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Elliott MK, Mehta V, Wijesuriya N, Sidhu BS, Gould J, Niederer S, Rinaldi CA. Multi-lead pacing for cardiac resynchronization therapy in heart failure: a meta-analysis of randomized controlled trials. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac013. [PMID: 35919119 PMCID: PMC9242027 DOI: 10.1093/ehjopen/oeac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/25/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022]
Abstract
Aims Multi-lead pacing is a potential therapy to improve response to cardiac resynchronization therapy (CRT) by providing rapid activation of the myocardium from multiple sites. Here, we perform a meta-analysis of randomized controlled trials to assess the efficacy of multi-lead pacing. Methods and results A literature search was performed which identified 251 unique records. After screening, 6 studies were found to meet inclusion criteria, with 415 patients included in the meta-analysis. Four studies performed multi-lead pacing with two left ventricular (LV) leads and one right ventricular (RV) lead. One study used two RV leads and one LV lead, and one study used both configurations. There was no difference between multi-lead pacing and conventional CRT in LV end-systolic volume [mean difference (MD) -0.54 mL, P = 0.93] or LV ejection fraction (MD 1.42%, P = 0.40). There was a borderline significant improvement in Minnesota Living With Heart Failure Questionnaire score for multi-lead pacing vs. conventional CRT (MD -4.46, P = 0.05), but the difference was not significant when only patients receiving LV-only multi-lead pacing were included (MD -3.59, P = 0.25). There was also no difference between groups for 6-min walk test (MD 15.06 m, P = 0.38) or New York Heart Association class at follow-up [odds ratio (OR) 1.49, P = 0.24]. There was no difference in mortality between groups (OR 1.11, P = 0.77). Conclusion This meta-analysis does not support the use of multi-lead pacing for CRT delivery. However, significant variation between studies was noted, and therefore a benefit for multi-lead pacing in select patients cannot be excluded, and further investigation may be warranted.
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Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
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Thibault B, Mondésert B, Cadrin-Tourigny J, Dubuc M, Macle L, Khairy P. Benefits of Multisite/Multipoint Pacing to Improve Cardiac Resynchronization Therapy Response. Card Electrophysiol Clin 2019; 11:99-114. [PMID: 30717857 DOI: 10.1016/j.ccep.2018.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article provides a general overview of the underlying mechanisms that support pacing from more discrete points and/or a wider vector (multisite and multipoint pacing) to improve left ventricular resynchronization. We performed a critical overview of the current literature and to identify some remaining knowledge gaps to spur further research. It was not our goal to provide a systematic review with a comprehensive bibliography, but rather to focus on selected publications that, in our opinion, have either expertly reviewed a specific aspect of cardiac resynchronization therapy or have been landmark studies in the field.
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Affiliation(s)
- Bernard Thibault
- Department of Cardiology, Montréal Heart Institute, University of Montréal, 5000 Bélanger Street, Montréal, Québec, H1T 1C8, Canada.
| | - Blandine Mondésert
- Department of Cardiology, Montréal Heart Institute, University of Montréal, 5000 Bélanger Street, Montréal, Québec, H1T 1C8, Canada
| | - Julia Cadrin-Tourigny
- Department of Cardiology, Montréal Heart Institute, University of Montréal, 5000 Bélanger Street, Montréal, Québec, H1T 1C8, Canada
| | - Marc Dubuc
- Department of Cardiology, Montréal Heart Institute, University of Montréal, 5000 Bélanger Street, Montréal, Québec, H1T 1C8, Canada
| | - Laurent Macle
- Department of Cardiology, Montréal Heart Institute, University of Montréal, 5000 Bélanger Street, Montréal, Québec, H1T 1C8, Canada
| | - Paul Khairy
- Department of Cardiology, Montréal Heart Institute, University of Montréal, 5000 Bélanger Street, Montréal, Québec, H1T 1C8, Canada
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Marques P, Nobre Menezes M, Lima da Silva G, Guimarães T, Bernardes A, Cortez-Dias N, Carpinteiro L, de Sousa J, Pinto FJ. Triple-site pacing for cardiac resynchronization in permanent atrial fibrillation: follow-up results from a prospective observational study. Europace 2018; 20:986-992. [PMID: 28430960 DOI: 10.1093/europace/eux036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/16/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Cardiac Resynchronization Therapy (CRT) is associated with a particularly high non-response rate in patients with atrial fibrillation (AF). We aimed to assess the effectiveness of triple-site (Tri-V) pacing CRT in this population. Methods and results Prospective observational study of patients with permanent AF who underwent CRT implantation with an additional right ventricle lead in the outflow tract septal wall. After implantation, programming mode (Tri-V or biventricular pacing) was selected based on cardiac output determination. Patients were classified as responders if NYHA class was reduced by at least one level and echocardiographic ejection fraction (EF) increased ≥ 10%, and as super-responders if in NYHA class I and EF ≥ 50%. Forty patients (93% male, mean age 72 ± 10 years) were included. Thirty-three were programmed in Tri-V. The following results pertain to this subgroup. At baseline, 58% were in NYHA class III and 36% NYHA class II. At 1 year follow-up, Minnesota QoL score was reduced (36 ± 23 vs. 8 ± 6; P = 0.001) and the 6MWT distance improved (384 ± 120 m to 462 ± 87 m, P = 0.003). Mean EF increased (26% ± 8 vs. 39 ± 10; P < 0.001 at 6 months and 41 ± 10; P < 0.001 at 12 months). Responder rate was 59% at 6 months and 79% at 12 months. Super-responder rate was 9% at 6 months and 16% at 12 months. One year survival free from heart failure hospitalization was 87.9%. Conclusion Tri-V CRT yielded higher response and super-response rates than usually reported for CRT in patients with permanent AF using clinical and remodeling criteria.
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Affiliation(s)
- Pedro Marques
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Miguel Nobre Menezes
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Gustavo Lima da Silva
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Tatiana Guimarães
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Ana Bernardes
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Nuno Cortez-Dias
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Luis Carpinteiro
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - João de Sousa
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
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Zhang B, Guo J, Zhang G. Comparison of triple-site ventricular pacing versus conventional cardiac resynchronization therapy in patients with systolic heart failure: A meta-analysis of randomized and observational studies. J Arrhythm 2018; 34:55-64. [PMID: 29721114 PMCID: PMC5828262 DOI: 10.1002/joa3.12018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/08/2017] [Indexed: 12/03/2022] Open
Abstract
Background Conventional cardiac resynchronization therapy (CRT, Bi‐V) is associated with no response in about 40% patients due to an insufficient resynchronization. Some studies showed triple‐site ventricular (Tri‐V) pacing had greater benefits compared with Bi‐V pacing, but the results of these studies were conflicting. We hypothesized that Tri‐V pacing had greater benefits on long‐term outcomes compared with Bi‐V pacing in patients with heart failure. Methods PubMed, EMBASE, and the Cochrane Library were searched for clinical studies with related outcomes. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated to compare the change in left ventricular ejection fraction (LVEF), left ventricular geometry, functional capacity, and quality of life between Tri‐V pacing group and control group. Results Five trials with 251 patients were included in the analysis. Patients in the Tri‐V pacing group had a greater improvement in LVEF (WMD 4.04; 95% CI 2.15‐5.92, P < .001) and NYHA classes (WMD −0.27; 95% CI −0.42 to −0.11, P = .001) compared with control group. However, there were no significant differences in left ventricular geometry, six‐min walk distance, or Minnesota Living With Heart Failure Questionnaire score between the two groups. The subgroup analyses showed there might be a greater improvement in LVEF in the Tri‐V pacing group in patients with QRS duration ≥ 155 ms (WMD 5.60; 95% CI 3.09‐8.10, P < .001). Conclusions The present analysis suggests that Tri‐V pacing has greater benefits in terms of an improvement in LVEF and functional capacity in patients with systolic heart failure, especially in patients with the duration of QRS ≥ 155 ms.
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Affiliation(s)
- Baowei Zhang
- Department of Cardiology The affiliated People's Hospital of Jiangsu University Zhenjiang China
| | - Junfang Guo
- Department of Cardiology The affiliated People's Hospital of Jiangsu University Zhenjiang China
| | - Guohui Zhang
- Department of Cardiology The affiliated People's Hospital of Jiangsu University Zhenjiang China
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Antoniadis AP, Sieniewicz B, Gould J, Porter B, Webb J, Claridge S, Behar JM, Rinaldi CA. Updates in Cardiac Resynchronization Therapy for Chronic Heart Failure: Review of Multisite Pacing. Curr Heart Fail Rep 2017; 14:376-383. [DOI: 10.1007/s11897-017-0350-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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IGARASHI MIYAKO, TADA HIROSHI, YAMASAKI HIRO, KUROKI KENJI, ISHIZU TOMOKO, SEO YOSHIHIRO, MACHINO TAKESHI, MURAKOSHI NOBUYUKI, SEKIGUCHI YUKIO, NOGUCHI YUICHI, NOGAMI AKIHIKO, AONUMA KAZUTAKA. Fragmented QRS Is a Novel Risk Factor for Ventricular Arrhythmic Events After Receiving Cardiac Resynchronization Therapy in Nonischemic Cardiomyopathy. J Cardiovasc Electrophysiol 2017; 28:327-335. [DOI: 10.1111/jce.13139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 11/27/2016] [Accepted: 11/29/2016] [Indexed: 01/20/2023]
Affiliation(s)
- MIYAKO IGARASHI
- Cardiovascular Division, Faculty of Medicine; University of Tsukuba; Tsukuba Ibaraki Japan
| | - HIROSHI TADA
- Department of Cardiovascular Medicine, Faculty of Medical Sciences; University of Fukui; Fukui Japan
| | - HIRO YAMASAKI
- Cardiovascular Division, Faculty of Medicine; University of Tsukuba; Tsukuba Ibaraki Japan
| | - KENJI KUROKI
- Cardiovascular Division, Faculty of Medicine; University of Tsukuba; Tsukuba Ibaraki Japan
| | - TOMOKO ISHIZU
- Cardiovascular Division, Faculty of Medicine; University of Tsukuba; Tsukuba Ibaraki Japan
| | - YOSHIHIRO SEO
- Cardiovascular Division, Faculty of Medicine; University of Tsukuba; Tsukuba Ibaraki Japan
| | - TAKESHI MACHINO
- Cardiovascular Division, Faculty of Medicine; University of Tsukuba; Tsukuba Ibaraki Japan
| | - NOBUYUKI MURAKOSHI
- Cardiovascular Division, Faculty of Medicine; University of Tsukuba; Tsukuba Ibaraki Japan
| | - YUKIO SEKIGUCHI
- Cardiovascular Division, Faculty of Medicine; University of Tsukuba; Tsukuba Ibaraki Japan
| | - YUICHI NOGUCHI
- Cardiovascular Division; Tsukuba Medical Center Hospital; Tsukuba Ibaraki Japan
| | - AKIHIKO NOGAMI
- Cardiovascular Division, Faculty of Medicine; University of Tsukuba; Tsukuba Ibaraki Japan
| | - KAZUTAKA AONUMA
- Cardiovascular Division, Faculty of Medicine; University of Tsukuba; Tsukuba Ibaraki Japan
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Triple-site pacing for cardiac resynchronization in permanent atrial fibrillation - Acute phase results from a prospective observational study. Rev Port Cardiol 2016; 35:331-8. [PMID: 27255170 DOI: 10.1016/j.repc.2015.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/20/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION AND AIM Multi-site pacing is emerging as a new method for improving response to cardiac resynchronization therapy (CRT), but has been little studied, especially in patients with atrial fibrillation. We aimed to assess the effects of triple-site (Tri-V) vs. biventricular (Bi-V) pacing on hemodynamics and QRS duration. METHODS This was a prospective observational study of patients with permanent atrial fibrillation and ejection fraction <40% undergoing CRT implantation (n=40). One right ventricular (RV) lead was implanted in the apex and another in the right ventricular outflow tract (RVOT) septal wall. A left ventricular (LV) lead was implanted in a conventional venous epicardial position. Cardiac output (using the FloTrac™ Vigileo™ system), mean QRS and ejection fraction were calculated. RESULTS Mean cardiac output was 4.81±0.97 l/min with Tri-V, 4.68±0.94 l/min with RVOT septal and LV pacing, and 4.68±0.94 l/min with RV apical and LV pacing (p<0.001 for Tri-V vs. both BiV). Mean pre-implantation QRS was 170±25 ms, 123±18 ms with Tri-V, 141±25 ms with RVOT septal pacing and LV pacing and 145±19 with RV apical and LV pacing (p<0.001 for Tri-V vs. both BiV and pre-implantation). Mean ejection fraction was significantly higher with Tri-V (30±11%) vs. Bi-V pacing (28±12% with RVOT septal and LV pacing and 28±11 with RV apical and LV pacing) and pre-implantation (25±8%). CONCLUSION Tri-V pacing produced higher cardiac output and shorter QRS duration than Bi-V pacing. This may have a significant impact on the future of CRT.
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8
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Triple-site pacing for cardiac resynchronization in permanent atrial fibrillation – Acute phase results from a prospective observational study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hamaoka M, Mine T, Kodani T, Kishima H, Mitsuno M, Masuyama T. Hemodynamic effects of Purkinje potential pacing in the left ventricular endocardium in patients with advanced heart failure. J Arrhythm 2015; 31:371-5. [PMID: 26702317 PMCID: PMC4672074 DOI: 10.1016/j.joa.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 06/03/2015] [Accepted: 06/16/2015] [Indexed: 11/14/2022] Open
Abstract
Background Various difficulties can occur in patients who undergo cardiac resynchronization therapy for drug-refractory heart failure with respect to placement of the left ventricular (LV) lead, because of anatomical features, pacing thresholds, twitching, or pacing lead anchoring, possibly requiring other pacing sites. The goal of this study was to determine whether Purkinje potential (PP) pacing could provide better hemodynamics in patients with left bundle branch block and heart failure than biventricular (BiV) pacing. Methods Eleven patients with New York Heart Association functional class II or III heart failure despite optimal medical therapy were selected for this study. All patients underwent left- and right-sided cardiac catheterization for measurement of LV functional parameters in the control state during BiV and PP pacing. Results Maximum dP/dt increased during BiV and PP pacing when compared with control measurements. This study compared parameters measured during BiV pacing with PP pacing and non-paced beats as the control state in each patient (717±171 mmHg/s vs. 917±191 mmHg/s, p<0.05; and 921±199 mmHg/s, p<0.005); however, the difference between PP pacing and BiV pacing was not significant. There was no difference in heart rate, electrocardiographic wave complex duration, minimum dP/dt, left ventricular end-diastolic pressure, left ventricular end-systolic pressure, pulmonary capillary wedge pressure, or cardiac index when comparing BiV pacing and PP pacing to control measurements. Conclusions The hemodynamic outcome of PP pacing was comparable to that of BiV pacing in patients with advanced heart failure.
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Affiliation(s)
- Mamoru Hamaoka
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya Hyogo 663-8501, Japan
| | - Takanao Mine
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya Hyogo 663-8501, Japan
| | - Takeshi Kodani
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya Hyogo 663-8501, Japan
| | - Hideyuki Kishima
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya Hyogo 663-8501, Japan
| | - Masataka Mitsuno
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya Hyogo 663-8501, Japan
| | - Tohru Masuyama
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya Hyogo 663-8501, Japan
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Naruse Y, Seo Y, Murakoshi N, Ishizu T, Sekiguchi Y, Aonuma K. Triventricular pacing improved dyssynchrony in heart failure patient with right-bundle branch block and left anterior fascicular block. J Cardiol Cases 2014; 9:158-161. [PMID: 30546790 DOI: 10.1016/j.jccase.2013.12.013] [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: 10/31/2013] [Revised: 12/23/2013] [Accepted: 12/30/2013] [Indexed: 10/25/2022] Open
Abstract
The present case report describes a 53-year-old man with drug-resistant heart failure. Electrocardiogram showed complete right-bundle branch block and left anterior fascicular block. A cardiac resynchronization therapy (CRT) device was implanted in him because echocardiography showed obvious left ventricular dyssynchrony between septal and lateral walls. After CRT implantation, dyssynchrony was improved and ejection fraction was increased. Evaluation of coexisting left hemiblock and left ventricular dyssynchrony may be needed in patients with atypical indications for CRT. <Learning objective: Cardiac resynchronization therapy (CRT) for patients with complete right-bundle branch block (CRBBB) is still controversial. Presence of hemiblock and left ventricular dyssynchrony between the pacing sites may be essential to determine CRT indication even in patients with CRBBB.>.
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Affiliation(s)
- Yoshihisa Naruse
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nobuyuki Murakoshi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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First experience of intraoperative echocardiography-guided optimization of cardiac resynchronization therapy delivery. Arch Cardiovasc Dis 2014; 107:169-77. [DOI: 10.1016/j.acvd.2014.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/25/2014] [Accepted: 03/03/2014] [Indexed: 11/21/2022]
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Abstract
In patients with advanced systolic heart failure and mechanical dyssynchrony, cardiac resynchronization therapy (CRT) is an effective means of improving symptoms and reducing mortality. There are now several recognized approaches to optimize CRT. Imaging modalities can assist with identifying the myocardium with the latest mechanical activation for targeted left ventricular lead implantation. Device programming can be tailored to maximize biventricular pacing, and thereby is its benefit. Cardiac imaging has shown that atrioventricular and interventricular intervals can be adjusted to further reduce dyssynchrony. We review these various approaches that maximize the benefit derived from CRT.
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Left Ventricular Endocardial Pacing and Multisite Pacing to Improve CRT Response. J Cardiovasc Transl Res 2012; 5:213-8. [DOI: 10.1007/s12265-011-9342-7] [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] [Received: 10/03/2011] [Accepted: 12/12/2011] [Indexed: 10/14/2022]
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