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Biffi M, Defaye P, Jaïs P, Ruffa F, Leclercq C, Gras D, Yang Z, Gerritse B, Ziacchi M, Morgan JM. Benefits of left ventricular endocardial pacing comparing failed implants and prior non-responders to conventional cardiac resynchronization therapy: A subanalysis from the ALSYNC study. Int J Cardiol 2018; 259:88-93. [PMID: 29579617 DOI: 10.1016/j.ijcard.2018.01.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 12/21/2017] [Accepted: 01/08/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cardiac resynchronisation therapy (CRT) is limited by a substantial proportion of non-responders. Left ventricular endocardial pacing (LVEP) may offer enhanced possibility to deliver CRT in patients with a failed attempt at implantation and to improve clinical status of CRT non-responders. METHODS The ALternate Site Cardiac ResYNChronisation (ALSYNC) study was a prospective, multi-centre cohort study that included 118 CRT patients with a successfully implanted endocardial left ventricular (LV) lead, including 90 failed coronary sinus (CS) implants and 28 prior non-responders who had worsened or unchanged heart failure status after at least 6 months of optimal conventional CRT therapy. RESULTS Patients were followed for 19 ± 9 months. At baseline, prior non-responders were sicker as evidenced by a larger LV end-diastolic diameter (70 ± 12 vs 65 ± 9 mm, p = .03) and a trend towards larger LV end-systolic volume index (LVESVi, 95 ± 51 vs 74 ± 39 ml/m2, p = .07), and were more frequently anti-coagulated (96% vs 72%, p = .008) despite similar history of atrial fibrillation (54% vs 51%, p = .83). At 6 months, LVEP significantly improved LV ejection fraction (2.3 ± 7.5 and 8.6 ± 10.0%), New York Heart Association Class (0.4 ± 0.9 and 0.7 ± 0.8), LVESVi (9 ± 16 and 18 ± 43 ml/m2), and six-minute walk test (56 ± 73 and 54 ± 92 m) in prior non-responders and failed CS implants, relative to baseline (all p < .05), respectively. LVESVi reduction ≥15% was seen in 47% of the prior non-responder patients and 57% of failed CS patients. CONCLUSION These data suggest that a sizable proportion of CRT non-responders can improve by LVEP, though to a lesser extent than failed CS implants. Clinical trial registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01277783.
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Affiliation(s)
- Mauro Biffi
- Policlinico S Orsola-Malpighi University Hospital, Bologna, Italy.
| | | | - Pierre Jaïs
- CHU Bordeaux - Bordeaux University, Bordeaux, France
| | | | | | - Daniel Gras
- Le Confluent Nouvelle Clinique Nantaises, Nantes, France
| | | | - Bart Gerritse
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - Matteo Ziacchi
- Policlinico S Orsola-Malpighi University Hospital, Bologna, Italy
| | - John M Morgan
- University Hospital Southampton, Southampton, United Kingdom
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Viveiros Monteiro A, Martins Oliveira M, Silva Cunha P, Nogueira da Silva M, Feliciano J, Branco L, Rio P, Pimenta R, Delgado AS, Cruz Ferreira R. Time to left ventricular reverse remodeling after cardiac resynchronization therapy: Better late than never. Rev Port Cardiol 2016; 35:161-7. [PMID: 26923367 DOI: 10.1016/j.repc.2015.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/22/2015] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Left ventricular reverse remodeling (LVRR), defined as reduction of end-diastolic and end-systolic dimensions and improvement of ejection fraction, is associated with the prognostic implications of cardiac resynchronization therapy (CRT). The time course of LVRR remains poorly characterized. Nevertheless, it has been suggested that it occurs ≤6 months after CRT. OBJECTIVE To characterize the long-term echocardiographic and clinical evolution of patients with LVRR occurring >6 months after CRT and to identify predictors of a delayed LVRR response. METHODS A total of 127 consecutive patients after successful CRT implantation were divided into three groups according to LVRR response: Group A, 19 patients (15%) with LVRR after >6 months (late LVRR); Group B, 58 patients (46%) with LVRR before 6 months (early LVRR); and Group C, 50 patients (39%) without LVRR during follow-up (no LVRR). RESULTS The late LVRR group was older, more often had ischemic etiology and fewer patients were in NYHA class ≤II. Overall, group A presented LVRR between group B and C. This was also the case with the percentage of clinical response (68.4% vs. 94.8% vs. 38.3%, respectively, p<0.001), and hospital readmissions due to decompensated heart failure (31.6% vs. 12.1% vs. 57.1%, respectively, p<0.001). Ischemic etiology (OR 0.044; p=0.013) and NYHA functional class <III (OR 0.056; p=0.063) were the variables with the highest predictive value for late LVRR. CONCLUSIONS Late LVRR has better clinical and echocardiographic outcomes than no LVRR, although with a suboptimal response compared to the early LVRR population. Ischemic etiology and NYHA functional class <III are predictors of late LVRR.
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Affiliation(s)
- André Viveiros Monteiro
- Serviço de Cardiologia do Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
| | - Mário Martins Oliveira
- Serviço de Cardiologia do Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Pedro Silva Cunha
- Serviço de Cardiologia do Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Manuel Nogueira da Silva
- Serviço de Cardiologia do Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Joana Feliciano
- Serviço de Cardiologia do Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Luísa Branco
- Serviço de Cardiologia do Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Pedro Rio
- Serviço de Cardiologia do Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Ricardo Pimenta
- Serviço de Cardiologia do Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Ana Sofia Delgado
- Serviço de Cardiologia do Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Rui Cruz Ferreira
- Serviço de Cardiologia do Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
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Viveiros Monteiro A, Martins Oliveira M, Silva Cunha P, Nogueira da Silva M, Feliciano J, Branco L, Rio P, Pimenta R, Delgado AS, Cruz Ferreira R. Time to left ventricular reverse remodeling after cardiac resynchronization therapy: Better late than never. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
There are still many aspects of heart failure care for which gaps remain in the evidence base, resulting in gaps in the guidelines. We aim to highlight these guideline gaps including areas that warrant further research and other areas where new data are forthcoming.
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Affiliation(s)
- Bao Tran
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles,California, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles,California, USA
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Colchero T, Arias MA, López-Sánchez FA, Pachón M, Domínguez-Pérez L, Puchol A, Jiménez-López J, Lázaro M, Martínez-Mateo V, Rodríguez-Padial L. Loss of continuous biventricular pacing in cardiac resynchronization therapy patients: incidence, causes, and outcomes. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 66:377-83. [PMID: 24775820 DOI: 10.1016/j.rec.2012.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/12/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES In recent years, implantation of cardiac resynchronization therapy devices has significantly increased. The benefits of this therapy are directly related to the maintenance of continuous biventricular pacing. This study analyzed the incidence, causes, and outcomes of loss of continuous biventricular pacing, and the approach adopted. METHODS We analyzed the clinical and follow-up data of a series of consecutive patients from a single center who underwent implantation of a cardiac resynchronization therapy device. RESULTS The study included 136 patients. During a mean follow-up of 33.4 months, loss of continuous biventricular pacing occurred in 45 patients (33%). The most common causes included atrial tachyarrhythmias (21.3%), lead macrodislodgement (18%), and loss of left ventricular capture (13.1%). In most patients (88.5%), loss of continuous biventricular pacing was transient and correctable, and occurred earlier in the follow-up when the cause was lead macrodislodgement, oversensing, or extracardiac stimulation. There were no significant differences in mortality between patients with and without loss of continuous biventricular pacing (P=.88). CONCLUSIONS Despite technical advances in cardiac resynchronization therapy, loss of continuous biventricular pacing is common; however, this loss can usually be corrected. In most patients, continuous biventricular pacing can be ensured by close monitoring and follow-up and a proactive approach.
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Affiliation(s)
- Teresa Colchero
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Miguel A Arias
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain.
| | - Fernando A López-Sánchez
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Marta Pachón
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Laura Domínguez-Pérez
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Alberto Puchol
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Jesús Jiménez-López
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - María Lázaro
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Virgilio Martínez-Mateo
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Luis Rodríguez-Padial
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
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Abstract
There are still many aspects of heart failure care for which gaps remain in the evidence base, resulting in gaps in the guidelines. We aim to highlight these guideline gaps including areas that warrant further research and other areas where new data are forthcoming.
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Affiliation(s)
- Bao Tran
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California, US
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California, US
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Schouwenburg JJ, Klinkenberg TJ, Maass AH, Mariani MA. Video-assisted thoracic placement of epicardial leads. J Card Surg 2013; 29:286-9. [PMID: 24345196 DOI: 10.1111/jocs.12283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cardiac resynchronization therapy is one of the cornerstones of heart failure treatment. Inability to access the coronary sinus or one of its sidebranches is one of the most common causes of therapeutic failure. We describe a technique using video-assisted thoracic surgery for epicardial placement of the left ventricular lead and use an intrathoracic route to connect the lead to the device.
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Affiliation(s)
- Jasper J Schouwenburg
- Department of Cardiothoracic Surgery, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Sankaranarayanan R, Visweswariah R, Fox DJ. New developments in cardiac resynchronization therapy. Br J Hosp Med (Lond) 2013; 74:503-9. [DOI: 10.12968/hmed.2013.74.9.503] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rajiv Sankaranarayanan
- Electrophysiology and British Heart Foundation Clinical Research Fellow University Hospital South Manchester and University of Manchester, Manchester M23 9LT
| | | | - David J Fox
- Department of Cardiology, University Hospital South Manchester, Manchester
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Galeotti L, van Dam PM, Loring Z, Chan D, Strauss DG. Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations. Europace 2013; 15:1816-21. [DOI: 10.1093/europace/eut132] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Colchero T, Arias MA, López-Sánchez FA, Pachón M, Domínguez-Pérez L, Puchol A, Jiménez-López J, Lázaro M, Martínez-Mateo V, Rodríguez-Padial L. Pérdida de estimulación biventricular continua en pacientes con terapia de resincronización cardiaca: incidencia, causas y resultados. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Di Molfetta A, Forleo GB, Santini L, Fresiello L, Papavasileiou LP, Magliano G, Sergi D, Capria A, Romeo F, Ferrari G. A novel methodology for AV and VV delay optimization in CRT: results from a randomized pilot clinical trial. J Artif Organs 2013; 16:273-83. [PMID: 23504186 DOI: 10.1007/s10047-013-0701-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/24/2013] [Indexed: 11/30/2022]
Abstract
The aim of this work was to determine whether the use of a newly developed methodology (Alg1) for AV and VV optimization improves cardiac resynchronization therapy (CRT) clinical and echocardiographic (ECHO) outcomes. In this single-center pilot clinical trial, 80 consecutive patients (79 % male; 70.1 ± 11.2 years) receiving CRT were randomly assigned to AV and VV optimization using Alg1 (group A) or standard commercial procedures (group B). Clinical status and ECHOs were analyzed at baseline (_0) , 3 (fu1), and 6 months (fu2) of follow-up evaluating left ventricular end systolic (LVESV) and end diastolic (LVEDV) volumes, ejection fraction (EF), Minnesota test, and 6-min walk test (6MWT). Alg1 is based on a cardiovascular model fed with patient data. Baseline characteristics did not differ significantly between groups. Group A had a better clinical outcome and reverse remodeling. Remodeling was calculated as the difference (Δ) between fu1 and _0 and between fu2 and fu1, respectively: [LVESV (ml): ΔA_fu1 = -55.3, ΔB_fu1 = -13.5, p_fu1 = 0.002; ΔA_fu2 = -22.8, ΔB_fu2 = 3.0, p_fu2 = 0.04], [LVEDV (ml): ΔA_fu1 = -61.9, ΔB_fu1 = -16.1, p_fu1 = 0.01; ΔA_fu2 = -30.4, ΔB_fu2 = 11.3, p_fu2 = 0.02]; Minnesota test: total (p_fu1 = 0.01; p_fu2 = 0.04), physical (p_fu1 = 0.01; p_fu2 = 0.03) and emotional scores (p_fu1 = 0.04; p_fu2 = 0.03) and in 6MWT (m) (p_fu2 = 0.008). No statistically significant difference was observed in QRS width. Compared with current standard of care, CRT optimization using Alg1 is associated with better outcomes, showing the power of a tailored CRT.
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Affiliation(s)
- Arianna Di Molfetta
- Cardiovascular Engineering Group, Institute of Clinical Physiology, Italian National Research Council, via San Martino della Battaglia, 44, 00185, Rome, Italy,
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Cheng CM, Huang JL, Wu TJ, Su CS, Pai HY, Liao MF, Ting CT, Chen SA. Comparison of quick optimization of interventricular delay between simple methods: intracardiac electrogram and surface electrocardiogram after cardiac resynchronization therapy. Europace 2012; 14:1317-23. [DOI: 10.1093/europace/eus061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bischoff M, Walther A, Serf C. [Who dictates the rhythm which must be followed? : Pacemakers and implantable cardioverter defibrillators in anesthesiology]. Anaesthesist 2011; 60:775-88. [PMID: 21833755 DOI: 10.1007/s00101-011-1906-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The number of patients with implantable cardiac devices for the treatment of cardiac dysrhythmia is steadily climbing. Due to the increase in indications for implantation and the range of functions, an end to this development is not yet in sight. In order to provide safety in the everyday handling of these systems it is necessary to pay attention to various aspects prior to, during and after surgery or anesthesia.
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Affiliation(s)
- M Bischoff
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. [corrected]
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BAI RONG, DI BIASE LUIGI, MOHANTY PRASANT, HESSELSON AARONB, DE RUVO ERMENEGILDO, GALLAGHER PETERL, ELAYI CLAUDES, MOHANTY SANGHAMITRA, SANCHEZ JAVIERE, BURKHARDT JDAVID, HORTON RODNEY, GALLINGHOUSE GJOSEPH, BAILEY SHANEM, ZAGRODZKY JASOND, CANBY ROBERT, MINATI MONIA, PRICE LARRYD, HUTCHINS CLYNN, MUIR MELODYA, CALO' LEONARDO, NATALE ANDREA, TOMASSONI GERYF. Positioning of Left Ventricular Pacing Lead Guided by Intracardiac Echocardiography with Vector Velocity Imaging During Cardiac Resynchronization Therapy Procedure. J Cardiovasc Electrophysiol 2011; 22:1034-41. [DOI: 10.1111/j.1540-8167.2011.02052.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kautzner J, Peichl P, Sedláček K. Imaging to improve the results of cardiac resynchronization therapy. Interv Cardiol 2011. [DOI: 10.2217/ica.11.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Evidence of scar tissue: contra-indication to cardiac resynchronization therapy? Int J Cardiovasc Imaging 2010; 27:59-63. [PMID: 20614190 PMCID: PMC3035785 DOI: 10.1007/s10554-010-9664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 06/25/2010] [Indexed: 11/06/2022]
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