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NESTI M, RICCIARDI G, PIERAGNOLI P, FUMAGALLI S, PADELETTI M, PERINI AP, CAVARRETTA E, SCIARRA L. Incidence of ventricular arrhythmias after biventricular defibrillator replacement: impact on safety of downgrading from CRT-D to CRT-P. Minerva Cardiol Angiol 2022; 70:447-454. [DOI: 10.23736/s2724-5683.20.05352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhang C, Liu HX, Deng XQ, Tong L, Wang H, Wang YF, Tong L, Cheng LC, Cai L. Delay optimization of multipoint pacing increases the cardiac index and narrows the QRS width. J Electrocardiol 2020; 60:114-117. [PMID: 32353803 DOI: 10.1016/j.jelectrocard.2020.03.013] [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: 02/11/2020] [Revised: 03/20/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The benefits of MPP delay optimization on hemodynamics and ventricular contraction synchronicity can be quantified with cardiac index (CI) and QRS width. A delay with the maximum CI and minimum QRS width may be the optimized settings for multipoint pacing (MPP). METHODS Twelve patients with advanced heart failure who received cardiac resynchronization therapy defibrillation with MPP at the Third People's Hospital of Chengdu from March 2016 to April 2019 were included. Interventricular and intraventricular delays were optimized through noninvasive cardiac output monitoring and a 12 lead ECG. RESULTS According to CI, the optimized left ventricular- left ventricular - right ventricular delay setting was mainly 25 ms-25 ms and 40 ms-40 ms. And the delay with the minimum QRS width was mainly in 5 ms-5 ms, 25 ms-25 ms, and 40 ms-25 ms. The optimal MPP configuration increased CI compared to the MPP setting that produced the minimum CI (4.5 ± 1.3 vs. 2.8 ± 1.0 L/min/m2, P < 0.001). The QRS width of the optimized MPP was narrower than the MPP setting that produced the maximum QRS width (127 ± 20 vs. 160 ± 29 ms, P < 0.001). CONCLUSION Delay optimization improves hemodynamic response and ventricular contraction synchronicity. The delay of 25 ms-25 ms may be the optimal setting for most MPP patients.
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Affiliation(s)
- Cui Zhang
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Han-Xiong Liu
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Xiao-Qi Deng
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Lin Tong
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Han Wang
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Yan-Feng Wang
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Lan Tong
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Lian-Chao Cheng
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Lin Cai
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China.
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Clinical outcome of left ventricular multipoint pacing versus conventional biventricular pacing in cardiac resynchronization therapy: a systematic review and meta-analysis. Heart Fail Rev 2019; 23:927-934. [PMID: 30209643 DOI: 10.1007/s10741-018-9737-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an effective treatment for selected patients with systolic heart failure. Unlike conventional biventricular pacing (BIP), the left ventricular multipoint pacing (MPP) can increase the number of left ventricular pacing sites via a quadripolar lead positioned in the coronary sinus. This synthetic study was conducted to integratively and quantitatively evaluate the clinical outcome of MPP in comparison with BIP. We systematically searched the databases of EMBASE, Ovid medline, and Cochrane Library through May 2018 for studies comparing the clinical outcome of MPP with BIP in the patients who accepted CRT. Hospitalization for reason of heart failure, left ventricular eject fraction (LVEF), CRT response, all-cause morbidity, and cardiovascular death rate was collected for meta-analysis. A total of 11 studies with 29,606 participants were included in this meta-analysis. Compared with BIP group, MPP decreased heart failure hospitalization (OR, 0.41; 95% CI, 0.33 to 0.50; P < 0.00001), improved LVEF (mean difference, 4.97; 95% CI, 3.11 to 6.83; P < 0.00001), increased CRT response (OR, 3.64; 95% CI, 1.68 to 7.87; P = 0.001), and decreased all-cause morbidity (OR, 0.41; 95% CI, 0.26-0.66; P = 0.0002) and cardiovascular death rate (OR, 0.21; 95% CI, 0.11-0.40; P < 0.00001). The published literature demonstrates that MPP was more effective than BIP in the heart failure patients who accepted cardiac resynchronization therapy.
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Weigand S, Karl M, Brkić A, Lennerz C, Grebmer C, Blažek P, Kornmayer M, Schaarschmidt C, Wesemann L, Reents T, Hessling G, Deisenhofer I, Kolb C. The impact of multipole pacing on left ventricular function in patients with cardiac resynchronization therapy - A real-time three-dimensional echocardiography approach. Int J Cardiol 2018; 272:238-243. [PMID: 30121181 DOI: 10.1016/j.ijcard.2018.08.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/22/2018] [Accepted: 08/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is standard of care in heart failure (HF), however this technique is associated with a non-responder rate of 30%. Multipole pacing (MPP) with a quadripolar lead may optimize CRT and responder rate by creating two electrical wave fronts in the left ventricular (LV) myocardium simultaneously in order to reduce mechanical dyssynchrony. The objective of this study was to investigate the acute impact of MPP on LV function by assessing systolic dyssynchrony index (SDI) and left ventricular ejection fraction (LVEF) via real-time three-dimensional echocardiography (RT3DE). METHODS In 41 consecutive patients (87.8% male; mean age 66.0 ± 12.7 years) who received CRT defibrillators with a quadripolar LV lead, RT3DE datasets were acquired the day after implantation under the following pacing configurations: Baseline AAI, conventional biventricular pacing using distal or proximal LV poles and MPP. Datasets were analyzed in paired samples evaluating SDI and LVEF depending on programmed pacing modality. RESULTS MPP resulted in statistically significant reduction of SDI compared to baseline (6.3%; IQR 4.4-7.8 and 9.9%; IQR 8.0-12.7; p < 0.001) and to conventional biventricular pacing using distal (7.6%; IQR 6.5-9.1; p < 0.001) or proximal (7.4%; IQR 6.2-8.8; p < 0.001) LV poles respectively. MPP yielded significant increase in LVEF compared to baseline (30.6%; IQR 25.8-37.5 and 27.2%; IQR 21.1-33.6; p < 0.001) and to conventional biventricular pacing configuration with distal (28.1%; IQR 22.1-34.5; p < 0.001) or proximal (28.6%; IQR 23.2-34.9; p < 0.001) LV poles respectively. CONCLUSIONS Multipole pacing improves mechanical dyssynchrony of the left ventricular myocardium as assessed by SDI and LVEF.
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Affiliation(s)
- Severin Weigand
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
| | - Michael Karl
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Amir Brkić
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Carsten Lennerz
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Christian Grebmer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Patrick Blažek
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Marielouise Kornmayer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Claudia Schaarschmidt
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Lorraine Wesemann
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Tilko Reents
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Gabriele Hessling
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
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Mele D, Bertini M, Malagù M, Nardozza M, Ferrari R. Current role of echocardiography in cardiac resynchronization therapy. Heart Fail Rev 2018; 22:699-722. [PMID: 28714039 DOI: 10.1007/s10741-017-9636-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. Patients are usually assessed by echocardiography, which provides a number of anatomical and functional information used for cardiac dyssynchrony assessment, prognostic stratification, identification of the optimal site of pacing in the left ventricle, optimization of the CRT device, and patient follow-up. Compared to other cardiac imaging techniques, echocardiography has the advantage to be non-invasive, repeatable, and safe, without exposure to ionizing radiation or nefrotoxic contrast. In this article, we review current evidence about the role of echocardiography before, during, and after the implantation of a CRT device.
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Affiliation(s)
- Donato Mele
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy. .,Noninvasive Cardiology Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Ferrara, Cona, Italy.
| | - Matteo Bertini
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Michele Malagù
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Marianna Nardozza
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Roberto Ferrari
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, RA, Italy
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Pereira H, Jackson TA, Sieniewicz B, Gould J, Yao C, Niederer S, Rinaldi CA. Non-invasive electrophysiological assessment of the optimal configuration of quadripolar lead vectors on ventricular activation times. J Electrocardiol 2018; 51:714-719. [PMID: 29997019 DOI: 10.1016/j.jelectrocard.2018.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/19/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is now generally delivered via quadripolar leads. Assessment of the effect of different vector programs from quadripolar leads on ventricular activation can be now done using non-invasive electrocardiographic mapping (ECM). MATERIAL AND METHODS In nineteen patients with quadripolar LV leads, activation maps were constructed. The total ventricular activation time (TVaT) and the time for the bulk of ventricular activation (VaT10-90) were calculated. RESULTS CRT delivered via a quadripolar lead significantly reduced TVaT and VaT10-90 by a mean of 16 ms and 31 ms, respectively, compared to baseline. There was a marked reduction in ventricular activation between the most and least synchronous vectors: 28% difference in baseline TVaT and 37% difference in VaT10-90. CONCLUSION Changes in the configuration of an LV quadripolar lead significantly affected ventricular activation timings in both ischaemic and non-ischaemic subjects. This suggests that programming of the optimal pacing vector may need to be individually tailored.
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Affiliation(s)
- Helder Pereira
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
| | - Tom A Jackson
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom; Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Benjamin Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom; Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom; Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Steven Niederer
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Christopher A Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom; Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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7
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Leshem E, Suleiman M, Laish-Farkash A, Haim M, Geist M, Luria D, Glikson M, Goldenberg I, Michowitz Y. Impact of quadripolar LV leads on heart failure hospitalization rates among patients implanted with CRT-D: data from the Israeli ICD Registry. J Interv Card Electrophysiol 2017; 51:5-12. [PMID: 29274032 DOI: 10.1007/s10840-017-0305-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure (HF); however, a third of patients are non-responders. The development of quadripolar left ventricular (LV) lead was shown, mainly in single manufactures' registry, to improve LV remodeling and overall mortality. However, limited reports exist on the impact of quadripolar LV leads on HF hospitalization rates in real-life cohorts. We evaluated the clinical outcomes associated with quadripolar LV leads in a large nation-wide registry including all patients implanted with a cardiac resynchronization therapy with defibrillator (CRT-D). METHODS Between July 2010 and October 2016, 2913 consecutive patients were implanted with a CRT-D and all were prospectively enrolled in the Israeli ICD Registry. Quadripolar LV leads were implanted in 973 (33.4%) patients during this period, and their clinical outcomes were compared to CRT-D recipients implanted with a bipolar LV lead. Primary endpoint was HF hospitalization rate. RESULTS Quadripolar leads were implanted more in patients with non-ischemic cardiomyopathy and for primary prevention indication and less in post-infarction patients and for secondary prevention of sudden death. Longer QRS duration was observed with quadripolar leads (147 ± 23 vs 143 ± 25; p < 0.001). Outcome event rate for 100 patient years revealed no difference in HF hospitalization rates between bipolar and quadripolar LV leads. Quadripolar lead implant led to lower cardiac mortality, with no influence on overall mortality. Multivariate analysis revealed no significant differences in study endpoints between bipolar and quadripolar LV leads. CONCLUSION In a large real-life registry, implantation of quadripolar LV leads in patients with CRT-D did not influence HF hospitalization rates.
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Affiliation(s)
- Eran Leshem
- Department of Cardiology, Tel-Aviv Medical Center, Tel Aviv, Israel. .,Cardiovascular Institute, Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Boston, MA, 02215, USA.
| | | | | | - Moti Haim
- Cardiology Department, Soroka Medical Center, Beer Sheva, Israel
| | - Michael Geist
- Cardiology Department, Edith Wolfson Medical Center, Holon, Israel
| | - David Luria
- Cardiology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Michael Glikson
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Ilan Goldenberg
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,IACT-Neufeld Cardiac Research Institute, Tel Hashomer, Israel
| | - Yoav Michowitz
- Department of Cardiology, Tel-Aviv Medical Center, Tel Aviv, Israel
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Spartalis M, Tzatzaki E, Spartalis E, Damaskos C, Athanasiou A, Livanis E, Voudris V. The Role of Echocardiography in the Optimization of Cardiac Resynchronization Therapy: Current Evidence and Future Perspectives. Open Cardiovasc Med J 2017; 11:133-145. [PMID: 29387277 PMCID: PMC5748829 DOI: 10.2174/1874192401711010133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 01/24/2023] Open
Abstract
Background: Cardiac resynchronization therapy (CRT) has become a mainstay in the management of heart failure. Up to one-third of patients who received resynchronization devices do not experience the full benefits of CRT. The clinical factors influencing the likelihood to respond to the therapy are wide QRS complex, left bundle branch block, female gender, non-ischaemic cardiomyopathy (highest responders), male gender, ischaemic cardiomyopathy (moderate responders) and narrow QRS complex, non-left bundle branch block (lowest, non-responders). Objective: This review provides a conceptual description of the role of echocardiography in the optimization of CRT. Method: A literature survey was performed using PubMed database search to gather information regarding CRT and echocardiography. Results: A total of 70 studies met selection criteria for inclusion in the review. Echocardiography helps in the initial selection of the patients with dyssynchrony, which will benefit the most from optimal biventricular pacing and provides a guide to left ventricular (LV) lead placement during implantation. Different echocardiographic parameters have shown promise and can offer the possibility of patient selection, response prediction, lead placement optimization strategies and optimization of device configurations. Conclusion: LV ejection fraction along with specific electrocardiographic criteria remains the cornerstone of CRT patient selection. Echocardiography is a non-invasive, cost-effective, highly reproducible method with certain limitations and accuracy that is affected by measurement errors. Echocardiography can assist with the identification of the appropriate electromechanical substrate of CRT response and LV lead placement. The targeted approach can improve the haemodynamic response, as also the patient-specific parameters estimation.
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Affiliation(s)
- Michael Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eleni Tzatzaki
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | - Christos Damaskos
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | | | - Efthimios Livanis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Vassilis Voudris
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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Sardu C, Barbieri M, Santamaria M, Giordano V, Sacra C, Paolisso P, Spirito A, Marfella R, Paolisso G, Rizzo MR. Multipolar pacing by cardiac resynchronization therapy with a defibrillators treatment in type 2 diabetes mellitus failing heart patients: impact on responders rate, and clinical outcomes. Cardiovasc Diabetol 2017; 16:75. [PMID: 28599667 PMCID: PMC5466779 DOI: 10.1186/s12933-017-0554-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/23/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a multi factorial disease, affecting clinical outcomes in failing heart patients treated by cardiac resynchronization therapy with a defibrillator (CRT-d). METHODS One hundred and ninety-five T2DM patients received a CRT-d treatment. Randomly the study population received a CRT-d via multipolar left ventricle (LV) lead pacing (n 99, multipolar group), vs a CRT-d via bipolar LV pacing (n 96, bipolar group). These patients were followed by clinical, and instrumental assessment, and telemetric device control at follow up. In this study we evaluated, in a population of failing heart T2DM patients, cardiac deaths, all cause deaths, arrhythmic events, CRT-d responders rate, hospitalizations for HF worsening, phrenic nerve stimulation (PNS), and LV catheter dislodgment events (and re-intervention for LV catheter re-positioning), comparing multipolar CRT-d vs bipolar CRT-d group of patients at follow up. RESULTS At follow up there was a statistical significant difference about atrial arrhythmic events [7 (7%) vs 16 (16.7%), p value 0.019], hospitalizations for HF worsening [15 (15.2% vs 24 (25%), p value 0.046], LV catheter dislodgments [1 (1%) vs 9 (9.4%), p value 0018], PNS [5 (5%) vs 18 (18.7%), p value 0.007], and LV re-positioning [1 (1%) vs 9 (9.4%), p value 0.018], comparing multipolar CRT-d vs bipolar CRT-d group of patients. Multipolar pacing was an independent predictor of all these events. CONCLUSIONS CRT-d pacing via multipolar LV lead vs bipolar LV lead may reduce arrhythmic burden, hospitalization rate, PNS, LV catheters dislodgments, and re-interventions in T2DM failing heart patients. Clinical trial number NCT03095196.
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Affiliation(s)
- Celestino Sardu
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy. .,Cardiovascular and Arrhythmias Department, John Paul II Research and Care Foundation, Campobasso, Italy. .,Cardiovascular Department, Inselspital of Bern University, Bern, Switzerland.
| | - Michelangela Barbieri
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Matteo Santamaria
- Cardiovascular and Arrhythmias Department, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Valerio Giordano
- Cardiovascular and Arrhythmias Department, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Cosimo Sacra
- Cardiovascular and Arrhythmias Department, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Pasquale Paolisso
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Alessandro Spirito
- Cardiovascular Department, Inselspital of Bern University, Bern, Switzerland
| | - Raffaele Marfella
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Giuseppe Paolisso
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Maria Rosaria Rizzo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
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10
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O'Donnell D, Sperzel J, Thibault B, Rinaldi CA, Pappone C, Gutleben KJ, Leclercq C, Razavi H, Ryu K, Mcspadden LC, Fischer A, Tomassoni G. Additional electrodes on the Quartet™ LV lead provide more programmable pacing options than bipolar and tripolar equivalents. Europace 2017; 19:588-595. [PMID: 28431058 DOI: 10.1093/europace/euw039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/02/2016] [Indexed: 10/13/2023] Open
Abstract
AIMS The aim of this study was to evaluate any benefits to the number of viable pacing vectors and maximal spatial coverage with quadripolar left ventricular (LV) leads when compared with tripolar and bipolar equivalents in patients receiving cardiac resynchronization therapy (CRT). METHODS AND RESULTS A meta-analysis of five previously published clinical trials involving the Quartet™ LV lead (St Jude Medical, St Paul, MN, USA) was performed to evaluate the number of viable pacing vectors defined as capture thresholds ≤2.5 V and no phrenic nerve stimulation and maximal spatial coverage of viable vectors in CRT patients at pre-discharge (n = 370) and first follow-up (n = 355). Bipolar and tripolar lead configurations were modelled by systematic elimination of two and one electrode(s), respectively, from the Quartet lead. The Quartet lead with its four pacing electrodes exhibited the greatest number of pacing vectors per patient when compared with the best bipolar and the best tripolar modelled equivalents. Similarly, the Quartet lead provided the highest spatial coverage in terms of the distance between two furthest viable pacing cathodes when compared with the best bipolar and the best tripolar configurations (P < 0.05). Among the three modelled bipolar configurations, the lead configuration with the two most distal electrodes resulted in the highest number of viable pacing vectors. Among the four modelled tripolar configurations, elimination of the second proximal electrode (M3) resulted in the highest number of viable pacing options per patient. There were no significant differences observed between pre-discharge and first follow-up analyses. CONCLUSION The Quartet lead with its four electrodes and the capability to pace from four anatomical locations provided the highest number of viable pacing vectors at pre-discharge and first follow-up visits, providing more flexibility in device programming and enabling continuation of CRT in more patients when compared with bipolar and tripolar equivalents.
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Affiliation(s)
- David O'Donnell
- Electrophysiology Unit, Department of Cardiology, Austin Health, Studley Road, Heidleberg 3084, Melbourne, Australia
| | | | | | | | - Carlo Pappone
- Department of Arrhythmology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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11
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Qiu Q, Yang L, Mai JT, Yang Y, Xie Y, Chen YX, Wang JF. Acute Effects of Multisite Biventricular Pacing on Dyssynchrony and Hemodynamics in Canines With Heart Failure. J Card Fail 2017; 23:304-311. [DOI: 10.1016/j.cardfail.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 12/13/2016] [Accepted: 01/09/2017] [Indexed: 01/14/2023]
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VAN DER BIJL PIETER, DELGADO VICTORIA, BAX JEROENJ. QRS Remodeling to Predict Left Ventricular Reverse Remodeling After Cardiac Resynchronization Therapy. J Cardiovasc Electrophysiol 2016; 27:600-1. [DOI: 10.1111/jce.12972] [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: 11/26/2022]
Affiliation(s)
- PIETER VAN DER BIJL
- Department of Cardiology, Heart Lung Center; Leiden University Medical Center; Leiden The Netherlands
| | - VICTORIA DELGADO
- Department of Cardiology, Heart Lung Center; Leiden University Medical Center; Leiden The Netherlands
| | - JEROEN J. BAX
- Department of Cardiology, Heart Lung Center; Leiden University Medical Center; Leiden The Netherlands
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Frommeyer G, Reinke F, Eckardt L. Haemodynamic Alterations Induced By Cardiac Pacing: Is Clinical Evaluation Sufficient Or Do We Need Long-Term Device Monitoring? J Atr Fibrillation 2015; 8:1198. [PMID: 27957202 DOI: 10.4022/jafib.1198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 07/24/2015] [Accepted: 08/06/2015] [Indexed: 11/10/2022]
Abstract
Cardiac pacing may induce haemodynamic alterations. RV pacing may have deleterious effects including a decrease of LV function as well as an increase of heart failure hospitalizations and mortality. Biventricular pacing is established in patients with heart failure and left bundle branch block or chronic AV block to improve haemodynamics. In the future, device optimization employing quadripolar leads or multisite pacing may further increase the rate of responders. However, cinical evaluation represents the most important tool to recognize the necessity for device optimization. Device algorithms are not yet successfully established to replace clinical and echocardiographic evaluation.
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Affiliation(s)
- Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Florian Reinke
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
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Quadripolar Leads in Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2015; 1:225-237. [DOI: 10.1016/j.jacep.2015.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 01/08/2023]
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Improved implant and postoperative lead performance in CRT-D patients implanted with a quadripolar left ventricular lead. A 6-month follow-up analysis from a multicenter prospective comparative study. J Interv Card Electrophysiol 2014; 42:59-66. [DOI: 10.1007/s10840-014-9956-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
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Forleo GB, Di Biase L, Bharmi R, Dalal N, Panattoni G, Pollastrelli A, Tesauro M, Santini L, Natale A, Romeo F. Hospitalization rates and associated cost analysis of cardiac resynchronization therapy with an implantable defibrillator and quadripolar vs. bipolar left ventricular leads: a comparative effectiveness study. Europace 2014; 17:101-7. [PMID: 25371428 PMCID: PMC4280828 DOI: 10.1093/europace/euu290] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aims This study compares, from a prospective, observational, non-randomized registry, the post-implant hospitalization rates and associated healthcare resource utilization of cardiac resynchronization therapy-defibrillator (CRT-D) patients with quadripolar (QUAD) vs. bipolar (BIP) left ventricular (LV) leads. Methods and results Between January 2009 and December 2012, 193 consecutive patients receiving de novo CRT-D implants with either a QUAD (n = 116) or a BIP (n = 77) LV lead were enrolled at implant and followed until July 2013 at a single-centre, university hospital. Post-implant hospitalizations related to heart failure (HF) or LV lead surgical revision and associated payer costs were identified using ICD-9-CM diagnosis and procedure codes. Italian national reimbursement rates were determined. Propensity scores were estimated using a logistic regression model based upon 11 pre-implant baseline characteristics and were used to derive a 1 : 1 matched cohort of QUAD (n = 77) and BIP (n = 77) patients. Hospitalization rates for the two groups were compared using negative binomial regression and associated payer costs were compared using non-parametric bootstrapping (×10 000) and one-sided hypothesis test. Hospitalization rates of the QUAD group [0.15/ patient (pt)-year] were lower than those of the BIP group (0.32/ pt-year); the incidence rate ratio was 0.46, P = 0.04. The hospitalization costs for the QUAD group (434 ± 128 €/pt-year) were lower than those for the BIP group (1136 ± 362 €/pt-year). The average difference was 718 €/pt-year, P = 0.016. Conclusions In this comparative effectiveness assessment of well-matched groups of CRT-D patients with quadripolar and bipolar LV leads, QUAD patients experienced a lower rate of hospitalizations for HF and LV lead surgical revision, and a lower cost burden. This has important implications for LV pacing lead choice.
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Affiliation(s)
- Giovanni B Forleo
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
| | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, USA Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, USA Department of Cardiology, University of Foggia, Foggia, Italy
| | | | | | - Germana Panattoni
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
| | | | - Manfredi Tesauro
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
| | - Luca Santini
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, USA
| | - Francesco Romeo
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
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