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Polyzos KA, Konstantelias AA, Falagas ME. Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2015; 17:767-77. [DOI: 10.1093/europace/euv053] [Citation(s) in RCA: 281] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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152
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Sohaib SMA, Kyriacou A, Jones S, Manisty CH, Mayet J, Kanagaratnam P, Peters NS, Hughes AD, Whinnett ZI, Francis DP. Evidence that conflict regarding size of haemodynamic response to interventricular delay optimization of cardiac resynchronization therapy may arise from differences in how atrioventricular delay is kept constant. Europace 2015; 17:1823-33. [PMID: 25855674 PMCID: PMC4700730 DOI: 10.1093/europace/euu374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 12/01/2014] [Indexed: 01/21/2023] Open
Abstract
Aims Whether adjusting interventricular (VV) delay changes haemodynamic efficacy of cardiac resynchronization therapy (CRT) is controversial, with conflicting results. This study addresses whether the convention for keeping atrioventricular (AV) delay constant during VV optimization might explain these conflicts. Method and results Twenty-two patients in sinus rhythm with existing CRT underwent VV optimization using non-invasive systolic blood pressure. Interventricular optimization was performed with four methods for keeping the AV delay constant: (i) atrium and left ventricle delay kept constant, (ii) atrium and right ventricle delay kept constant, (iii) time to the first-activated ventricle kept constant, and (iv) time to the second-activated ventricle kept constant. In 11 patients this was performed with AV delay of 120 ms, and in 11 at AV optimum. At AV 120 ms, time to the first ventricular lead (left or right) was the overwhelming determinant of haemodynamics (13.75 mmHg at ±80 ms, P < 0.001) with no significant effect of time to second lead (0.47 mmHg, P = 0.50), P < 0.001 for difference. At AV optimum, time to first ventricular lead again had a larger effect (5.03 mmHg, P < 0.001) than time to second (2.92 mmHg, P = 0.001), P = 0.02 for difference. Conclusion Time to first ventricular activation is the overwhelming determinant of circulatory function, regardless of whether this is the left or right ventricular lead. If this is kept constant, the effect of changing time to the second ventricle is small or nil, and is not beneficial. In practice, it may be advisable to leave VV delay at zero. Specifying how AV delay is kept fixed might make future VV delay research more enlightening.
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Affiliation(s)
- S M Afzal Sohaib
- International Centre for Circulatory Health, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK
| | - Andreas Kyriacou
- International Centre for Circulatory Health, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK
| | - Siana Jones
- International Centre for Circulatory Health, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK
| | - Charlotte H Manisty
- International Centre for Circulatory Health, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK
| | - Jamil Mayet
- International Centre for Circulatory Health, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK
| | - Prapa Kanagaratnam
- International Centre for Circulatory Health, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK
| | - Nicholas S Peters
- International Centre for Circulatory Health, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK
| | - Alun D Hughes
- International Centre for Circulatory Health, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK
| | - Zachary I Whinnett
- International Centre for Circulatory Health, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK
| | - Darrel P Francis
- International Centre for Circulatory Health, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK
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153
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Crossley GH, Biffi M, Johnson B, Lin A, Gras D, Hussin A, Cuffio A, Collier JL, El-Chami M, Li S, Holloman K, Exner DV. Performance of a novel left ventricular lead with short bipolar spacing for cardiac resynchronization therapy: Primary results of the Attain Performa Quadripolar Left Ventricular Lead Study. Heart Rhythm 2015; 12:751-8. [DOI: 10.1016/j.hrthm.2014.12.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Indexed: 10/24/2022]
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154
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Witt CT, Kronborg MB, Nohr EA, Mortensen PT, Gerdes C, Nielsen JC. Optimization of heart failure medication after cardiac resynchronization therapy and the impact on long-term survival. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:182-8. [DOI: 10.1093/ehjcvp/pvv016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/25/2015] [Indexed: 11/15/2022]
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155
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Leyva F, Plummer CJ. National Institute for Health and Care Excellence 2014 guidance on cardiac implantable electronic devices: health economics reloaded. Europace 2015; 17:339-42. [DOI: 10.1093/europace/euu384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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156
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Zaca V, Marcucci R, Parodi G, Limbruno U, Notarstefano P, Pieragnoli P, Di Cori A, Bongiorni MG, Casolo G. Management of antithrombotic therapy in patients undergoing electrophysiological device surgery. Europace 2015; 17:840-54. [DOI: 10.1093/europace/euu357] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/13/2014] [Indexed: 11/14/2022] Open
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157
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Eschalier R, Ploux S, Lumens J, Whinnett Z, Varma N, Meillet V, Ritter P, Jaïs P, Haïssaguerre M, Bordachar P. Detailed analysis of ventricular activation sequences during right ventricular apical pacing and left bundle branch block and the potential implications for cardiac resynchronization therapy. Heart Rhythm 2015; 12:137-43. [DOI: 10.1016/j.hrthm.2014.09.059] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Indexed: 11/29/2022]
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158
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Sciaraffia E, Dagres N, Hernandez-Madrid A, Proclemer A, Todd D, Blomstrom-Lundqvist C. Do cardiologists follow the European guidelines for cardiac pacing and resynchronization therapy? Results of the European Heart Rhythm Association survey. Europace 2014; 17:148-51. [DOI: 10.1093/europace/euu395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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159
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Garbi M, McDonagh T, Cosyns B, Bucciarelli-Ducci C, Edvardsen T, Kitsiou A, Nieman K, Lancellotti P. Appropriateness criteria for cardiovascular imaging use in heart failure: report of literature review. Eur Heart J Cardiovasc Imaging 2014; 16:147-53. [PMID: 25550363 DOI: 10.1093/ehjci/jeu299] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The Imaging Task Force appointed by the European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging (EACVI) identified the need to develop appropriateness criteria for the use of cardiovascular imaging in heart failure as a result of continuously increasing demand for imaging in diagnosis, definition of aetiology, follow-up, and treatment planning. This article presents the report of literature review performed in order to inform the process of definition of clinical indications and to aid the decisions of the appropriateness criteria voting panel. The report is structured according to identified common heart failure clinical scenarios.
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Affiliation(s)
- Madalina Garbi
- King's Health Partners, King's College Hospital NHS Foundation Trust, London, UK
| | - Theresa McDonagh
- King's Health Partners, King's College Hospital NHS Foundation Trust, London, UK
| | - Bernard Cosyns
- Universitair Ziekenhuis van Brussel, CHVZ and ICMI Laboratory, CHIREC, Brussels, Belgium
| | - Chiara Bucciarelli-Ducci
- Bristol NIHR Cardiovascular Biomedical Research Unit (BRU), Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Norway
| | | | - Koen Nieman
- Department of Cardiology and Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Patrizio Lancellotti
- Department of GIGA Cardiovascular Sciences, Heart Valve Clinic, Department of Cardiology, University of Liège Hospital, University Hospital SartTilman, Liège, Belgium Department of GVM Care and Research, Bologna, Italy
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160
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Sommer A, Kronborg MB, Witt CT, Norgaard BL, Nielsen JC. The paced electrocardiogram cannot be used to identify left and right ventricular pacing sites in cardiac resynchronization therapy: validation by cardiac computed tomography. Europace 2014; 17:432-8. [DOI: 10.1093/europace/euu323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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161
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Kumar P, Schwartz JD. Device therapies: new indications and future directions. Curr Cardiol Rev 2014; 11:33-41. [PMID: 25391852 PMCID: PMC4347207 DOI: 10.2174/1573403x1101141106121553] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 07/09/2013] [Accepted: 09/27/2013] [Indexed: 01/29/2023] Open
Abstract
Implantable cardioverter-defibrillator (ICDs), cardiac resynchronization (CRT) and combination (CRT-D) therapy have become an integral part of the management of patients with heart failure with reduced ejection fraction (HFrEF). ICDs treat ventricular arrhythmia and CRTs improve left ventricular systolic function by resynchronizing ventricular contraction. Device therapies (ICD, CRT-D), have been shown to reduce all-cause mortality, including sudden cardiac death. Hospitalizations are reduced with CRT and CRT-D therapy. Major device related complications include device infection, inappropriate shocks, lead malfunction and complications related to extraction of devices. Improvements in device design and implantation have included progressive miniaturization and increasing battery life of the device, optimization of response to CRT, and minimizing inappropriate device therapy. Additionally, better definition of the population with the greatest benefit is an area of active research.
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Affiliation(s)
| | - Jennifer D Schwartz
- University of North Carolina at Chapel Hill, Heart and Vascular, 160 Dental Circle, CB 7075, Chapel Hill NC 27599, USA.
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162
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Qiu Q, Chen YX, Mai JT, Yuan WL, Wei YL, Liu YM, Yang L, Wang JF. Effects of cardiac resynchronization therapy on left ventricular remodeling and dyssynchrony in patients with left ventricular noncompaction and heart failure. Int J Cardiovasc Imaging 2014; 31:329-37. [PMID: 25392055 DOI: 10.1007/s10554-014-0568-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/05/2014] [Indexed: 12/18/2022]
Abstract
Left ventricular noncompaction (LVNC) is a rare cardiomyopathy with high incidence of heart failure (HF). It is unclear whether LVNC patients with desynchronized HF would benefit from cardiac resynchronization therapy (CRT). In order to evaluate the effect of CRT on LVNC, this study explored left ventricular (LV) remodeling and mechanical synchronicity before and after CRT in LVNC patients, and compare with that in idiopathic dilated cardiomyopathy (DCM) patients. We collected 15 LVNC and 30 matched DCM patients. All the patients underwent clinical evaluation,electrocardiogram and echocardiography before CRT and ≥6 months later. LV response was defined as ≥15 % decrease in LV end-systolic volume (LVESV). Longitudinal synchronicity was quantified by YU-index using tissue Doppler imaging. The time delay of peak radial strain from anteroseptal to posterior wall, which derived from speckle tracking imaging, was used to quantify radial synchronicity. In LVNC group, LV ejection fraction increased from 27.6 ± 5.5 to 39.1 ± 7.0 % (P < 0.01) during follow-up, but LV volumes did not change significantly (both P > 0.05). Five LVNC patients (33.3 %) responded to CRT, and all of them were super-responders (reduction in LVESV > 30 %). In addition, the number of noncompacted segments and the thickness ratio of noncompacted to compacted myocardium decreased (both P < 0.05). Inter-ventricular, longitudinal and radial intra-ventricular dyssynchrony also reduced significantly (all P < 0.05). Compared with DCM group, there was no significant difference in LV response rate (33.3 vs. 60.0 %, P = 0.092), improvement of LV function and dyssynchrony index (all P < 0.05). In conclusion, CRT improved heart function, morphology and mechanical dyssynchrony in LVNC patients.
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Affiliation(s)
- Qiong Qiu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510120, China
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163
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164
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Providência R, Marijon E, Combes S, Bouzeman A, Jourda F, Khoueiry Z, Cardin C, Combes N, Boveda S, Albenque JP. Higher contact-force values associated with better mid-term outcome of paroxysmal atrial fibrillation ablation using the SmartTouch™ catheter. Europace 2014; 17:56-63. [PMID: 25280910 DOI: 10.1093/europace/euu218] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Real-time measurement of contact force (CF) during catheter ablation of atrial fibrillation (AF) has been recently suggested to potentially impact procedural outcome. However, the role of CF intensity on mid-term results using the SmartTouch™ catheter has not been investigated so far. METHODS AND RESULTS Pulmonary vein isolation (PVI) using the SmartTouch™ catheter was performed in 100 eligible patients (age 62 ± 8; 79% men) undergoing a first procedure of paroxysmal AF catheter ablation. Continuous CF monitoring during catheter ablation allowed calculation of mean CF per patient. Patients were dichotomized into high CF (≥22 g, upper quartile) and low CF (<22 g, remaining) and enroled in a standardized follow-up programme (after a 3-month blanking period), free from antiarrhythmic therapy, with regular evaluations including 24 h Holter recordings at 1, 3, 6, 9, 12, 18, and 24 months. Atrial fibrillation relapse was defined as any symptomatic or asymptomatic atrial arrhythmia lasting >30 s. The average CF among all procedures was 19.6 ± 3.7 g. Though complete PVI was eventually achieved in all cases in both groups, success using an exclusively anatomical approach was higher in the high CF group (92.0 vs. 72.0%; P = 0.04). During a mean follow-up of 19 ± 5 months, a lower incidence of AF relapse was observed in higher CF patients (4.0 vs. 20.0%; log rank P = 0.04). Pericardial tamponade occurred in one patient in the higher CF group. No thromboembolism or procedure-associated deaths were observed. CONCLUSION Higher values of CF overall during antral PVI appear to be associated with a higher likelihood of sinus rhythm maintenance without significantly increasing the complication rate.
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Affiliation(s)
- Rui Providência
- Département de Rythmologie, Clinique Pasteur, 45 Avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Eloi Marijon
- European Georges Pompidou Hospital, Paris, France
| | - Stéphane Combes
- Département de Rythmologie, Clinique Pasteur, 45 Avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Abdeslam Bouzeman
- Département de Rythmologie, Clinique Pasteur, 45 Avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - François Jourda
- Département de Rythmologie, Clinique Pasteur, 45 Avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Ziad Khoueiry
- Département de Rythmologie, Clinique Pasteur, 45 Avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Christelle Cardin
- Département de Rythmologie, Clinique Pasteur, 45 Avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Nicolas Combes
- Département de Rythmologie, Clinique Pasteur, 45 Avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Serge Boveda
- Département de Rythmologie, Clinique Pasteur, 45 Avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Jean-Paul Albenque
- Département de Rythmologie, Clinique Pasteur, 45 Avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
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165
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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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166
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Gage RM, Burns KV, Bank AJ. Echocardiographic and clinical response to cardiac resynchronization therapy in heart failure patients with and without previous right ventricular pacing. Eur J Heart Fail 2014; 16:1199-205. [DOI: 10.1002/ejhf.143] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/19/2014] [Accepted: 06/25/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ryan M. Gage
- Research Division; United Heart & Vascular Clinic; 225 N. Smith Avenue, #400 St Paul MN USA
| | - Kevin V. Burns
- Research Division; United Heart & Vascular Clinic; 225 N. Smith Avenue, #400 St Paul MN USA
| | - Alan J. Bank
- Research Division; United Heart & Vascular Clinic; 225 N. Smith Avenue, #400 St Paul MN USA
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167
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Mlynarski R, Mlynarska A, Sosnowski M. Coronary venous system in cardiac computer tomography: Visualization, classification and role. World J Radiol 2014; 6:399-408. [PMID: 25071880 PMCID: PMC4109091 DOI: 10.4329/wjr.v6.i7.399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/28/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
The role of the coronary venous system was underestimated for many years. In the last 20 years, a few percutaneous cardiology techniques in which the anatomy of the coronary venous system was significant were developed and are in use. The most important seems to be cardiac resynchronization therapy, which is an invasive method for the treatment of heart failure. Unfortunately, one of the major problems is the significant anatomical variability of the coronary venous system. The description of the selected anatomical structures is only useful in selected cases such as, for example, the obstruction of selected vessels, a huge Thebesian valve, etc. The 3D images can add significant value; however, their usefulness is limited due to the different points of view that are obtained during intra-operational fluoroscopy. After summarizing all of the articles and guidelines, it can be recommended that the visualization of the coronary venous system be performed in certain patients before cardiac resynchronization. The best option is to use tomography with retrospective gating with the optimal reconstruction of cardiac veins that occurs during the diastolic phases.
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168
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Burri H. Iterative method for atrioventricular optimization of cardiac resynchronization therapy: is beauty only in the eye of the beholder? Europace 2014; 16:1865-6. [PMID: 25034719 DOI: 10.1093/europace/euu152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Haran Burri
- Cardiology Service, University Hospital of Geneva, Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland
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169
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Bakos Z, Ostenfeld E, Markstad H, Werther-Evaldsson A, Roijer A, Arheden H, Carlsson M, Borgquist R. A comparison between radial strain evaluation by speckle-tracking echocardiography and cardiac magnetic resonance imaging, for assessment of suitable segments for left ventricular lead placement in cardiac resynchronization therapy. Europace 2014; 16:1779-86. [DOI: 10.1093/europace/euu167] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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170
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Kydd AC, Khan FZ, Watson WD, Pugh PJ, Virdee MS, Dutka DP. Prognostic Benefit of Optimum Left Ventricular Lead Position in Cardiac Resynchronization Therapy. JACC-HEART FAILURE 2014; 2:205-12. [DOI: 10.1016/j.jchf.2013.11.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022]
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Urbanek I, Kaczmarek K, Cygankiewicz I, Ptaszynski P. Risk-benefit assessment of ivabradine in the treatment of chronic heart failure. DRUG HEALTHCARE AND PATIENT SAFETY 2014; 6:47-54. [PMID: 24855390 PMCID: PMC4010635 DOI: 10.2147/dhps.s43275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Heart rate is not only a major risk marker in heart failure but also a general risk marker. Within the last few years, it has been demonstrated that reduction of resting heart rate to <70 bpm is of significant benefit for patients with heart failure, especially those with impaired left ventricular systolic function. Ivabradine is the first innovative drug synthesized to reduce heart rate. It selectively and specifically inhibits the pacemaker I f ionic current, which reduces cardiac pacemaker activity. Therefore, the main effect of ivabradine therapy is a substantial lowering of heart rate. Ivabradine does not influence intracardiac conduction, contractility, or ventricular repolarization. According to the European Society of Cardiology guidelines, ivabradine should be considered in symptomatic patients (New York Heart Association functional class II-IV) with sinus rhythm, left ventricular ejection fraction ≤35%, and heart rate ≥70 bpm despite optimal treatment with a beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and a mineralocorticoid receptor antagonist. As shown in numerous clinical studies, ivabradine improves clinical outcomes and quality of life and reduces the risk of death from heart failure or cardiovascular causes. Treatment with ivabradine is very well tolerated and safe, even at maximal recommended doses.
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Affiliation(s)
- Irmina Urbanek
- Department of Electrocardiology, Chair of Cardiology and Cardiosurgery, Medical University, Lodz, Poland
| | - Krzysztof Kaczmarek
- Department of Electrocardiology, Chair of Cardiology and Cardiosurgery, Medical University, Lodz, Poland
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Chair of Cardiology and Cardiosurgery, Medical University, Lodz, Poland
| | - Pawel Ptaszynski
- Department of Electrocardiology, Chair of Cardiology and Cardiosurgery, Medical University, Lodz, Poland
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Vernooy K, van Deursen CJM, Strik M, Prinzen FW. Strategies to improve cardiac resynchronization therapy. Nat Rev Cardiol 2014; 11:481-93. [PMID: 24839977 DOI: 10.1038/nrcardio.2014.67] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiac resynchronization therapy (CRT) emerged 2 decades ago as a useful form of device therapy for heart failure associated with abnormal ventricular conduction, indicated by a wide QRS complex. In this Review, we present insights into how to achieve the greatest benefits with this pacemaker therapy. Outcomes from CRT can be improved by appropriate patient selection, careful positioning of right and left ventricular pacing electrodes, and optimal timing of electrode stimulation. Left bundle branch block (LBBB), which can be detected on an electrocardiogram, is the predominant substrate for CRT, and patients with this conduction abnormality yield the most benefit. However, other features, such as QRS morphology, mechanical dyssynchrony, myocardial scarring, and the aetiology of heart failure, might also determine the benefit of CRT. No single left ventricular pacing site suits all patients, but a late-activated site, during either the intrinsic LBBB rhythm or right ventricular pacing, should be selected. Positioning the lead inside a scarred region substantially impairs outcomes. Optimization of stimulation intervals improves cardiac pump function in the short term, but CRT procedures must become easier and more reliable, perhaps with the use of electrocardiographic measures, to improve long-term outcomes.
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Affiliation(s)
- Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, Netherlands
| | | | - Marc Strik
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, Netherlands
| | - Frits W Prinzen
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands
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Höke U, Putter H, Van Der Velde ET, Schalij MJ, Delgado V, Bax JJ, Marsan NA. Left ventricular reverse remodeling, device-related adverse events, and long-term outcome after cardiac resynchronization therapy in the elderly. Circ Cardiovasc Qual Outcomes 2014; 7:437-44. [PMID: 24823954 DOI: 10.1161/circoutcomes.113.000821] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data are available on efficacy, safety, and long-term prognosis after cardiac resynchronization therapy (CRT) in elderly patients. We aimed at evaluating the effect of CRT, device-related adverse events, and long-term outcome after CRT among elderly patients. METHODS AND RESULTS A total of 798 CRT recipients (208 elderly: age, ≥75 years; 590 nonelderly: age, <75 years) underwent clinical and echocardiographic evaluation at baseline and 6-month follow-up. Elderly patients had similar improvements in clinical symptoms, left ventricular function, and left ventricular reverse remodeling as their counterparts. Similar rates of device-related in-hospital (within 24 hours; P=0.552), early (within 30 days; P=0.984), and long-term adverse events (entire follow-up; hazard ratio, 0.90; P=0.620) were observed between groups. During long-term follow-up (median, 38.6 months; interquartile range, 22.5-61.8 months), all-cause mortality rate was significantly higher among the elderly patients. However, the differences in cumulative event rates started after 4 years of follow-up (P=0.013), and the cause of death was mainly noncardiac (29% in the elderly versus 19% in nonelderly; P<0.001). Diabetes mellitus (hazard ratio, 2.322; P=0.019), impaired renal function (hazard ratio, 0.975; P=0.006), and reduced 6-minute walk distance (hazard ratio, 0.996; P<0.019) were independently associated with all-cause mortality in elderly patients. CONCLUSIONS CRT efficacy and device-related adverse events in elderly patients were comparable with that of nonelderly patients. However, after 4 years of follow-up, elderly patients showed worse survival and the cause of death was mainly noncardiac. Diabetes mellitus, impaired renal function, and reduced 6-minute walk distance were independently associated with all-cause mortality of elderly patients.
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Affiliation(s)
- Ulas Höke
- From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.)
| | - Hein Putter
- From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.)
| | - Enno T Van Der Velde
- From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.)
| | - Martin J Schalij
- From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.)
| | - Victoria Delgado
- From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.)
| | - Jeroen J Bax
- From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.)
| | - Nina Ajmone Marsan
- From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.).
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Perrotta L, Xhaferi B, Chiostri M, Pieragnoli P, Ricciardi G, Di Biase L, Natale A, Ricceri I, Biria M, Lakkireddy D, Valleggi A, Emdin M, Michelotti F, Mascioli G, Pandozi A, Santini M, Padeletti L. Effects of smoking in patients treated with cardiac resynchronization therapy. Intern Emerg Med 2014; 9:311-8. [PMID: 23250544 DOI: 10.1007/s11739-012-0891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 12/03/2012] [Indexed: 11/28/2022]
Abstract
Smoking is associated with increased morbidity and mortality in cardiac patients. However, data on the prognostic impact of smoking in heart failure (HF) patients on cardiac resynchronization therapy with defibrillator (CRT-D) are absent. We investigated the effects of smoking on all-cause mortality and on a composite endpoint (all-cause death/appropriate device therapy), appropriate and inappropriate device therapy, in 649 patients with HF who underwent CRT-D between January 2003 and October 2011 in 6 Centers (4 in Italy and 2 in USA). 68 patients were current smokers, 396 previous-smokers (patients who had smoked in the past but who had quit before the CRT-D implant), and 185 had never smoked. The risk of each endpoint by smoking status was evaluated with both Kaplan-Meier and Cox proportional-hazard analysis. After adjusting for age, left ventricular ejection fraction, QRS width and ischemic etiology, both current and previous smoking were independent predictors of all-cause death [HR = 5.07 (95 % CI 2.68-9.58), p < 0.001 and HR = 2.43 (95 % CI 1.38-4.29), p = 0.002, respectively) and of composite endpoint [HR = 1.63 (1.04-2.56); p = 0.033 and HR = 1.46 (1.04-2.04) p = 0.027]. In addition, current smokers had a significantly higher rate of inappropriate device therapy compared to never smokers [HR = 21.74 (4.53-104.25), p = 0.005]. Our study indicates that in patients with HF who received a CRT-D device, current and previous smoking increase the event rate per person-time of death and of appropriate and inappropriate ICD therapy more than other known negative prognostic factors such as age, left ventricular dysfunction, prolonged QRS duration and ischemic etiology.
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Affiliation(s)
- Laura Perrotta
- University of Florence, Viale Morgagni 85, 50134, Florence, Italy,
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Meta-analysis of effects of optimization of cardiac resynchronization therapy on left ventricular function, exercise capacity, and quality of life in patients with heart failure. Am J Cardiol 2014; 113:988-94. [PMID: 24461769 DOI: 10.1016/j.amjcard.2013.12.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 12/04/2013] [Accepted: 12/04/2013] [Indexed: 11/23/2022]
Abstract
The contribution of postimplant optimization of device settings to the beneficial effect of cardiac resynchronization therapy (CRT) in heart failure is uncertain. We performed a meta-analysis to investigate the impact of CRT optimization on the improvement of left ventricular function, exercise capacity, and quality of life. We undertook a systemic review of the evidence from a search of relevant controlled clinical studies in the MEDLINE and EMBASE databases. Changes in left ventricular ejection fraction (LVEF), 6-minute walk distance, and Minnesota Living with Heart Failure score at follow-up were assessed; the primary outcome was ejection fraction. A random-effects model was used to combine weighted mean difference (WMD) and 95% confidence intervals (CIs). A metaregression was undertaken to assess the impact of potential covariates. Data were collated from 13 studies enrolling 1,431 patients (919 optimized and 669 controls). Pooled analysis demonstrated that the optimization procedure resulted in a significant increase in LVEF (WMD 2.6%, 95% CI 0.8 to 4.4, p = 0.001) as compared with a nonoptimized CRT. No improvements with the optimization of CRT were seen in 6-minute walk distance and quality of life (WMD 12 m, 95% CI 23 to 48, p = 0.49, and 3.6, 95% CI 2.2 to 9.5, p = 0.22, respectively); however, this part of the analysis was performed using limited data. Thus, these collated data suggest that the optimization of CRT leads to a significant but small improvement in LVEF in patients with heart failure. Additional, adequately powered studies are needed to evaluate the effects of this procedure on exercise tolerance and quality of life.
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Sohal M, Chen Z, Sammut E, Jackson T, Behar J, Carr-White G, Razavi R, Rinaldi CA. New developments in the delivery of cardiac resynchronization therapy: targeted lead placement, multi-site and endocardial pacing. Expert Rev Med Devices 2014; 11:295-304. [DOI: 10.1586/17434440.2014.885320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Auricchio A, Delnoy PP, Butter C, Brachmann J, Van Erven L, Spitzer S, Moccetti T, Seifert M, Markou T, Laszo K, Regoli F, Ramos MA, Pasotti E, Scopigni F, Ramos MA, Hagne C, Siclari F, Demertzis S, Sinha A, Schalji M, Wellens HJJ, Padeletti L, Van Hemel N. Feasibility, safety, and short-term outcome of leadless ultrasound-based endocardial left ventricular resynchronization in heart failure patients: results of the Wireless Stimulation Endocardially for CRT (WiSE-CRT) study. Europace 2014; 16:681-8. [DOI: 10.1093/europace/eut435] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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García-Orta R, Mahía-Casado P, Gómez de Diego JJ, Barba-Cosials J, Rodriguez-Palomares JF, Aguadé-Bruix S, Candell-Riera J. Novedades en imagen cardiaca 2013. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Varma N, Auricchio A. Recommendations for post-implant monitoring of patients with cardiovascular implantable electronic devices: where do we stand today? Europace 2014; 15 Suppl 1:i11-i13. [PMID: 23737222 DOI: 10.1093/europace/eut115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Niraj Varma
- Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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181
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García-Orta R, Mahía-Casado P, Gómez de Diego JJ, Barba-Cosials J, Rodriguez-Palomares JF, Aguadé-Bruix S, Candell-Riera J. Update on cardiac imaging techniques 2013. ACTA ACUST UNITED AC 2014; 67:127-34. [PMID: 24795120 DOI: 10.1016/j.rec.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/02/2013] [Indexed: 11/29/2022]
Abstract
Cardiac imaging is a cornerstone of diagnosis in heart conditions, and an essential tool for assessing prognosis and establishing treatment decisions. This year, echocardiography stands out as a guide in interventional procedures and in choosing the size of the prosthesis. It is also proving to be a valuable technique in low-flow, low-gradient aortic stenosis. Three-dimensional echocardiography is advancing our knowledge of cardiac anatomy and valvular measurements. The parameters indicating tissue deformation have predictive power in valve disease and in the follow-up of drug-induced cardiotoxicity. Single-photon emission computed tomography and positron emission tomography are proving useful in ischemic heart disease and in the diagnosis of cardiac inflammation and infections. The role of computed tomography has been strengthened in noninvasive coronary angiography, the emergency room management of chest pain, assessment of chronic occlusions, and morphologic study of coronary plaque. Cardiac magnetic resonance imaging remains the gold standard for tissue characterization in ischemic heart disease and cardiomyopathies, and is assuming a greater role in stress studies and in the assessment of myocardial viability.
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Affiliation(s)
- Rocío García-Orta
- Servicio de Cardiología, Hospital Virgen de las Nieves, Granada, Spain.
| | | | | | - Joaquín Barba-Cosials
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | | | | | - Jaume Candell-Riera
- Servicio de Medicina Nuclear, Hospital Vall d'Hebron, Barcelona, Spain; Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain
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182
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Cleland JG, Abraham WT, Linde C, Gold MR, Young JB, Claude Daubert J, Sherfesee L, Wells GA, Tang AS. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J 2013; 34:3547-56. [PMID: 23900696 PMCID: PMC3855551 DOI: 10.1093/eurheartj/eht290] [Citation(s) in RCA: 380] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/24/2013] [Accepted: 07/04/2013] [Indexed: 12/25/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) with or without a defibrillator reduces morbidity and mortality in selected patients with heart failure (HF) but response can be variable. We sought to identify pre-implantation variables that predict the response to CRT in a meta-analysis using individual patient-data. METHODS AND RESULTS An individual patient meta-analysis of five randomized trials, funded by Medtronic, comparing CRT either with no active device or with a defibrillator was conducted, including the following baseline variables: age, sex, New York Heart Association class, aetiology, QRS morphology, QRS duration, left ventricular ejection fraction (LVEF), and systolic blood pressure. Outcomes were all-cause mortality and first hospitalization for HF or death. Of 3782 patients in sinus rhythm, median (inter-quartile range) age was 66 (58-73) years, QRS duration was 160 (146-176) ms, LVEF was 24 (20-28)%, and 78% had left bundle branch block. A multivariable model suggested that only QRS duration predicted the magnitude of the effect of CRT on outcomes. Further analysis produced estimated hazard ratios for the effect of CRT on all-cause mortality and on the composite of first hospitalization for HF or death that suggested increasing benefit with increasing QRS duration, the 95% confidence bounds excluding 1.0 at ∼140 ms for each endpoint, suggesting a high probability of substantial benefit from CRT when QRS duration exceeds this value. CONCLUSION QRS duration is a powerful predictor of the effects of CRT on morbidity and mortality in patients with symptomatic HF and left ventricular systolic dysfunction who are in sinus rhythm. QRS morphology did not provide additional information about clinical response. CLINICALTRIALSGOV NUMBERS NCT00170300, NCT00271154, NCT00251251.
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Affiliation(s)
- John G. Cleland
- National Heart and Lung Institute, Imperial College London (Royal Brompton & Harefield Hospitals) and Department of Cardiology, Castle Hill Hospital, University of Hull, Kingston-upon-Hull, UK
| | - William T. Abraham
- Division of Cardiovascular Medicine and the Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Cecilia Linde
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - James B. Young
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | | | | | | | - Anthony S.L. Tang
- The Island Medical Program, University of British Columbia, Vancouver, Canada
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Affiliation(s)
- Frits W. Prinzen
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Kevin Vernooy
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Angelo Auricchio
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
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184
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Kuck KH, Bordachar P, Borggrefe M, Boriani G, Burri H, Leyva F, Schauerte P, Theuns D, Thibault B, Kirchhof P, Hasenfuss G, Dickstein K, Leclercq C, Linde C, Tavazzi L, Ruschitzka F. New devices in heart failure: an European Heart Rhythm Association report: Developed by the European Heart Rhythm Association; Endorsed by the Heart Failure Association. Europace 2013; 16:109-28. [DOI: 10.1093/europace/eut311] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bakos Z, Markstad H, Ostenfeld E, Carlsson M, Roijer A, Borgquist R. Combined preoperative information using a bullseye plot from speckle tracking echocardiography, cardiac CT scan, and MRI scan: targeted left ventricular lead implantation in patients receiving cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2013; 15:523-31. [DOI: 10.1093/ehjci/jet233] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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186
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Zecchin M, Proclemer A, Magnani S, Vitali-Serdoz L, Facchin D, Muser D, Nordio A, Barbati G, Puggia I, Sinagra G, Proclemer A. Long-term outcome of 'super-responder' patients to cardiac resynchronization therapy. Europace 2013; 16:363-71. [PMID: 24189477 DOI: 10.1093/europace/eut339] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS To evaluate the long-term changes of clinical and echocardiographic parameters, the incidence of cardiac events and parameters associated with late cardiac events in 'super-responders' to cardiac resynchronization therapy (CRT) with [CRT defibrillator (CRT-D)] or without defibrillator back-up. METHODS AND RESULTS In all consecutive patients treated with CRT in two Italian centres (Trieste and Udine) with left ventricular ejection fraction (LVEF) ≤0.35 at implantation (Timp) and LVEF > 0.50 1 and/or 2 years (Tnorm) after implantation, the long-term outcome and the evolution of echocardiographic parameters were assessed; factors associated with a higher risk of cardiac events, defined as hospitalization or death for heart failure (HF), sudden death, or CRT-D appropriate interventions, were also analysed. Among the 259 patients evaluated, 62 (24%) had LVEF ≥ 0.50 at Tnorm (n = 44 with at 1 year, n = 18 at 2 years). During a mean follow-up of 68 ± 30 months, one cardiac death (for HF) and eight cardiovascular events (two hospitalization for HF and six appropriate CRT-D interventions) occurred. At the last echo evaluation (Tfup) performed 51 ± 26 months after Timp, LVEF was <0.50 in five patients (>0.45 in four of them). At univariable analysis, only LV end-systolic volume evaluated at Tfup was associated with a higher risk of cardiac events during follow-up. CONCLUSION In 'super-responders' to CRT long-term outcome is excellent. However, cardiac events, mainly CRT-D appropriate interventions, can occur despite the persistence of LVEF > 0.50. Early identification of these patients is still an unsolved issue.
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Affiliation(s)
- Massimo Zecchin
- Cardiovascular Department, University and 'Ospedali Riuniti di Trieste' Hospital, Via Valdoni, 7, 34129 Trieste, Italy
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187
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Sorgente A, Cappato R. A Critical Reappraisal of the Current Clinical Indications to Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2013; 2:91-4. [PMID: 26835046 DOI: 10.15420/aer.2013.2.2.91] [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: 11/04/2022] Open
Abstract
Cardiac resynchronisation therapy (CRT) is a well-established non-pharmacological treatment option for patients with refractory symptomatic heart failure (HF) already under optimal medical therapy. CRT is founded on the principle that interventricular conduction disturbances and more in particular left bundle branch block (LBBB) are deleterious to cardiac performance, and may contribute to the systolic and diastolic incompetency typical of patients with HF. Although CRT is associated with a not negligible percentage of non-response, all the international guidelines on chronic HF have extended their indications to CRT, also to patients with less symptomatic HF who are already showing signs of systolic dysfunction and interventricular dyssynchrony, without giving any substantial advice to reduce the number of failures of this therapy. This review seeks to point out the potential issues linked to CRT, with the aim of making a reappraisal of the clinical evidences supporting the current indications to CRT, and to figure out which type of research should be warranted in the field for the future to reduce the percentage of non-responders to this therapy.
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Affiliation(s)
- Antonio Sorgente
- Arrhythmia and Electrophysiology Department, Policlinico San Donato, Milan, Italy
| | - Riccardo Cappato
- Arrhythmia and Electrophysiology Department, Policlinico San Donato, Milan, Italy
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188
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Bongiorni MG, Proclemer A, Dobreanu D, Marinskis G, Pison L, Blomstrom-Lundqvist C, Blomstrom-Lundqvist C, Bongiorni MG, Chen J, Dagres N, Estner H, Hernandez-Madrid A, Hocini M, Larsen TB, Pison L, Potpara T, Proclemer A, Sciraffia E, Todd D. Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European Heart Rhythm Association survey. Europace 2013; 15:1664-8. [DOI: 10.1093/europace/eut345] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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189
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Applicability of the iterative technique for cardiac resynchronization therapy optimization: full-disclosure, 50-sequential-patient dataset of transmitral Doppler traces, with implications for future research design and guidelines. ACTA ACUST UNITED AC 2013; 16:541-50. [DOI: 10.1093/europace/eut257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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190
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Singh JP, Abraham WT, Chung ES, Rogers T, Sambelashvili A, Coles JA, Martin DO. Clinical response with adaptive CRT algorithm compared with CRT with echocardiography-optimized atrioventricular delay: a retrospective analysis of multicentre trials. Europace 2013; 15:1622-8. [PMID: 24014804 DOI: 10.1093/europace/eut107] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Adaptive cardiac resynchronization therapy (aCRT) is a novel algorithm for CRT pacing that provides automatic ambulatory selection between synchronized left ventricular (LV) or bi-ventricular (BiV) pacing and optimization of atrioventricular (AV) and inter-ventricular (VV) delays based on periodic measurement of intrinsic conduction. We aimed to compare the clinical response between aCRT and standard CRT in historical trials. METHODS AND RESULTS The treatment arm of the aCRT trial was compared with a pooled historical control (HC) derived from the CRT arms of four clinical trials (MIRACLE, MIRACLE ICD, PROSPECT, and InSync III Marquis) with respect to the proportion of patients who had an improved clinical composite score (CCS) at the 6-month follow-up. Patients in the HC underwent echocardiography-guided AV optimization after the implant. A propensity score model was used to adjust for 22 potential baseline confounders of the effect of CRT. Patients were stratified into quintiles according to the propensity score and the adjusted absolute treatment effect was obtained by averaging estimates across these quintiles. The propensity score model included 751 patients (aCRT: 266, historical trials: 485). The adjusted absolute difference in percent improved in CCS between the aCRT and HC arms was 11.9% [95% confidence interval (CI): 2.7-19.2%] favouring aCRT. The patients in the aCRT group were significantly more likely to have an improved CCS than the patients in the HC (odds ratio = 1.65, 95% CI: 1.1-2.5). CONCLUSION The aCRT algorithm may be associated with additional improvement in clinical response compared with historical CRT with echocardiographic AV optimization.
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Affiliation(s)
- Jagmeet P Singh
- Massachusetts General Hospital Heart Center, Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA
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191
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Diagnose und Therapie von Herzrhythmusstörungen bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-2906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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192
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Pison L, Proclemer A, Bongiorni MG, Marinskis G, Hernandez-Madrid A, Blomstrom-Lundqvist C. Imaging techniques in electrophysiology and implantable device procedures: results of the European Heart Rhythm Association survey. Europace 2013; 15:1333-6. [DOI: 10.1093/europace/eut259] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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193
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Bartos JA, Francis GS. The High-Risk Patient With Heart Failure With Reduced Ejection Fraction: Treatment Options and Challenges. Clin Pharmacol Ther 2013; 94:509-18. [DOI: 10.1038/clpt.2013.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/08/2013] [Indexed: 12/17/2022]
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194
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An exploratory study on coronary sinus lead tip three-dimensional trajectory changes in cardiac resynchronization therapy. Heart Rhythm 2013; 10:1360-7. [PMID: 23851066 DOI: 10.1016/j.hrthm.2013.07.008] [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] [Received: 05/19/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prediction of response to cardiac resynchronization therapy (CRT) is still an unsolved major issue. The interface between left ventricular mechanics, coronary sinus (CS) lead, and pacing delivery has been little investigated. OBJECTIVE To investigate CS lead tip movements at baseline and during biventricular pacing (BiV) in the hypothesis that they could provide some insights into left ventricular mechanical behavior in CRT. METHODS Three-dimensional reconstruction of CS lead tip trajectory throughout the cardiac cycle using a novel fluoroscopy-based method was performed in 22 patients with chronic heart failure (19 men; mean age 70 ± 10 years). Three trajectories were computed: before (T-1) and immediately after (T0) BiV start-up and after 6 months (T1). CRT response was the echocardiographic end-systolic volume reduction ≥15% at T1. Metrics describing trajectory at T0, T-1, and T1 were compared between 9 responders (R) and 13 nonresponders (NR). RESULTS At T-1 trajectories demonstrated heterogeneous shapes and metrics, but at T0 the variations in the ratio between the two main axes (S1/S2) and in the eccentricity were statistically different between R and NR, pointing out a trajectory's change toward a significantly more circular shape at BiV start-up in R. Remarkably, R and NR could be completely separated by means of the percent variation in S1/S2 from T-1 to T0 (R: 47.5% [31.5% to 54.1%] vs. NR: -25.6% [-67% to -6.5%]). This single marker computed at T0 would have predicted CRT response at T1. CONCLUSIONS Preliminary data showed that CS lead tip trajectory changes induced by BiV were related to mechanical resynchronization.
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Varma N, Brugada P. Automatic remote monitoring: milestones reached, paths to pave. Europace 2013; 15 Suppl 1:i69-i71. [DOI: 10.1093/europace/eut118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gierula J, Cubbon RM, Jamil HA, Byrom R, Baxter PD, Pavitt S, Gilthorpe MS, Hewison J, Kearney MT, Witte KKA. Cardiac resynchronization therapy in pacemaker-dependent patients with left ventricular dysfunction. Europace 2013; 15:1609-14. [PMID: 23736807 DOI: 10.1093/europace/eut148] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIMS Heart failure and left ventricular (LV) systolic dysfunction (LVSD) are common in patients with permanent pacemakers. The aim was to determine if cardiac resynchronization therapy (CRT) at the time of pulse generator replacement (PGR) is of benefit in patients with unavoidable RV pacing and LVSD. METHODS AND RESULTS Fifty patients with unavoidable RV pacing, LVSD, and mild or no symptoms of heart failure, listed for PGR were randomized 1 : 1 to either standard RV-PGR (comparator) or CRT. The primary endpoint was the difference in change in LV ejection fraction (LVEF) between RV-PGR and CRT groups from baseline to 6 months. Secondary endpoints included peak oxygen consumption, quality of life, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. At 6 months there was a difference in change in median (interquartile range) LVEF [9 (6-12) vs. -1.5 (-4.5 to -0.8)%; P < 0.0001] between the CRT and RV-PGR arms. There were also improvements in exercise capacity (P = 0.007), quality of life (P = 0.03), and NT-proBNP (P = 0.007) in those randomized to CRT. After 809 (729-880) days, 17 patients had died or been hospitalized (6 in CRT group and 11 in the comparator RV-PGR group) and two patients in the RV-PGR arm had required CRT for deteriorating heart failure. Patients with standard RV-PGR had more days in hospital during follow-up than those in the CRT group [4 (2-7) vs. 11 (6-16) days; P = 0.047]. CONCLUSION Performing CRT in pacemaker patients with unavoidable RV pacing and LVSD but without severe symptoms of heart failure, at the time of PGR, improves cardiac function, exercise capacity, quality of life, and NT-pro-BNP levels.
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Affiliation(s)
- John Gierula
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
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Abstract
In patients with advanced systolic heart failure and mechanical dyssynchrony, cardiac resynchronization therapy (CRT) is an effective means of improving symptoms and reducing mortality. There are now several recognized approaches to optimize CRT. Imaging modalities can assist with identifying the myocardium with the latest mechanical activation for targeted left ventricular lead implantation. Device programming can be tailored to maximize biventricular pacing, and thereby is its benefit. Cardiac imaging has shown that atrioventricular and interventricular intervals can be adjusted to further reduce dyssynchrony. We review these various approaches that maximize the benefit derived from CRT.
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Janssens U, Reith S. [The chronic critically ill patient from the cardiologist's perspective]. Med Klin Intensivmed Notfmed 2013; 108:267-78. [PMID: 23612917 DOI: 10.1007/s00063-012-0193-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 02/22/2013] [Accepted: 02/26/2013] [Indexed: 11/29/2022]
Abstract
In recent years the prognosis and survival of chronic and acute heart failure (HF) patients has been steadily improving; however, many patients develop advanced chronic HF which is characterized by worsening of symptoms, unplanned hospital admission due to acute decompensation, development of complications, such as life-threatening arrhythmia and shorter life span. Optimal medical therapy is supplemented by interventional cardiology, cardiovascular implantable electronic devices (CIEDs), minimally invasive valve replacement or repair, circulatory mechanical support and heart transplantation. Medical indications and informed consent are essential prerequisites for successfully implementing treatment goals. For patients who are incapable of decisions a legally defined surrogate decision-maker has the same right to refuse or request the withdrawal of treatment as the patient would have if the patient had decision-making capability. As the use of circulatory mechanical support becomes increasingly more prevalent, ethical issues are likely to arise at an increasing rate, as will social and legal ramifications. The concept of turning off an implanted device as death nears is challenging because of ethical and technical concerns. The same holds true for CIEDs. A palliative care approach is applicable to heart failure patients and is particularly relevant to those with advanced disease. Palliative care should be integrated as part of a team approach to comprehensive HF care and should not be reserved for those who are expected to die within days or weeks.
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Affiliation(s)
- U Janssens
- Klinik für Innere Medizin, St. Antonius Hospital, Eschweiler.
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Noninvasive Assessment of Myocardial Dyssynchrony Prior to Cardiac Resynchronization Therapy. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Boidol J, Średniawa B, Kowalski O, Szulik M, Mazurek M, Sokal A, Pruszkowska-Skrzep P, Kukulski T, Kalarus Z, Lenarczyk R. Many response criteria are poor predictors of outcomes after cardiac resynchronization therapy: validation using data from the randomized trial. ACTA ACUST UNITED AC 2013; 15:835-44. [DOI: 10.1093/europace/eus390] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Joanna Boidol
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Skłodowskiej-Curie Street 9, 41-800 Zabrze, Poland
| | - Beata Średniawa
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Skłodowskiej-Curie Street 9, 41-800 Zabrze, Poland
| | - Oskar Kowalski
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Skłodowskiej-Curie Street 9, 41-800 Zabrze, Poland
| | - Mariola Szulik
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Skłodowskiej-Curie Street 9, 41-800 Zabrze, Poland
| | - Michał Mazurek
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Skłodowskiej-Curie Street 9, 41-800 Zabrze, Poland
| | - Adam Sokal
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Skłodowskiej-Curie Street 9, 41-800 Zabrze, Poland
| | - Patrycja Pruszkowska-Skrzep
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Skłodowskiej-Curie Street 9, 41-800 Zabrze, Poland
| | - Tomasz Kukulski
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Skłodowskiej-Curie Street 9, 41-800 Zabrze, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Skłodowskiej-Curie Street 9, 41-800 Zabrze, Poland
| | - Radosław Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Skłodowskiej-Curie Street 9, 41-800 Zabrze, Poland
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