301
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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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302
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MARTIN DAVIDO, DAY JOHND, LAI PETERY, MURPHY ALLANL, NAYAK HEMALM, VILLAREAL ROLLOP, WEINER STANISLAV, KRAUS STACIAM, STOLEN KIRAQ, GOLD MICHAELR. Atrial Support Pacing in Heart Failure: Results from the Multicenter PEGASUS CRT Trial. J Cardiovasc Electrophysiol 2012; 23:1317-25. [DOI: 10.1111/j.1540-8167.2012.02402.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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303
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KYRIACOU ANDREAS, PABARI PUNAMA, WHINNETT ZACHARYI, ARRI SATPAL, WILLSON KEITH, BARUAH RESHAM, STEGEMANN BERTHOLD, MAYET JAMIL, KANAGARATNAM PRAPA, HUGHES ALUND, FRANCIS DARRELP. Fully Automatable, Reproducible, Noninvasive Simple Plethysmographic Optimization: Proof of Concept and Potential for Implantability. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:948-60. [DOI: 10.1111/j.1540-8159.2012.03435.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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304
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Kutyifa V, Breithardt OA. Evaluación del paciente que no responde al tratamiento de resincronización cardiaca: un enfoque escalonado completo. Rev Esp Cardiol 2012; 65:504-10. [DOI: 10.1016/j.recesp.2011.12.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 12/23/2011] [Indexed: 11/28/2022]
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305
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Stevenson WG, Hernandez AF, Carson PE, Fang JC, Katz SD, Spertus JA, Sweitzer NK, Tang WHW, Albert NM, Butler J, Westlake Canary CA, Collins SP, Colvin-Adams M, Ezekowitz JA, Givertz MM, Hershberger RE, Rogers JG, Teerlink JR, Walsh MN, Stough WG, Starling RC. Indications for cardiac resynchronization therapy: 2011 update from the Heart Failure Society of America Guideline Committee. J Card Fail 2012; 18:94-106. [PMID: 22300776 DOI: 10.1016/j.cardfail.2011.12.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 12/09/2011] [Indexed: 12/14/2022]
Abstract
Cardiac resynchronization therapy (CRT) improves survival, symptoms, quality of life, exercise capacity, and cardiac structure and function in patients with New York Heart Association (NYHA) functional class II or ambulatory class IV heart failure (HF) with wide QRS complex. The totality of evidence supports the use of CRT in patients with less severe HF symptoms. CRT is recommended for patients in sinus rhythm with a widened QRS interval (≥150 ms) not due to right bundle branch block (RBBB) who have severe left ventricular (LV) systolic dysfunction and persistent NYHA functional class II-III symptoms despite optimal medical therapy (strength of evidence A). CRT may be considered for several other patient groups for whom evidence of benefit is clinically significant but less substantial, including patients with a QRS interval of ≥120 to <150 ms and severe LV systolic dysfunction who have persistent mild to severe HF despite optimal medical therapy (strength of evidence B), some patients with atrial fibrillation, and some with ambulatory class IV HF. Several evidence gaps remain that need to be addressed, including the ideal threshold for QRS duration, QRS morphology, lead placement, degree of myocardial scarring, and the modality for evaluating dyssynchrony. Recommendations will evolve over time as additional data emerge from completed and ongoing clinical trials.
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Affiliation(s)
- William G Stevenson
- Department of Medicine, Division of Cardiology Brigham and Women's Hospital, Boston, Massachusetts, USA
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Altman RK, Parks KA, Schlett CL, Orencole M, Park MY, Truong QA, Deeprasertkul P, Moore SA, Barrett CD, Lewis GD, Das S, Upadhyay GA, Heist EK, Picard MH, Singh JP. Multidisciplinary care of patients receiving cardiac resynchronization therapy is associated with improved clinical outcomes. Eur Heart J 2012; 33:2181-8. [PMID: 22613342 DOI: 10.1093/eurheartj/ehs107] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIMS Although cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with heart failure, a significant minority of patients do not respond adequately to this therapy. The objective of this study was to examine the impact of a 'multidisciplinary care' (MC) approach on the clinical outcome in CRT patients. METHODS AND RESULTS The clinical outcome in patients prospectively receiving MC (n = 254) was compared with a control group of patients who received conventional care (CC, n = 173). The MC group was followed prospectively in an integrated clinic setting by a team of subspecialists from the heart failure, electrophysiology, and echocardiography service at 1-, 3-, and 6-months post-implant. All patients had echocardiographic-guided optimization at their 1-month visit. The proportional hazards model (adjusting for all covariates) and Kaplan-Meier time to first event curves were compared between the two groups, over a 2-year follow-up. The long-term outcome was measured as a combined endpoint of heart failure hospitalization, cardiac transplantation, or all-cause mortality. The clinical characteristics between the MC and CC groups at baseline were comparable (age, 68 ± 13 vs. 69 ± 12; NYHA III, 90 vs. 82%; ischaemic cardiomyopathy 55 vs. 64%, P = NS, respectively). The event-free survival was significantly higher in the multidisciplinary vs. the CC group (P = 0.0015). A significant reduction in clinical events was noted in the MC group vs. the CC group (hazard ratio: 0.62, 95% CI: 0.46-0.83, P = 0.001). CONCLUSION Integrated MC may improve 2-year event-free survival in patients receiving cardiac resynchronization therapy. Prospective randomized studies are needed to validate our findings.
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Affiliation(s)
- Robert K Altman
- Cardiac Arrhythmia Service, Massachusetts General Hospital Heart Center, Harvard Medical School, Boston, MA 02114, USA
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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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308
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GAGE RYANM, BURNS KEVINV, VATTEROTT DANIELB, KUBO SPENCERH, BANK ALANJ. Pacemaker Optimization in Nonresponders to Cardiac Resynchronization Therapy: Left Ventricular Pacing as an Available Option. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:685-94. [DOI: 10.1111/j.1540-8159.2012.03384.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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309
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Auger D, Bleeker GB, Bertini M, Ewe SH, van Bommel RJ, Witkowski TG, Ng AC, van Erven L, Schalij MJ, Bax JJ, Delgado V. Effect of cardiac resynchronization therapy in patients without left intraventricular dyssynchrony. Eur Heart J 2012; 33:913-20. [PMID: 22279110 PMCID: PMC3345550 DOI: 10.1093/eurheartj/ehr468] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 11/11/2011] [Accepted: 11/30/2011] [Indexed: 01/28/2023] Open
Abstract
AIMS To evaluate the effects of cardiac resynchronization therapy (CRT) on long-term survival of patients without baseline left ventricular (LV) mechanical dyssynchrony. METHODS AND RESULTS A total of 290 heart failure patients (age 67 ± 10 years, 77% males) without significant baseline LV dyssynchrony (<60 ms as assessed with tissue Doppler imaging) were treated with CRT. Patients were divided according to the median LV dyssynchrony measured after 48 h of CRT into two groups. All-cause mortality was compared between the subgroups. In addition, the all-cause mortality rates of these subgroups were compared with the all-cause mortality of 290 heart failure patients treated with CRT who showed significant LV dyssynchrony (≥60 ms) at baseline. In the group of patients without significant LV dyssynchrony, median LV dyssynchrony increased from 22 ms (inter-quartile range 16-34 ms) at baseline to 40 ms (24-56 ms) 48 h after CRT. The cumulative mortality rates at 1-, 2-, and 3-year follow-up of patients with LV dyssynchrony ≥40 ms 48 h after CRT implantation were significantly higher when compared with patients with LV dyssynchrony <40 ms (10, 17, and 23 vs. 3, 8, and 10%, respectively; log-rank P< 0.001). Finally, the cumulative mortality rates at 1-, 2-, and 3-year follow-up of patients with baseline LV dyssynchrony were 3, 8, and 11%, respectively (log-rank P= 0.375 vs. patients with LV dyssynchrony <40 ms). Induction of LV dyssynchrony after CRT was an independent predictor of mortality (hazard ratio: 1.247; P= 0.009). CONCLUSION In patients without significant LV dyssynchrony, the induction of LV dyssynchrony after CRT may be related to a less favourable long-term outcome.
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Affiliation(s)
- Dominique Auger
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Gabe B. Bleeker
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Matteo Bertini
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - See H. Ewe
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Rutger J. van Bommel
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Tomasz G. Witkowski
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Arnold C.T. Ng
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Martin J. Schalij
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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310
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Simple regional strain pattern analysis to predict response to cardiac resynchronization therapy: rationale, initial results, and advantages. Am Heart J 2012; 163:697-704. [PMID: 22520537 DOI: 10.1016/j.ahj.2012.01.025] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 01/26/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND A classical strain pattern of early contraction in one wall and prestretching of the opposing wall followed by late contraction has previously been associated with left bundle branch block (LBBB) activation and short-term response to cardiac resynchronization therapy (CRT). Aims of this study were to establish the long-term predictive value of an LBBB-related strain pattern and to identify changes in contraction patterns during short-term and long-term CRT. METHODS AND RESULTS Sixty-seven patients with standard CRT criteria were prospectively enrolled between early 2009 and late 2010. Echocardiography including regional strain analysis by 2-dimensional speckle tracking was performed 1 week before implantation, at day 1, and 6 months after. Response was defined as a decrease in left ventricular end-systolic volume ≥ 15%. The predictive ability of a classical pattern was compared with time-to-peak measurements from velocity and deformation analysis. Forty-three patients (65%) were classified as responders. The presence of a classical pattern showed 91% specificity and 95% sensitivity for response and performed significantly better than time-to-peak parameters in prediction of response to CRT (P < .001, all). In responders, CRT acutely increased septal longitudinal peak systolic strain (-8.7% ± 3.6% to -11.1% ± 3%, P < .001) but not in nonresponders. CONCLUSIONS The classical pattern is highly predictive of response to CRT and superior to time-to-peak methods. Patients who obtain long-term reverse remodeling are characterized by short-term reversal of the classical strain pattern. These findings emphasize the value of recognizing potentially reversible strain patterns in selection of CRT candidates.
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311
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KAWATA HIRO, NODA TAKASHI, YAMADA YUKO, OKAMURA HIDEO, NAKAJIMA HIROYUKI, KOBAYASHI JUNJIRO, KAMAKURA SHIRO. Abrupt Heart Rate Fallings in a Patient with Biventricular Pacing: Latent Risk for Exacerbation of Heart Failure. Pacing Clin Electrophysiol 2012; 35:e55-8. [DOI: 10.1111/j.1540-8159.2010.02855.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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312
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CUOCO FRANKA, GOLD MICHAELR. Optimization of Cardiac Resynchronization Therapy: Importance of Programmed Parameters. J Cardiovasc Electrophysiol 2011; 23:110-8. [DOI: 10.1111/j.1540-8167.2011.02235.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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313
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Porciani MC, Ricceri I, Attanà P, Pennesi M, Michelotti F, Mascia G, Sacchi S, Hashtroudi L, Padeletti L. Discordant electrical and mechanical atrial delays affect intracavitary electrogram-based cardiac resynchronization therapy optimization. Europace 2011; 14:593-8. [PMID: 22041885 DOI: 10.1093/europace/eur335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS It has been shown that atrioventricular (AV) delay optimization improves cardiac resynchronization therapy (CRT) response. Recently, an automatic algorithm (QuickOpt™, St Jude Medical), able to quickly identify the individual optimal AV interval, has been developed. The algorithm suggests an AV delay based on atrial intracavitary electrogram (IEGM) duration. We hypothesized that the difference between electrical and mechanical atrial delays could affect the effectiveness of QuickOpt method. The aim of this study was to test this hypothesis in 23 CRT patients who were recipients of St. Jude Medical devices. METHODS AND RESULTS Using echocardiography, aortic flow velocity time integral (VTI) was evaluated at baseline, at QuickOpt suggested AV delay and after reducing it by 25 and 50%. Mechanical inter-atrial delay (MIAD) derived from echo/Doppler and electrical inter-atrial delay (EIAD) derived from IEGM were also analysed. Optimal AV delay was identified by the maximal VTI. In 11 patients (Group 1) the maximal VTI was achieved at the AV delay suggested by the algorithm, in 6 patients (Group 2) after a 25% reduction, and in 6 patients (Group 3) after a 50% reduction. While EIAD was similar among the three groups, MIAD was significantly different (P< 0.001). MIAD was longer than EIAD in Group 1 (P= 0.028) and shorter than EIAD in Groups 2 (P= 0.028) and 3. (P< 0.001). Mechanical inter-atrial delay was the only independent predictor of the AV interval associated with the best VTI (R(2) = 0.77; P< 0.001). CONCLUSION Our results show that MIAD plays the main role in determining the optimal AV delay, thus caution should be taken when optimizing AV by IEGM-based methods.
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Affiliation(s)
- Maria Cristina Porciani
- Department of Medical and Surgical Critical Care, University of Florence, Viale Morgagni 85, Florence, Italy.
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314
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Exner DV. Predicting Benefit From CRT. JACC Cardiovasc Imaging 2011; 4:1077-9. [DOI: 10.1016/j.jcmg.2011.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 09/06/2011] [Indexed: 12/01/2022]
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315
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316
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Buga L, Cleland JGF. Increasing knowledge and changing views in cardiac resynchronization therapy. Heart Fail Rev 2011; 17:721-5. [DOI: 10.1007/s10741-011-9281-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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317
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Jensen C, Liadski A, Bell M, Naber C, Bruder O, Sabin G, Küpper B, Wieneke H. Echocardiography versus intracardiac electrocardiography-based optimization for cardiac resynchronization therapy. Herz 2011; 36:592-9. [DOI: 10.1007/s00059-011-3507-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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318
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Balmain S, McDonald MA. Cardiac resynchronization therapy in mildly symptomatic heart failure: the earlier the better. Expert Rev Cardiovasc Ther 2011; 9:1147-53. [DOI: 10.1586/erc.11.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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319
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Hayes DL, Boehmer JP, Day JD, Gilliam F, Heidenreich PA, Seth M, Jones PW, Saxon LA. Cardiac resynchronization therapy and the relationship of percent biventricular pacing to symptoms and survival. Heart Rhythm 2011; 8:1469-75. [DOI: 10.1016/j.hrthm.2011.04.015] [Citation(s) in RCA: 246] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 04/06/2011] [Indexed: 11/15/2022]
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320
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Abstract
Implantable cardioverter defibrillators and cardiac resynchronisation therapy (CRT) have become standard of care in modern treatment for heart failure. Results from trials have provided ample evidence that CRT, in addition to its proven benefits in patients with symptomatic heart failure (New York Heart Association [NYHA] class III), might also reduce morbidity and mortality in those with mildly symptomatic heart failure (NYHA class II). As a result, the 2010 European Society of Cardiology guidelines now recommend CRT for both patient populations. In this review we summarise and critically assess the landmark randomised clinical trials REVERSE, MADIT-CRT, and RAFT. Furthermore, we discuss the rationale and available evidence for other emerging indications of CRT, including its use in patients with a mildly reduced left ventricular ejection fraction (>35%), in those with a narrow QRS complex (≤120 ms), and in those with concomitant bradyarrhythmic pacemaker indications. We also focus on patients who do not respond to CRT, and on CRT optimisation.
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Affiliation(s)
- Johannes Holzmeister
- Department of Cardiology and Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.
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321
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Mullens W, Kepa J, De Vusser P, Vercammen J, Rivero-Ayerza M, Wagner P, Dens J, Vrolix M, Vandervoort P, Tang WW. Importance of adjunctive heart failure optimization immediately after implantation to improve long-term outcomes with cardiac resynchronization therapy. Am J Cardiol 2011; 108:409-15. [PMID: 21550578 DOI: 10.1016/j.amjcard.2011.03.060] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/22/2011] [Accepted: 03/22/2011] [Indexed: 10/18/2022]
Abstract
Despite improvement in morbidity and mortality with cardiac resynchronization therapy (CRT), disease progression continues to affect a subset of patients and there is limited effort to identify contributing factors. Our objective was to investigate if a protocol-driven approach incorporated in a management strategy of heart failure immediately after implantation would provide incremental benefits beyond usual care after implantation. We reviewed 114 consecutive patients with CRT implanted from 2005 through 2009 who received usual care after implantation or underwent protocol-driven CRT care after implantation. Preimplantation characteristics in patients receiving usual versus protocol-driven care were similar in left ventricular (LV) dimension (LV internal diastolic diameter 6.2 ± 0.8 vs 6.4 ± 1.0 cm), LV ejection fraction (26 ± 8% vs 25% ± 8%), QRS width, and medication usage. Major adjustments during the protocol-driven approach were uptitration of neurohormonal blockers (64%), echocardiographically guided atrioventricular optimization (50%), heart failure education (42%), arrhythmia management (19%), and LV lead repositioning (7%). Although positive LV remodeling was noted in the 2 groups at 6 months, extent was significantly greater in the protocol-driven approach compared to usual care (change in LV internal diastolic diameter 0.7 ± 0.6 cm vs 0.2 ± 1.2 cm, p = 0.01; change in LV ejection fraction 11 ± 7% vs 7 ± 9%, p = 0.01), which was associated with fewer major adverse events (14% vs 53%, p <0.001). In conclusion, a protocol-driven approach for patients with CRT started immediately after implantation is associated with incremental favorable effects on reverse remodeling and fewer adverse events compared to usual care after implantation. These effects appeared to be driven not only by changes in device settings and arrhythmia management but also by concomitant medication optimization and heart failure education.
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322
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Taha N, Zhang J, Rafie R, Ranjan R, Qamruddin S, Naqvi TZ. Pre-ejection period by radial artery tonometry supplements echo Doppler findings during biventricular pacemaker optimization. Cardiovasc Ultrasound 2011; 9:20. [PMID: 21794181 PMCID: PMC3162875 DOI: 10.1186/1476-7120-9-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 07/28/2011] [Indexed: 11/10/2022] Open
Abstract
Background Biventricular (Biv) pacemaker echo optimization has been shown to improve cardiac output however is not routinely used due to its complexity. We investigated the role of a simple method involving computerized pre-ejection time (PEP) assessment by radial artery tonometry in guiding Biv pacemaker optimization. Methods Blinded echo and radial artery tonometry were performed simultaneously in 37 patients, age 69.1 ± 12.8 years, left ventricular (LV) ejection fraction (EF) 33 ± 10%, during Biv pacemaker optimization. Effect of optimization on echo derived velocity time integral (VTI), ejection time (ET), myocardial performance index (MPI), radial artery tonometry derived PEP and echo-radial artery tonometry derived PEP/VTI and PEP/ET indices was evaluated. Results Significant improvement post optimization was achieved in LV ET (286.9 ± 37.3 to 299 ± 34.6 ms, p < 0.001), LV VTI (15.9 ± 4.8 cm to 18.4 ± 5.1 cm, p < 0.001) and MPI (0.57 ± 0.2 to 0.45 ± 0.13, p < 0.001) and in PEP (246.7 ± 36.1 ms to 234.7 ± 35.5 ms, p = 0.003), PEP/ET (0.88 ± 0.21 to 0.79 ± 0.17, p < 0.001), and PEP/VTI (17.3 ± 7 to 13.78 ± 4.7, p < 0.001). The correlation between comprehensive echo Doppler and radial artery tonometry-PEP guided optimal atrioventricular delay (AVD) and optimal interventricular delay (VVD) was 0.75 (p < 0.001) and 0.69 (p < 0.001) respectively. In 29 patients with follow up assessment, New York Heart Association (NYHA) class reduced from 2.5 ± 0.8 to 2.0 ± 0.9 (p = 0.004) at 1.8 ± 1.4 months. Conclusion An acute shortening of PEP by radial artery tonometry occurs post Biv pacemaker optimization and correlates with improvement in hemodynamics by echo Doppler and may provide a cost-efficient approach to assist with Biv pacemaker echo optimization.
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Affiliation(s)
- Nima Taha
- Non Invasive Diagnostic Services and Echocardiography Laboratory, Cardiovascular and Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles, USA
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323
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Chest radiography is a poor predictor of left ventricular lead position in patients undergoing cardiac resynchronization therapy: comparison with multidetector computed tomography. J Interv Card Electrophysiol 2011; 32:59-65. [DOI: 10.1007/s10840-011-9586-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 04/25/2011] [Indexed: 11/25/2022]
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324
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Burri H, Bennani I, Domenichini G, Ganière V, Sunthorn H, Stettler C, Gentil P, Shah D. Biatrial pacing improves atrial haemodynamics and atrioventricular timing compared with pacing from the right atrial appendage. Europace 2011; 13:1262-7. [PMID: 21474460 DOI: 10.1093/europace/eur099] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Patients with interatrial conduction delay may have suboptimal left atrioventricular (AV) timing due to delayed contraction of the left atrium with foreshortening of ventricular filling. This may be an issue in pacemaker patients, especially those requiring resychronization therapy. Pacing from the high interatrial septum (IAS) or the distal or proximal coronary sinus (CSD and CSP) may improve left AV synchrony compared with pacing from the right atrial appendage (RAA). Our aim was to compare haemodynamics of these pacing sites. METHODS AND RESULTS A total of 24 patients undergoing radiofrequency ablation for paroxysmal atrial fibrillation were studied. Left atrial pressures were recorded in sinus rhythm, and during pacing from the RAA, IAS, CSD, CSP, and with biatrial (BiA) pacing from the IAS + CSD. Amplitudes, +dP/dT(max), and timing of the a-wave were compared between recordings. Left atrial contractility, measured by +dP/dT(max), was greatest during BiA pacing (P ≤ 0.03 for all comparisons). There was a marked reduction in delay to peak a-wave when pacing from all sites compared with the RAA, with BiA pacing yielding the shortest delay (P ≤ 0.001). However, AV conduction was shortened by all alternative pacing sites, which mitigated the anticipation of left atrial contraction with respect to ventricular activation, except for BiA pacing (P < 0.001). Pacing of the IAS did not result in any improvement in haemodynamics or AV synchrony. CONCLUSION Multisite atrial pacing results in favourable acute atrial haemodynamics and left AV synchrony. This may be a solution in pacemaker patients with interatrial conduction delay.
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Affiliation(s)
- Haran Burri
- Cardiology Service, University Hospital, 4, Rue Gabrielle-Gentil, Geneva 1211, Switzerland.
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RICKARD JOHN, POPOVIC ZORAN, VERHAERT DAVID, SRAOW DAN, BARANOWSKI BRYAN, MARTIN DAVIDO, LINDSAY BRUCED, VARMA NIRAJ, TCHOU PATRICK, GRIMM RICHARDA, WILKOFF BRUCEL, CHUNG MINAK. The QRS Narrowing Index Predicts Reverse Left Ventricular Remodeling Following Cardiac Resynchronization Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:604-11. [DOI: 10.1111/j.1540-8159.2010.03022.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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327
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Ishikawa T. Limitations and Problems of Assessment of Mechanical Dyssynchrony in Determining Cardiac Resynchronization Therapy Indication - Is Assessment of Mechanical Dyssynchrony Necessary in Determining CRT Indication? (Con) -. Circ J 2011; 75:465-71. [DOI: 10.1253/circj.cj-10-1252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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328
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Palmieri V, Russo C, Buonomo A, Cimmino G, Tartaglione D, Pezzullo S, Celentano A. Test–re-test reproducibility of Doppler echocardiography for assessment of electromechanical dyssynchrony: Implications for heart failure clinic. J Cardiol 2010; 56:271-9. [DOI: 10.1016/j.jjcc.2010.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 05/03/2010] [Accepted: 06/10/2010] [Indexed: 11/17/2022]
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329
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Echocardiography-Guided Biventricular Pacemaker Optimization. JACC Cardiovasc Imaging 2010; 3:1168-80. [DOI: 10.1016/j.jcmg.2010.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 05/24/2010] [Accepted: 06/08/2010] [Indexed: 11/18/2022]
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330
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Van Bommel RJ, Delgado V, Schalij MJ, Bax JJ. Critical Appraisal of the Use of Cardiac Resynchronization Therapy Beyond Current Guidelines. J Am Coll Cardiol 2010; 56:754-62. [DOI: 10.1016/j.jacc.2010.04.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 03/30/2010] [Accepted: 04/06/2010] [Indexed: 11/25/2022]
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331
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Adlbrecht C, Hülsmann M, Gwechenberger M, Graf S, Wiesbauer F, Strunk G, Khazen C, Brodnjak I, Neuhold S, Binder T, Maurer G, Pacher R. Electrical optimization of cardiac resynchronization in chronic heart failure is associated with improved clinical long-term outcome. Eur J Clin Invest 2010; 40:678-84. [PMID: 20546015 DOI: 10.1111/j.1365-2362.2010.02311.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an established treatment option for symptomatic chronic heart failure (CHF) patients with pharmacological baseline therapy, but not all patients benefit from device therapy. One reason for this may be inadequate device settings. In real-world practice, echocardiographic evaluation of atrioventricular (AV) delay is not performed in a high proportion of patients, as the effect of electrical optimization of CRT is an issue open for investigation. MATERIALS AND METHODS We performed a retrospective observational study analysing the effect of AV-interval evaluation with echocardiography on long-term [32 (23?43) months] clinical outcome in 205 CHF patients. A stepwise Cox regression model including a co-morbidity score, failed AV-interval evaluation, satisfactory device function after the first implantation attempt, failure to reach 100% of the recommended renin-angiotensin system inhibitor and beta-blocker dose at follow-up and CRT device implantation compared with CRT in combination with an implanted cardioverter defibrillator (ICD) was applied. RESULTS In the total study cohort, 124 (60.5%) patients had reached the primary combined endpoint death or cardiac hospitalization and 59 (28.8%) had died. Cox regression analysis revealed that failed AV-interval evaluation [HR = 1.72 (1.19-2.49), P = 0.004] non-optimized CHF pharmacotherapy dosages [HR = 2.12 (1.32-3.42), P = 0.002], the presence of a CRT/ICD combination device [HR = 1.87 (1.28-2.71), P = 0.001] and satisfactory device function after the first implantation attempt [HR = 0.44 (0.25-0.77), P = 0.004] were associated with the primary endpoint. CONCLUSION Echocardiographic evaluation of the AV-interval in patients with CRT was independently associated with improved clinical outcome, impacting on daily clinical practice of HF patient care.
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Affiliation(s)
- Christopher Adlbrecht
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
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REINSCH NICO, KONORZA THOMAS, WOYDOWSKI DAGMAR, BRUCK HEIKE, VOLSEK MICHAELA, MÜLLER-TASCH THOMAS, NEUMANN TILL, ERBEL RAIMUND, WIENEKE HEINRICH. Iterative Cardiac Output Measurement for Optimizing Cardiac Resynchronization Therapy: A Randomized, Blinded, Crossover Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1188-94. [DOI: 10.1111/j.1540-8159.2010.02848.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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333
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Rickard J, Kumbhani DJ, Popovic Z, Verhaert D, Manne M, Sraow D, Baranowski B, Martin DO, Lindsay BD, Grimm RA, Wilkoff BL, Tchou P. Characterization of super-response to cardiac resynchronization therapy. Heart Rhythm 2010; 7:885-9. [DOI: 10.1016/j.hrthm.2010.04.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 04/02/2010] [Indexed: 11/15/2022]
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Echocardiographic Effects of Changing Atrioventricular Delay in Cardiac Resynchronization Therapy Based on Displacement. J Am Soc Echocardiogr 2010; 23:621-7. [DOI: 10.1016/j.echo.2010.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Indexed: 11/20/2022]
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335
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Verhaert D, Grimm RA, Puntawangkoon C, Wolski K, De S, Wilkoff BL, Starling RC, Tang WHW, Thomas JD, Popović ZB. Long-term reverse remodeling with cardiac resynchronization therapy: results of extended echocardiographic follow-up. J Am Coll Cardiol 2010; 55:1788-95. [PMID: 20413027 DOI: 10.1016/j.jacc.2010.01.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 11/20/2009] [Accepted: 01/05/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this study was to describe the long-term course of left ventricular remodeling induced by cardiac resynchronization therapy (CRT), adjusting for the confounding effect of patient loss due to disease. BACKGROUND Reverse remodeling has been identified as the primary mechanism of improved symptoms and outcome in heart failure patients. METHODS A total of 313 consecutive patients who underwent CRT with available baseline echocardiograms and subsequent clinical and echocardiographic follow-up were included in the analysis. Long-term follow-up included all-cause mortality, heart transplantation, and implantation of a left ventricular assist device. Longitudinal data analysis of left ventricular end-systolic volume index (LVESVi) was performed to adjust for the confounding effect of patient loss during follow-up. RESULTS Patients with uneventful survival had a lower baseline LVESVi (Delta = 8.6 ml/m(2), SE = 4.6 ml/m(2), p < 0.0001) and a decreased LVESVi by -0.11 ml/m(2)/day during first 6 months, whereas the LVESVi remained unchanged in patients with adverse events (p < 0.0001). Beyond 6 months, the LVESVi remained unchanged in patients with uneventful survival, whereas the LVESVi continued to increase in those with adverse events at a rate of 0.01 ml/m(2)/day (p < 0.0001). Predictors of reverse remodeling were nonischemic etiology, female sex, and a wider QRS duration (p < 0.0001, p = 0.014, and p = 0.001, respectively). In the majority of patients, 6 months indicates a break point after which reverse remodeling becomes significantly less pronounced. CONCLUSIONS CRT patients with uneventful survival show a significant decrease in the LVSVi at 6 months and generally maintain this response in the long term. Those with adverse outcomes are characterized by left ventricular dilation despite CRT.
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Affiliation(s)
- David Verhaert
- Department of Cardiovascular Medicine, Section of Cardiac Imaging, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Abstract
Dilated cardiomyopathy is characterised by left ventricular dilation that is associated with systolic dysfunction. Diastolic dysfunction and impaired right ventricular function can develop. Affected individuals are at risk of left or right ventricular failure, or both. Heart failure symptoms can be exercise-induced or persistent at rest. Many patients are asymptomatic. Chronically treated patients sometimes present acutely with decompensated heart failure. Other life-threatening risks are ventricular arrhythmias and atrioventricular block, syncope, and sudden death. Genetic inheritance arises in 30-48% of patients, and inflammatory disorders such as myocarditis or toxic effects from medications, alcohol, or illicit drugs also result in dilated cardiomyopathy. Genes that cause dilated cardiomyopathy generally encode cytoskeletal and sarcomeric (contractile apparatus) proteins, although disturbance of calcium homeostasis also seems to be important. In children, disrupted mitochondrial function and metabolic abnormalities have a causal role. Treatments focus on improvement of cardiac efficiency and reduction of mechanical stress. Arrhythmia therapy and prevention of sudden death continue to be mainstays of treatment. Despite progress over the past 10 years, outcomes need to be improved.
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Affiliation(s)
- John Lynn Jefferies
- Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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337
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The Year in Heart Failure. J Am Coll Cardiol 2010; 55:688-96. [DOI: 10.1016/j.jacc.2009.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 10/21/2009] [Accepted: 10/25/2009] [Indexed: 11/13/2022]
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Enhancing the Response to Cardiac Resynchronization Therapy. J Am Coll Cardiol 2010; 55:576-8. [DOI: 10.1016/j.jacc.2009.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 10/30/2009] [Indexed: 11/20/2022]
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Marsan NA, Bleeker GB, Van Bommel RJ, Borleffs CJW, Bertini M, Holman ER, van der Wall EE, Schalij MJ, Bax JJ. Cardiac resynchronization therapy in patients with ischemic versus non-ischemic heart failure: Differential effect of optimizing interventricular pacing interval. Am Heart J 2009; 158:769-76. [PMID: 19853696 DOI: 10.1016/j.ahj.2009.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 09/03/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Whether sequential biventricular pacing provides substantial benefits over conventional simultaneous stimulation remains unclear, particularly regarding the differences between ischemic and non-ischemic patients. The purpose of this study was to evaluate the acute effect of interventricular pacing interval (V-V) optimization on left ventricular (LV) systolic performance and dyssynchrony in ischemic versus non-ischemic patients. METHODS Sixty-nine consecutive patients underwent cardiac resynchronization therapy. Within 3 days after implantation, V-V was optimized by measuring (every 20-millisecond interval) LV systolic performance (LV outflow-tract velocity-time-integral, LVOT VTI) and LV dyssynchrony (using tissue Doppler imaging). Optimal pacing configuration was the one achieving maximal increase in LVOT VTI. RESULTS Optimized sequential pacing provided a significant improvement in LVOT VTI compared to simultaneous stimulation (from 138 +/- 42 to 163 +/- 38 mm, P < .001) and was associated with a significant reduction in LV dyssynchrony (from 33 +/- 31 to 19 +/- 24 milliseconds, P < .001). The increase in LVOT VTI and LV ejection fraction after implantation was greater in non-ischemic as compared to ischemic patients (P < .001). However, V-V optimization yielded a larger improvement in LV systolic performance in ischemic patients (P = .03). Consequently, the 2 groups showed comparable response after V-V optimization. A significant correlation was observed between LV scar tissue and optimal V-V interval (r = 0.58, P < .001), with a larger extent of scar related to a larger level of LV preactivation, probably reflecting slow intra-LV conduction. CONCLUSIONS Optimized sequential biventricular pacing further increased LV systolic performance as compared to simultaneous stimulation, particularly in ischemic patients where the presence of a large scar was correlated with a larger LV preactivation.
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Affiliation(s)
- Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, The Netherlands
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Atchley AE, Trimble MA, Samad Z, Shaw LK, Pagnanelli R, Chen J, Garcia EV, Iskandrian AE, Velazquez EJ, Borges-Neto S. Use of phase analysis of gated SPECT perfusion imaging to quantify dyssynchrony in patients with mild-to-moderate left ventricular dysfunction. J Nucl Cardiol 2009; 16:888-94. [PMID: 19690935 PMCID: PMC3048054 DOI: 10.1007/s12350-009-9136-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 07/02/2009] [Accepted: 08/02/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND CRT has been shown to be beneficial in the majority of patients with NYHA class III-IV symptoms, prolonged QRS duration, and an EF < or =35%. The use of imaging modalities to quantify dyssynchrony may help identify patients who may benefit from CRT, but do not meet current selection criteria. We hypothesize that patients with mild-to-moderate LV dysfunction have significant degrees of mechanical dyssynchrony. METHODS We compared phase analysis measures of mechanical dyssynchrony from gated SPECT imaging in patients with mild-to-moderate LV dysfunction (EF 35-50%, n = 93), with patients with severe LV dysfunction (EF < or = 35%, n = 167), and with normal controls (EF > or = 55%, n = 75). Furthermore, we evaluated the relationships between QRS duration and dyssynchrony and determined the prevalence of dyssynchrony in patients with mild-moderate LV dysfunction. RESULTS Patients with mild-moderate LV dysfunction have more dyssynchrony than normal controls (phase SD 37.7 degrees vs 8.8 degrees , P < .001 and bandwidth 113.5 degrees vs 28.7 degrees , P < .001), but less dyssynchrony than patients with severe LV dysfunction (phase SD 37.7 degrees vs 52.0 degrees , P < .001 and bandwidth 113.5 degrees vs 158.2 degrees , P < .001). In the cohort of patients with LV EF 35-50%, there were only weak correlations between QRS duration and dyssynchrony (phase SD, r = 0.28 and bandwidth, r = 0.20). There were 73 patients with LVEF 35-50% and QRS duration <120 milliseconds of which 21 (28.8%) had mechanical dyssynchrony. Overall, 37% of patients with mild-to-moderate LV dysfunction had significant degrees of mechanical dyssynchrony. CONCLUSIONS This is the largest reported study evaluating mechanical dyssynchrony in patients with mild-moderate LV dysfunction using phase analysis of gated SPECT imaging. In this study, approximately one-third of patients with mild-to-moderate LV dysfunction had significant LV mechanical dyssynchrony. With further study, phase analysis of gated SPECT imaging may help improve patient selection for CRT.
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Affiliation(s)
- Allen E. Atchley
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Mark A. Trimble
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Zainab Samad
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | | | - Robert Pagnanelli
- Department of Radiology, Division of Nuclear Cardiology, Duke University Medical Center, Durham, NC
| | - Ji Chen
- Department of Radiology, Emory University School of Medicine, Emory University, Atlanta, GA
| | - Ernest V. Garcia
- Department of Radiology, Emory University School of Medicine, Emory University, Atlanta, GA
| | - Ami E. Iskandrian
- Department of Cardiology, University Of Alabama at Birmingham, Birmingham, AL
| | - Eric J. Velazquez
- Duke Clinical Research Institute, Durham, NC
- Department of Internal Medicine, Division of Cardiology, Duke University Medical Center, Duke University, Durham, NC
| | - Salvador Borges-Neto
- Division of Cardiology, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
- Department of Radiology, Division of Nuclear Medicine, Duke University Medical Center, Durham, NC
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Breithardt OA. Echocardiographic patient selection for cardiac resynchronization therapy: betting on a dead horse? JACC. CARDIOVASCULAR IMAGING 2009; 2:544-7. [PMID: 19442938 DOI: 10.1016/j.jcmg.2009.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 03/17/2009] [Indexed: 11/16/2022]
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Duchateau N, De Craene M, Silva E, Sitges M, Bijnens BH, Frangi AF. Septal Flash Assessment on CRT Candidates Based on Statistical Atlases of Motion. ACTA ACUST UNITED AC 2009; 12:759-66. [DOI: 10.1007/978-3-642-04271-3_92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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