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Del Greco M, Zorzi A, Di Matteo I, Cima A, Maines M, Angheben C, Catanzariti D. Coronary sinus activation patterns in patients with and without left bundle branch block undergoing electroanatomic mapping system-guided cardiac resynchronization therapy device implantation. Heart Rhythm 2016; 14:225-233. [PMID: 27989791 DOI: 10.1016/j.hrthm.2016.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Implantation of the left ventricular (LV) lead in segments with delayed electrical activation may improve response to cardiac resynchronization therapy (CRT). OBJECTIVE The purpose of this study was to evaluate the amount and regional distribution of LV electrical delay (LVED) in patients with or without left bundle branch block (LBBB). METHODS We enrolled 60 patients who underwent electroanatomic mapping system-guided CRT device implantation. Activation mapping of the coronary sinus (CS) branches was performed using an insulated guidewire. LVED was defined as the interval between the beginning of the QRS complex on the surface electrocardiogram (ECG) and the local electrogram and expressed in milliseconds or as percentage of the total QRS duration (LVED%). RESULTS Forty-three patients showed a LBBB and 17 a non-LBBB electrocardiographic pattern. A total of 148 CS branches (mean 2.5 per patient; range 2-4 per patient) were mapped. Patients with LBBB showed higher maximum LVED (135 ms [108-150 ms] vs 100 ms [103-110 ms]; P < .001) and LVED% (86% [79%-89%] vs 72% [54%-80%]; P < .001) than did patients without LBBB. The maximum LVED was recorded in mid-basal anterolateral or inferolateral LV segments (traditional CRT targets), significantly more often in patients with LBBB than in patients without LBBB (85% vs 59%; P = .02). The number of CS branches showing LVED >50% of the total QRS duration, >75% of the total QRS duration, and >85 ms was significantly higher in patients with LBBB than in patients without LBBB. CONCLUSION Patients without LBBB showed lower LVED and more heterogeneous electrical activation of the CS than did patients with LBBB. This finding may contribute to a lower rate of response to CRT of patients without LBBB and suggests the use of activation mapping to guide LV lead placement.
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Affiliation(s)
| | - Alessandro Zorzi
- Santa Maria del Carmine Hospital, Rovereto TN, Italy,; Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Anna Cima
- Santa Maria del Carmine Hospital, Rovereto TN, Italy
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Pastore G, Maines M, Marcantoni L, Zanon F, Noventa F, Corbucci G, Baracca E, Aggio S, Picariello C, Lanza D, Rigatelli G, Carraro M, Roncon L, Barold SS. ECG parameters predict left ventricular conduction delay in patients with left ventricular dysfunction. Heart Rhythm 2016; 13:2289-2296. [DOI: 10.1016/j.hrthm.2016.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Indexed: 11/27/2022]
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Kaypakli O, Koç M, Gözübüyük G, Şahin DY. High Left Ventricular Lead Sensing Delay Predicts QRS Narrowing and Good Response to Cardiac Resynchronization Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1317-1326. [PMID: 27753447 DOI: 10.1111/pace.12963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/28/2016] [Accepted: 10/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) was shown to improve heart failure (HF) prognosis. But many patients do not benefit from CRT. Optimization of left ventricular (LV) lead position to the latest activated LV area is important to increase CRT response. We aimed to detect the relationship between LV lead sensing delay and echocardiographic and electrocardiographic response to CRT treatment. METHODS We prospectively included 156 consecutive patients with HF diagnosis, QRS ≥ 120 ms, left bundle branch block, New York Heart Association II-IV, LV ejection fraction (LVEF) < 35%, and scheduled for CRT (100 male, 56 female; mean age 65.8 ± 10.06 years). Echocardiographic CRT response was defined as ≥15% reduction in LV end-systolic volume (LVESV). LV lead sensing delay was calculated as the time interval from the onset of surface QRS wave to the onset of depolarization wave recorded from the LV lead by using the LV pacing lead as a bipolar electrode. RESULTS LVESV reduction was associated with baseline QRS width (r = 0.292, P = 001), QRS narrowing (r = 0.332, P < 001), and LV lead sensing delay (r = 0.454, P < 001) in bivariate analysis. In logistic regression analysis, LV lead sensing delay was found to be the only independent parameter for predicting significant LVESV reduction (β = 0.423, P < 0.001). LV lead sensing delay was also found to be significantly associated with LVEF increase (r = 0.320, P < 0.001) and QRS narrowing (r = 0.345, P < 0.001). CONCLUSION LV lead sensing delay is the only independent predictor for significant reduction in LVESV and was found to be significantly associated with LVEF increase and QRS narrowing after CRT treatment. We suggest that LV lead sensing delay may be used as a marker to predict the favorable response to CRT.
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Affiliation(s)
- Onur Kaypakli
- Department of Cardiology, University of Health Sciences, Adana Health Practices and Research Center, Adana, Turkey
| | - Mevlüt Koç
- Department of Cardiology, University of Health Sciences, Adana Health Practices and Research Center, Adana, Turkey
| | - Gökhan Gözübüyük
- Department of Cardiology, University of Health Sciences, Adana Health Practices and Research Center, Adana, Turkey
| | - Durmuş Yildiray Şahin
- Department of Cardiology, University of Health Sciences, Adana Health Practices and Research Center, Adana, Turkey
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Kronborg MB, Johansen JB, Riahi S, Petersen HH, Haarbo J, Jørgensen OD, Nielsen JC. An anterior left ventricular lead position is associated with increased mortality and non-response in cardiac resynchronization therapy. Int J Cardiol 2016; 222:157-162. [DOI: 10.1016/j.ijcard.2016.07.235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/26/2016] [Accepted: 07/29/2016] [Indexed: 11/30/2022]
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Zanon F, Marcantoni L, Baracca E, Pastore G, Lanza D, Fraccaro C, Picariello C, Conte L, Aggio S, Roncon L, Pacetta D, Badie N, Noventa F, Prinzen FW. Optimization of left ventricular pacing site plus multipoint pacing improves remodeling and clinical response to cardiac resynchronization therapy at 1 year. Heart Rhythm 2016; 13:1644-51. [DOI: 10.1016/j.hrthm.2016.05.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Indexed: 11/29/2022]
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Interventricular Electrical Delay Is Predictive of Response to Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2016; 2:438-447. [PMID: 29759863 DOI: 10.1016/j.jacep.2016.02.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/16/2016] [Accepted: 02/29/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study was conceived to evaluate the relationship between interventricular electrical delay, as measured by the right ventricle-left ventricle (RV-LV) interval, and outcomes in a prospectively designed substudy of the SMART-AV (SMARTDELAY determined AV Optimization) trial. BACKGROUND Despite the well-documented benefit of cardiac resynchronization therapy (CRT), the nonresponder rate remains an important clinical problem. Implanting LV leads by traditional anatomic criteria has limited impact on outcomes. However, pacing at sites with late electrical activation improves CRT response rates. Thus, we hypothesized that interventricular electrical delay is associated with improved CRT outcomes. METHODS This was a multicenter study of patients with advanced heart failure undergoing CRT implantation. In 419 subjects, the unpaced RV-LV interval was measured in sinus rhythm. LV volumes and ejection fraction were measured by echocardiography at baseline and after 6 months of CRT by a blinded core laboratory. Quality of life (QOL) was assessed by a standardized questionnaire. RESULTS When separated by quartiles based on interventricular delay, the magnitudes of LV volumes, ejection fraction and the QOL measure increased significantly with prolongation of RV-LV delay (p < 0.05). The LV end-systolic volume response rate increased progressively from 30% to 75% (p < 0.001), and the QOL response rate increased from 50% to 65% (p = 0.08). Patients in the highest quartile of RV-LV had a 5.98-fold increase (p < 0.001) in their odds of a reverse remodeling response, with female sex, ischemic etiology, and baseline LV end-systolic volume being the other independent predictors of response. CONCLUSIONS Baseline interventricular delay is a potent independent predictor of remodeling and QOL responses with CRT.
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Calzolari V, Crosato M, De Mattia L, Squasi PM, Indiani S, Pacetta D. Cardiac resynchronization therapy device implantation guided by electroanatomic mapping system when contrast medium infusion is contraindicated. HeartRhythm Case Rep 2016; 2:244-247. [PMID: 28491679 PMCID: PMC5419771 DOI: 10.1016/j.hrcr.2016.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Vittorio Calzolari
- Ospedale Ca’ Foncello, Treviso, Italy
- Address reprints and correspondence: Dr Vittorio Calzolari, Arrhythmia and EP Unit, Cardiology Department, Cà Foncello Hospital, Piazzale Ospedale n 1, 31100 Treviso, ItalyArrhythmia and EP Unit, Cardiology Department, Cà Foncello Hospital, Piazzale Ospedale n 1, 31100 TrevisoItaly
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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.
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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
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van Gelder BM, Nathoe R, Bracke FA. Haemodynamic evaluation of alternative left ventricular endocardial pacing sites in clinical non-responders to cardiac resynchronisation therapy. Neth Heart J 2015; 24:85-92. [PMID: 26645710 PMCID: PMC4692838 DOI: 10.1007/s12471-015-0773-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction Non response to cardiac resynchronisation therapy (CRT) may be related to the position of the coronary sinus lead. Methods We studied the acute haemodynamic response (AHR) from alternative left ventricular (LV) endocardial pacing sites in clinical non-responders to CRT. AHR and the interval from QRS onset to LV sensing (Q-LV interval) from four different endocardial pacing sites were evaluated in 24 clinical non-responders. A rise in LVdP/dtmax ≥ 15 % from baseline was considered a positive AHR. We also compared the AHR from endocardial with the corresponding epicardial lead position. Results The implanted system showed an AHR ≥ 15 % in 5 patients. In 9 of the 19 remaining patients, AHR could be elevated to ≥ 15 % by endocardial LV pacing. The optimal endocardial pacing site was posterolateral. There was no significant difference in AHR between the epicardial and the corresponding endocardial position. The longest Q-LV interval corresponded with the best AHR in 12 out of the 14 patients with a positive AHR, with an average Q-LV/QRS width ratio of 90 %. Conclusions Acute haemodynamic testing may indicate an alternative endocardial pacing site with a positive AHR in clinical non-responders. The Q-LV interval is a strongly correlated with the optimal endocardial pacing site. Endocardial pacing opposite epicardial sites does not result in a better AHR.
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Affiliation(s)
- B M van Gelder
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - R Nathoe
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - F A Bracke
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Frommeyer G, Reinke F, Eckardt L. Haemodynamic Alterations Induced By Cardiac Pacing: Is Clinical Evaluation Sufficient Or Do We Need Long-Term Device Monitoring? J Atr Fibrillation 2015; 8:1198. [PMID: 27957202 DOI: 10.4022/jafib.1198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 07/24/2015] [Accepted: 08/06/2015] [Indexed: 11/10/2022]
Abstract
Cardiac pacing may induce haemodynamic alterations. RV pacing may have deleterious effects including a decrease of LV function as well as an increase of heart failure hospitalizations and mortality. Biventricular pacing is established in patients with heart failure and left bundle branch block or chronic AV block to improve haemodynamics. In the future, device optimization employing quadripolar leads or multisite pacing may further increase the rate of responders. However, cinical evaluation represents the most important tool to recognize the necessity for device optimization. Device algorithms are not yet successfully established to replace clinical and echocardiographic evaluation.
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Affiliation(s)
- Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Florian Reinke
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
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Anselme F, Bordachar P, Pasquié JL, Klug D, Leclercq C, Milhem A, Alonso C, Deharo JC, Gras D, Probst V, Piot O, Savouré A. Safety, feasibility, and outcome results of cardiac resynchronization with triple-site ventricular stimulation compared to conventional cardiac resynchronization. Heart Rhythm 2015; 13:183-9. [PMID: 26325531 DOI: 10.1016/j.hrthm.2015.08.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The nonresponder rate to cardiac resynchronization therapy (CRT) may be due to incomplete resynchronization, with dyssynchrony persisting in approximately 30% of patients. We hypothesized that CRT with triple-site ventricular stimulation (TRIV) may improve resynchronization and its outcomes. OBJECTIVE The purpose of this study was to assess the feasibility and safety of TRIV and collected data on clinical outcomes to dimension future studies. METHODS Our pilot randomized trial was designed to assess the safety and feasibility of TRIV with 2 right ventricular leads and 1 left ventricular leads compared to conventional CRT. The primary end-point was the rate of severe adverse events at 6 months. Secondary end-points included functional improvement parameters, quality-of-life (QOL) score, and changes of echocardiographic indices at 6 and 12 months in a subset of patients. RESULTS Seventy-six patients were enrolled at 11 centers and randomized to control or TRIV arm. All implant procedures but one were successful. At 6 months, there was no statistical difference between proportions of patients with at least 1 severe adverse event in both groups (34.1% vs 25.7%, P = .425). There also was no difference between functional improvement parameters, 6-minute walking distances (P = .40), QOL scores (P = .27), and echographic indices. At 12 months, the proportions of patients with a left ventricular ejection fraction gain of more than 5%, 10%, or 15% were significantly superior with TRIV. CONCLUSION TRIV pacing is an effective and safe technique and may provide a greater benefit in ventricular remodeling than conventional CRT. Further studies are needed to assess its long-term benefit.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Daniel Gras
- Nouvelles Cliniques Nantaises-Le Confluent, Nantes, France
| | | | - Olivier Piot
- Centre Cardiologique du Nord, Saint-Denis, France
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Liang Y, Yu H, Zhou W, Xu G, Sun YI, Liu R, Wang Z, Han Y. Left Ventricular Lead Placement Targeted at the Latest Activated Site Guided by Electrophysiological Mapping in Coronary Sinus Branches Improves Response to Cardiac Resynchronization Therapy. J Cardiovasc Electrophysiol 2015; 26:1333-9. [PMID: 26249040 DOI: 10.1111/jce.12771] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/29/2015] [Accepted: 07/26/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Electrophysiological mapping (EPM) in coronary sinus (CS) branches is feasible for guiding LV lead placement to the optimal, latest activated site at cardiac resynchronization therapy (CRT) procedures. However, whether this procedure optimizes the response to CRT has not been demonstrated. This study was to evaluate effects of targeting LV lead at the latest activated site guided by EPM during CRT. METHODS Seventy-six consecutive patients with advanced heart failure who were referred for CRT were divided into mapping (MG) and control groups (CG). In MG, the LV lead, also used as a mapping bipolar electrode, was placed at the latest activated site determined by EPM in CS branches. In CG, conventional CRT procedure was performed. Patients were followed for 6 months after CRT. RESULTS Baseline characteristics were comparable between the 2 groups. In MG (n = 29), EPM was successfully performed in 85 of 91 CS branches during CRT. A LV lead was successfully placed at the latest activated site guided by EPM in 27 (93.1%) patients. Compared with CG (n = 47), MG had a significantly higher rate (86.2% vs. 63.8%, P = 0.039) of response (>15% reduction in LV end-systolic volume) to CRT, a higher percentage of patients with clinical improvement of ≥2 NYHA functional classes (72.4% vs. 44.7%, P = 0.032), and a shorter QRS duration (P = 0.004). CONCLUSIONS LV lead placed at the latest activated site guided by EPM resulted in a significantly greater CRT response, and a shorter QRS duration.
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Affiliation(s)
- Yanchun Liang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Haibo Yu
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Weiwei Zhou
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Guoqing Xu
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Y I Sun
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Rong Liu
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Zulu Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
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Osca J, Alonso P, Cano O, Andrés A, Miro V, Tello MJS, Olagüe J, Martínez L, Salvador A. The use of multisite left ventricular pacing via quadripolar lead improves acute haemodynamics and mechanical dyssynchrony assessed by radial strain speckle tracking: initial results. Europace 2015; 18:560-7. [PMID: 26333378 DOI: 10.1093/europace/euv211] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 05/19/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS The objective of the present study was to evaluate the effect of multipoint pacing (MPP) on acute haemodynamics, cardiac contractility, and left ventricle (LV) dyssynchrony, in comparison with conventional cardiac resynchronization therapy (CRT). METHODS AND RESULTS An open-label, non-randomized, single-centre, prospective study was designed. Twenty-seven consecutive patients were included. Evaluation of pacing configurations was performed in a random order. Transthoracic echocardiography was used to obtain haemodynamic and dyssynchrony parameters. Left ventricular ejection fraction (LVEF) was significantly superior in MPP compared with baseline (38.4 ± 1.8% vs. 26.1 ± 2.2%; P < 0.001), and in conventional pacing configuration compared with baseline (33.2 ± 1.8% vs. 26.1 ± 2.2%; P = 0.007). Cardiac index (CI) was increased by 21.8 ± 5.4% and 34.7 ± 5.1% in conventional and MPP configurations, respectively (P = 0.19). Percentage of acute responders (CI increase ≥10%) was 62.9 and 85.2% in conventional and MPP, respectively (P < 0.001). LV dyssynchrony was defined by radial strain rate parameters. Baseline anteroseptal-to-posterior wall time delay was 168 ± 21 ms. It was reduced until 70.4 ± 29 ms in conventional and -6.6 ± 11 ms in MPP (conventional vs. baseline P = 0.04; MPP vs. conventional P = 0.05). Standard deviation of the time-to-peak radial strain of the 6 LV basal segments was 101 ± 9.7, 80.3 ± 9.2, and 66 ± 8.03 ms in baseline, conventional, and MPP configurations, respectively (MPP vs. basal P = 0.012). Finally, we observed a positive correlation (r = 0.69) between reduction in dyssynchrony and CI increase (P < 0.0001). CONCLUSION MPP showed a further reduction in LV dyssynchrony compared with conventional biventricular pacing. Moreover, MPP resulted in an additional improvement in LVEF and in CI, and this was translated into a higher number of acute responders to CRT.
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Affiliation(s)
- Joaquín Osca
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, El Bachiller, 7-47, Valencia 46010, Spain
| | - Pau Alonso
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, El Bachiller, 7-47, Valencia 46010, Spain
| | - Oscar Cano
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, El Bachiller, 7-47, Valencia 46010, Spain
| | - Ana Andrés
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, El Bachiller, 7-47, Valencia 46010, Spain
| | - Vicente Miro
- Image Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María José Sancho Tello
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, El Bachiller, 7-47, Valencia 46010, Spain
| | - Jose Olagüe
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, El Bachiller, 7-47, Valencia 46010, Spain
| | - Luis Martínez
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Antonio Salvador
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Quadripolar Leads in Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2015; 1:225-237. [DOI: 10.1016/j.jacep.2015.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 01/08/2023]
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Trolese L, Bode C, Asbach S. Author's reply. Europace 2015; 17:1000. [DOI: 10.1093/europace/euu400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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66
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Multipoint pacing by a left ventricular quadripolar lead improves the acute hemodynamic response to CRT compared with conventional biventricular pacing at any site. Heart Rhythm 2015; 12:975-81. [DOI: 10.1016/j.hrthm.2015.01.034] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Indexed: 11/20/2022]
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Martens P, Verbrugge FH, Mullens W. Optimizing CRT - Do We Need More Leads and Delivery Methods. J Atr Fibrillation 2015; 7:1202. [PMID: 27957161 DOI: 10.4022/jafib.1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 11/10/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established therapeutic option in symptomatic heart failure with reduced ejection fraction and evidence of left ventricular (LV) conduction delay (QRS width ≥120 ms), especially when typical left bundle branch block is present. The rationale behind CRT is restoration of aberrant LV electrical activation. As there is considerable heterogeneity of the LV electrical activation pattern among CRT candidates, an individualized approach with targeting of the LV lead in the region of latest electrical activation while avoiding scar tissue may enhance CRT response. Echocardiography, electro anatomic mapping, and cardiac magnetic resonance imaging with late gadolinium enhancement are helpful to guide such targeted LV lead placement. However, an important limitation remains the anatomy of the coronary sinus, which often does not allow concordant LV lead placement in the optimal region. Epicardial LV lead placement through minimal invasive surgery or endocardial LV lead placement through transseptal punction may overcome this limitation, obviously with an increased complication risk. Furthermore, recent pacing algorithms suggest superiority of LV-only versus biventricular pacing in patients with preserved atrio ventricular (AV) conduction and a typical LBBB pattern. Finally, pacing from only one LV site might not overcome the wide electrical dispersion often seen in patients with LV conduction delays. Therefore, multisite pacing has gained significant interest to improve CRT response. The use of multiple LV leads may potentially lead to more favorable reverse remodeling, improved functional capacity and quality of life in CRT candidates, but adverse events and a shorter battery span are more frequent because of the extra lead. The use of one multipolar LV lead increases the number of pacing configurations within the same coronary sinus side branch (within small distances from each other) without the use of an additional lead. Small observational studies suggest that more effective resynchronization can be achieved with this approach. Finally, there are many reasons for non effective CRT delivery in carefully selected patients with an adequately implanted device. Multidisciplinary, post implantation care inside a dedicated CRT clinic ensures optimal CRT delivery, improves response rate and should be considered standard of care.
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Affiliation(s)
- Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Frederik Hendrik Verbrugge
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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van Everdingen WM, van Gelder B, Meine M. Comment on the article by Trolese T et al. Europace 2015; 17:999. [DOI: 10.1093/europace/euu382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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García-Bolao I, Ruiz-Mateas F, Bazan V, Berruezo A, Alcalde O, Leal del Ojo J, Acosta J, Martínez Sellés M, Mosquera I. Update in cardiac arrhythmias and pacing. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2015; 68:226-233. [PMID: 25677720 DOI: 10.1016/j.rec.2014.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/11/2014] [Indexed: 06/04/2023]
Abstract
This article discusses the main advances in cardiac arrhythmias and pacing published between 2013 and 2014. Special attention is given to the interventional treatment of atrial fibrillation and ventricular arrhythmias, and on advances in cardiac pacing and implantable cardioverter defibrillators, with particular reference to the elderly patient.
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Affiliation(s)
- Ignacio García-Bolao
- Unidad de Arritmias, Departamento de Cardiología y Cirugía Cardiaca, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain.
| | - Francisco Ruiz-Mateas
- Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Victor Bazan
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antonio Berruezo
- Unidad de Arritmias, Servicio de Cardiología, Instituto del Tórax, Hospital Clinic e IDIBAPS, Barcelona, Spain
| | - Oscar Alcalde
- Unidad de Arritmias, Departamento de Cardiología y Cirugía Cardiaca, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Juan Leal del Ojo
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital Nuestra Señora de Valme, Sevilla, Spain
| | - Juan Acosta
- Unidad de Arritmias, Servicio de Cardiología, Instituto del Tórax, Hospital Clinic e IDIBAPS, Barcelona, Spain
| | - Manuel Martínez Sellés
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio Mosquera
- Unidad de Arritmias, Hospital Universitario A Coruña, A Coruña, Spain
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Gillis AM. Optimal pacing for right ventricular and biventricular devices: minimizing, maximizing, and right ventricular/left ventricular site considerations. Circ Arrhythm Electrophysiol 2015; 7:968-77. [PMID: 25336367 DOI: 10.1161/circep.114.001360] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The results from numerous clinical studies provide guidance for optimizing outcomes related to RV or biventricular pacing in the pacemaker and ICD populations. (1) Programming algorithms to minimize RV pacing is imperative in patients with dual-chamber pacemakers who have intrinsic AV conduction or intermittent AV conduction block. (2) Dual-chamber ICDs should be avoided in candidates without an indication for bradycardia pacing. (3) Alternate RV septal pacing sites may be considered at the time of pacemaker implantation. (4) Biventricular pacing may be beneficial in some patients with mild LV dysfunction. (5) LV lead placement at the site of latest LV activation is desirable. (6) Programming CRT systems to achieve biventricular/LV pacing >98.5% is important. (7) Protocols for AV and VV optimization in patients with CRT are not recommended after device implantation but may be considered for CRT nonresponders. (8) Novel algorithms to maximize the benefit of CRT are in evolution further.
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Affiliation(s)
- Anne M Gillis
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
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Improved implant and postoperative lead performance in CRT-D patients implanted with a quadripolar left ventricular lead. A 6-month follow-up analysis from a multicenter prospective comparative study. J Interv Card Electrophysiol 2014; 42:59-66. [DOI: 10.1007/s10840-014-9956-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
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Forleo GB, Di Biase L, Bharmi R, Dalal N, Panattoni G, Pollastrelli A, Tesauro M, Santini L, Natale A, Romeo F. Hospitalization rates and associated cost analysis of cardiac resynchronization therapy with an implantable defibrillator and quadripolar vs. bipolar left ventricular leads: a comparative effectiveness study. Europace 2014; 17:101-7. [PMID: 25371428 PMCID: PMC4280828 DOI: 10.1093/europace/euu290] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aims This study compares, from a prospective, observational, non-randomized registry, the post-implant hospitalization rates and associated healthcare resource utilization of cardiac resynchronization therapy-defibrillator (CRT-D) patients with quadripolar (QUAD) vs. bipolar (BIP) left ventricular (LV) leads. Methods and results Between January 2009 and December 2012, 193 consecutive patients receiving de novo CRT-D implants with either a QUAD (n = 116) or a BIP (n = 77) LV lead were enrolled at implant and followed until July 2013 at a single-centre, university hospital. Post-implant hospitalizations related to heart failure (HF) or LV lead surgical revision and associated payer costs were identified using ICD-9-CM diagnosis and procedure codes. Italian national reimbursement rates were determined. Propensity scores were estimated using a logistic regression model based upon 11 pre-implant baseline characteristics and were used to derive a 1 : 1 matched cohort of QUAD (n = 77) and BIP (n = 77) patients. Hospitalization rates for the two groups were compared using negative binomial regression and associated payer costs were compared using non-parametric bootstrapping (×10 000) and one-sided hypothesis test. Hospitalization rates of the QUAD group [0.15/ patient (pt)-year] were lower than those of the BIP group (0.32/ pt-year); the incidence rate ratio was 0.46, P = 0.04. The hospitalization costs for the QUAD group (434 ± 128 €/pt-year) were lower than those for the BIP group (1136 ± 362 €/pt-year). The average difference was 718 €/pt-year, P = 0.016. Conclusions In this comparative effectiveness assessment of well-matched groups of CRT-D patients with quadripolar and bipolar LV leads, QUAD patients experienced a lower rate of hospitalizations for HF and LV lead surgical revision, and a lower cost burden. This has important implications for LV pacing lead choice.
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Affiliation(s)
- Giovanni B Forleo
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
| | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, USA Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, USA Department of Cardiology, University of Foggia, Foggia, Italy
| | | | | | - Germana Panattoni
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
| | | | - Manfredi Tesauro
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
| | - Luca Santini
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, USA
| | - Francesco Romeo
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
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Mafi Rad M, Blaauw Y, Dinh T, Pison L, Crijns HJ, Prinzen FW, Vernooy K. Different regions of latest electrical activation during left bundle-branch block and right ventricular pacing in cardiac resynchronization therapy patients determined by coronary venous electro-anatomic mapping. Eur J Heart Fail 2014; 16:1214-22. [DOI: 10.1002/ejhf.178] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/10/2014] [Accepted: 08/29/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Masih Mafi Rad
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Yuri Blaauw
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Trang Dinh
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Laurent Pison
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Harry J. Crijns
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Frits W. Prinzen
- Maastricht University, Cardiovascular Research Institute Maastricht (CARIM); Department of Physiology; PO Box 616 6200 MD Maastricht the Netherlands
| | - Kevin Vernooy
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
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Mafi Rad M, Blaauw Y, Dinh T, Pison L, Crijns HJ, Prinzen FW, Vernooy K. Left ventricular lead placement in the latest activated region guided by coronary venous electroanatomic mapping. Europace 2014; 17:84-93. [DOI: 10.1093/europace/euu221] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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