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Sabitov YT, Dusypov AA, Abdrakhmanov AS, Orekhov AY, Turubaev EM. [Resynchronization Therapy for Chronic Heart Failure: Diagnostic and Therapeutic Approaches]. KARDIOLOGIYA 2019; 59:84-91. [PMID: 31849315 DOI: 10.18087/cardio.2019.12.n391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 08/19/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022]
Abstract
Chronic heart failure (CHF) remains one of the most important problems of modern cardiology. One of the effective treatment methods is resynchronization therapy (RT). The article presents an analysis of literature data on the effectiveness of RT in improving the quality of life, reducing the number of hospitalizations and mortality in patients with heart failure with severe left ventricular systolic dysfunction and expanding QRS complex, and also discusses key methods for optimizing RT.
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Hajek P, Safarikova I, Baxa J. Image-guided left ventricular lead placement in cardiac resynchronization therapy: focused on image fusion methods. J Appl Biomed 2019; 17:199-208. [PMID: 34907722 DOI: 10.32725/jab.2019.019] [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: 08/18/2019] [Accepted: 10/30/2019] [Indexed: 11/05/2022] Open
Abstract
Cardiac resynchronization therapy is an effective and widely accessible treatment for patients with advanced, drug-refractory heart failure. It has been shown to reverse maladaptive ventricular remodeling, increase exercise capacity, and lower hospitalization and mortality rates. However, there still exists a considerable proportion of patients who do not respond favorably to the therapy. Tailored left ventricular (LV) lead positioning instead of empiric implantation is thought to have the greatest potential to increase response rates. In our paper, we focus on the rationale for guided LV lead implantation and provide a review of the non-invasive imaging modalities applicable for navigation during LV lead implantation, with special attention to the latest achievements in the field of multimodality imaging and image fusion techniques. Current limitations and future perspectives of the concept are discussed as well.
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Affiliation(s)
- Premysl Hajek
- Ceske Budejovice Hospital, Department of Cardiology, Ceske Budejovice, Czech Republic
| | - Iva Safarikova
- Ceske Budejovice Hospital, Department of Cardiology, Ceske Budejovice, Czech Republic.,University of South Bohemia in Ceske Budejovice, Faculty of Health and Social Sciences, Budejovice, Czech Republic
| | - Jan Baxa
- Charles University in Prague, University Hospital and Faculty of Medicine in Pilsen, Department of Imaging Methods, Pilsen, Czech Republic
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Visualisation of coronary venous anatomy by computed tomography angiography prior to cardiac resynchronisation therapy implantation. Neth Heart J 2018; 26:433-444. [PMID: 30030750 PMCID: PMC6115304 DOI: 10.1007/s12471-018-1132-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The purpose of this study was to illustrate the additive value of computed tomography angiography (CTA) for visualisation of the coronary venous anatomy prior to cardiac resynchronisation therapy (CRT) implantation. METHODS Eighteen patients planned for CRT implantation were prospectively included. A specific CTA protocol designed for visualisation of the coronary veins was carried out on a third-generation dual-source CT platform. Coronary veins were semi-automatically segmented to construct a 3D model. CTA-derived coronary venous anatomy was compared with intra-procedural fluoroscopic angiography (FA) in right and left anterior oblique views. RESULTS Coronary venous CTA was successfully performed in all 18 patients. CRT implantation and FA were performed in 15 patients. A total of 62 veins were visualised; the number of veins per patient was 3.8 (range: 2-5). Eighty-five per cent (53/62) of the veins were visualised on both CTA and FA, while 10% (6/62) were visualised on CTA only, and 5% (3/62) on FA only. Twenty-two veins were present on the lateral or inferolateral wall; of these, 95% (21/22) were visualised by CTA. A left-sided implantation was performed in 13 patients, while a right-sided implantation was performed in the remaining 2 patients because of a persistent left-sided superior vena cava with no left innominate vein on CTA. CONCLUSION Imaging of the coronary veins by CTA using a designated protocol is technically feasible and facilitates the CRT implantation approach, potentially improving the outcome.
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Rials SJ, Pershing M, Collins C. Guidewire Method for Measuring Local Left Ventricular Electrical Activation Time During Cardiac Resynchronization Implantation. J Innov Card Rhythm Manag 2018; 9:2989-2995. [PMID: 32477783 PMCID: PMC7252739 DOI: 10.19102/icrm.2018.090102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/04/2017] [Indexed: 12/27/2022] Open
Abstract
The timing of local activation at left ventricular (LV) pacing leads is measured from the onset of the QRS complex to the peak of the LV electrogram (QLV). Pacing from the sites of late activation is associated with higher response rates to cardiac resynchronization therapy (CRT). Prior studies have measured QLV from permanent pacing leads, or have used electroanatomic mapping systems. The current study compares QLV measurements made with a guidewire to those collected from permanent LV pacing leads positioned at the same venous site without the use of electroanatomic mapping systems. In this study, 20 patients undergoing CRT implantation (14 males, mean QRS: 164.0 ms) had QLV measurements taken using a guidewire. QLV and LV electrogram duration measurements were made at LV pacing sites, and were repeated after positioning the permanent LV pacing lead at the same site. There was no difference in QLV measurements obtained using a guidewire and those obtained using the permanent pacing lead placed at the same site (p = 0.569). QLV measurements obtained with a guidewire and the permanent LV pacing lead at the same site, respectively, were strongly correlated (r = 0.965; p < 0.001). The median absolute difference in electrogram duration was 7.0 ms (p = 0.55). The average time required to make QLV measurements using the guidewire was 11.7 minutes [standard deviation (SD): 6.8]. The average total fluoroscopy time for the entire CRT implant procedure was 10.9 minutes (SD: 5.1). In light of these results, it can be suggested that a guidewire can be used to prospectively measure LV prior to selection or placement of a permanent pacing lead without the use of an electroanatomic mapping system.
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Affiliation(s)
- Seth J Rials
- OhioHealth Heart and Vascular Physicians, Division of Cardiology, Grant Medical Center, Columbus, OH, USA
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Behar JM, Rajani R, Pourmorteza A, Preston R, Razeghi O, Niederer S, Adhya S, Claridge S, Jackson T, Sieniewicz B, Gould J, Carr-White G, Razavi R, McVeigh E, Rinaldi CA. Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy. Heart Rhythm 2017; 14:1364-1372. [PMID: 28479514 PMCID: PMC5575356 DOI: 10.1016/j.hrthm.2017.04.041] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Indexed: 01/26/2023]
Abstract
Background Optimal lead positioning is an important determinant of cardiac resynchronization therapy (CRT) response. Objective The purpose of this study was to evaluate cardiac computed tomography (CT) selection of the optimal epicardial vein for left ventricular (LV) lead placement by targeting regions of late mechanical activation and avoiding myocardial scar. Methods Eighteen patients undergoing CRT upgrade with existing pacing systems underwent preimplant electrocardiogram-gated cardiac CT to assess wall thickness, hypoperfusion, late mechanical activation, and regions of myocardial scar by the derivation of the stretch quantifier for endocardial engraved zones (SQUEEZ) algorithm. Cardiac venous anatomy was mapped to individualized American Heart Association (AHA) bull’s-eye plots to identify the optimal venous target and compared with acute hemodynamic response (AHR) in each coronary venous target using an LV pressure wire. Results Fifteen data sets were evaluable. CT-SQUEEZ–derived targets produced a similar mean AHR compared with the best achievable AHR (20.4% ± 13.7% vs 24.9% ± 11.1%; P = .36). SQUEEZ-derived guidance produced a positive AHR in 92% of target segments, and pacing in a CT-SQUEEZ target vein produced a greater clinical response rate vs nontarget segments (90% vs 60%). Conclusion Preprocedural CT-SQUEEZ–derived target selection may be a valuable tool to predict the optimal venous site for LV lead placement in patients undergoing CRT upgrade.
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Affiliation(s)
- Jonathan M Behar
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Ronak Rajani
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Amir Pourmorteza
- Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Rebecca Preston
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Orod Razeghi
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
| | - Steve Niederer
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
| | - Shaumik Adhya
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon Claridge
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tom Jackson
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ben Sieniewicz
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gerry Carr-White
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Reza Razavi
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
| | - Elliot McVeigh
- Departments of Bioengineering, Medicine, and Radiology, University of California San Diego, La Jolla, California
| | - Christopher Aldo Rinaldi
- Department of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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ANDERSON ROBERTH, MORI SHUMPEI. How Can We Best Describe the Cardiac Components? J Cardiovasc Electrophysiol 2016; 27:972-5. [DOI: 10.1111/jce.13013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/10/2016] [Indexed: 11/27/2022]
Affiliation(s)
- ROBERT H. ANDERSON
- Institute of Genetic Medicine; Newcastle University; Newcastle-upon-Tyne UK
| | - SHUMPEI MORI
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
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Uhm JS, Park JW, Lee H, Kim TH, Youn JC, Joung B, Pak HN, Kang SM, Lee MH. Cardiac Vein Accessibility According to Heart Diseases and Sex: Implications for Cardiac Resynchronization Therapy. Pacing Clin Electrophysiol 2016; 39:513-21. [PMID: 26969827 DOI: 10.1111/pace.12843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/10/2016] [Accepted: 03/06/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an important therapy in patients with heart failure (HF) and dyssynchrony. We performed the present study to elucidate clinical factors associated with cardiac vein accessibility. METHODS In 255 consecutive patients (age, 48.7 ± 19.4 years; male, 126), cardiac venography was performed during CRT implantation or an electrophysiological study. We measured the diameters and the proximal branching angles of the lateral cardiac and posterior ventricular veins. Easy accessibility of the cardiac vein was defined as a lumen diameter ≥1.6 mm with an angle of ≥90°. We compared baseline characteristics between patients with and without easily accessible cardiac veins. We compared cardiac vein accessibility between patients with and without HF, including ischemic and nonischemic HF, and between males and females. RESULTS In 189 (74.1%) patients, the cardiac veins were easily accessible. The cardiac veins were more easily accessible in patients with HF (n = 75) compared with patients without HF (n = 180; 89.3% and 67.8%, respectively; P < 0.001). The cardiac veins were more easily accessible in patients with nonischemic HF (n = 56) compared with patients with ischemic HF (n = 19; 96.4% and 68.4%, respectively; P = 0.003). The cardiac veins were more easily accessible in females compared with males (79.8% and 68.3%, respectively; P = 0.035). CONCLUSIONS Accessing the cardiac veins for CRT implantation was difficult in ∼10% of patients with HF. Cardiac vein accessibility was high in patients with nonischemic HF and in females.
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Affiliation(s)
- Jae-Sun Uhm
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Je Wook Park
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hancheol Lee
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hoon Kim
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Chan Youn
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hui-Nam Pak
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Min Kang
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Bun SS, Latcu DG, Errahmouni A, Saoudi N. Non-contrast cardiac resynchronization therapy implantation is feasible in case of renal insufficiency. J Interv Card Electrophysiol 2015; 44:81-6. [DOI: 10.1007/s10840-015-0027-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
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Spencer JH, Goff RP, Iaizzo PA. Left phrenic nerve anatomy relative to the coronary venous system: Implications for phrenic nerve stimulation during cardiac resynchronization therapy. Clin Anat 2015; 28:621-6. [DOI: 10.1002/ca.22537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 02/02/2015] [Accepted: 02/22/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Julianne H. Spencer
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolis Minnesota
- Department of SurgeryUniversity of MinnesotaMinneapolis Minnesota
- Medtronic Inc.Mounds View Minnesota
| | - Ryan P. Goff
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolis Minnesota
- Department of SurgeryUniversity of MinnesotaMinneapolis Minnesota
| | - Paul A. Iaizzo
- Department of SurgeryUniversity of MinnesotaMinneapolis Minnesota
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Spencer JH, Sundaram CC, Iaizzo PA. The relative anatomy of the coronary arterial and venous systems. Clin Anat 2014; 27:1023-9. [DOI: 10.1002/ca.22419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/02/2014] [Accepted: 05/02/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Julianne H. Spencer
- Department of Biomedical Engineering; University of Minnesota; Minneapolis Minnesota
- Medtronic, Inc.; Minneapolis Minnesota
- Institute for Engineering in Medicine; University of Minnesota; Minneapolis Minnesota
| | | | - Paul A. Iaizzo
- Department of Surgery; University of Minnesota; Minneapolis Minnesota
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