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Kramer DB, Reynolds MR, Mitchell SL. Resynchronization: considering device-based cardiac therapy in older adults. J Am Geriatr Soc 2013; 61:615-21. [PMID: 23581915 DOI: 10.1111/jgs.12174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cardiac resynchronization therapy (CRT) is a device-based treatment available to select individuals with systolic heart failure (HF), a large proportion of whom are aged 65 and older. As the field of CRT advances, together with shifting demographics and expanded indications for implantation, there is a need for practitioners caring for older adults to understand what is and is not known about the use of CRT specifically in this population. Clinical trials demonstrating benefits for severe and mild HF have uncertain generalizability to older adults. Other studies demonstrate that device-related complications may be more common with CRT than with simpler devices and more common in older adults. CRT clinical trials also may not adequately capture outcomes and concerns specific to older adults, including quality of life and end-of-life care experiences. Informed decision-making by clinicians, policy-makers, and patients will require greater understanding of the use and outcomes of CRT in older persons.
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Affiliation(s)
- Daniel B Kramer
- Hebrew Senior Life Institute for Aging Research, Boston, MA 02215, USA.
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252
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Daubert JC, Saxon L, Adamson PB, Auricchio A, Berger RD, Beshai JF, Breithard O, Brignole M, Cleland J, DeLurgio DB, Dickstein K, Exner DV, Gold M, Grimm RA, Hayes DL, Israel C, Leclercq C, Linde C, Lindenfeld J, Merkely B, Mont L, Murgatroyd F, Prinzen F, Saba SF, Shinbane JS, Singh J, Tang AS, Vardas PE, Wilkoff BL, Zamorano JL, Anand I, Blomström-Lundqvist C, Boehmer JP, Calkins H, Cazeau S, Delgado V, Estes NAM, Haines D, Kusumoto F, Leyva P, Ruschitzka F, Stevenson LW, Torp-Pedersen CT. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Europace 2013; 14:1236-86. [PMID: 22930717 DOI: 10.1093/europace/eus222] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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253
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Association between QRS duration and outcome with cardiac resynchronization therapy: a systematic review and meta-analysis. J Electrocardiol 2013; 46:147-55. [PMID: 23394690 DOI: 10.1016/j.jelectrocard.2012.12.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE We conducted a systematic review and meta-analysis of randomized and observational studies to evaluate the associations between QRS duration (QRSd) at baseline or in follow-up and outcomes with cardiac resynchronization therapy (CRT). METHODS We searched online databases to December 2010 and included 6 randomized controlled trials (RCTs) and 38 observational studies. Outcomes included clinical/functional response, left ventricular (LV) remodeling, hospitalizations and mortality. RESULTS In RCTs, a benefit of CRT was evident only in patients with QRSd >150ms. In observational studies, those meeting either clinical or remodeling CRT response definitions had both wider pooled baseline QRSd and significantly more QRS narrowing with CRT than non-responders. CONCLUSIONS RCTs demonstrate that benefit with CRT appears restricted to those with baseline QRSd wider than 150ms. Both wider baseline QRS and more QRS narrowing are associated with CRT response in observational studies. Electrocardiographic QRSd plays an important role in CRT patient selection and follow-up.
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PADELETTI LUIGI, PIERAGNOLI PAOLO, RICCIARDI GIUSEPPE, PERROTTA LAURA, PERINI ALESSANDROP, GRIFONI GINO, RICCERI ILARIA, PADELETTI MARGHERITA, LIONETTI VINCENZO, VALSECCHI SERGIO. Larger Interventricular Conduction Time Enhances Mechanical Response to Resynchronization Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:416-23. [DOI: 10.1111/pace.12068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/21/2012] [Accepted: 11/13/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - PAOLO PIERAGNOLI
- Institute of Internal Medicine and Cardiology, University of Florence; Florence; Italy
| | - GIUSEPPE RICCIARDI
- Institute of Internal Medicine and Cardiology, University of Florence; Florence; Italy
| | - LAURA PERROTTA
- Institute of Internal Medicine and Cardiology, University of Florence; Florence; Italy
| | - ALESSANDRO P. PERINI
- Institute of Internal Medicine and Cardiology, University of Florence; Florence; Italy
| | - GINO GRIFONI
- Institute of Internal Medicine and Cardiology, University of Florence; Florence; Italy
| | - ILARIA RICCERI
- Institute of Internal Medicine and Cardiology, University of Florence; Florence; Italy
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KANDALA JAGDESH, UPADHYAY GAURAVA, ALTMAN ROBERTK, BOSE ABHISHEK, HEIST EKEVIN, MELA THEOFANIE, SINGH JAGMEETP. Electrical Delay in Apically Positioned Left Ventricular Leads and Clinical Outcome After Cardiac Resynchronization Therapy. J Cardiovasc Electrophysiol 2012; 24:182-7. [DOI: 10.1111/j.1540-8167.2012.02428.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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256
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Daubert JC, Saxon L, Adamson PB, Auricchio A, Berger RD, Beshai JF, Breithard O, Brignole M, Cleland J, Delurgio DB, Dickstein K, Exner DV, Gold M, Grimm RA, Hayes DL, Israel C, Leclercq C, Linde C, Lindenfeld J, Merkely B, Mont L, Murgatroyd F, Prinzen F, Saba SF, Shinbane JS, Singh J, Tang AS, Vardas PE, Wilkoff BL, Zamorano JL. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Heart Rhythm 2012; 9:1524-76. [PMID: 22939223 DOI: 10.1016/j.hrthm.2012.07.025] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 11/30/2022]
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257
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Westenbrink BD, Damman K, Rienstra M, Maass AH, van der Meer P. Heart failure highlights in 2011. Eur J Heart Fail 2012; 14:1090-6. [PMID: 22898804 DOI: 10.1093/eurjhf/hfs121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Heart failure (HF) remains a major medical problem, and the European Journal of Heart Failure is dedicated to publishing research further investigating its pathophysiology and diagnosis in order to help clinicians alleviate symptoms and improve patient outcomes.( 1) This review reports on important studies in the field of HF published in 2011. All research areas are addressed, including experimental studies, biomarkers, clinical trials, arrhythmias, and new insights into the role of device therapy.
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Affiliation(s)
- B Daan Westenbrink
- Department of Cardiology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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258
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Differential Response to Cardiac Resynchronization Therapy and Clinical Outcomes According to QRS Morphology and QRS Duration. J Am Coll Cardiol 2012; 60:592-8. [DOI: 10.1016/j.jacc.2012.03.059] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 03/21/2012] [Indexed: 11/20/2022]
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Singh JP, Mela T. Anatomical left ventricular lead location and clinical outcome: not a one size fit all strategy. Europace 2012; 14:1076-8. [PMID: 22832575 DOI: 10.1093/europace/eus239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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260
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BOGAARD MARGOTD, HESSELINK TIM, MEINE MATHIAS, LOH PETER, HAUER RICHARDN, CRAMER MAARTENJ, DOEVENDANS PIETERA, TUINENBURG ANTONE. The ECG in Cardiac Resynchronization Therapy: Influence of Left and Right Ventricular Preactivation and Relation to Acute Response. J Cardiovasc Electrophysiol 2012; 23:1237-45. [DOI: 10.1111/j.1540-8167.2012.02388.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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261
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Polasek R, Kucera P, Nedbal P, Roubicek T, Belza T, Hanuliakova J, Horak D, Wichterle D, Kautzner J. Local electrogram delay recorded from left ventricular lead at implant predicts response to cardiac resynchronization therapy: retrospective study with 1 year follow up. BMC Cardiovasc Disord 2012; 12:34. [PMID: 22607487 PMCID: PMC3447687 DOI: 10.1186/1471-2261-12-34] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 04/30/2012] [Indexed: 11/15/2022] Open
Abstract
Background Considerable proportion of patients does not respond to the cardiac resynchronization therapy (CRT). This study investigated clinical relevance of left ventricular electrode local electrogram delay from the beginning of QRS (QLV). We hypothesized that longer QLV indicating more optimal lead placement in the late activated regions is associated with the higher probability of positive CRT response. Methods We conducted a retrospective, single–centre analysis of 161 consecutive patients with heart failure and LBBB or nonspecific intraventricular conduction delay (IVCD) treated with CRT. We routinely intend to implant the LV lead in a region with long QLV. Clinical response to CRT, left ventricular (LV) reverse remodelling (i.e. decrease in LV end-systolic diameter - LVESD ≥10%) and reduction in plasma level of NT-proBNP >30% at 12-month post-implant were the study endpoints. We analyzed association between pre-implant variables and the study endpoints. Results Clinical CRT response rate reached 58%, 84% and 92% in the lowest (≤105 ms), middle (106-130 ms) and the highest (>130 ms) QLV tertile (p < 0.0001), respectively. Longer QRS duration (p = 0.002), smaller LVESD and a non-ischemic cardiomyopathy (both p = 0.02) were also univariately associated with positive clinical CRT response. In a multivariate analysis, QLV remained the strongest predictor of clinical CRT response (p < 0.00001), followed by LVESD (p = 0.01) and etiology of LV dysfunction (p = 0.04). Comparable predictive power of QLV for LV reverse remodelling and NT-proBNP response rates was observed. Conclusion LV lead position assessed by duration of the QLV interval was found the strongest independent predictor of beneficial clinical response to CRT.
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Affiliation(s)
- Rostislav Polasek
- Department of Cardiology, Regional Hospital Liberec, Liberec, Czech Republic.
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Exner DV, Auricchio A, Singh JP. Contemporary and future trends in cardiac resynchronization therapy to enhance response. Heart Rhythm 2012; 9:S27-35. [PMID: 22521939 DOI: 10.1016/j.hrthm.2012.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Indexed: 10/28/2022]
Abstract
The rationale for cardiac resynchronization therapy (CRT), expectations in terms of patient benefit, patient selection for CRT, selection of a CRT pacemaker (CRT-P) vs CRT plus implantable cardioverter-defibrillator (CRT-D) platform, and studies evaluating device programming to enhance benefit from CRT are reviewed. The notion of an "optimal" left ventricular (LV) pacing site, the rationale for identifying and avoiding LV pacing in regions of scar, the use of anatomic, hemodynamic, and electrical parameters to identify an optimal LV pacing site, and the potential utility of multisite LV pacing to enhance benefit from CRT are discussed. Finally, the advantages and disadvantages of the various methods for LV lead delivery are reviewed.
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Affiliation(s)
- Derek V Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
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Gorcsan J, Prinzen FW. Understanding the cardiac substrate and the underlying physiology: Implications for individualized treatment algorithm. Heart Rhythm 2012; 9:S18-26. [PMID: 22521936 DOI: 10.1016/j.hrthm.2012.04.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Indexed: 11/27/2022]
Affiliation(s)
- John Gorcsan
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Kristiansen HM, Hovstad T, Vollan G, Keilegavlen H, Faerestrand S. Clinical implication of right ventricular to left ventricular interlead sensed electrical delay in cardiac resynchronization therapy. Europace 2012; 14:986-93. [PMID: 22308084 DOI: 10.1093/europace/eur429] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIMS To evaluate the clinical implication of right ventricular (RV) to left ventricular (LV) interlead sensed electrical delay (RV-LVs) and the relation to ventricular lead position in cardiac resynchronization therapy (CRT). METHODS AND RESULTS Eighty-five consecutive CRT patients (mean age 66 ± 11 years) received LV lead prospectively targeted to the latest mechanical activated segment (concordant), assessed by two-dimensional speckle tracking radial strain (ST-RS) echocardiography. The RV lead was randomized to RV apex (n= 43) or RV high posterior septum (n= 42). Right ventricular to left ventricular interlead sensed electrical delay was obtained during the CRT implant procedure. Intraventricular dyssynchrony was evaluated by ST-RS echocardiography. Interventricular mechanical delay (IVMD) was measured by using pulse-wave Doppler. Separated by the median RV-LVs (82 ms), a long RV-LVs demonstrated more LV end-systolic volume (LVESV) reduction than a short RV-LVs (-27 ± 20 vs. -16 ± 22%; P= 0.02), 6 months after CRT (6FU). Right ventricular to left ventricular interlead sensed electrical delay correlated to IVMD (r = 0.50; P< 0.001) and intraventricular dyssynchrony (r = 0.25; P= 0.02) at baseline. Concordant LV leads (n= 61) demonstrated superior reduction of LVESV (P= 0.005) 6 months after CRT; however, both RV lead positions had similar effects. Right ventricular to left ventricular interlead sensed electrical delay was irrespective to LV lead concordance and RV lead position (P= ns). Independent predictors to reverse remodelling (reduction of LVESV ≥ 15%) at 6FU were concordant LV lead (odds ratio, 3.210; P= 0.029) and IVMD (odds ratio, 1.028; P= 0.026). CONCLUSION Right ventricular to left ventricular interlead sensed electrical delay was not predictive to LV reverse remodelling affected by CRT at 6FU. Concordant LV leads demonstrated superior LV reverse remodelling at 6FU. Right ventricular to left ventricular interlead sensed electrical delay was irrespective of ventricular lead position and might be insufficient to target optimal LV lead position in CRT. TRIAL REGISTRATION http://clinicaltrials.gov. Unique identifier: NCT01035489.
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Affiliation(s)
- Hans Morten Kristiansen
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway.
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