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Ye Y, Lv Y, Mao Y, Li L, Chen X, Zheng R, Hou X, Yu C, Gabriella C, Fu GS. Cardiovascular imaging in conduction system pacing: What does the clinician need? Pacing Clin Electrophysiol 2023; 46:548-557. [PMID: 36516139 DOI: 10.1111/pace.14644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
Permanent pacemakers are used for symptomatic bradycardia and biventricular pacing (BVP)-cardiac resynchronization therapy (BVP-CRT) is established for heart failure (HF) patients traditionally. According to guidelines, patients' selection for CRT is based on QRS duration (QRSd) and morphology by surface electrocardiogram (ECG). Cardiovascular imaging techniques evaluate cardiac structure and function as well as identify pathophysiological substrate changes including the presence of scar. Cardiovascular imaging helps by improving the selection of candidates, guiding left ventricular (LV) lead placement, and optimization devices during the follow-up. Conduction system pacing (CSP) includes His bundle pacing (HBP) and left bundle branch pacing (LBBP) which is screwed into the interventricular septum. CSP maintains and restores ventricular synchrony in patients with native narrow QRSd and left bundle branch block (LBBB), respectively. LBBP is more feasible than HBP due to a wider target area. This review highlights the role of multimodality cardiovascular imaging including fluoroscopy, echocardiography, cardiac magnetic resonance (CMR), myocardial scintigraphy, and computed tomography (CT) in the pre-procedure assessment for CSP, better selection for CSP candidates, the guidance of CSP lead implantation, and the optimization of devices programming after the procedure. We also compare the different characteristics of multimodality imaging and discuss their potential roles in future CSP implantation.
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Affiliation(s)
- Yang Ye
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yuan Lv
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yankai Mao
- Department of Diagnostic Ultrasound and Echocardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lin Li
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xueying Chen
- Shanghai Institution of Cardiovascular Disease, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rujie Zheng
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Xiaofeng Hou
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chan Yu
- Department of Diagnostic Ultrasound and Echocardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Captur Gabriella
- Institute of Cardiovascular Science, University College London, London, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, London, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Guo-Sheng Fu
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
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Vidigal Ferreira MJ, Silva R, Cabanelas N, Cunha MJ, Ramos D, Albuquerque A, Teixeira R, Moreira AP, Costa G, Lima J, Providência LA. Left ventricular mechanical dyssynchrony in patients with impaired left ventricular function undergoing gated SPECT myocardial perfusion imaging. Rev Port Cardiol 2013; 32:387-94. [PMID: 23702241 DOI: 10.1016/j.repc.2012.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 08/12/2012] [Accepted: 09/04/2012] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Gated SPECT myocardial perfusion imaging (MPI) has been used to quantify mechanical dyssynchrony. Mechanical dyssynchrony appears to be related to response to cardiac resynchronization therapy. OBJECTIVE To evaluate the presence and predictors of mechanical dyssynchrony in patients with impaired left ventricular function (LVEF) ≤50%. METHODS The study included 143 consecutive patients referred for gated SPECT MPI with LVEF ≤50%. Gated SPECT MPI was performed according to a stress/rest protocol acquiring images with Tc 99m-tetrofosmin. Emory Cardiac Toolbox software was used for phase analysis and a standard deviation (SD) ≥43° was considered to indicate mechanical dyssynchrony. RESULTS Mechanical dyssynchrony was present in 53.1% of the patients. Its predictors were diabetes (OR 2.0, p≤0.05), summed stress score (OR 1.1, p≤0.0005), summed rest score (OR 1.1, p≤0.0001), end-diastolic volume (OR 1.0, p≤0.0001), LVEF (OR 0.9, p≤0.0001), LVEF ≤35% (OR 3.1, p≤0.005) and LVEF ≤35% and QRS ≥120 ms (OR 3.5, p≤0.05). In this study QRS width and QRS ≥120 ms were not predictors of mechanical dyssynchrony. CONCLUSIONS Myocardial perfusion imaging can be used to assess mechanical dyssynchrony. In patients with impaired ventricular function mechanical dyssynchrony was highly prevalent and was related to parameters of left ventricular function and perfusion.
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Affiliation(s)
- Maria João Vidigal Ferreira
- Faculdade de Medicina, Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra (HUC), Serviço de Cardiologia, Coimbra, Portugal.
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Left ventricular mechanical dyssynchrony in patients with impaired left ventricular function undergoing gated SPECT myocardial perfusion imaging. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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García-Bolao I, Calvo N, Gavira JJ, Moreno-Galdós L, Arguedas-Jiménez H, Canepa JP, García-De-Yébenes M. [Current status of cardiac resynchronization therapy]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2012; 82:235-42. [PMID: 23021361 DOI: 10.1016/j.acmx.2012.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 02/27/2012] [Accepted: 04/02/2012] [Indexed: 10/27/2022] Open
Abstract
The present document reviews various aspects of the current status of cardiac resynchronization therapy: mechanisms of action, current indications and implantation technique.
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Affiliation(s)
- Ignacio García-Bolao
- Unidad de Electrofisiología y Arritmias, Departamento de Cardiología y Cirugía Cardiaca, Clínica Universidad de Navarra, Pamplona, España.
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Nesser HJ, Winter S. Speckle tracking in the evaluation of left ventricular dyssynchrony. Echocardiography 2009; 26:324-36. [PMID: 19291018 DOI: 10.1111/j.1540-8175.2008.00866.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A number of echocardiographic techniques have been introduced to determine left ventricular dyssynchrony (LVD) and to improve selection of patients for CRT. During the last years tissue Doppler imaging (TDI) has been used as the most preferred technique to quantify LVD, but results with nonresponder rates below 30% have been shown only in small studies based on high experience. Angle of incidence dependency, noise, artifacts, and tethering motion of adjacent segments are the main limitations of TDI influencing selection of patients for CRT. Although strain TDI is not affected by translation or tethering, accurate measurement of regional strain is also limited. Two-dimensional (2D) strain imaging based on novel speckle tracking echocardiography (STE) is a relatively new tool to define regional myocardial strain and to quantify dyssynchrony based on a more robust technique and avoiding angle of incidence. Current studies are promising to use strain or vector velocity imaging derived from STE for qualitative and quantitative assessment of LVD and follow-up studies as well. If one compare different types of strain components at present, radial strain imaging seems to be the most promising technique to determine LVD and to predict positive response to CRT. Furthermore, STE offers an insight into rotational mechanics of the dyssynchronous ventricle. Although clinical studies using 2D strain have analyzed LVD related to various conditions, measures are based on a 2D data set. Three-dimensional strain imaging, based on speckle tracking will probably open a new door to assess patients with heart failure and LVD.
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Affiliation(s)
- Hans-Joachim Nesser
- Elisabethinen Teaching Hospital, 2 Medical Department, Fadingerstrasse, Linz, Austria.
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Abstract
About 30% of patients with left ventricular systolic dysfunction also have ventricular conduction delays (prolonged QRS duration greater than 0.12 second) most frequently seen as left bundle branch block. This intraventricular conduction delay causes nonsynchronous ventricular activation between the right ventricle and the left ventricle (or dyssychrony), compromising cardiac function. Cardiac resynchronization therapy, or biventricular pacing, is a recent intervention for ventricular dyssychrony that incorporates 3 leads for pacing the right atrium and simultaneous pacing of the right ventricle and left ventricle. Left ventricular lead placement can be difficult to implant because of coronary venous anatomy and can require longer procedure time for the patient. Restoring ventricular synchrony has been shown to decrease septal wall dyskinesis, decrease mitral regurgitation, increase left ventricular filling time, decrease pulmonary capillary wedge pressure, and reverse ventricular modeling.
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Affiliation(s)
- Lauren Saul
- University of Pittsburgh Medical Center, Presbyterian Shadyside-Shadyside Campus, Pittsburgh, PA 15232, USA.
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