
Lahiri A, Chahadi FK, Ganesan AN, McGavigan AD. Characteristics that Predict Response After Cardiac Resynchronization Therapy. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00640-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
|
16
|
Kasagawa A, Nakajima I, Izumo M, Nakayama Y, Yamada M, Takano M, Matsuda H, Furukawa T, Miyazaki H, Harada T, Akashi YJ. Novel Device-Based Algorithm Provides Optimal Hemodynamics During Exercise in Patients With Cardiac Resynchronization Therapy. Circ J 2019; 83:2002-2009. [PMID: 31462585 DOI: 10.1253/circj.cj-19-0512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND An adaptive cardiac resynchronization therapy (aCRT) algorithm has been described for synchronized left ventricular (LV) pacing and continuous optimization of cardiac resynchronization therapy (CRT). However, there are few algorithmic data on the effect of changes during exercise. METHODS AND RESULTS We enrolled 27 patients with availability of the aCRT algorithm. Eligible patients were manually programmed to optimal atrioventricular (AV) and interventricular (VV) delays by using echocardiograms at rest or during 2 stages of supine bicycle exercise. We compared the maximum cardiac output between manual echo-optimization and aCRT-on during each phase. After initiating exercise, the optimal AV delay progressively shortened (P<0.05) with incremental exercise levels. The manual-optimized settings and aCRT resulted in similar cardiac performance, as demonstrated by a high concordance correlation coefficient between the LV outflow tract velocity time integral (LVOT-VTI) during each exercise stage (Ex.1: r=0.94 P<0.0008, Ex.2: r=0.88 P<0.001, respectively). Synchronized LV-only pacing in patients with normal AV conduction could provide a higher LVOT-VTI as compared with manual-optimized conventional biventricular pacing at peak exercise (P<0.05). CONCLUSIONS The aCRT algorithm was physiologically sound during exercise by patients.
Collapse
Affiliation(s)
- Akira Kasagawa
- Division of Cardiology, St. Marianna University School of Medicine
| | - Ikutaro Nakajima
- Division of Cardiology, St. Marianna University School of Medicine
| | - Masaki Izumo
- Division of Cardiology, St. Marianna University School of Medicine
| | - Yui Nakayama
- Division of Cardiology, St Marianna University School of Medicine, Yokohama City Seibu Hospital
| | - Marika Yamada
- Division of Cardiology, St. Marianna University School of Medicine
| | - Makoto Takano
- Division of Cardiology, St. Marianna University School of Medicine
| | - Hisao Matsuda
- Division of Cardiology, St Marianna University School of Medicine, Yokohama City Seibu Hospital
| | - Toshiyuki Furukawa
- Division of Cardiology, St. Marianna University School of Medicine, Toyoko Hospital
| | | | - Tomoo Harada
- Division of Cardiology, St. Marianna University School of Medicine
| | | |
Collapse
|
|
17
|
Dauw J, Martens P, Mullens W. CRT Optimization: What Is New? What Is Necessary? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:45. [PMID: 31342198 DOI: 10.1007/s11936-019-0751-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiac resynchronization therapy (CRT) has proven to improve quality of life, reduce heart failure hospitalization, and prolong life in selected heart failure patients with reduced ejection fraction, on optimal medical therapy and with electrical dyssynchrony. To ensure maximal benefit for CRT patients, optimization of care should be implemented. This begins with appropriate referring as well as selecting patients, knowing that the presence of left bundle branch block and QRS ≥ 150 ms is associated with the greatest reverse remodeling. The LV lead, preferably quadripolar, is best targeted in a postero-lateral position. After implantation, optimal device programming should aim for maximal biventricular pacing and in selected cases further electrical delay optimization might be of use. Even as important, is the implementation of thorough multidisciplinary heart failure care with medication uptitration, remote monitoring, rehabilitation, and patient education. The role of newer pacing strategies as endocardial or His-bundle pacing remains the subject of ongoing investigation.
Collapse
Affiliation(s)
- Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium.
| |
Collapse
|
|
18
|
AlTurki A, Lima PY, Garcia D, Montemezzo M, Al-Dosari A, Vidal A, Toscani B, Diaz S, Bernier M, Hadjis T, Joza J, Essebag V. Cardiac resynchronization therapy reprogramming to improve electrical synchrony in patients with existing devices. J Electrocardiol 2019; 56:94-99. [PMID: 31349133 DOI: 10.1016/j.jelectrocard.2019.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/06/2019] [Accepted: 07/15/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Optimal programming of cardiac resynchronization therapy (CRT) has not yet been fully elucidated. A novel algorithm (SyncAV) has been developed to improve electrical synchrony by fusion of the triple wavefronts: intrinsic, right ventricular (RV)-paced, and left ventricular (LV)-paced. METHODS Consecutive patients at a single tertiary care center with a previously implanted CRT device with SyncAV algorithm (programmable negative AV hysteresis) were evaluated. QRS duration (QRSd) was measured during 1) intrinsic conduction, 2) existing CRT pacing as chronically programmed by treating physician, 3) using the device-based QuickOpt™ algorithm for optimization of AV and VV delays, and 4) ECG-based optimized SyncAV programming. The paced QRSd was assessed and compared to intrinsic conduction and between the different modes of programming. RESULTS Of 64 consecutive, potentially eligible patients who underwent assessment, 34 patients who were able to undergo SyncAV programming were included. Mean intrinsic conduction QRSd was 163 ± 24 ms. In comparison, the mean QRSd was 152 ± 25 ms (-11.1 ± 19.0) during existing CRT pacing, 160 ± 25 ms (-4.1 ± 25.2) using the QuickOpt™ algorithm and 138 ± 23 (-24.9 ± 17.2) using ECG-based optimized SyncAV programming. SyncAV optimization resulted in significant reductions in QRSd compared to existing CRT pacing (P = 0.02) and QuickOpt™ (P < 0.001). Of the 32% of patients who did not have QRS narrowing with existing CRT, 72% experienced QRS narrowing with SyncAV. CONCLUSION ECG-based atrio-ventricular delay optimization using SyncAV significantly improved electrical synchrony in patients with a previously implanted CRT. Further studies are needed to assess the impact on long-term outcomes.
Collapse
Affiliation(s)
- Ahmed AlTurki
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Pedro Y Lima
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Daniel Garcia
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | | | - Alaa Al-Dosari
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Alejandro Vidal
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Bruno Toscani
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Sergio Diaz
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Martin Bernier
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Tomy Hadjis
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, Montreal, Canada.
| |
Collapse
|
|
19
|
Gwag HB, Park Y, Lee SS, Kim JS, Park KM, On YK, Park SJ. Efficacy of Cardiac Resynchronization Therapy Using Automated Dynamic Optimization and Left Ventricular-only Pacing. J Korean Med Sci 2019; 34:e187. [PMID: 31293111 PMCID: PMC6624415 DOI: 10.3346/jkms.2019.34.e187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/21/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although device-based optimization has been developed to overcome the limitations of conventional optimization methods in cardiac resynchronization therapy (CRT), few real-world data supports the results of clinical trials that showed the efficacy of automatic optimization algorithms. We investigated whether CRT using the adaptive CRT algorithm is comparable to non-adaptive biventricular (BiV) pacing optimized with electrocardiogram or echocardiography-based methods. METHODS Consecutive 155 CRT patients were categorized into 3 groups according to the optimization methods: non-adaptive BiV (n = 129), adaptive BiV (n = 11), and adaptive left ventricular (LV) pacing (n = 15) groups. Additionally, a subgroup of patients (n = 59) with normal PR interval and left bundle branch block (LBBB) was selected from the non-adaptive BiV group. The primary outcomes included cardiac death, heart transplantation, LV assist device implantation, and heart failure admission. Secondary outcomes were electromechanical reverse remodeling and responder rates at 6 months after CRT. RESULTS During a median 27.5-month follow-up, there was no significant difference in primary outcomes among the 3 groups. However, there was a trend toward better outcomes in the adaptive LV group compared to the other groups. In a more rigorous comparisons among the patients with normal PR interval and LBBB, similar patterns were still observed. CONCLUSION In our first Asian-Pacific real-world data, automated dynamic CRT optimization showed comparable efficacy to conventional methods regarding clinical outcomes and electromechanical remodeling.
Collapse
Affiliation(s)
- Hye Bin Gwag
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Youngjun Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Min Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Jung Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
|
20
|
Hsu JC, Birnie D, Stadler RW, Cerkvenik J, Feld GK, Birgersdotter-Green U. Adaptive cardiac resynchronization therapy is associated with decreased risk of incident atrial fibrillation compared to standard biventricular pacing: A real-world analysis of 37,450 patients followed by remote monitoring. Heart Rhythm 2019; 16:983-989. [DOI: 10.1016/j.hrthm.2019.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Indexed: 11/16/2022]
|
|
21
|
Abstract
PURPOSE OF REVIEW Cardiac resynchronization therapy (CRT) is an effective treatment option for therapy-refractory mild to severe heart failure (HF) patients with reduced ejection fraction and left ventricular (LV) conduction delay. Multiple clinical trials have shown that CRT improves cardiac function and overall quality of life, as well as reduces HF hospitalizations, health care costs, and mortality. RECENT FINDINGS Despite its effectiveness, the "non-response" rate to CRT is around 30%, remaining a major challenge that faces electrophysiologists and researchers. It has been recently suggested that the etiology of CRT non-response is multifactorial, and it requires a multifaceted approach to address it. In this focused review, we will summarize the definitions of CRT non-response, identify key factors for CRT non-response, and offer a simplified framework to address CRT non-response with the main goal of improving CRT outcomes.
Collapse
Affiliation(s)
- Syed Yaseen Naqvi
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., Box 653, Rochester, NY, 14642, USA
| | - Anas Jawaid
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., Box 653, Rochester, NY, 14642, USA
| | - Ilan Goldenberg
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., Box 653, Rochester, NY, 14642, USA
| | - Valentina Kutyifa
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., Box 653, Rochester, NY, 14642, USA.
| |
Collapse
|
|
22
|
Pujol-López M, San Antonio R, Mont L, Trucco E, Tolosana JM, Arbelo E, Guasch E, Heist EK, Singh JP. Electrocardiographic optimization techniques in resynchronization therapy. Europace 2019; 21:1286-1296. [DOI: 10.1093/europace/euz126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/05/2019] [Indexed: 12/22/2022] Open
Abstract
Abstract
Cardiac resynchronization therapy (CRT) is a cornerstone of therapy for patients with heart failure, reduced left ventricular (LV) ejection fraction, and a wide QRS complex. However, not all patients respond to CRT: 30% of CRT implanted patients are currently considered clinical non-responders and up to 40% do not achieve LV reverse remodelling. In order to achieve the best CRT response, appropriate patient selection, device implantation, and programming are important factors. Optimization of CRT pacing intervals may improve results, increasing the number of responders, and the magnitude of the response. Echocardiography is considered the reference method for atrioventricular and interventricular (VV) intervals optimization but it is time-consuming, complex and it has a large interobserver and intraobserver variability. Previous studies have linked QRS shortening to clinical response, echocardiographic improvement and favourable prognosis. In this review, we describe the electrocardiographic optimization methods available: 12-lead electrocardiogram; fusion-optimized intervals (FOI); intracardiac electrogram-based algorithms; and electrocardiographic imaging. Fusion-optimized intervals is an electrocardiographic method of optimizing CRT based on QRS duration that combines fusion with intrinsic conduction. The FOI method is feasible and fast, further reduces QRS duration, can be performed during implant, improves acute haemodynamic response, and achieves greater LV remodelling compared with nominal programming of CRT.
Collapse
Affiliation(s)
- Margarida Pujol-López
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Rodolfo San Antonio
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Lluís Mont
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Emilce Trucco
- Department of Cardiology, Hospital Universitari Doctor Josep Trueta, Girona, Catalonia, Spain
| | - José María Tolosana
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Elena Arbelo
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Edwin Kevin Heist
- Cardiology Division, Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jagmeet P Singh
- Cardiology Division, Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
|
23
|
Carpio EF, Gomez JF, Sebastian R, Lopez-Perez A, Castellanos E, Almendral J, Ferrero JM, Trenor B. Optimization of Lead Placement in the Right Ventricle During Cardiac Resynchronization Therapy. A Simulation Study. Front Physiol 2019; 10:74. [PMID: 30804805 PMCID: PMC6378298 DOI: 10.3389/fphys.2019.00074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
Patients suffering from heart failure and left bundle branch block show electrical ventricular dyssynchrony causing an abnormal blood pumping. Cardiac resynchronization therapy (CRT) is recommended for these patients. Patients with positive therapy response normally present QRS shortening and an increased left ventricle (LV) ejection fraction. However, around one third do not respond favorably. Therefore, optimal location of pacing leads, timing delays between leads and/or choosing related biomarkers is crucial to achieve the best possible degree of ventricular synchrony during CRT application. In this study, computational modeling is used to predict the optimal location and delay of pacing leads to improve CRT response. We use a 3D electrophysiological computational model of the heart and torso to get insight into the changes in the activation patterns obtained when the heart is paced from different regions and for different atrioventricular and interventricular delays. The model represents a heart with left bundle branch block and heart failure, and allows a detailed and accurate analysis of the electrical changes observed simultaneously in the myocardium and in the QRS complex computed in the precordial leads. Computational simulations were performed using a modified version of the O'Hara et al. action potential model, the most recent mathematical model developed for human ventricular electrophysiology. The optimal location for the pacing leads was determined by QRS maximal reduction. Additionally, the influence of Purkinje system on CRT response was assessed and correlation analysis between several parameters of the QRS was made. Simulation results showed that the right ventricle (RV) upper septum near the outflow tract is an alternative location to the RV apical lead. Furthermore, LV endocardial pacing provided better results as compared to epicardial stimulation. Finally, the time to reach the 90% of the QRS area was a good predictor of the instant at which 90% of the ventricular tissue was activated. Thus, the time to reach the 90% of the QRS area is suggested as an additional index to assess CRT effectiveness to improve biventricular synchrony.
Collapse
Affiliation(s)
- Edison F Carpio
- Centre for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Juan F Gomez
- Centre for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Rafael Sebastian
- Computational Multiscale Simulation Lab (CoMMLab), Department of Computer Science, Universitat de València, Valencia, Spain
| | - Alejandro Lopez-Perez
- Centre for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Eduardo Castellanos
- Electrophysiology Laboratory and Arrhythmia Unit, Grupo HM Hospitales, Hospital Monteprincipe, University CEU-San Pablo, Madrid, Spain
| | - Jesus Almendral
- Electrophysiology Laboratory and Arrhythmia Unit, Grupo HM Hospitales, Hospital Monteprincipe, University CEU-San Pablo, Madrid, Spain
| | - Jose M Ferrero
- Centre for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Beatriz Trenor
- Centre for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
| |
Collapse
|
|
24
|
Tolosana JM, Brugada J. Optimizing Cardiac Resynchronization Therapy Devices in Follow-up to Improve Response Rates and Outcomes. Card Electrophysiol Clin 2019; 11:89-98. [PMID: 30717856 DOI: 10.1016/j.ccep.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although cardiac resynchronization therapy (CRT) will improve symptoms and survival in selected heart failure patients, there still remains a high percentage of CRT recipients who do not obtain benefit from the therapy. During CRT follow-up, an effort should be made to identify and to treat reversible causes of nonresponse to CRT. This effort includes optimization of medical therapy, checking for appropriate and effective biventricular pacing, and treatment of arrhythmias and other reversible causes of CRT malfunction.
Collapse
Affiliation(s)
- Jose María Tolosana
- Cardiovascular Institute, Hospital Clínic, Arrhythmia Unit Hospital Clinic, University of Barcelona, Villarroel 170, Barcelona 08036, Spain
| | - Josep Brugada
- Pediatric Arrhythmia Unit, Cardiovascular Institute, Hospital Clínic, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
|
25
|
Cardiac resynchronisation therapy optimisation of interventricular delay by the systolic dyssynchrony index: A comparative, randomised, 12-month follow-up study. Hellenic J Cardiol 2019; 60:16-25. [DOI: 10.1016/j.hjc.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/29/2017] [Accepted: 11/01/2017] [Indexed: 11/23/2022] Open
|
|
26
|
André P, Plourde B, Molin F, Sarrazin JF, Champagne J, Philippon F. T-wave oversensing due to left ventricle–only pacing in cardiac resynchronization therapy optimization algorithm. HeartRhythm Case Rep 2018; 4:401-404. [PMID: 30228964 PMCID: PMC6140408 DOI: 10.1016/j.hrcr.2018.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
|
27
|
Gold MR, Yu Y, Singh JP, Birgersdotter-Green U, Stein KM, Wold N, Meyer TE, Ellenbogen KA. Effect of Interventricular Electrical Delay on Atrioventricular Optimization for Cardiac Resynchronization Therapy. Circ Arrhythm Electrophysiol 2018; 11:e006055. [PMID: 30354310 PMCID: PMC6110372 DOI: 10.1161/circep.117.006055] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/01/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Routine atrioventricular optimization (AVO) has not been shown to improve outcomes with cardiac resynchronization therapy (CRT). However, more recently subgroup analyses of multicenter CRT trials have identified electrocardiographic or lead positions associated with benefit from AVO. Therefore, the purpose of this analysis was to evaluate whether interventricular electrical delay modifies the impact of AVO on reverse remodeling with CRT. METHODS This substudy of the SMART-AV trial (SMARTDELAY Determined AV Optimization) included 275 subjects who were randomized to either an electrogram-based AVO (SmartDelay) or nominal atrioventricular delay (120 ms). Interventricular delay was defined as the time between the peaks of the right ventricular (RV) and left ventricular (LV) electrograms (RV-LV duration). CRT response was defined prospectively as a >15% reduction in LV end-systolic volume from implant to 6 months. RESULTS The cohort was 68% men, with a mean age of 65±11 years and LV ejection fraction of 28±8%. Longer RV-LV durations were significantly associated with CRT response ( P<0.01) for the entire cohort. Moreover, the benefit of AVO increased as RV-LV duration prolonged. At the longest quartile, there was a 4.26× greater odds of a remodeling response compared with nominal atrioventricular delays ( P=0.010). CONCLUSIONS Baseline interventricular delay predicted CRT response. At long RV-LV durations, AVO can increase the likelihood of reverse remodeling with CRT. AVO and LV lead location optimized to maximize interventricular delay may work synergistically to increase CRT response. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT00874445.
Collapse
Affiliation(s)
- Michael R. Gold
- Department of Medicine, Medical University of South Carolina, Charleston (M.R.G.)
| | - Yinghong Yu
- Department of Research, Boston Scientific, St. Paul (Y.Y.)
| | - Jagmeet P. Singh
- Department of Medicine, Massachusetts General Hospital, Boston (J.P.S.)
| | | | - Kenneth M. Stein
- Department of Clinical Sciences, Boston Scientific, St. Paul (K.M.S., N.W., T.E.M.)
| | - Nicholas Wold
- Department of Clinical Sciences, Boston Scientific, St. Paul (K.M.S., N.W., T.E.M.)
| | - Timothy E. Meyer
- Department of Clinical Sciences, Boston Scientific, St. Paul (K.M.S., N.W., T.E.M.)
| | - Kenneth A. Ellenbogen
- Department of Medicine, Virginia Commonwealth University Medical Center, Richmond (K.A.E.)
| |
Collapse
|
|
28
|
Vondrák J, Marek D, Večeřa J, Benešová K, Vojtíšek P. Cardiac resynchronization therapy - A comparison of VV delay optimization by 3D echocardiography using systolic dyssynchrony index and QRS width assessment at 6 months after CRT implantation. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
29
|
Mele D, Bertini M, Malagù M, Nardozza M, Ferrari R. Current role of echocardiography in cardiac resynchronization therapy. Heart Fail Rev 2018; 22:699-722. [PMID: 28714039 DOI: 10.1007/s10741-017-9636-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. Patients are usually assessed by echocardiography, which provides a number of anatomical and functional information used for cardiac dyssynchrony assessment, prognostic stratification, identification of the optimal site of pacing in the left ventricle, optimization of the CRT device, and patient follow-up. Compared to other cardiac imaging techniques, echocardiography has the advantage to be non-invasive, repeatable, and safe, without exposure to ionizing radiation or nefrotoxic contrast. In this article, we review current evidence about the role of echocardiography before, during, and after the implantation of a CRT device.
Collapse
Affiliation(s)
- Donato Mele
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy. .,Noninvasive Cardiology Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Ferrara, Cona, Italy.
| | - Matteo Bertini
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Michele Malagù
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Marianna Nardozza
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Roberto Ferrari
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, RA, Italy
| |
Collapse
|
|
30
|
Shortening of paced QRS duration after electrocardiographic optimization of left ventricular pacing vector in patients treated with Cardiac Resynchronization Therapy. J Electrocardiol 2018; 51:628-633. [PMID: 29997002 DOI: 10.1016/j.jelectrocard.2018.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/12/2018] [Accepted: 04/24/2018] [Indexed: 11/20/2022]
Abstract
Background Choice of left ventricular pacing vector (LVPV) affects the QRS-duration (QRSd) in patients with Cardiac Resynchronization Therapy (CRT). It is not known whether testing all LVPVs reduces QRSd compared to device-based “standard-programming”. Methods In patients implanted with CRT several ECGs were recorded for each usable LVPV (no phrenic nerve stimulation and threshold <3.5 V) and during “standard-programming” after device-based optimization of AV/VV delays. Results 22 consecutive patients were included. Average QRSd reduction after CRT + “standard-programming” was 27.3 ± 22 ms. Additional QRSd-reduction was possible in 4 patients by changing the LVPV, and in 5 other patients after optimization of AV- and VV delays without changing LVPV. Conclusions Shortening of QRSd compared to “standard-programming” was possible approximately 40% of these patients treated with CRT by testing all LVPVs and re-optimizing AV/VV delays during follow-up. Studies of clinical effects are needed.
Collapse
|
|
31
|
Bilchick KC. Optimizing Resynchronization Programming With the Surface Electrocardiogram. JACC Clin Electrophysiol 2018; 4:190-192. [PMID: 29749936 DOI: 10.1016/j.jacep.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 01/10/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Kenneth C Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.
| |
Collapse
|
|
32
|
Varma N, Stadler RW, Ghosh S, Kloppe A. Influence of automatic frequent pace-timing adjustments on effective left ventricular pacing during cardiac resynchronization therapy. Europace 2018; 19:831-837. [PMID: 27230561 DOI: 10.1093/europace/euw108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/15/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) requires effective left ventricular (LV) pacing (i.e. sufficient energy and appropriate timing to capture). The AdaptivCRT™ (aCRT) algorithm serves to maintain ventricular fusion during LV or biventricular pacing. This function was tested by comparing the morphological consistency of ventricular depolarizations and percentage effective LV pacing in CRT patients randomized to aCRT vs. echo-optimization. Methods and results Continuous recordings (≥20 h) of unipolar LV electrograms from aCRT (n = 38) and echo-optimized patients (n = 22) were analysed. Morphological consistency was determined by the correlation coefficient between each beat and a template beat. Effective LV pacing of paced beats was assessed by algorithmic analysis of negative initial EGM deflection in each evoked response. The %CRT pacing delivered, %effective LV pacing (i.e. % of paced beats with effective LV pacing), and overall %effective CRT (i.e. product of %CRT pacing and %effective LV pacing) were compared between aCRT and echo-optimized patients. Demographics were similar between groups. The mean correlation coefficient between individual beats and template was greater for aCRT (0.96 ± 0.03 vs. 0.91 ± 0.13, P = 0.07). Although %CRT pacing was similar for aCRT and echo-optimized (median 97.4 vs. 98.6%, P = 0.14), %effective LV pacing was larger for aCRT [99.6%, (99.1%, 99.9%) vs. 94.3%, (24.3%, 99.8%), P=0.03]. For aCRT vs. echo-optimized groups, the proportions of patients with ≥90% effective LV pacing was 92 vs. 55% (P = 0.002), and with ≥90% effective CRT was 79 vs. 45%, respectively (P = 0.018). Conclusion AdaptivCRT™ significantly increased effective LV pacing over echo-optimized CRT.
Collapse
Affiliation(s)
- Niraj Varma
- Cleveland Clinic Main Campus, Mail Code J2-2, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Robert W Stadler
- Medtronic PLC, 8200 Coral Sea St., Mail Stop: MVN41, Mounds View, MN 55112, USA
| | - Subham Ghosh
- Medtronic PLC, 8200 Coral Sea St., Mail Stop: MVN41, Mounds View, MN 55112, USA
| | - Axel Kloppe
- Department of Cardiology and Angiology, Ruhr-Universität Bochum, Bochum, Germany
| |
Collapse
|
|
33
|
Yan J, Zhang S, Huang D, Xue X, Xu J, Tao Q, Zhang W, Zhang Z, Hua W, Liang Y, Tang B, Xu W, Xu G, Ren X, Wang J, Guo T, Jia S, Dong Y, Jiang H, Fu G, Zhu L, Chen L, Tian F, Ling F, Li J, Qi X, Hao Y, Wang Y, Zheng L, Pu X, Shen F, Li G, Li H, Peng F. Evaluation of the therapeutic effects of QuickOpt optimization in Chinese patients with chronic heart failure treated by cardiac resynchronization. Sci Rep 2018. [PMID: 29523823 PMCID: PMC5844885 DOI: 10.1038/s41598-018-22525-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In this trial, long-term therapeutic effects and clinical improvements in Chinese chronic heart failure patients optimized by QuickOpt or echocardiography were compared for atrioventricular (AV) and interventricular (VV) delay optimizations after cardiac resynchronization therapy (CRT) with pacing (CRT-P) or with pacing and defibrillator (CRT-D) therapy. One hundred and ninety-six subjects (50%) had dilated cardiomyopathy, 108 (27.6%) had ischemic heart disease and 112 (28.6%) were hypertensive and were randomized into QuickOpt (198) or echocardiographic optimization (control) (194) groups at ≤2-weeks post-implantation. Programmed AV/VV delay was optimized at baseline and at 3 and 6 months. Left ventricular end-systolic volume (LVESV), New York Heart Association (NYHA) class, specific activity scale (SAS), and the six-minute walk tests (6MWT) were evaluated by blinded researchers at 12 months. Of the QuickOpt group, LVESV decreased significantly by 24.7% ± 33.9% compared with baseline, while LVESV of Controls decreased by 25.1% ± 36.1% (P = 0.924). NYHA class, SAS and 6MWT also improved similarly in both groups at 12 months. Mortality in both groups was not significantly different (11.0% vs 7.6%, P = 0.289). However, there was a significant difference in the time required for optimization by QuickOpt compared with echocardiography (3.33 ± 3.11 vs 58.79 ± 27.03 minutes, P < 0.000).
Collapse
Affiliation(s)
- Ji Yan
- Department of Cardiology, Anhui Provincial Hospital, No. 17 Lujiang Road, Hefei, 230001, China
| | - Shu Zhang
- Cardiac Arrhythmia center, Fuwai Hospital, Chinese Academy of medical Sciences, No. 167 North Lishi Road, Beijing, 100037, China.
| | - Dejia Huang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 Guoxue lane, Chengdu, 610041, China.
| | - Xiaolin Xue
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, China
| | - Jing Xu
- Department of Cardiology, Tianjin chest hospital, No. 93 Xi'an Road, Tianjin, 300051, China
| | - Qianmin Tao
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Weize Zhang
- Department of Cardiology, The General Hospital of Lanzhou Military, No. 98 Xiaoxihu West Street, Lanzhou, 730050, China
| | - Zheng Zhang
- Department of Cardiology, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Lanzhou, 730000, China
| | - Wei Hua
- Cardiac Arrhythmia center, Fuwai Hospital, Chinese Academy of medical Sciences, No. 167 North Lishi Road, Beijing, 100037, China
| | - Yanchun Liang
- Department of Cardiology, The General Hospital of Shenyang Military, No. 83 Wenhua Road, Shenyang, 110840, China
| | - Baopeng Tang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137 Liyushan South Road, Urumqi, 830054, China
| | - Wei Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, China
| | - Geng Xu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Xuejun Ren
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, 100029, China
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, China
| | - Tao Guo
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming, 650032, China
| | - Shaobin Jia
- Department of Cardiology, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Yinchuan, 750004, China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Er Road, Guangzhou, 510080, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital of Medicine, Zhejiang University, No. 3 Qingchun East Road, Hangzhou, 310020, China
| | - Liguang Zhu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanjing, 530021, China
| | - Lin Chen
- Department of Cardiology, Fujian Provincial Hospital, No. 134 East Street, Fuzhou, 350001, China
| | - Fuli Tian
- The First Department of Cardiology, The 251ST Hospital of PLA, No. 13 Jianguo Road, Zhangjiakou, 075000, China
| | - Feng Ling
- Department of Cardiology, Hangzhou First People's Hospital, No. 261 HuanSha Road, Hangzhou, 310006, China
| | - Jianmei Li
- Department of Cardiology, The second people's Hospital of Yunnan Province, No. 176 Qingnian Road, Kunming, 650021, China
| | - Xiaoyong Qi
- Department of Cardiology, Hebei General Hospital, No. 348 Heping West Road, Shijiazhuang, 050051, China
| | - Yinglu Hao
- Department of Cardiology, People's Hospital of Yuxi City, No. 21 Nieer Road, Yuxi, 653100, China
| | - Yutang Wang
- Department of Cardiology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Liangrong Zheng
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Xiaoqun Pu
- Department of Cardiology, Xiangya Hospital Central South University, No. 87 xiangya Road, Changsha, 410008, China
| | - Farong Shen
- Department of Cardiology, Zhejiang Greentown Hospital, No. 409 Gudun Road, Hangzhou, 310000, China
| | - Guangping Li
- Department of Cardiology, The Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Tianjin, 300211, China
| | - Hui Li
- Department of Cardiology, Daqing Oilfield General Hospital, No. 9 Zhongkang Street, Daqing, 163000, China
| | - Fang Peng
- Department of Cardiology, Shaoxing People's Hospital, No. 568 Zhongxing North Road, Shaoxing, 312000, China
| |
Collapse
|
|
34
|
Socie P, Squara F, Semichon M, Thomas O, Khemache A, Riccini P, Squara P, Algalarrondo V, Moubarak G. Combination of the best pacing configuration and atrioventricular and interventricular delays optimization in cardiac resynchronization therapy. Pacing Clin Electrophysiol 2018; 41:362-367. [PMID: 29405324 DOI: 10.1111/pace.13294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/13/2018] [Accepted: 01/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy optimization can be pursued by left ventricular pacing vector selection and atrioventricular (AV) and interventricular (VV) delays optimization. The combination of these methods and its comparison with multipoint pacing (MPP) is scarcely studied. METHODS Using noninvasive cardiac output (CO) measurement, the best of five left ventricular pacing vectors was determined, then AV and VV delays optimization was applied on top of the best vector. Response to the optimization protocol was defined as a >5% CO increase compared to the standard biventricular configuration. RESULTS Twenty-two patients (18 men, age 71 ± 9 years) were included. Standard biventricular configuration increased CO compared to baseline (4.65 ± 1.55 L/min vs 4.27 ± 1.53 L/min, respectively, P = 0.02). The best quadripolar configuration increased CO to 4.85 ± 1.67 L/min (P = 0.03 compared to the standard biventricular configuration). AV then VV delay optimization both provided additional benefit (final CO 5.56 ± 2.03 L/min, P = 0.001 compared to the best quadripolar configuration). Fifteen (68%) patients responded to the optimization protocol. Anatomical MPP (based on maximal anatomical separation between electrodes) and electrical MPP (based on maximal electrical activation difference between electrodes) were evaluated in 16 patients and yielded a CO similar to that of the optimization procedure. CONCLUSIONS The combination of choosing the best quadripolar pacing configuration and optimizing atrioventricular and interventricular delays resulted in an improvement of cardiac output compared to standard biventricular stimulation in 68% of patients. The final cardiac output was comparable to multipoint pacing.
Collapse
Affiliation(s)
- Pierre Socie
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Fabien Squara
- Department of Cardiology, Pasteur University Hospital, Nice, France
| | - Marc Semichon
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Olivier Thomas
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Alain Khemache
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Philippe Riccini
- Department of Cardiology, Pasteur University Hospital, Nice, France
| | - Pierre Squara
- Intensive Care Unit, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Vincent Algalarrondo
- Department of Cardiology, Antoine Béclère Hospital, Université Paris-Sud, Clamart, France
| | - Ghassan Moubarak
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| |
Collapse
|
|
35
|
Improvement of Reverse Remodeling Using Electrocardiogram Fusion-Optimized Intervals in Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2018; 4:181-189. [DOI: 10.1016/j.jacep.2017.11.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 01/20/2023]
|
|
36
|
Santini L, Forleo GB, Minni V, Mafhouz K, Della Rocca DG, Fresiello L, Romeo F, Ferrari G, Di Molfetta A. Towards a Personalized and Dynamic CRT-D. Methods Inf Med 2018; 51:495-506. [DOI: 10.3414/me12-01-0011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 07/20/2012] [Indexed: 11/09/2022]
Abstract
SummaryBackground: In spite of cardiac resynchronization therapy (CRT) benefits, 25 – 30% of patients are still non responders. One of the possible reasons could be the non optimal atrioventricular (AV) and interventricular (VV) intervals settings. Our aim was to exploit a numerical model of cardiovascular system for AV and VV intervals optimization in CRT.Methods: A numerical model of the cardiovascular system CRT-dedicated was previously developed. Echocardiographic parameters, Systemic aortic pressure and ECG were collected in 20 consecutive patients before and after CRT. Patient data were simulated by the model that was used to optimize and set into the device the intervals at the baseline and at the follow up. The optimal AV and VV intervals were chosen to optimize the simulated selected variable/s on the base of both echocardiographic and electrocardiographic parameters.Results: Intervals were different for each patient and in most cases, they changed at follow up. The model can well reproduce clinical data as verified with Bland Altman analysis and T-test (p > 0.05). Left ventricular remodeling was 38.7% and left ventricular ejection fraction increasing was 11% against the 15% and 6% reported in literature, respectively.Conclusions: The developed numerical model could reproduce patients conditions at the baseline and at the follow up including the CRT effects. The model could be used to optimize AV and VV intervals at the baseline and at the follow up realizing a personalized and dynamic CRT. A patient tailored CRT could improve patients outcome in comparison to literature data.
Collapse
|
|
37
|
Rowe MK, Kaye GC. Advances in atrioventricular and interventricular optimization of cardiac resynchronization therapy - what's the gold standard? Expert Rev Cardiovasc Ther 2018; 16:183-196. [PMID: 29338475 DOI: 10.1080/14779072.2018.1427582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) is one of the most important advances in heart failure management in the last twenty years. Approximately one-third of patients appear not to respond to therapy. Although there are a number of possible mechanisms for non-response, an important factor is suboptimal atrioventricular (AV) and interventricular (VV) timing intervals. There remains controversy over whether routinely optimizing intervals is necessary and there is no agreed gold standard methodology. Optimization has classically been performed using echocardiography which has limits related to resource use, time-cost and variable reproducibility. Newer optimization methods using device-based sensors and algorithms show promise in reducing heart-failure hospitalization compared with echocardiography. Areas covered: This review outlines the rationale for optimization, the principles of AV and VV optimization, the standard echocardiographic approach and newer device-based algorithms and the evidence base for their use. Expert commentary: The incremental gains of optimization are likely to be real, but small, compared to the overall improvement gained from cardiac resynchronization itself. At this time routine optimization may not be mandatory but should be performed where there is no response to CRT. Device-based optimization algorithms appear to be practical and in some cases, deliver superior clinical outcomes compared to echocardiography.
Collapse
Affiliation(s)
- Matthew K Rowe
- a Department of Cardiology , Princess Alexandra Hospital , Brisbane , Australia.,b Faculty of Medicine , The University of Queensland , Brisbane , Australia
| | - Gerald C Kaye
- a Department of Cardiology , Princess Alexandra Hospital , Brisbane , Australia.,b Faculty of Medicine , The University of Queensland , Brisbane , Australia
| |
Collapse
|
|
38
|
Spartalis M, Tzatzaki E, Spartalis E, Damaskos C, Athanasiou A, Livanis E, Voudris V. The Role of Echocardiography in the Optimization of Cardiac Resynchronization Therapy: Current Evidence and Future Perspectives. Open Cardiovasc Med J 2017; 11:133-145. [PMID: 29387277 PMCID: PMC5748829 DOI: 10.2174/1874192401711010133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has become a mainstay in the management of heart failure. Up to one-third of patients who received resynchronization devices do not experience the full benefits of CRT. The clinical factors influencing the likelihood to respond to the therapy are wide QRS complex, left bundle branch block, female gender, non-ischaemic cardiomyopathy (highest responders), male gender, ischaemic cardiomyopathy (moderate responders) and narrow QRS complex, non-left bundle branch block (lowest, non-responders). OBJECTIVE This review provides a conceptual description of the role of echocardiography in the optimization of CRT. METHOD A literature survey was performed using PubMed database search to gather information regarding CRT and echocardiography. RESULTS A total of 70 studies met selection criteria for inclusion in the review. Echocardiography helps in the initial selection of the patients with dyssynchrony, which will benefit the most from optimal biventricular pacing and provides a guide to left ventricular (LV) lead placement during implantation. Different echocardiographic parameters have shown promise and can offer the possibility of patient selection, response prediction, lead placement optimization strategies and optimization of device configurations. CONCLUSION LV ejection fraction along with specific electrocardiographic criteria remains the cornerstone of CRT patient selection. Echocardiography is a non-invasive, cost-effective, highly reproducible method with certain limitations and accuracy that is affected by measurement errors. Echocardiography can assist with the identification of the appropriate electromechanical substrate of CRT response and LV lead placement. The targeted approach can improve the haemodynamic response, as also the patient-specific parameters estimation.
Collapse
Affiliation(s)
- Michael Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eleni Tzatzaki
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | - Christos Damaskos
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | | | - Efthimios Livanis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Vassilis Voudris
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| |
Collapse
|
|
39
|
Ciconte G, Ćalović Ž, Vicedomini G, Cuko A, McSpadden LC, Jiang C, Ryu K, Caporaso I, Stutz R, Winter D, Saviano M, Vitale R, Conti M, Santinelli V, Pappone C. Multipoint pacing improves peripheral hemodynamic response: Noninvasive assessment using radial artery tonometry. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:106-113. [PMID: 29222865 DOI: 10.1111/pace.13254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 11/14/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multipoint left ventricular (LV) pacing (MultiPoint™ Pacing [MPP], Abbott, Sylmar, CA, USA) improves the response rate to cardiac resynchronization therapy (CRT). We evaluated the feasibility of noninvasive radial artery tonometry (RAT) to characterize arterial pressure morphology changes (pre-ejection period [PEP] and ejection duration [ED]) between conventional CRT and MPP pacing interventions. METHODS Patients with a MPP-enabled CRT device (Quadra Assura MP™, Abbott) underwent noninvasive RAT assessment (SphygmoCor CVMS, AtCor Medical Inc., Itasca, IL, USA) at 3-6 months after implantation. A pacing protocol was performed in a randomized order including one optimized conventional biventricular CRT (CONV) configuration using the distal electrode and five MPP configurations. The PEP, ED, and PEP/ED ratio were determined for each intervention from the RAT pressure waveform and electrocardiogram. RESULTS Pressure waveforms were successfully recorded in 19 patients (89% male, QRS 147 ± 16 ms, 63% ischemic). In 17/19 (89%) patients, at least one MPP intervention resulted in improved PEP, ED, and PEP/ED compared to CONV. The MPP intervention with greatest separation of LV cathodes and minimum intra-LV delay significantly improved PEP (mean PEP -15 ± 33% vs -8 ± 32% [CONV], P = 0.04) and ED (mean ED +8 ± 8% [MPP] vs +4 ± 7% [CONV], P = 0.02), and PEP/ED (-0.07 ± 0.14 [MPP] vs -0.04 ± 0.13 [CONV], P = 0.02) compared with CONV. CONCLUSIONS Noninvasive RAT efficiently characterizes changes in PEP and ED between CONV and MPP interventions. MPP configurations using the widest separation among LV cathodes and minimum intra-LV delay may significantly improve RAT-derived parameters as compared to conventional CRT.
Collapse
Affiliation(s)
- Giuseppe Ciconte
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Žarko Ćalović
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Gabriele Vicedomini
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Amarild Cuko
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | | | | | | | | | | | | | - Massimo Saviano
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Raffaele Vitale
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Manuel Conti
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Vincenzo Santinelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Carlo Pappone
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| |
Collapse
|
|
40
|
Continuous optimization of cardiac resynchronization therapy reduces atrial fibrillation in heart failure patients: Results of the Adaptive Cardiac Resynchronization Therapy Trial. Heart Rhythm 2017; 14:1820-1825. [DOI: 10.1016/j.hrthm.2017.08.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Indexed: 02/03/2023]
|
|
41
|
Auricchio A, Prinzen FW. Enhancing Response in the Cardiac Resynchronization Therapy Patient. JACC Clin Electrophysiol 2017; 3:1203-1219. [DOI: 10.1016/j.jacep.2017.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/02/2017] [Accepted: 08/10/2017] [Indexed: 12/17/2022]
|
|
42
|
Abstract
PURPOSE OF REVIEW Medical devices have become an integral part of comprehensive heart failure management. Not all heart failure patients, however, accrue benefit from every new device, and even with extensive practice guidelines, this remains an evolving field. RECENT FINDINGS The addition of implantable devices, like internal cardioverter defibrillators (ICDs), and novel pacing technologies, including cardiac resynchronization therapy (CRT), have helped to compliment goal-directed medical therapy and positively impact prognosis in multiple high-quality clinical trials. This review attempts to summarize the rapidly evolving literature with respect to existing device guidelines for routine implantable devices as well as some available and future technologies that are not yet a part of routine guidelines. ICD, CRT, and other implantable devices continue to save lives, decrease hospitalizations, and evolve the management of patients with heart failure beyond the capabilities of optimal guideline-directed medical therapy alone.
Collapse
Affiliation(s)
- Brett G Angel
- Division of Cardiology, Hahnemann University Hospital, Drexel University College of Medicine, 245 North 15th Street, Suite 6122, Philadelphia, PA, 19102, USA.
| | - Heath Saltzman
- Division of Cardiology, Hahnemann University Hospital, Drexel University College of Medicine, 245 North 15th Street, Suite 6122, Philadelphia, PA, 19102, USA
| | - Luke S Kusmirek
- Division of Cardiology, Hahnemann University Hospital, Drexel University College of Medicine, 245 North 15th Street, Suite 6122, Philadelphia, PA, 19102, USA
| |
Collapse
|
|
43
|
Chia PL, Foo D. Overview of implantable cardioverter defibrillator and cardiac resynchronisation therapy in heart failure management. Singapore Med J 2017; 57:354-9. [PMID: 27440409 DOI: 10.11622/smedj.2016117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Clinical trials have established the benefits of implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) in the treatment of heart failure patients. As adjuncts to guideline-directed medical therapy, ICDs confer mortality benefits from sudden cardiac arrest, while CRT reduces mortality, hospitalisation rates and improves functional capacity. This review discusses the use of ICDs and CRT devices in heart failure management, outlining the evidence supporting their use, indications and contraindications.
Collapse
Affiliation(s)
- Pow-Li Chia
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - David Foo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
|
44
|
Abstract
Nonresponse to cardiac resynchronization therapy (CRT) is still a major issue in therapy expansion. The description of fast, simple, cost-effective methods to optimize CRT could help in adapting pacing intervals to individual patients. A better understanding of the importance of appropriate patient selection, left ventricular lead placement, and device programming, together with a multidisciplinary approach and an optimal follow-up of the patients, may reduce the percentage of nonresponders.
Collapse
Affiliation(s)
- José María Tolosana
- Hospital Clinic, Universitat de Barcelona, Villarroel 170, Barcelona, Catalonia 08036, Spain
| | - Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Villarroel 170, Barcelona, Catalonia 08036, Spain.
| |
Collapse
|
|
45
|
Sinner GJ, Gupta VA, Seratnahaei A, Charnigo RJ, Darrat YH, Elayi SC, Leung SW, Sorrell VL. Atrioventricular dyssynchrony from empiric device settings is common in cardiac resynchronization therapy and adversely impacts left ventricular morphology and function. Echocardiography 2017; 34:496-503. [DOI: 10.1111/echo.13486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Gregory J. Sinner
- Department of Internal Medicine; University of Kentucky Medical Center; University of Kentucky; Lexington KY USA
| | - Vedant A. Gupta
- Division of Cardiovascular Medicine; Gill Heart Institute; University of Kentucky Medical Center; University of Kentucky; Lexington KY USA
| | - Arash Seratnahaei
- Division of Cardiovascular Medicine; Gill Heart Institute; University of Kentucky Medical Center; University of Kentucky; Lexington KY USA
| | | | - Yousef H. Darrat
- Division of Cardiovascular Medicine; Gill Heart Institute; University of Kentucky Medical Center; University of Kentucky; Lexington KY USA
| | - Samy C. Elayi
- Division of Cardiovascular Medicine; Gill Heart Institute; University of Kentucky Medical Center; University of Kentucky; Lexington KY USA
| | - Steve W. Leung
- Division of Cardiovascular Medicine; Gill Heart Institute; University of Kentucky Medical Center; University of Kentucky; Lexington KY USA
| | - Vincent L. Sorrell
- Division of Cardiovascular Medicine; Gill Heart Institute; University of Kentucky Medical Center; University of Kentucky; Lexington KY USA
| |
Collapse
|
|
46
|
|
|
47
|
Friedman DJ, Bao H, Spatz ES, Curtis JP, Daubert JP, Al-Khatib SM. Association Between a Prolonged PR Interval and Outcomes of Cardiac Resynchronization Therapy: A Report From the National Cardiovascular Data Registry. Circulation 2016; 134:1617-1628. [PMID: 27760795 DOI: 10.1161/circulationaha.116.022913] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/26/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND A prolonged PR interval is common among cardiac resynchronization therapy (CRT) candidates; however, the association between PR interval and outcomes is unclear, and the data are conflicting. METHODS We conducted inverse probability weighted analyses of 26 451 CRT-eligible (ejection fraction ≤35, QRS ≥120 ms) patients from the National Cardiovascular Data Registry ICD Registry to assess the association between a prolonged PR interval (≥230 ms), receipt of CRT with defibrillator (CRT-D) versus implantable cardioverter defibrillator (ICD), and outcomes. We first tested the association between a prolonged PR interval and outcomes among patients stratified by device type. Next, we performed a comparative effectiveness analysis of CRT-D versus ICD among patients when stratified by PR interval. Using Medicare claims data, we followed up with patients up to 5 years for incident heart failure hospitalization or death. RESULTS Patients with a PR≥230 ms (15%; n=4035) were older and had more comorbidities, including coronary artery disease, atrial arrhythmias, diabetes mellitus, and chronic kidney disease. After risk adjustment, a PR≥230 ms (versus PR<230 ms) was associated with increased risk of heart failure hospitalization or death among CRT-D (hazard ratio, 1.23; 95% confidence interval, 1.14-1.31; P<0.001) but not ICD recipients (hazard ratio, 1.08; 95% confidence interval, 0.97-1.20; P=0.17) (Pinteraction=0.043). CRT-D (versus ICD) was associated with lower rates of heart failure hospitalization or death among patients with PR<230 ms (hazard ratio, 0.79; 95% confidence interval, 0.73-0.85; P<0.001) but not PR≥230 ms (hazard ratio, 1.01; 95% confidence interval, 0.87-1.17; P=0.90) (Pinteraction=0.0025). CONCLUSIONS A PR≥230 ms is associated with increased rates of heart failure hospitalization or death among CRT-D patients. The real-world comparative effectiveness of CRT-D (versus ICD) is significantly less among patients with a PR≥230 ms in comparison with patients with a PR<230 ms.
Collapse
Affiliation(s)
- Daniel J Friedman
- From Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., J.P.D., S.M.A.-K.); Duke Clinical Research Institute, Durham, NC (D.J.F., S.M.A.-K.); and Yale University School of Medicine, New Haven, CT (H.B., E.S.S., J.P.C.).
| | - Haikun Bao
- From Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., J.P.D., S.M.A.-K.); Duke Clinical Research Institute, Durham, NC (D.J.F., S.M.A.-K.); and Yale University School of Medicine, New Haven, CT (H.B., E.S.S., J.P.C.)
| | - Erica S Spatz
- From Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., J.P.D., S.M.A.-K.); Duke Clinical Research Institute, Durham, NC (D.J.F., S.M.A.-K.); and Yale University School of Medicine, New Haven, CT (H.B., E.S.S., J.P.C.)
| | - Jeptha P Curtis
- From Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., J.P.D., S.M.A.-K.); Duke Clinical Research Institute, Durham, NC (D.J.F., S.M.A.-K.); and Yale University School of Medicine, New Haven, CT (H.B., E.S.S., J.P.C.)
| | - James P Daubert
- From Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., J.P.D., S.M.A.-K.); Duke Clinical Research Institute, Durham, NC (D.J.F., S.M.A.-K.); and Yale University School of Medicine, New Haven, CT (H.B., E.S.S., J.P.C.)
| | - Sana M Al-Khatib
- From Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., J.P.D., S.M.A.-K.); Duke Clinical Research Institute, Durham, NC (D.J.F., S.M.A.-K.); and Yale University School of Medicine, New Haven, CT (H.B., E.S.S., J.P.C.)
| |
Collapse
|
|
48
|
Abstract
Cardiac resynchronisation therapy (CRT) is an important therapy for patients with heart failure with a reduced ejection fraction and interventricular conduction delay. Large trials have established the role of CRT in reducing heart failure hospitalisations and improving symptoms, left ventricular (LV) function and mortality. Guidelines from major medical societies are consistent in support of CRT for patients with New York Health Association (NYHA) class II, III and ambulatory class IV heart failure, reduced LV ejection fraction and QRS prolongation, particularly left bundle branch block. The current challenge facing practitioners is to maximise the rate of patients who respond to CRT and the magnitude of that response. Current areas of interest for achieving these goals include tailoring patient selection, individualising LV lead placement and application of new technologies and techniques for CRT delivery.
Collapse
Affiliation(s)
- Geoffrey F Lewis
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, US
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, US
| |
Collapse
|
|
49
|
Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, McGuire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. J Arrhythm 2016; 32:1-28. [PMID: 26949427 PMCID: PMC4759125 DOI: 10.1016/j.joa.2015.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Key Words
- AF, atrial fibrillation
- ATP, antitachycardia pacing
- Bradycardia mode and rate
- CI, confidence interval
- CL, cycle length
- CRT, cardiac resynchronization therapy
- CRT-D, cardiac resynchronization therapy–defibrillator
- DT, defibrillation testing
- Defibrillation testing
- EEG, electroencephalography
- EGM, electrogram
- HF, heart failure
- HR, hazard ratio
- ICD, implantable cardioverter-defibrillator
- Implantable cardioverter-defibrillator
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- MVP, managed ventricular pacing
- NCDR, National Cardiovascular Data Registry
- NYHA, New York Heart Association
- OR, odds ratio
- PEA, peak endocardial acceleration
- PVC, premature ventricular contraction
- Programming
- RCT, randomized clinical trial
- RV, right ventricle
- S-ICD, subcutaneous implantable cardioverter-defibrillator
- SCD, sudden cardiac death
- SVT, supraventricular tachycardia
- TIA, transient ischemic attack
- Tachycardia detection
- Tachycardia therapy
- VF, ventricular fibrillation
- VT, ventricular tachycardia (Heart Rhythm 2015;0:1–37)
- aCRT, adaptive cardiac resynchronization therapy
Collapse
Affiliation(s)
| | | | | | - Carlos A Morillo
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | - Jesœs Almendral
- Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | | | | | - Alejandro Cuesta
- Servicio de Arritmias, Instituto de Cardiologia Infantil, Montevideo, Uruguay
| | | | - Sergio Dubner
- Clinica y Maternidad Suizo Argentina; De Los Arcos Sanatorio, Buenos Aires, Argentina
| | | | | | | | - Fermin C Garcia
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - David E Haines
- William Beaumont Hospital Division of Cardiology, Royal Oak, Michigan
| | - Jeff S Healey
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | | | | | | | | | | | | | - Luis G Molina
- Mexico's National University, Mexico's General Hospital, Mexico City, Mexico
| | - Ken Okumura
- Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Alessandro Proclemer
- Azienda Ospedaliero Universitaria S. Maria della Misericordia- Udine, Udine, Italy
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Wee Siong Teo
- National Heart Centre Singapore, Singapore, Singapore
| | - William Uribe
- CES Cardiología and Centros Especializados San Vicente Fundación, Medellín y Rionegro, Colombia
| | - Sami Viskin
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shu Zhang
- National Center for Cardiovascular Disease and Beijing Fu Wai Hospital, Peking Union Medical College and China Academy of Medical Sciences, Beijing, China
| |
Collapse
|
|
50
|
2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm 2015; 13:e50-86. [PMID: 26607062 DOI: 10.1016/j.hrthm.2015.11.018] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Indexed: 12/12/2022]
|