1
|
Parlavecchio A, Vetta G, Caminiti R, Coluccia G, Magnocavallo M, Ajello M, Pistelli L, Dattilo G, Foti R, Carerj S, Della Rocca DG, Crea P, Palmisano P. Left bundle branch pacing versus biventricular pacing for cardiac resynchronization therapy: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2023; 46:432-439. [PMID: 37036831 DOI: 10.1111/pace.14700] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalization and all-cause mortality in HF patients with left bundle branch block (LBBB). Biventricular pacing (BVP) is the gold standard for achieving CRT, but about 30%-40% of patients do not respond to BVP-CRT. Recent studies showed that left bundle branch pacing (LBBP) provided remarkable results in CRT. Therefore, we conducted a meta-analysis aiming to compare LBBP-CRT versus BVP-CRT in HF patients. METHODS We systematically searched the electronic databases for studies published from inception to December 29, 2022 and focusing on LBBP-CRT versus BVP-CRT in HF patients. The primary endpoint was HF hospitalization. The effect size was estimated using a random-effect model as Risk Ratio (RR) and mean difference (MD). RESULTS Ten studies enrolling 1063 patients met the inclusion criteria. Compared to BVP-CRT, LBBP-CRT led to significant reduction in HF hospitalization [7.9% vs.14.5%; RR: 0.60 (95%CI: 0.39-0.93); p = .02], QRSd [MD: 30.26 ms (95%CI: 26.68-33.84); p < .00001] and pacing threshold [MD: -0.60 (95%CI: -0.71 to -0.48); p < .00001] at follow up. Furthermore, LBBP-CRT improved LVEF [MD: 5.78% (95%CI: 4.78-6.77); p < .00001], the rate of responder [88.5% vs.72.5%; RR: 1.19 (95%CI: 1.07-1.32); p = .002] and super-responder [60.8% vs. 36.5%; RR: 1.56 (95%CI: 1.27-1.91); p < .0001] patients and the NYHA class [MD: -0.42 (95%CI: -0.71 to -0.14); p < .00001] compared to BVP-CRT. CONCLUSION In HF patients, LBBP-CRT was superior to BVP-CRT in reducing HF hospitalization. Further significant benefits occurred within the LBBP-CRT group in terms of QRSd, LVEF, pacing thresholds, NYHA class and the rate of responder and super-responder patients.
Collapse
Affiliation(s)
- Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giampaolo Vetta
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Michele Magnocavallo
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Manuela Ajello
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Lorenzo Pistelli
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Dattilo
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Scipione Carerj
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | |
Collapse
|
2
|
De Innocentiis C, Astore P, Buonpane A, Santamaria AP, Patragnoni F, Santamaria M. Case report: An unusual case of phrenic nerve stimulation in a patient with single chamber implantable cardioverter defibrillator. Front Cardiovasc Med 2023; 10:1088697. [PMID: 36910536 PMCID: PMC9995897 DOI: 10.3389/fcvm.2023.1088697] [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: 11/03/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Background Phrenic nerve stimulation is a well-recognized complication related to cardiac implantable electronic devices, in particular with left ventricular coronary sinus pacing leads for cardiac resynchronization therapy. Case presentation We report an unusual case of symptomatic phrenic nerve stimulation due to inadvertent placement of a right ventricular defibrillation lead in coronary sinus posterior branch in a patient with heart failure with reduced ejection fraction with a recently implanted single-chamber cardioverter defibrillator. Discussion Phrenic nerve stimulation is a relatively common complication of left ventricular pacing. Inadvertent placement of a right ventricular lead in a coronary sinus branch is a rare but possible cause of phrenic nerve stimulation. Careful evaluation of intraprocedural fluoroscopic and electrocardiographic appearance of pacing and defibrillation leads during implantation may prevent inadvertent placement of a right ventricular lead in the coronary sinus.
Collapse
Affiliation(s)
- Carlo De Innocentiis
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Campobasso, CB, Italy
| | - Pasquale Astore
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Campobasso, CB, Italy
| | - Angela Buonpane
- Agostino Gemelli IRCCS University Hospital Foundation, Rome, Italy
| | | | | | - Matteo Santamaria
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Campobasso, CB, Italy
| |
Collapse
|
3
|
von Bary C, Laski V, Fricke H, Linhardt F, Reithmann C, Fiek M. Impact of intraoperative mechanical ventilation on left ventricular lead function in cardiac resynchronization therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:578-582. [PMID: 29577341 DOI: 10.1111/pace.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/04/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intraoperative controlled mechanical ventilation (CMV) changes the intrathoracic geometry and may impact postoperative left ventricular (LV) lead function after CRT implantation. This multicenter study investigates the effect of intraoperative ventilation setting (spontaneous breathing [SB] vs CMV) on postoperative LV lead function taking into account patients' body mass index (BMI). METHODS CRT implantation was performed at two centers during SB in 92 and during CMV in 73 patients. Follow-up was carried out after 3 ± 5 and 36 ± 53 days. Functional lead parameters (FLP; pacing threshold and impedance), postoperative adverse events (A; phrenic nerve stimulation [PNS] and lead malfunction), and patients' BMI were assessed. Delta values of FLP between baseline and follow-up visits were analyzed applying an analysis of covariance model to detect subclinical alterations in LV lead function. RESULTS AE occurred in a total of 36 (21%) patients. PNS was observed in 26 (15%) patients and LV lead repositioning due to malfunction was necessary in 10 (6%) patients. Both AE and FLP delta values between baseline and follow-up were not associated with intraoperative ventilation settings nor the patients' BMI. CONCLUSIONS This study demonstrates that there is no impact of the intraoperative ventilation setting (SB vs CMV) on postoperative FLP or the occurrence of AE. This is also the case taking into account the BMI. With respect to these findings both approaches-sedation only or general anaesthesia including CMV-can be safely implemented during CRT implantation.
Collapse
Affiliation(s)
- Christian von Bary
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Viktoria Laski
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Hannes Fricke
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Florian Linhardt
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Christopher Reithmann
- Medizinische Klinik I, Helios Klinikum München West, Lehrkrankenhaus der Ludwig-Maximilans-Universität München, München, Germany
| | - Michael Fiek
- Medizinische Klinik I, Helios Klinikum München West, Lehrkrankenhaus der Ludwig-Maximilans-Universität München, München, Germany
| |
Collapse
|
4
|
MITTAL SUNEET, NAIR DEVI, PADANILAM BENZYJ, CIUFFO ALLEN, GUPTA NIGEL, GALLAGHER PETER, GOLDNER BRUCE, HAMMILL ERICF, WOLD NICOLAS, STEIN KENNETH, BURKE MARTIN. Performance of Anatomically Designed Quadripolar Left Ventricular Leads: Results from the NAVIGATE X4 Clinical Trial. J Cardiovasc Electrophysiol 2016; 27:1199-1205. [DOI: 10.1111/jce.13044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/24/2016] [Accepted: 07/05/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - DEVI NAIR
- Division of Cardiac Electrophysiology, Department of Medicine St. Bernard's Heart & Vascular Center Jonesboro AR USA
| | | | - ALLEN CIUFFO
- Department of Medicine Sentara Heart Hospital Norfolk VA USA
| | - NIGEL GUPTA
- Department of Medicine, Kaiser Permanente Los Angeles Medical Center Los Angeles CA USA
| | - PETER GALLAGHER
- Department of Medicine Nebraska Heart Institute Lincoln NE USA
| | - BRUCE GOLDNER
- Department of Medicine Northwell Health System New Hyde Park NY USA
| | | | | | | | - MARTIN BURKE
- Section of Cardiology, Department of Medicine, Heart Rhythm Center University of Chicago USA
| |
Collapse
|
5
|
Boriani G, Connors S, Kalarus Z, Lemke B, Mullens W, Osca Asensi J, Raatikainen P, Gazzola C, Farazi TG, Leclercq C. Cardiac Resynchronization Therapy With a Quadripolar Electrode Lead Decreases Complications at 6 Months. JACC Clin Electrophysiol 2016; 2:212-220. [DOI: 10.1016/j.jacep.2015.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/14/2015] [Accepted: 10/08/2015] [Indexed: 11/29/2022]
|
6
|
Huntsinger ME, Rabara R, Peralta I, Doshi RN. Current Technology to Maximize Cardiac Resynchronization Therapy Benefit for Patients With Symptomatic Heart Failure. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The incidence of heart failure (HF) continues to increase, affecting millions of people in the United States each year. Cardiac resynchronization therapy (CRT) has been used and studied for patients with symptomatic HF for more than 20 years. The purpose of this article is to review technologies and developments to help maximize CRT for patients with symptomatic HF. Although most interventions to optimize CRT are physician directed, nurses also have an important role in the care and education of patients with symptomatic HF and can affect clinical outcomes. Therefore, nurses’ understanding of CRT and measures to maximize this lifesaving therapy is critical in HF management.
Collapse
Affiliation(s)
- Mary Eng Huntsinger
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Roselou Rabara
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Irene Peralta
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Rahul N. Doshi
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| |
Collapse
|
7
|
Syed FF, DeSimone CV, Ebrille E, Gaba P, Ladewig DJ, Mikell SB, Suddendorf SH, Gilles EJ, Danielsen AJ, Lukášová M, Wolf J, Leinveber P, Novák M, Stárek Z, Kara T, Bruce CJ, Friedman PA, Asirvatham SJ. Percutaneous Epicardial Pacing using a Novel Insulated Multi-electrode Lead. JACC Clin Electrophysiol 2015; 1:273-283. [PMID: 27547832 DOI: 10.1016/j.jacep.2015.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Epicardial cardiac resynchronization therapy (CRT) permits unrestricted electrode positioning. However, this requires surgical placement of device leads and the risk of unwanted phrenic nerve stimulation. We hypothesized that shielded electrodes can capture myocardium without extracardiac stimulation. METHODS In 6 dog and 5 swine experiments, we used a percutaneous approach to access the epicardial surface of the heart, and deploy novel leads housing multiple electrodes with selective insulation. Bipolar pacing thresholds at prespecified sites were tested compare electrode threshold data both facing towards and away from the epicardial surface. RESULTS In 151 paired electrode recordings (70 in 6 dogs; 81 in 5 swine), thresholds facing myocardium were lower than facing away (median [IQR] mA: dogs 0.9 [0.4-1.6] vs 4.6 [2.1 to >10], p<0.0001; swine 0.5 [0.2-1] vs 2.5 [0.5-6.8], p<0.0001). Myocardial capture was feasible without extracardiac stimulation at all tested sites, with mean ± SE threshold margin 3.6±0.7 mA at sites of high output extracardiac stimulation (p=0.004). CONCLUSION Selective electrode insulation confers directional pacing to a multielectrode epicardial pacing lead. This device has the potential for a novel percutaneous epicardial resynchronization therapy that permits placement at an optimal pacing site, irrespective of the anatomy of the coronary veins or phrenic nerves.
Collapse
Affiliation(s)
- Faisal F Syed
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Christopher V DeSimone
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Elisa Ebrille
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | - Markéta Lukášová
- ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic
| | - Jiří Wolf
- ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic
| | - Pavel Leinveber
- ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic
| | - Miroslav Novák
- ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic
| | - Zdeněk Stárek
- ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic
| | - Tomas Kara
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN; ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic
| | - Charles J Bruce
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
8
|
Philippon F, Liu L, Fung JWH, Deharo JC, Anselme F, Delnoy PP, Crijns H, Morillo CA, Krahn AD, Gutleben K, Delumeau J, Molin F. Left ventricular three-dimensional quadripolar lead acute clinical study: the LILAC study. Pacing Clin Electrophysiol 2015; 38:438-47. [PMID: 25627985 DOI: 10.1111/pace.12584] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 12/14/2014] [Accepted: 12/17/2014] [Indexed: 11/30/2022]
Abstract
AIMS This multicenter acute clinical study was designed to verify novel three-dimensional (3D) quadripolar lead designs that can achieve ≤2.5 V average pacing capture threshold (PCT) not only at the apex, but also at the base of the left ventricle with phrenic nerve stimulation (PNS) avoidance for cardiac resynchronization. METHODS During the implant procedure, up to two different left ventricular investigational leads were introduced and tested in the same target coronary vein based on the coronary sinus venogram in a wedged and unwedged position. Adverse events were collected in 30 days following the procedure. RESULTS Eighty-seven leads were tested in 50 patients. When the best performing spiral electrode was chosen from each lead testing, the average of the best PCT on spiral in a wedged position was similar to the unwedged position (1.7 ± 1.5 V vs 1.9 ± 1.5 V, P = ns) and was similar to the wedged tip electrode average PCT (1.7 ± 1.5 V vs 1.6 ± 1.6 V, P = ns). In the majority of patients (89-96%), pacing was achievable in a mid-basal ventricular location without PNS. CONCLUSIONS This acute study demonstrated that a 3D quadripolar spiral lead design can achieve acceptable PCTs and avoid PNS without repositioning the lead at implant in the vast majority of patients. It also demonstrated that this lead design can achieve mid-basal ventricular stimulation with low PCT and good acute stability.
Collapse
Affiliation(s)
- François Philippon
- Electrophysiology Division, Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Rinaldi CA, Burri H, Thibault B, Curnis A, Rao A, Gras D, Sperzel J, Singh JP, Biffi M, Bordachar P, Leclercq C. A review of multisite pacing to achieve cardiac resynchronization therapy. Europace 2014; 17:7-17. [DOI: 10.1093/europace/euu197] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
10
|
Moubarak G, Bouzeman A, Ollitrault J, Anselme F, Cazeau S. Phrenic nerve stimulation in cardiac resynchronization therapy. J Interv Card Electrophysiol 2014; 41:15-21. [DOI: 10.1007/s10840-014-9917-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 05/07/2014] [Indexed: 11/28/2022]
|