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Capuano E, Regazzoni F, Maines M, Fornara S, Locatelli V, Catanzariti D, Stella S, Nobile F, Greco MD, Vergara C. Personalized computational electro-mechanics simulations to optimize cardiac resynchronization therapy. Biomech Model Mechanobiol 2024:10.1007/s10237-024-01878-8. [PMID: 39192164 DOI: 10.1007/s10237-024-01878-8] [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: 02/09/2024] [Accepted: 07/12/2024] [Indexed: 08/29/2024]
Abstract
In this study, we present a computational framework designed to evaluate virtual scenarios of cardiac resynchronization therapy (CRT) and compare their effectiveness based on relevant clinical biomarkers. Our approach involves electro-mechanical numerical simulations personalized, for patients with left bundle branch block, by means of a calibration obtained using data from Electro-Anatomical Mapping System (EAMS) measures acquired by cardiologists during the CRT procedure, as well as ventricular pressures and volumes, both obtained pre-implantation. We validate the calibration by using EAMS data coming from right pacing conditions. Three patients with fibrosis and three without are considered to explore various conditions. Our virtual scenarios consist of personalized numerical experiments, incorporating different positions of the left electrode along reconstructed epicardial veins; different locations of the right electrode; different ventriculo-ventricular delays. The aim is to offer a comprehensive tool capable of optimizing CRT efficiency for individual patients. We provide preliminary answers on optimal electrode placement and delay, by computing some relevant biomarkers such as d P / d t max , ejection fraction, stroke work. From our numerical experiments, we found that the latest activated segment during sinus rhythm is an effective choice for the non-fibrotic cases for the location of the left electrode. Also, our results showed that the activation of the right electrode before the left one seems to improve the CRT performance for the non-fibrotic cases. Last, we found that the CRT performance seems to improve by positioning the right electrode halfway between the base and the apex. This work is on the line of computational works for the study of CRT and introduces new features in the field, such as the presence of the epicardial veins and the movement of the right electrode. All these studies from the different research groups can in future synergistically flow together in the development of a tool which clinicians could use during the procedure to have quantitative information about the patient's propagation in different scenarios.
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Affiliation(s)
- Emilia Capuano
- MOX, Dipartimento di Mathematica, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 201333, Milan, Italy
| | - Francesco Regazzoni
- MOX, Dipartimento di Mathematica, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 201333, Milan, Italy
| | - Massimiliano Maines
- Cardiology department, S.M. del Carmine Hospital, APSS, Corso Verona, 4, Rovereto, 38068, Trento, Italy
| | - Silvia Fornara
- LABS, Dipartimento di Chimica, Materiali e Ingegneria Chimica, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 201333, Milan, Italy
| | - Vanessa Locatelli
- LABS, Dipartimento di Chimica, Materiali e Ingegneria Chimica, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 201333, Milan, Italy
| | - Domenico Catanzariti
- Cardiology department, S.M. del Carmine Hospital, APSS, Corso Verona, 4, Rovereto, 38068, Trento, Italy
| | - Simone Stella
- MOX, Dipartimento di Mathematica, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 201333, Milan, Italy
| | - Fabio Nobile
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Station 8, Av. Piccard, CH-1015, Lausanne, Switzerland
| | - Maurizio Del Greco
- Cardiology department, S.M. del Carmine Hospital, APSS, Corso Verona, 4, Rovereto, 38068, Trento, Italy
| | - Christian Vergara
- LABS, Dipartimento di Chimica, Materiali e Ingegneria Chimica, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 201333, Milan, Italy.
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Park YS, Cha MJ, Cho MS, Kim J, Nam GB, Choi KJ. Triventricular pacing with leadless pacemaker combined with cardiac resynchronization therapy in severe heart failure. HeartRhythm Case Rep 2024; 10:537-540. [PMID: 39155904 PMCID: PMC11328587 DOI: 10.1016/j.hrcr.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Affiliation(s)
- Young-Sun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Soo Cho
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gi-Byoung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kee-Joon Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Passafaro F, Rapacciuolo A, Ruocco A, Ammirati G, Crispo S, Pasceri E, Santarpia G, Mauro C, Esposito G, Indolfi C, Curcio A. COMPArison of Multi-Point Pacing and ConvenTional Cardiac Resynchronization Therapy Through Noninvasive Hemodynamics Measurement: Short- and Long-Term Results of the COMPACT-MPP Study. Am J Cardiol 2024; 215:42-49. [PMID: 38237796 DOI: 10.1016/j.amjcard.2023.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024]
Abstract
Invasive hemodynamic studies have shown improved left ventricular (LV) performances when cardiac resynchronization therapy/defibrillator is delivered through multipoint pacing (MPP). Nowadays, strategies have become available that allow studying the same hemodynamic parameters at a noninvasive level. The aim of the present study was to evaluate the clinical implication of using a patient-tailored approach for cardiac resynchronization therapy programming based on noninvasively assessed LV hemodynamics to identify the best biventricular pacing modality between standard single-site pacing (STD) and MPP for each patient. Therefore, 51 patients with heart failure (age 69 ± 9 years, 35 men, 27% ischemic etiology) implanted with cardiac resynchronization therapy/defibrillator underwent noninvasive LV function assessment through photoplethysmography before hospital discharge for addressing dP/dt and stroke volume in both pacing modalities (STD and MPP). The modality that performed better in terms of hemodynamic improvement was permanently programmed. Global longitudinal strain (GLS) was also assessed, and repeated at 3 months. Compared with intrinsic rhythm (928 ± 486 mm Hg/s), dP/dtmax showed a trend to increase in both biventricular pacing modes (1,000 ± 577 mm Hg/s in STD, 1,036 ± 530 mm Hg/s in MPP, p = NS). MPP was associated with a wider hemodynamic improvement than was STD and was the modality of choice in 34 of 51 patients (67%). GLS at predischarge did not differ between groups (-10.3 ± 3.8% vs -10.2 ± 3.5%), but significant improvement of ejection fraction at 1 month (34.4 ± 5.3%, p <0.001) and of GLS at 3 months (-12.9 ± 2.9%, p <0.005) was observed across the entire cohort. At 3 months, 77% of patients were classified as responders. Interestingly, long-term (3 years) follow-up unveiled a reduction in all-cause mortality in the MPP group compared with the STD group. In conclusion, cardiac resynchronization therapy programming guided by acute noninvasive hemodynamics favored MPP modality and caused short-term LV positive remodeling and improved long-term outcomes. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT04299360.
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Affiliation(s)
- Francesco Passafaro
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Rapacciuolo
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Antonio Ruocco
- Division of Cardiology, Emergency Department, AORN Cardarelli, Naples, Italy
| | - Giuseppe Ammirati
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Salvatore Crispo
- Division of Cardiology, Emergency Department, AORN Cardarelli, Naples, Italy
| | - Eugenia Pasceri
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Santarpia
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Ciro Mauro
- Division of Cardiology, Emergency Department, AORN Cardarelli, Naples, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Curcio
- Division of Cardiology, Department of Pharmacy, Health Sciences and Nutrition, University of Calabria, Cosenza, Italy.
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Al Hennawi H, Khan MK, Khalid M, Khalid H, Fatima L, Ashraf MT, Bhimani S, Pavri BB. Beyond biventricular pacing: Exploring the advantages of his-bundle pacing and left bundle branch pacing in heart failure-A systematic review and meta-analysis. Pacing Clin Electrophysiol 2024; 47:156-166. [PMID: 38071452 DOI: 10.1111/pace.14892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/23/2023] [Accepted: 11/17/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND This meta-analysis compares His-Purkinje system pacing (HPSP), a novel cardiac resynchronization therapy (CRT) technique that targets the intrinsic conduction system of the heart, with conventional biventricular pacing (BiVP) in heart failure (HF) patients with left ventricular (LV) dysfunction and dyssynchrony. METHODS We searched multiple databases up to May 2023 and identified 18 studies (five randomized controlled trials and 13 observational studies) involving 1291 patients. The outcome measures were QRS duration, left ventricular ejection fraction (LVEF) improvement, left ventricular end-diastolic diameter (LVEDD) change, HF hospitalization, and New York Heart Association (NYHA) functional class improvement. We used a random-effects model to calculate odds ratios (OR), and mean differences (MD) with 95% confidence intervals (CI). We also assessed the methodological quality of the studies. RESULTS The mean LVEF was 30.7% and the mean follow-up duration was 8.1 months. Among LBBP, HBP, and BiVP, HBP provided the shortest QRS duration [MD: -18.84 ms, 95% CI: -28.74 to -8.94; p = 0.0002], while LBBP showed the greatest improvement in LVEF [MD: 5.74, 95% CI: 2.74 to 7.46; p < 0.0001], LVEDD [MD: -5.55 mm, 95% CI: -7.51 to -3.59; p < 0.00001], and NYHA functional class [MD: -0.58, 95% CI: -0.80 to --0.35; p < 0.00001]. However, there was no significant difference in HF hospitalization between HPSP and BiVP. CONCLUSION LBBP as modality of HPSP demonstrated superior outcomes in achieving electrical ventricular synchrony and systolic function, as well as alleviating HF symptoms, compared to other pacing techniques.
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Affiliation(s)
- Hussam Al Hennawi
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, Philadelphia, USA
| | | | - Momina Khalid
- Department of Internal Medicine, Jinnah Sindh Medical University Karachi, Karachi, Pakistan
| | - Hiba Khalid
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Laveeza Fatima
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Muhammad Talal Ashraf
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Sameer Bhimani
- Department of Internal Medicine, Jinnah Sindh Medical University Karachi, Karachi, Pakistan
| | - Behzad B Pavri
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, USA
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Sramko M, Kryze L, Kukla J, Necasova L, Wunschova H, Bocek J, Sedova KA, Kautzner J. Acute Hemodynamic Effect of a Novel Dual-Vein, Multisite Biventricular Pacing Configuration. JACC Clin Electrophysiol 2023; 9:2329-2338. [PMID: 37632507 DOI: 10.1016/j.jacep.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/07/2023] [Accepted: 07/03/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Biventricular pacing (BVP) from multiple left ventricular (LV) sites could enhance the efficacy of cardiac resynchronization therapy (CRT) by engaging a greater myocardial mass. OBJECTIVES The goal of this study was to evaluate the acute hemodynamic effect of various multisite pacing (MSP) configurations against conventional BVP. METHODS Twenty patients with nonischemic dilated cardiomyopathy and left bundle branch block (mean age: 59 ± 14 years; LV ejection fraction: 27% ± 6%; native QRS: 171 ± 16 milliseconds) were investigated during a routine CRT implant procedure. In addition to conventional right atrial and right ventricular leads, 2 quadripolar leads were placed in the distant coronary venous branches. LV hemodynamics was evaluated by using a micromanometer-tipped catheter during atrioventricular BVP with 4 LV lead configurations: single-lead conventional BVP; single-lead multipoint pacing; triventricular pacing from distal dipoles of 2 LV leads; and maximum MSP (MSP-Max) from 4 dipoles of 2 LV leads. RESULTS Compared with right atrial pacing, any BVP configuration produced a significant increase in the maximal LV diastolic pressure rise (LVdP/dTMax) (a median relative increase of 28% [IQR: 8%-45%], 25% [IQR: 18%-46%], 36% [IQR: 18%-54%], and 38% [IQR: 28%-58%], respectively; all, P < 0.001). MSP-Max but no other multisite BVP generated a significant increase of the maximal LVdP/dTMax than conventional BVP (P = 0.041). Increased LVdP/dTMax during MSP-Max was associated with greater LV diameter and lower LV ejection fraction, independently of the QRS width. CONCLUSIONS The study shows the hemodynamic advantage of a novel dual-vein MSP-Max configuration that could be useful for CRT in patients with advanced LV remodeling.
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Affiliation(s)
- Marek Sramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Lukas Kryze
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Kukla
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lucie Necasova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hanka Wunschova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Bocek
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ksenia A Sedova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Moustafa AT, Tang ASL, Khan HR. Conduction system pacing on track to replace CRT? Review of current evidence and prospects of conduction system pacing. Front Cardiovasc Med 2023; 10:1220709. [PMID: 37649666 PMCID: PMC10463741 DOI: 10.3389/fcvm.2023.1220709] [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: 05/11/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
Conduction system pacing (CSP) has been emerging over the last decade as a pacing option instead of conventional right ventricular (RV) pacing and biventricular (BiV) pacing. Numerous case reports, some observational studies and a few randomized control trials have looked at optimum pacing strategies for heart failure (HF) with left bundle branch block (LBBB) or cases where left ventricular (LV) dysfunction is anticipated due to chronic RV pacing (RVP). Evolution of pacing strategies from standard RVP to septal RVP, BiV pacing and now CSP have shown improving hemodynamic responses and possible ease of implantation of CSP systems. In this review article, we review the literature on the evolution of CSP and common scenarios where it might be beneficial.
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Affiliation(s)
| | | | - Habib Rehman Khan
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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Abstract
Left ventricular (LV) dP/dtmax provides a sensitive measure of the acute hemodynamic response to cardiac resynchronization therapy (CRT) and can predict reverse remodeling on echocardiography. Its use to guide LV lead placement has been shown to improve outcomes in a multicenter randomized trial. Given the invasive protocol required for measurement, it is unlikely to be universally beneficial for patients undergoing CRT but may be useful for patients who do not respond to conventional CRT, or in those who have borderline indications or risk factors for non-response. In such cases, LV dP/dtmax may help guide LV lead placement, optimize device programming, and select the best alternative method of delivering CRT, such endocardial LV pacing or conduction system pacing.
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Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Hua W, Cai L, Su Y, Xu W, Shen F, Wang J, Gu M, Badie N, Jiang C, Zhang S. Acute Hemodynamic Impact of Atrioventricular Delay and Left Ventricular Pacing Vector Programming in MultiPoint Pacing. Pacing Clin Electrophysiol 2022; 45:649-657. [PMID: 35306672 DOI: 10.1111/pace.14485] [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: 07/05/2021] [Revised: 02/15/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Wei Hua
- Fuwai Hospital CAMS & PUMC Beijing China
| | - Lin Cai
- The Third People's Hospital of Chengdu Chengdu China
| | - Yangang Su
- Shanghai Zhongshan Hospital Shanghai China
| | - Wei Xu
- Gulou Hospital Nanjing China
| | | | | | - Min Gu
- Fuwai Hospital CAMS & PUMC Beijing China
| | | | | | - Shu Zhang
- Fuwai Hospital CAMS & PUMC Beijing China
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Ghossein MA, Zanon F, Salden F, van Stipdonk A, Marcantoni L, Engels E, Luermans J, Westra S, Prinzen F, Vernooy K. Left Ventricular Lead Placement Guided by Reduction in QRS Area. J Clin Med 2021; 10:jcm10245935. [PMID: 34945236 PMCID: PMC8707800 DOI: 10.3390/jcm10245935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 12/07/2022] Open
Abstract
Background: Reduction in QRS area after cardiac resynchronization therapy (CRT) is associated with improved long-term clinical outcome. The aim of this study was to investigate whether the reduction in QRS area is associated with hemodynamic improvement by pacing different LV sites and can be used to guide LV lead placement. Methods: Patients with a class Ia/IIa CRT indication were prospectively included from three hospitals. Acute hemodynamic response was assessed as the relative change in maximum rate of rise of left ventricular (LV) pressure (%∆LVdP/dtmax). Change in QRS area (∆QRS area), in QRS duration (∆QRS duration), and %∆LVdP/dtmax were studied in relation to different LV pacing locations within a patient. Results: Data from 52 patients paced at 188 different LV pacing sites were investigated. Lateral LV pacing resulted in a larger %∆LVdP/dtmax than anterior or posterior pacing (p = 0.0007). A similar trend was found for ∆QRS area (p = 0.001) but not for ∆QRS duration (p = 0.23). Pacing from the proximal electrode pair resulted in a larger %∆LVdP/dtmax (p = 0.004), and ∆QRS area (p = 0.003) but not ∆QRS duration (p = 0.77). Within patients, correlation between ∆QRS area and %∆LVdP/dtmax was 0.76 (median, IQR 0.35; 0,89). Conclusion: Within patients, ∆QRS area is associated with %∆LVdP/dtmax at different LV pacing locations. Therefore, QRS area, which is an easily, noninvasively obtainable and objective parameter, may be useful to guide LV lead placement in CRT.
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Affiliation(s)
- Mohammed Ali Ghossein
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands;
- Correspondence:
| | - Francesco Zanon
- Santa Maria Della Misericordia General Hospital, 45100 Rovigo, Italy; (F.Z.); (L.M.)
| | - Floor Salden
- Maastricht University Medical Center, Department of Cardiology, Maastricht University, 6229 HX Maastricht, The Netherlands; (F.S.); (A.v.S.); (J.L.); (K.V.)
| | - Antonius van Stipdonk
- Maastricht University Medical Center, Department of Cardiology, Maastricht University, 6229 HX Maastricht, The Netherlands; (F.S.); (A.v.S.); (J.L.); (K.V.)
| | - Lina Marcantoni
- Santa Maria Della Misericordia General Hospital, 45100 Rovigo, Italy; (F.Z.); (L.M.)
| | - Elien Engels
- Yale New Haven Hospital, New Haven, CT 06510, USA;
| | - Justin Luermans
- Maastricht University Medical Center, Department of Cardiology, Maastricht University, 6229 HX Maastricht, The Netherlands; (F.S.); (A.v.S.); (J.L.); (K.V.)
| | - Sjoerd Westra
- Radboud University Medical Center, Radboud University Nijmegen, 6525 GA Nijmegen, The Netherlands;
| | - Frits Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Kevin Vernooy
- Maastricht University Medical Center, Department of Cardiology, Maastricht University, 6229 HX Maastricht, The Netherlands; (F.S.); (A.v.S.); (J.L.); (K.V.)
- Radboud University Medical Center, Radboud University Nijmegen, 6525 GA Nijmegen, The Netherlands;
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Fyenbo DB, Park Frausing MHJ, Kronborg MB. Bipolar versus quadripolar left ventricular leads for cardiac resynchronization therapy: evidence to date. Expert Rev Cardiovasc Ther 2021; 19:1075-1084. [PMID: 34865590 DOI: 10.1080/14779072.2021.2013813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In cardiac resynchronization therapy (CRT) devices, transvenous left ventricular (LV) leads are more prone to instability, high pacing thresholds, and phrenic nerve stimulation (PNS) that may necessitate lead revision, replacement in a suboptimal position, or deactivation of the lead. To overcome some of these challenges, quadripolar (QP) LV leads have been developed and accounted for over 90% of implanted LV leads 5 years after they were introduced. AREAS COVERED This review provides an overview of the current evidence of implanting QP leads in CRT as compared with traditional bipolar (BP) leads including details about feasibility, safety and lead performance, clinical outcome and cost-effectiveness. EXPERT OPINION Based on the current literature, implantation with a QP lead decreases revision rates but does not affect any clinical outcomes including mortality, hospitalization, symptoms, or echocardiographic parameters. Feasibility and stability do not differ between QP and BP leads. A QP lead should be preferred as first choice over a BP lead due to lower rates of PNS and lower pacing thresholds leading to less frequent lead revisions and battery replacements. In addition, this strategy may be cost saving despite a higher price of QP leads.
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Affiliation(s)
- Daniel Benjamin Fyenbo
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmar
| | - Maria Hee Jung Park Frausing
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmar
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmar
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Cardiac resynchronization therapy with multipoint pacing via quadripolar lead versus traditional biventricular pacing: A systematic review and meta-analysis of clinical studies on hemodynamic, clinical, and prognostic parameters. Heart Rhythm O2 2021; 2:682-690. [PMID: 34988517 PMCID: PMC8710588 DOI: 10.1016/j.hroo.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is one of the cornerstones of heart failure (HF) therapy, as it has reduced mortality and morbidity and has shown improvement in functional capacity. Multipoint pacing (MPP) is a way of configuring CRT with the aim to improve the percentage of patients who respond to CRT. Objective To demonstrate the effectiveness of the MPP compared to traditional biventricular pacing (BiV). Methods We performed a systematic review and meta-analysis according to PRISMA guidelines of studies in which MPP vs BiV strategy were compared. Results MPP use is associated with a higher rate of patients experiencing functional improvement (odds ratio: 2.51, 95% confidence interval [CI], 1.56–4.06; P = .0002) and with higher delta LV dP/dtmax (mean difference, 1.82; 95% CI, 0.24–3.39; P = .0240) with respect to BiV. MPP and BiV have no significantly different effect on left ventricular end-systolic volume (LVESV) (mean difference, 0.39; 95% CI, -11.12 to 11.89; P = .9475); moreover, there is no significant difference between the 2 treatments regarding hospitalization for HF (odds ratio, 0.70; 95% CI, 0.32 to 1.54; P = .3816) and all-cause death (odds ratio, 0.81; 95% CI, 0.40 to 1.62; P = .5460). MPP is associated with a significantly lower projected battery longevity (mean difference -8.66 months; 95% CI, -13.67 to -3.66; P = .00007) with respect to BiV. Conclusion MPP significantly improves functional class and acute hemodynamic parameters with respect to BiV. Prognostic indices and LVESV are not significantly influenced by MPP. MPP is associated with a significant reduction in projected battery longevity.
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Schiedat F, Mijic D, Karosiene Z, Bogossian H, Zarse M, Lemke B, Hanefeld C, Mügge A, Kloppe A. Improvement of electrical synchrony in cardiac resynchronization therapy using dynamic atrioventricular delay programming and multipoint pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1963-1971. [PMID: 34586643 DOI: 10.1111/pace.14372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/06/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Optimization of cardiac resynchronization therapy (CRT) is often time-consuming and therefore underused in a clinical setting. Novel device-based algorithms aiming to simplify optimization include a dynamic atrioventricular delay (AVD) algorithm (SyncAV, Abbott) and multipoint pacing (MPP, Abbott). This study examines the acute effect of SyncAV and MPP on electrical synchrony in patients with newly and chronically implanted CRT devices. METHODS Patients with SyncAV and MPP enabled devices were prospectively enrolled during implant or scheduled follow-up. Blinded 12-lead electrocardiographic acute measurements of QRS duration (QRSd) were performed for intrinsic QRSd (Intrinsic), bi-ventricular pacing (BiV), MPP, BiV with SyncAV at default offset 50 ms (BiVSyncAVdef ), BiV with SyncAV at patient-specific optimised offset (BiVSyncAVopt ), MPP with SyncAV at default offset 50 ms (MPPSyncAVdef ), and MPP with SyncAV at patient-specific optimised offset (MPPSyncAVopt ). RESULTS Thirty-three patients were enrolled. QRSd for Intrinsic, BiV, MPP, BiVSyncAVdef , BiVSyncAVopt , MPPSyncAVdef , MPPSyncAVopt were 160.4 ± 20.6 ms, 141.0 ± 20.5 ms, 130.2 ± 17.2 ms, 121.7 ± 20.9 ms, 117.0 ± 19.0 ms, 121.2 ± 17.1 ms, 108.7 ± 16.5 ms respectively. MPPSyncAVopt led to greatest reduction of QRSd relative to Intrinsic (-31.6 ± 11.1%; p < .001), showed significantly shorter QRSd compared to all other pacing configurations (p < .001) and shortest QRSd in every patient. Shortening of QRSd was not significantly different between newly and chronically implanted devices (-51.6 ± 14.7 ms vs. -52.7 ± 21.9 ms; p = .99). CONCLUSION SyncAV and MPP improved acute electrical synchrony in CRT. Combining both technologies with patient-specific optimization resulted in greatest improvement, regardless of time since implantation. Whats new Novel device-based algorithms like a dynamic AVD algorithm (SyncAV, Abbott) and multipoint pacing (MPP, Abbott) aim to simplify CRT optimization. Our data show that a combination of patient tailored SyncAV optimization and MPP results in greatest improvement of electrical synchrony in CRT measured by QRS duration, regardless if programmed in newly or chronically implanted devices. This is the first study to our knowledge to examine a combination of these device-based algorithms. The results help understanding the ideal ventricular excitation in heart failure.
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Affiliation(s)
- Fabian Schiedat
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, Bochum, Germany.,Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Germany
| | - Dejan Mijic
- Practice for Cardiology and Cardiac Surgery, Wuppertal, Germany
| | - Zana Karosiene
- Department of Cardiology, Electrophysiology and Angiology, Klinikum, Luedenscheid, Germany
| | - Harilaos Bogossian
- Department of Cardiology, Electrophysiology and Angiology, Klinikum, Luedenscheid, Germany.,University of Witten/Herdecke, Witten, Germany
| | - Markus Zarse
- Department of Cardiology, Electrophysiology and Angiology, Klinikum, Luedenscheid, Germany
| | - Bernd Lemke
- Department of Cardiology, Electrophysiology and Angiology, Klinikum, Luedenscheid, Germany
| | - Christoph Hanefeld
- Department of Internal Medicine at Elisabeth Krankenhaus Bochum of the Ruhr University, Bochum, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, Bochum, Germany
| | - Axel Kloppe
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Germany
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13
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Butter C, Georgi C, Stockburger M. Optimal CRT Implantation-Where and How To Place the Left-Ventricular Lead? Curr Heart Fail Rep 2021; 18:329-344. [PMID: 34495452 PMCID: PMC8484220 DOI: 10.1007/s11897-021-00528-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 12/28/2022]
Abstract
Purpose of Review Cardiac resynchronization therapy (CRT) represents a well-established and effective non-pharmaceutical heart failure (HF) treatment in selected patients. Still, a significant number of patients remain CRT non-responders. An optimal placement of the left ventricular (LV) lead appears crucial for the intended hemodynamic and hence clinical improvement. A well-localized target area and tools that help to achieve successful lead implantation seem to be of utmost importance to reach an optimal CRT effect. Recent Findings Recent studies suggest previous multimodal imaging (CT/cMRI/ECG torso) to guide intraprocedural LV lead placement. Relevant benefit compared to empirical lead optimization is still a matter of debate. Technical improvements in leads and algorithms (e.g., multipoint pacing (MPP), adaptive algorithms) promise higher procedural success. Recently emerging alternatives for ventricular synchronization such as conduction system pacing (CSP), LV endocardial pacing, or leadless pacing challenge classical biventricular pacing. Summary This article reviews current strategies for a successful planning, implementation, and validation of the optimal CRT implantation. Pre-implant imaging modalities offer promising assistance for complex cases; empirical lead positioning and intraoperative testing remain the cornerstone in most cases and ensure a successful CRT effect.
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Affiliation(s)
- Christian Butter
- Department of Cardiology, Heart Center Brandenburg, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Christian Georgi
- Department of Cardiology, Heart Center Brandenburg, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Martin Stockburger
- Department of Internal Medicine/Cardiology, Havelland Kliniken GmbH, Nauen, Germany
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14
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Drucker MN, Manyam H, Singh G, Glascock DN, Gillett S, Miller C, Sharmin K, Parks KA. MultiPole pacing in non-responders to cardiac resynchronization therapy: Results from the QP ExCELs/MPP sub-study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1683-1690. [PMID: 34405423 DOI: 10.1111/pace.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/26/2021] [Accepted: 08/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Multisite LV stimulation therapy allows for stimulation of two different left ventricular pacing vectors within a single LV lead and may improve responsiveness to cardiac resynchronization therapy (CRT). This study prospectively evaluated the safety and efficacy of the MultiPole Pacing (MPP) feature in CRT non-responder patients. METHODS AND RESULTS CRT non-responders with a standard CRT-D indication were eligible for enrollment into the MPP Sub-Study. Patient status, NYHA classification, Patient Global Assessment (PGA), and adverse events were collected at follow-up. A clinical composite score (CCS) was determined at the 6 month follow-up visit. The primary objective was defined as the proportion of patients with an improved CCS. Safety was evaluated as freedom from MPP system related adverse events requiring additional invasive intervention to resolve. A total of 53 patients were enrolled across 26 U.S. centers. The cumulative follow-up duration was 24.1 years. CCS was improved in 35.6% of patients (p < .0001 when compared to a performance goal of 3%) after 6 months of MPP therapy. When incorporating patient feedback into a modified CCS, 60.0% of patients showed an improvement. Three patients (5.7%) experienced hospitalization for heart failure, and three patient deaths occurred over the follow-up period. No MPP system-related events were reported for an AE-free rate of 100% (95% CI 93.28% to 100.0%). CONCLUSIONS The results of this small, non-randomized study suggest that the MPP feature is safe, and may be effective at converting a percentage of CRT non-responders to responders. Larger, randomized studies are needed to confirm this result.
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Affiliation(s)
| | | | | | | | | | | | | | - Kimberly A Parks
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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15
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Herweg B, Welter-Frost A, Vijayaraman P. The evolution of cardiac resynchronization therapy and an introduction to conduction system pacing: a conceptual review. Europace 2021; 23:496-510. [PMID: 33247913 DOI: 10.1093/europace/euaa264] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Indexed: 01/14/2023] Open
Abstract
In chronic systolic heart failure and conduction system disease, cardiac resynchronization therapy (CRT) is the only known non-pharmacologic heart failure therapy that improves cardiac function, functional capacity, and survival while decreasing cardiac workload and hospitalization rates. While conventional bi-ventricular pacing has been shown to benefit patients with heart failure and conduction system disease, there are limitations to its therapeutic success, resulting in widely variable clinical response. Limitations of conventional CRT evolve around myocardial scar, fibrosis, and inability to effectively simulate diseased tissue. Studies have shown endocardial stimulation in closer proximity to the specialized conduction system is more effective when compared with epicardial stimulation. Several observational and acute haemodynamic studies have demonstrated improved electrical resynchronization and echocardiographic response with conduction system pacing (CSP). Our objective is to provide a systematic review of the evolution of CRT, and an introduction to CSP as an intriguing, though experimental physiologic alternative to conventional CRT.
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Affiliation(s)
- Bengt Herweg
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, South Tampa Center, 2 Tampa General Circle, Tampa, FL 33606, USA.,Tampa General Hospital, USF Health South Tampa Center, 1 Tampa General Circle, Tampa, FL 33606, USA
| | - Allan Welter-Frost
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, South Tampa Center, 2 Tampa General Circle, Tampa, FL 33606, USA.,Tampa General Hospital, USF Health South Tampa Center, 1 Tampa General Circle, Tampa, FL 33606, USA
| | - Pugazhendhi Vijayaraman
- Division of Cardiology, Geisinger Commonwealth School of Medicine, Geisinger Heart Institute, MC 36-10, 1000 E Mountain Blvd, Wilkes-Barre, PA 18711, USA
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16
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Dell'Era G, Gravellone M, Scacchi S, Franzone PC, Pavarino LF, Boggio E, Prenna E, De Vecchi F, Occhetta E, Devecchi C, Patti G. A clinical-in silico study on the effectiveness of multipoint bicathodic and cathodic-anodal pacing in cardiac resynchronization therapy. Comput Biol Med 2021; 136:104661. [PMID: 34332350 DOI: 10.1016/j.compbiomed.2021.104661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
Up to one-third of patients undergoing cardiac resynchronization therapy (CRT) are nonresponders. Multipoint bicathodic and cathodic-anodal left ventricle (LV) stimulations could overcome this clinical challenge, but their effectiveness remains controversial. Here we evaluate the performance of such stimulations through both in vivo and in silico experiments, the latter based on computer electromechanical modeling. Seven patients, all candidates for CRT, received a quadripolar LV lead. Four stimulations were tested: right ventricular (RVS); conventional single point biventricular (S-BS); multipoint biventricular bicathodic (CC-BS) and multipoint biventricular cathodic-anodal (CA-BS). The following parameters were processed: QRS duration; maximal time derivative of arterial pressure (dPdtmax); systolic arterial pressure (Psys); and stroke volume (SV). Echocardiographic data of each patient were then obtained to create an LV geometric model. Numerical simulations were based on a strongly coupled Bidomain electromechanical coupling model. Considering the in vivo parameters, when comparing S-BS to RVS, there was no significant decrease in SV (from 45 ± 11 to 44 ± 20 ml) and 6% and 4% increases of dPdtmax and Psys, respectively. Focusing on in silico parameters, with respect to RVS, S-BS exhibited a significant increase of SV, dPdtmax and Psys. Neither the in vivo nor in silico results showed any significant hemodynamic and electrical difference among S-BS, CC-BS and CA-BS configurations. These results show that CC-BS and CA-BS yield a comparable CRT performance, but they do not always yield improvement in terms of hemodynamic parameters with respect to S-BS. The computational results confirmed the in vivo observations, thus providing theoretical support to the clinical experiments.
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Affiliation(s)
- G Dell'Era
- Cardiologia 1, Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy
| | - M Gravellone
- Divisione di Cardiologia, Ospedale Degli Infermi, Biella, Italy
| | - S Scacchi
- Dipartimento di Matematica, Università Degli Studi di Milano, Via Saldini 50, 20133, Milano, Italy.
| | - P Colli Franzone
- Dipartimento di Matematica, Università Degli Studi di Pavia, Via Ferrata 1, 27100, Pavia, Italy
| | - L F Pavarino
- Dipartimento di Matematica, Università Degli Studi di Pavia, Via Ferrata 1, 27100, Pavia, Italy
| | - E Boggio
- Divisione di Cardiologia, Ospedale Degli Infermi, Biella, Italy
| | - E Prenna
- Cardiologia 1, Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy
| | - F De Vecchi
- Divisione di Cardiologia, Ospedale Sant'Andrea, Vercelli, Italy
| | - E Occhetta
- Divisione di Cardiologia, Ospedale Sant'Andrea, Vercelli, Italy
| | - C Devecchi
- Divisione di Cardiologia, Ospedale Sant'Andrea, Vercelli, Italy
| | - G Patti
- Cardiologia 1, Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy; Dipartimento di Medicina Traslazionale, Università Del Piemonte Orientale, Novara, Italy
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17
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Marques P, Nunes-Ferreira A, Silvério António P, Aguiar-Ricardo I, Rodrigues T, Badie N, Marcos I, Bernardes A, Pinto FJ, de Sousa J. Clinical impact of MultiPoint pacing in responders to cardiac resynchronization therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1577-1584. [PMID: 34255874 DOI: 10.1111/pace.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/08/2021] [Accepted: 07/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy demonstrated benefits in heart failure. However, only 60-70% are responders and only 22% are super-responders. MultiPoint pacing (MPP) improves structural remodeling, but data in responder patients is scarce. METHODS A prospective, randomized study of the efficacy of MPP was conducted in patients who were CRT responders after 6 months of bi-ventricular (BiV) therapy. At 6 months, responder patients (LV end-systolic volume [LVESV] reduction ≥15%) were randomized to either continued BiV therapy or to MPP programmed with wide anatomical separation ≥30 mm, and followed until 12 months. Efficacy was determined by 6-12 month changes in LVESV and LV ejection fraction (LVEF). Evaluations of super-responder rate (LVESV reduction ≥30%) and quality of life (NYHA, EQ-5D, MLHFQ) were also performed. RESULTS From February 2017 to February 2019, 73 CRTs with Quartet LV leads were implanted (42.9% female, 65.7 ± 10.8 years old, 79.5% dilated cardiomyopathy). At 6 months, 74.2% responded to BiV and were randomized to BiV (n = 25) or MPP (n = 24). MPP versus BiV delivered greater LVESV improvement (8.3% decrease in MPP vs. 10.3% increase in BiV patients, p = .047), greater increase in LVEF (7.7% vs. 1.8%, p = .008), and higher 0-12 month super-responder rate (86.4% vs. 56.0%, p = .027). More MPP vs. BiV patients experienced an improvement in NYHA (84.6% vs. 50.0%, p = .047) and EQ-5D (94.4% vs. 54.0%, p = .006). CONCLUSIONS MPP with wide anatomical spacing in CRT responder patients resulted in improved LV reverse remodeling with higher rates of super-responders, and better quality of life metrics.
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Affiliation(s)
- Pedro Marques
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Afonso Nunes-Ferreira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Pedro Silvério António
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Inês Aguiar-Ricardo
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Tiago Rodrigues
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | | | - Ivo Marcos
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Ana Bernardes
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - João de Sousa
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
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18
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Bazoukis G, Naka KK, Alsheikh-Ali A, Tse G, Letsas KP, Korantzopoulos P, Liu T, Yeung C, Efremidis M, Tsioufis K, Baranchuk A, Stavrakis S. Association of QRS narrowing with response to cardiac resynchronization therapy-a systematic review and meta-analysis of observational studies. Heart Fail Rev 2021; 25:745-756. [PMID: 31392534 DOI: 10.1007/s10741-019-09839-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Prolonged QRS duration, which reflects a higher degree of mechanical dysynchrony, is a predictor of response to CRT. However, the association of QRS narrowing after biventricular pacing with CRT response rates is not clear. Our aim was to conduct a systematic review and meta-analysis on the association between QRS narrowing after cardiac resynchronization therapy (CRT) and clinical and echocardiographic response to CRT in patients with heart failure. Two independent investigators searched MedLine and EMBASE databases through July 2018 without any limitations. Studies providing estimates (continuous data) on the association of QRS shortening with either clinical (defined as New York Heart Association (NYHA) reduction ≥ 1) or echocardiographic (defined as left ventricular end-systolic volume (LVESV) reduction ≥ 15%) response to CRT were finally included in the quantitative synthesis. We included 32 studies (14 studies (1274 patients mean age 64 years old, males 79.3%) using clinical CRT response and 18 studies (1270 patients, mean age 64 years old, males 69.1%) using echocardiographic CRT response). A significant association between QRS narrowing and shorter attained QRS duration with clinical and echocardiographic CRT response was observed. The observed association was independent of the timing of QRS width measurement after CRT implantation. Acute and late improvement of electrical dysynchrony as depicted by QRS narrowing following biventricular pacing is associated with clinical and echocardiographic response to CRT. However, large prospective studies are needed to further examine our findings.
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Affiliation(s)
- George Bazoukis
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece. .,The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Katerina K Naka
- Second Department of Cardiology, University of Ioannina, GR 45110, Ioannina, Greece
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - Konstantinos P Letsas
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | | | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Cynthia Yeung
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Michael Efremidis
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Stavros Stavrakis
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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19
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Almusaad A, Sweidan R, Alanazi H, Jamiel A, Bokhari F, Al Hebaishi Y, Al Fagih A, Alrawahi N, Al-Mandalawi A, Hashim M, Al Ghamdi B, Amin M, Elmaghawry M, Al Shoaibi N, Sorgente A, Loricchio M, AlMohani G, Al Abri I, Benjamin E, Sudan N, Chami A, Badie N, Sayed M, Hersi A. Long-term reverse remodeling and clinical improvement by MultiPoint Pacing in a randomized, international, Middle Eastern heart failure study. J Interv Card Electrophysiol 2021; 63:399-407. [PMID: 34156610 PMCID: PMC8983631 DOI: 10.1007/s10840-020-00928-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/27/2020] [Indexed: 11/28/2022]
Abstract
Purpose Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint™ Pacing, MPP) has been shown to improve CRT response, although MPP response using automated pacing vector programming has not been demonstrated in the Middle East. The purpose of this study was to compare the impact of MPP to conventional biventricular pacing (BiV) using echocardiographic and clinical changes at 6-month post-implant. Methods This prospective, randomized study was conducted at 13 Middle Eastern centers. After de novo CRT-D implant (Abbott Unify Quadra MP™ or Quadra Assura MP™) with quadripolar LV lead (Abbott Quartet™), patients were randomized to either BiV or MPP therapy. In BiV patients, the LV pacing vector was selected per standard practice; in MPP patients, the two LV pacing vectors were selected automatically using VectSelect. CRT response was defined at 6-month post-implant by a reduction in LV end-systolic volume (ESV) ≥ 15%. Results One hundred and forty-two patients (61 years old, 68% male, NYHA class II/III/IV 19%/75%/6%, 33% ischemic, 57% hypertension, 52% diabetes, 158 ms QRS, 25.8% ejection fraction [EF]) were randomized to either BiV (N = 69) or MPP (N = 73). After 6 months, MPP vs. BiV patients experienced greater ESV reduction (25.0% vs. 15.3%, P = 0.08), greater EF improvement (11.9% vs. 8.6%, P = 0.36), significantly greater ESV response rate (68.5% vs. 50.7%, P = 0.04), and significantly greater NYHA class improvement rate (80.8% vs. 60.3%, P = 0.01). Conclusions With MPP and automatic LV vector selection, more CRT patients in the Middle East experienced reverse remodeling and clinical improvement relative to conventional BiV pacing.
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Affiliation(s)
- Abdulmohsen Almusaad
- King Abdalaziz Medical City -National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
| | - Raed Sweidan
- King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Haitham Alanazi
- King Abdalaziz Medical City -National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Abdelrahman Jamiel
- King Abdalaziz Medical City -National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Fayez Bokhari
- King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | | | - Ahmed Al Fagih
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Najib Alrawahi
- National Heart Center at the Royal Hospital, Muscat, Oman
| | | | | | - Bandar Al Ghamdi
- King Faisal Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | | | | | - Naeem Al Shoaibi
- King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | | | | | | | - Ismail Al Abri
- National Heart Center at the Royal Hospital, Muscat, Oman
| | | | | | | | | | - Mohammed Sayed
- Aswan Heart Centre - Magdi Yacoub Heart Foundation, Aswan, Egypt
| | - Ahmad Hersi
- King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia
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20
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Bessa A, Mendes Pimentel PG, Da Silva Menezes Junior A, Gonçalves LC, Barbosa VA, Fernandes JF, Laranjeira TDA, Cordeiro Silva AMT. Effectiveness of multipoint cardiac resynchronizing therapy in heart failure: a systematic review and meta-analysis of randomized controlled trials. Expert Rev Cardiovasc Ther 2021; 19:655-665. [PMID: 34106800 DOI: 10.1080/14779072.2021.1940961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy is an important validated technique for patients with dyssynchrony and heart failure. However, the response rate to conventional resynchronization is approximately 50%; therefore, new techniques and schedules have emerged. This study aimed to evaluate the different clinical and echocardiographic variables of conventional versus multipoint cardiac resynchronization therapy. RESEARCH DESIGN AND METHOD A systematic review was conducted of randomized clinical trials in the PubMed, Cochrane, and Embase databases on cardiac resynchronization intervention with multipoint stimulation clinical and echocardiographic outcomes evaluated before and 3 months after the intervention. RESULTS Three studies (N = 139) were ultimately selected, and 100% of patients had a New York Heart Association functional class of II-IV, QRS > 120 ms, and a left ventricular ejection fraction < 35%. Significantly greater improvement was observed in the functional class of patients who underwent multipoint versus conventional therapy. The final systolic volume and ejection fraction improved in the multipoint group, but the difference was not statistically significant. CONCLUSIONS The literature lacks sufficient randomized controlled studies to enable conclusions regarding cardiac resynchronization therapy responses using different strategies. Moreover, the improvement in functional class in the multipoint pacing group involved few patients and had slight statistical relevance.
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Affiliation(s)
- Alex Bessa
- School of Medical, Pharmaceutical and Biomedical Sciences, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil
| | | | - Antonio Da Silva Menezes Junior
- School of Medical, Pharmaceutical and Biomedical Sciences, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil.,Medical School,Federal University of Goiás, Goiânia, GO, Brazil
| | | | - Vinicius Araújo Barbosa
- School of Medical, Pharmaceutical and Biomedical Sciences, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil
| | - Joaquim Ferreira Fernandes
- School of Medical, Pharmaceutical and Biomedical Sciences, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil
| | - Tiago De Almeida Laranjeira
- School of Medical, Pharmaceutical and Biomedical Sciences, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil
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21
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Multipoint left ventricular pacing effects on hemodynamic parameters and functional status: HUMVEE single-arm clinical trial (NCT03189368). Hellenic J Cardiol 2021; 63:8-14. [DOI: 10.1016/j.hjc.2021.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/31/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022] Open
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22
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San Antonio R, Guasch E, González-Ascaso A, Jiménez-Arjona R, Climent AM, Pujol-López M, Doltra A, Alarcón F, Garre P, Liberos A, Trotta O, Quinto L, Borràs R, Arbelo E, Roca-Luque I, Atienza F, Brugada J, Fernández-Avilés F, Guillem MS, Sitges M, Tolosana JM, Mont L. Optimized single-point left ventricular pacing leads to improved resynchronization compared with multipoint pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:519-527. [PMID: 33538337 DOI: 10.1111/pace.14185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multipoint pacing (MPP) in cardiac resynchronization therapy (CRT) activates the left ventricle from two locations, thereby shortening the QRS duration and enabling better resynchronization; however, compared with conventional CRT, MPP reduces battery longevity. On the other hand, electrocardiogram-based optimization using the fusion-optimized intervals (FOI) method achieves more significant reverse remodeling than nominal CRT programming. Our study aimed to determine whether MPP could attain better resynchronization than single-point pacing (SPP) optimized by FOI. METHODS This prospective study included 32 consecutive patients who successfully received CRT devices with MPP capabilities. After implantation, the QRS duration was measured during intrinsic rhythm and with three pacing configurations: MPP, SPP-FOI, and MPP-FOI. In 14 patients, biventricular activation times (by electrocardiographic imaging, ECGI) were obtained during intrinsic rhythm and for each pacing configuration to validate the findings. Device battery longevity was estimated at the 45-day follow-up. RESULTS The SPP-FOI method achieved greater QRS shortening than MPP (-56 ± 16 vs. -42 ± 17 ms, p < .001). Adding MPP to the best FOI programming did not result in further shortening (MPP-FOI: -58 ± 14 ms, p = .69). Although biventricular activation times did not differ significantly among the three pacing configurations, only the two FOI configurations achieved significant shortening compared with intrinsic rhythm. The estimated battery longevity was longer with SPP than with MPP (8.1 ± 2.3 vs. 6.3 ± 2.0 years, p = .03). CONCLUSIONS SPP optimized by FOI resulted in better resynchronization and longer battery duration than MPP.
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Affiliation(s)
- Rodolfo San Antonio
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ana González-Ascaso
- ITACA Institute, Universitat Politècnica de València, Camino de Vera s/n, Valencia, Spain
| | - Rafael Jiménez-Arjona
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Andreu M Climent
- ITACA Institute, Universitat Politècnica de València, Camino de Vera s/n, Valencia, Spain
| | - Margarida Pujol-López
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Adelina Doltra
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Francisco Alarcón
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Paz Garre
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Alejandro Liberos
- ITACA Institute, Universitat Politècnica de València, Camino de Vera s/n, Valencia, Spain
| | - Omar Trotta
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Levio Quinto
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Roger Borràs
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Elena Arbelo
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ivo Roca-Luque
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Felipe Atienza
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain, Instituto de Investigación Sanitaria Gregorio Marañon (IISGM), Madrid, Spain
| | - Josep Brugada
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Francisco Fernández-Avilés
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain, Instituto de Investigación Sanitaria Gregorio Marañon (IISGM), Madrid, Spain
| | - María S Guillem
- ITACA Institute, Universitat Politècnica de València, Camino de Vera s/n, Valencia, Spain
| | - Marta Sitges
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Jose María Tolosana
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Lluís Mont
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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23
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Bianchi V, Martiniello AR, Mangual J, Tavoletta V, Pedrizzetti G, Tonti G, Caso VM, Caso P, D'Onofrio A. Impact of synchronous atrioventricular delay optimization on left ventricle flow force angle evaluated by echocardiographic particle image velocimetry. J Interv Card Electrophysiol 2021; 63:1-8. [PMID: 33474704 DOI: 10.1007/s10840-020-00923-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/27/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the improvement in electrical synchrony and left ventricle (LV) hemodynamics provided by combining the dynamic atrioventricular delay (AVD) of SyncAVTM CRT and the multiple LV pacing sites of MultiPoint pacing (MPP). METHODS Patients with LBBB and QRS duration (QRSd) > 140 ms implanted with a CRT-D or CRT-P device and quadripolar LV lead were enrolled in this prospective study. During a post-implant follow-up visit, QRSd was measured from 12-lead surface electrograms by experts blinded to pacing configurations. QRSd reduction relative to intrinsic rhythm was evaluated during biventricular pacing (BiV) and MPP for two AVDs: nominal (140/110 ms paced/sensed) and SyncAV (patient-optimized SyncAV offset [10-60 ms] minimizing QRSd). Echocardiography particle imaging velocimetry (Echo-PIV) analysis was performed for each configuration. The resulting hemodynamic force LV flow angle (φ) was analyzed, which ranges from 0o (predominantly base-apex forces) to 90o (predominantly transverse forces). Higher angles indicate more energy dissipation at lateral walls due to transverse flow; lower angles indicate healthier flow aligned with the longitudinal base-apex path of the pressure gradient. RESULTS Twelve patients (58% male, 17% ischemic, 32±7% ejection fraction, 165 ± 18 ms intrinsic QRSd) completed QRSd and Echo-PIV assessment. Relative to intrinsic rhythm, BiV and MPP with nominal AVD reduced QRSd by 10 ± 9% and 12 ± 9%, respectively. BiV+SyncAV and MPP+SyncAV further reduced QRSd by 19 ± 8%, (p < 0.05 vs. BiV with nominal AVD) and 23 ± 9% (p < 0.05 vs BiV+SyncAV), respectively. Echo-PIV showed similar sequential hemodynamic improvements. LV flow angular orientation during intrinsic activation (46 ± 3o) reduced with BiV+SyncAV (37 ± 4o, p < 0.05 vs intrinsic) and further with MPP+SyncAV (34 ± 4o, p < 0.05 vs BiV+SyncAV). CONCLUSION These results suggest that SyncAV may improve electrical synchrony and influence LV flow patterns in patients suffering from heart failure compared to conventional CRT with a fixed AVD, with further improvement observed by combining with MPP.
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Affiliation(s)
- Valter Bianchi
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy.
| | | | | | - Vincenzo Tavoletta
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Giovanni Tonti
- Cardiology Division, "G. D'Annunzio" University, Chieti, Italy
| | - Valentina Maria Caso
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Pio Caso
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Antonio D'Onofrio
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
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24
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Wang Z, Wu Y, Zhang J. Cardiac resynchronization therapy in heart failure patients: tough road but clear future. Heart Fail Rev 2020; 26:735-745. [PMID: 33098491 DOI: 10.1007/s10741-020-10040-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 01/14/2023]
Abstract
Cardiac resynchronization therapy (CRT) based on biventricular pacing (BVP) is an invaluable intervention currently used in heart failure (HF) patients. The therapy involves electromechanical dyssynchrony, which can not only improve heart function and quality of life but also reduce hospitalization and mortality rates. However, approximately 30% to 40% of patients remain unresponsive to conventional BVP in clinical practice. In the recent years, extensive research has been employed to find a more physiological approach to cardiac resynchronization. The His-Purkinje system pacing (HPSP) including His bundle pacing (HBP) and left bundle branch area pacing (LBBaP) may potentially be the future of CRT. These technologies present various advantages including offering an almost real physiological pacing, less complicated procedures, and economic feasibility. Additionally, other methods, such as isolated left-ventricular pacing and multipoint pacing, may in the future be important but non-mainstream alternatives to CRT because currently, there is no strong evidence to support their effectiveness. This article reviews the current situation and latest progress in CRT, explores the existing technology, and highlights future prospects in the development of CRT.
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Affiliation(s)
- Ziyu Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Junmeng Zhang
- Department of Cardiology, Heart Center, the First Hospital of Tsinghua University, No. 6 Jiuxianqiao 1st Street, Chaoyang District, Beijing, 100016, China.
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25
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Electrical synchronization achieved by multipoint pacing combined with dynamic atrioventricular delay. J Interv Card Electrophysiol 2020; 61:453-460. [DOI: 10.1007/s10840-020-00842-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
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26
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Heckman LIB, Kuiper M, Anselme F, Ziglio F, Shan N, Jung M, Zeemering S, Vernooy K, Prinzen FW. Evaluating multisite pacing strategies in cardiac resynchronization therapy in the preclinical setting. Heart Rhythm O2 2020; 1:111-119. [PMID: 34113865 PMCID: PMC8183878 DOI: 10.1016/j.hroo.2020.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Multisite pacing strategies that improve response to cardiac resynchronization therapy (CRT) have been proposed. Current available options are pacing 2 electrodes in a multipolar lead in a single vein (multipoint pacing [MPP]) and pacing using 2 leads in separate veins (multizone pacing [MZP]). Objective The purpose of this study was to compare in a systematic manner the acute hemodynamic response (AHR) and electrophysiological effects of MPP and MZP and compare them with conventional biventricular pacing (BiVP). Methods Hemodynamic and electrophysiological effects were evaluated in a porcine model of acute left bundle branch block (LBBB) (n = 8). AHR was assessed as LVdP/dtmax. Activation times were measured using >100 electrodes around the epicardium, measuring total activation time (TAT) and left ventricular activation time (LVAT). Results Compared to LBBB, BiVP, MZP, and MPP reduced TAT by 26% ± 10%, 32% ± 13%, and 32% ± 14%, respectively (P = NS between modes) and LVAT by 4% ± 5%, 11% ± 5%, and 12% ± 5%, respectively (P <.05 BiVP vs MPP and MZP). On average, BiVP increased LVdP/dtmax by 8% ± 4%, and optimal BiVP increased LVdP/dtmax by 13% ± 4%. The additional improvement in LVdP/dtmax by MZP and MPP was significant only when its increase during BiVP and decrease in TAT were poor (lower 25% of all sites in 1 subject). The increase in LVdP/dtmax was larger when large interelectrode distances (>5 cm vs <2.2 cm) were used. Conclusion In this animal model of acute LBBB, MPP and MZP create similar degrees of electrical resynchronization and hemodynamic effect, which are larger if interelectrode distance is large. MPP and MZP increase the benefit of CRT only if the left ventricular lead used for BiVP provides poor response.
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Affiliation(s)
- Luuk I B Heckman
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Marion Kuiper
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | | | | | | | | | - Stef Zeemering
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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27
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Lahiri A, Chahadi FK, Ganesan AN, McGavigan AD. Characteristics that Predict Response After Cardiac Resynchronization Therapy. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00640-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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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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29
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Forleo GB, Santini L, Calò L, Ricciardi D, Curnis A, Pignalberi C, Calzolari V, Giammaria M, Morani G, Bertaglia E, Ribatti V, Biffi M, Potenza D, Piro A, Covino G, Natale V, Gasperetti A, Notarstefano P, Lavalle C, Nabutovsky Y, Tondo C, Zanon F. Clinical and economic impact of multipoint left ventricular pacing: A comparative analysis from the Italian registry on multipoint pacing in cardiac resynchronization therapy (IRON‐MPP). J Cardiovasc Electrophysiol 2020; 31:1166-1174. [DOI: 10.1111/jce.14433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Giovanni B. Forleo
- Department of CardiologyAzienda Ospedaliera‐Universitaria “Luigi Sacco” Milano Italy
| | - Luca Santini
- Division of CardiologyOspedale GB Grassi Ostia Italy
| | - Leonardo Calò
- Division of CardiologyPoliclinico Casilino Roma Italy
| | - Danilo Ricciardi
- Department of CardiologyPoliclinico Universitario Campus Bio‐Medico Italy
| | - Antonio Curnis
- Department of CardiologySpedali Civili di Brescia Brescia Italy
| | | | | | | | - Giovanni Morani
- Department of CardiologyAzienda Ospedaliera Universitaria Verona Italy
| | | | | | - Mauro Biffi
- Department of CardiologyPoliclinico S. Orsola‐Maplighi Bologna Italy
| | - Domenico Potenza
- Division of CardiologyOspedale Casa Sollievo Della Sofferenza San Giovanni Rotondo Italy
| | - Agostino Piro
- Department of CardiologyPoliclinico Universitario Umberto I Roma Italy
| | - Gregorio Covino
- Division of CardiologyOspedale San Giovanni Bosco Napoli Italy
| | - Veronica Natale
- Department of CardiologyAzienda Ospedaliera‐Universitaria “Luigi Sacco” Milano Italy
| | - Alessio Gasperetti
- Department of CardiologyAzienda Ospedaliera‐Universitaria “Luigi Sacco” Milano Italy
- Department of CardiologyCentro Cardiologico Monzino Milano Italy
| | | | - Carlo Lavalle
- Department of CardiologyPoliclinico Universitario Umberto I Roma Italy
| | | | - Claudio Tondo
- Department of CardiologyCentro Cardiologico Monzino Milano Italy
| | - Francesco Zanon
- Division of CardiologySanta Maria della Misericordia Hospital Rovigo Italy
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30
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García Guerrero JJ, Fernández de la Concha Castañeda J, Chacón Piñero A, Hidalgo Martínez C, Badie N, McSpadden L, Ryu K. Extending multipoint pacing CRT battery longevity by swapping left ventricular pulse configurations. J Interv Card Electrophysiol 2020; 57:481-487. [DOI: 10.1007/s10840-020-00720-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/23/2020] [Indexed: 11/29/2022]
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31
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Solimene F, Nigro G, Canciello M, Tavoletta V, Shopova G, Calvanese R, Rago A, La Rosa C, Nappi F, Viscusi M, Urraro F, Manzo G, Gallo P, Andriani A, Rovaris G, Palmisano P, Innocenti S, D'Onofrio A. Design and rationale of the Impact of MultiPoint pacing in CRT patients with reduced RV-to-LV delay (IMAGE-CRT) study. J Cardiovasc Med (Hagerstown) 2020; 21:250-258. [PMID: 32004245 DOI: 10.2459/jcm.0000000000000928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an established treatment in patients with heart failure and prolonged QRS duration. A biventricular device is implanted to achieve faster activation and more synchronous contraction of the ventricles. Despite the convincing effect of CRT, 30-40% of patients do not respond. We decided to investigate the role of multipoint pacing (MPP) in a selected group of patients with right ventricle (RV)-to-left ventricle (LV) intervals less than 80 ms that do not respond to traditional CRT. METHODS We will enrol 248 patients in this patient-blinded, observational, clinical study aiming to investigate if MPP could decrease LV end-systolic volume (ESV) in patients with RV-to-LV interval less than 80 ms. MPP will be activated ON at implant in patients with RV-to-LV delay less than 80 ms and OFF in RV-to-LV at least 80 ms. At follow-up the activation of MPP will be related to CRT response. The primary study endpoint will be the responder rate at 6 months, defined as a decrease in LV ejection fraction, LV end-diastolic volume, LV end-systolic volume (LVESV) at least 15% from baseline. Secondary outcomes include 12 months relative percentage reduction in LVESV and a combined clinical outcome measure of response to CRT defined as the patient being alive, no hospitalization due to heart failure, and experiencing an improvement in New York Heart Association functional class (Composite-Score). CONCLUSION Reducing the nonresponder rate continues to be an important goal for CRT.If an increase in reverse remodelling can be achieved by MPP, this study supports the conduct of larger trials investigating the role of MPP on clinical outcomes in selected patients treated, right now, only with traditional CRT. TRIAL REGISTRATION ClinicalTrials.gov, NCT02713308. Registered on 18 March 2016.
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Affiliation(s)
| | - Gerardo Nigro
- University of Campania 'Luigi Vanvitelli', Monaldi Hospital
| | | | | | | | | | - Anna Rago
- University of Campania 'Luigi Vanvitelli', Monaldi Hospital
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32
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Maffessanti F, Jadczyk T, Kurzelowski R, Regoli F, Caputo ML, Conte G, Gołba KS, Biernat J, Wilczek J, Dąbrowska M, Pezzuto S, Moccetti T, Krause R, Wojakowski W, Prinzen FW, Auricchio A. The influence of scar on the spatio-temporal relationship between electrical and mechanical activation in heart failure patients. Europace 2020; 22:777-786. [DOI: 10.1093/europace/euz346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/05/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The aim of this study was to determine the relationship between electrical and mechanical activation in heart failure (HF) patients and whether electromechanical coupling is affected by scar.
Methods and results
Seventy HF patients referred for cardiac resynchronization therapy or biological therapy underwent endocardial anatomo-electromechanical mapping (AEMM) and delayed-enhancement magnetic resonance (CMR) scans. Area strain and activation times were derived from AEMM data, allowing to correlate mechanical and electrical activation in time and space with unprecedented accuracy. Special attention was paid to the effect of presence of CMR-evidenced scar. Patients were divided into a scar (n = 43) and a non-scar group (n–27). Correlation between time of electrical and mechanical activation was stronger in the non-scar compared to the scar group [R = 0.84 (0.72–0.89) vs. 0.74 (0.52–0.88), respectively; P = 0.01]. The overlap between latest electrical and mechanical activation areas was larger in the absence than in presence of scar [72% (54–81) vs. 56% (36–73), respectively; P = 0.02], with smaller distance between the centroids of the two regions [10.7 (4.9–17.4) vs. 20.3 (6.9–29.4) % of left ventricular radius, P = 0.02].
Conclusion
Scar decreases the association between electrical and mechanical activation, even when scar is remote from late activated regions.
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Affiliation(s)
- Francesco Maffessanti
- Center for Computational Medicine in Cardiology, Università della Svizzera italiana, Via G. Buffi 13, CH-6900 Lugano, Switzerland
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne’s University Hospital Brno, Czech Republic
| | - Radosław Kurzelowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - François Regoli
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Maria Luce Caputo
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Giulio Conte
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Krzysztof S Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Jolanta Biernat
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Magdalena Dąbrowska
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Simone Pezzuto
- Center for Computational Medicine in Cardiology, Università della Svizzera italiana, Via G. Buffi 13, CH-6900 Lugano, Switzerland
| | - Tiziano Moccetti
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Rolf Krause
- Center for Computational Medicine in Cardiology, Università della Svizzera italiana, Via G. Buffi 13, CH-6900 Lugano, Switzerland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Frits W Prinzen
- Department of Physiology, CARIM, Maastricht University, Maastricht, The Netherlands
| | - Angelo Auricchio
- Center for Computational Medicine in Cardiology, Università della Svizzera italiana, Via G. Buffi 13, CH-6900 Lugano, Switzerland
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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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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Shun-Shin MJ, Miyazawa AA, Keene D, Sterliński M, Sokal A, Van Heuverswyn F, Rinaldi CA, Cornelussen R, Stegemann B, Francis DP, Whinnett Z. How to deliver personalized cardiac resynchronization therapy through the precise measurement of the acute hemodynamic response: Insights from the iSpot trial. J Cardiovasc Electrophysiol 2019; 30:1610-1619. [PMID: 31115945 DOI: 10.1111/jce.14001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/17/2019] [Accepted: 05/19/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION New pacing technologies offer a greater choice of left ventricular pacing sites and greater personalization of cardiac resynchronization therapy (CRT). The effects on cardiac function of novel pacing configurations are often compared using multi-beat averages of acute hemodynamic measurements. In this analysis of the iSpot trial, we explore whether this is sufficient. MATERIALS AND METHODS The iSpot trial was an international, prospective, acute hemodynamic trial that assessed seven CRT configurations: standard CRT, MultiSpot (posterolateral vein), and MultiVein (anterior and posterior vein) pacing. Invasive and noninvasive blood pressure, and left ventricular (LV) dP/dtmax were recorded. Eight beats were recorded before and after an alternation from AAI to the tested pacing configuration and vice-versa. Eight alternations were performed for each configuration at each of the five atrioventricular delays. RESULTS Twenty-five patients underwent the full protocol of eight alternations. Only four (16%) patients had a statistically significant >3 mm Hg improvement over conventional CRT configuration (posterolateral vein, distal electrode). However, if only one alternation was analyzed (standard multi-beat averaging protocol), 15 (60%) patients falsely appeared to have a superior nonconventional configuration. Responses to pacing were significantly correlated between the different hemodynamic measures: invasive systolic blood pressure (SBP) vs noninvasive SBP r = 0.82 (P < .001); invasive SBP vs LV dP/dt r = 0.57, r2 = 0.32 (P < .001). CONCLUSIONS Current standard multibeat acquisition protocols are unfortunately unable to prevent false impressions of optimality arising in individual patients. Personalization processes need to include distinct repeated transitions to the tested pacing configuration in addition to averaging multiple beats. The need is not only during research stages but also during clinical implementation.
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Affiliation(s)
- Matthew J Shun-Shin
- International Centre for Circulatory Health, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Alejandra A Miyazawa
- International Centre for Circulatory Health, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Daniel Keene
- International Centre for Circulatory Health, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Maciej Sterliński
- The Second Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Adam Sokal
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center of Heart Disease, Zabrze, Poland
| | | | | | - Richard Cornelussen
- Bakken Research Center B.V., Research and Technology, Maastricht, The Netherlands
| | - Berthold Stegemann
- Bakken Research Center B.V., Research and Technology, Maastricht, The Netherlands
| | - Darrel P Francis
- International Centre for Circulatory Health, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Zachary Whinnett
- International Centre for Circulatory Health, Imperial College London, Hammersmith Hospital, London, United Kingdom
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35
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Zweerink A, Salden OA, van Everdingen WM, de Roest GJ, van de Ven PM, Cramer MJ, Doevendans PA, van Rossum AC, Vernooy K, Prinzen FW, Meine M, Allaart CP. Hemodynamic Optimization in Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2019; 5:1013-1025. [DOI: 10.1016/j.jacep.2019.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 11/16/2022]
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Abstract
CRT is a cornerstone of therapy for patients with heart failure and reduced ejection fraction. By restoring left ventricular (LV) electrical and mechanical synchrony, CRT can reduce mortality, improve LV function and reduce heart failure symptoms. Since its introduction, many advances have been made that have improved the delivery of and enhanced the response to CRT. Improving CRT outcomes begins with proper patient selection so CRT is delivered to all populations that could benefit from it, and limiting the implantation of CRT in those with a small chance of response. In addition, advancements in LV leads and delivery technologies coupled with multimodality imaging and electrical mapping have enabled operators to place coronary sinus leads in locations that will optimise electrical and mechanical synchrony. Finally, new pacing strategies using LV endocardial pacing or His bundle pacing have allowed for CRT delivery and improved response in patients with poor coronary sinus anatomy or lack of response to traditional CRT.
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Affiliation(s)
- George Thomas
- Department of Medicine, Division of Cardiology, Cornell University Medical Center New York, US
| | - Jiwon Kim
- Department of Medicine, Division of Cardiology, Cornell University Medical Center New York, US
| | - Bruce B Lerman
- Department of Medicine, Division of Cardiology, Cornell University Medical Center New York, US
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37
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Multisite pacing via a quadripolar lead for cardiac resynchronization therapy. J Interv Card Electrophysiol 2019; 56:117-125. [PMID: 31321658 DOI: 10.1007/s10840-019-00592-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
Cardiac resynchronization therapy is challenging. Up to 40% of patients are non-responder. Multisite pacing via a quadripolar lead, also called multipoint/multipole pacing (MPP), is a debated alternative. In this review, we summarize evidence in the literature, tips and pitfalls related to MPP programming, and the different algorithms of MPP in different manufacturers.
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38
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Multipoint left ventricular pacing with large anatomical separation improves reverse remodeling and response to cardiac resynchronization therapy in responders and non-responders to conventional biventricular pacing. Clin Res Cardiol 2019; 109:183-193. [DOI: 10.1007/s00392-019-01499-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
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39
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Pujol-López M, San Antonio R, Mont L, Trucco E, Tolosana JM, Arbelo E, Guasch E, Heist EK, Singh JP. Electrocardiographic optimization techniques in resynchronization therapy. Europace 2019; 21:1286-1296. [DOI: 10.1093/europace/euz126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/05/2019] [Indexed: 12/22/2022] Open
Abstract
Abstract
Cardiac resynchronization therapy (CRT) is a cornerstone of therapy for patients with heart failure, reduced left ventricular (LV) ejection fraction, and a wide QRS complex. However, not all patients respond to CRT: 30% of CRT implanted patients are currently considered clinical non-responders and up to 40% do not achieve LV reverse remodelling. In order to achieve the best CRT response, appropriate patient selection, device implantation, and programming are important factors. Optimization of CRT pacing intervals may improve results, increasing the number of responders, and the magnitude of the response. Echocardiography is considered the reference method for atrioventricular and interventricular (VV) intervals optimization but it is time-consuming, complex and it has a large interobserver and intraobserver variability. Previous studies have linked QRS shortening to clinical response, echocardiographic improvement and favourable prognosis. In this review, we describe the electrocardiographic optimization methods available: 12-lead electrocardiogram; fusion-optimized intervals (FOI); intracardiac electrogram-based algorithms; and electrocardiographic imaging. Fusion-optimized intervals is an electrocardiographic method of optimizing CRT based on QRS duration that combines fusion with intrinsic conduction. The FOI method is feasible and fast, further reduces QRS duration, can be performed during implant, improves acute haemodynamic response, and achieves greater LV remodelling compared with nominal programming of CRT.
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Affiliation(s)
- Margarida Pujol-López
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Rodolfo San Antonio
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Lluís Mont
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Emilce Trucco
- Department of Cardiology, Hospital Universitari Doctor Josep Trueta, Girona, Catalonia, Spain
| | - José María Tolosana
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Elena Arbelo
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Edwin Kevin Heist
- Cardiology Division, Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jagmeet P Singh
- Cardiology Division, Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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40
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Sieniewicz BJ, Jackson T, Claridge S, Pereira H, Gould J, Sidhu B, Porter B, Niederer S, Yao C, Rinaldi CA. Optimization of CRT programming using non-invasive electrocardiographic imaging to assess the acute electrical effects of multipoint pacing. J Arrhythm 2019; 35:267-275. [PMID: 31007792 PMCID: PMC6457383 DOI: 10.1002/joa3.12153] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/13/2018] [Indexed: 12/07/2022] Open
Abstract
AIM Quadripolar lead technology and multi-point pacing (MPP) are important clinical adjuncts in cardiac resynchronization therapy (CRT) pacing aimed at reducing the rate of non-response to therapy. Mixed results have been achieved using MPP and it is critical to identify which patients require this approach and how to configure their MPP stimulation, in order to achieve optimal electrical resynchronization. METHODS & RESULTS We sought to investigate whether electrocardiographic imaging (ECGi), using the CARDIOINSIGHT ™ inverse ECG mapping system, could identify alterations in electrical resynchronization during different methods of device optimization. In no patient did a single form of programming optimization provide the best electrical response. The effects of utilizing MPP were idiosyncratic and highly patient specific. ECGi activation maps were clearly able to discern changes in bulk LV activation during differing MPP programming. In two of the five subjects, MPP resulted in more rapid activation of the left ventricle compared to standard CRT; however, in the remaining three patients, the use of MPP did not appear to acutely improve electrical resynchronization. Crucially, this cohort showed evidence of extensive LV scarring which was well visualized using both CMR and ECGi voltage mapping. CONCLUSIONS Our work suggests a potential role for ECGi in the optimization of non-responders to CRT, as it allows the fusion of activation maps and scar analysis above and beyond interrogation of the 12 lead ECG.
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Affiliation(s)
- Benjamin J. Sieniewicz
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
| | - Tom Jackson
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
| | - Simon Claridge
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
| | - Helder Pereira
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - Justin Gould
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
| | - Baldeep Sidhu
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
| | - Steve Niederer
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - Cheng Yao
- CardioInsight Technologies, MedtronicMinneapolisMinnesota
| | - Christopher A. Rinaldi
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
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41
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Sinagra G, Proclemer A, Zecchin M. Resynchronization therapy in heart failure: the 'nonresponder'. J Cardiovasc Med (Hagerstown) 2019. [PMID: 29538157 DOI: 10.2459/jcm.0000000000000567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Trieste, Italy
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42
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Rationale and design of a randomized clinical trial to assess the safety and efficacy of multipoint pacing therapy: MOre REsponse on Cardiac Resynchronization Therapy with MultiPoint Pacing (MORE-CRT MPP-PHASE II). Am Heart J 2019; 209:1-8. [PMID: 30616009 DOI: 10.1016/j.ahj.2018.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 12/03/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. Data from the MultiPoint Pacing (MPP) IDE trial and MORE-CRT MPP-PHASE I study suggest improved response in subjects in the MPP arm-programmed with wide left ventricular (LV) electrode anatomical separation (≥30 mm) and shortest timing delays of 5 milliseconds (MPP-AS)-compared with quadripolar biventricular (BiV) pacing. STUDY DESIGN The MORE-CRT MPP-PHASE II trial is a prospective, randomized, multicenter study to assess the 6-month impact of MPP programmed to mandated MPP-AS settings in subjects who do not respond to 6 months of BiV pacing (MPP OFF). Approximately 5,000 subjects with a standard CRT indication will be enrolled and implanted with a quadripolar CRT system (Abbott) capable of delivering MPP. Only BiV pacing is activated at implant. At 6 months, subjects classified as CRT nonresponders (<15% reduction in LV end-systolic volume) are randomized (1:1) to MPP or continued BiV pacing. The mandated MPP parameters (eg, MPP-AS) are programmed to subjects randomized to the MPP arm. At 12 months, the 2 groups will be compared to determine if there is a difference in CRT response rate. CONCLUSIONS This trial will evaluate whether MPP programmed to mandated MPP-AS settings improves LV reverse remodeling and clinical response to CRT in patients who fail to respond to 6 months of BiV pacing (www.clinicaltrials.gov identifier NCT02006069).
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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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Della Rocca DG, Gianni C, Di Biase L, Natale A, Al-Ahmad A. Leadless Pacemakers: State of the Art and Future Perspectives. Card Electrophysiol Clin 2019; 10:17-29. [PMID: 29428139 DOI: 10.1016/j.ccep.2017.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leadless pacemaker therapy is a new technology that aims at avoiding lead- and pocket-related complications of conventional transvenous and epicardial pacing. To date, 2 self-contained leadless pacemakers for right ventricular pacing have been clinically available: the Nanostim Leadless Pacemaker System and the Micra Transcatheter Pacing System. Additionally, a new multicomponent leadless pacemaker for endocardial left ventricular pacing has been proposed as an alternative choice for cardiac resynchronization therapy. In this review, we describe the state of the art of leadless pacing and compare the currently available devices with traditional transvenous leadless pacemakers.
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Affiliation(s)
- Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA; Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Atrial Fibrillation and Arrhythmia Center, California Pacific Medical Center, San Francisco, CA, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA.
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Sieniewicz BJ, Gould J, Porter B, Sidhu BS, Teall T, Webb J, Carr-White G, Rinaldi CA. Understanding non-response to cardiac resynchronisation therapy: common problems and potential solutions. Heart Fail Rev 2019; 24:41-54. [PMID: 30143910 PMCID: PMC6313376 DOI: 10.1007/s10741-018-9734-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Heart failure is a complex clinical syndrome associated with a significant morbidity and mortality burden. Reductions in left ventricular (LV) function trigger adaptive mechanisms, leading to structural changes within the LV and the potential development of dyssynchronous ventricular activation. This is the substrate targeted during cardiac resynchronisation therapy (CRT); however, around 30-50% of patients do not experience benefit from this treatment. Non-response occurs as a result of pre-implant, peri-implant and post implant factors but the technical constraints of traditional, transvenous epicardial CRT mean they can be challenging to overcome. In an effort to improve response, novel alternative methods of CRT delivery have been developed and of these endocardial pacing, where the LV is stimulated from inside the LV cavity, appears the most promising.
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Affiliation(s)
- Benjamin J Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK.
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Baldeep S Sidhu
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Thomas Teall
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Jessica Webb
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Gerarld Carr-White
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Christopher A Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
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46
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O'Brien T, Park MS, Youn JC, Chung ES. The Past, Present and Future of Cardiac Resynchronization Therapy. Korean Circ J 2019; 49:384-399. [PMID: 31074211 PMCID: PMC6511527 DOI: 10.4070/kcj.2019.0114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 01/28/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) has revolutionized the care of the patients with heart failure with reduced ejection fraction and electrical dyssynchrony. The current guidelines for patient selection include measurement of left ventricular systolic function, QRS duration and morphology, and functional classification. Despite consistent and increasing evidence supporting CRT use in appropriate patients, CRT has been underutilized. Notwithstanding the heterogeneous definitions of non-response, more than one-third of patients demonstrate a lack of echocardiographic reverse remodeling or poor clinical outcome following CRT. Since the causes of this non-response are multifactorial, it will require multidisciplinary efforts to overcome including optimal patient selection, procedural strategies, as well as optimizing post-implant care in patients undergoing CRT. The innovations of novel pacing approaches combined with advanced imaging technologies may eventually offer a personalized CRT system uniquely tailored to each patient's dyssynchrony signature.
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Affiliation(s)
- Thomas O'Brien
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA.,The Lindner Center for Research and Education, Cincinnati, OH, USA
| | - Myung Soo Park
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jong Chan Youn
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
| | - Eugene S Chung
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA.,The Lindner Center for Research and Education, Cincinnati, OH, USA
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47
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Ciconte G, Ćalović Ž, McSpadden LC, Ryu K, Mangual J, Caporaso I, Baldi M, Saviano M, Cuko A, Vitale R, Conti M, Giannelli L, Vicedomini G, Santinelli V, Pappone C. Multipoint left ventricular pacing improves response to cardiac resynchronization therapy with and without pressure-volume loop optimization: comparison of the long-term efficacy of two different programming strategies. J Interv Card Electrophysiol 2018; 54:141-149. [DOI: 10.1007/s10840-018-0480-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022]
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48
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Improved acute haemodynamic response to cardiac resynchronization therapy using multipoint pacing cannot solely be explained by better resynchronization. J Electrocardiol 2018; 51:S61-S66. [DOI: 10.1016/j.jelectrocard.2018.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/06/2018] [Accepted: 07/14/2018] [Indexed: 11/18/2022]
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49
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Müller-Leisse J, Zormpas C, König T, Duncker D, Veltmann C. [Multipoint pacing-more CRT or a waste of battery power?]. Herz 2018; 43:596-604. [PMID: 30209518 DOI: 10.1007/s00059-018-4751-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with broad QRS complex ≥130 ms and heart failure with reduced ejection fraction despite optimal guideline-directed medical therapy. However, approximately 30% of the patients implanted with a CRT system do not show clinical benefit. Reasons for nonresponse are complex and some aspects can be addressed during follow-up. Based on quadripolar lead technology, multipoint pacing (MPP) allows left ventricular stimulation at two different sites along the lead. In particular, in scarred and fibrotic ventricular myocardium stimulation at two different sites may overcome conduction barriers and lead to homogeneous ventricular depolarization. Especially for patients that do not respond to conventional CRT, activation of MPP may present an option to increase clinical response. On the other hand, MPP may significantly decrease battery longevity.This review offers an overview of the current knowledge and data on MPP balancing the potential clinical benefit and the possible disadvantages of this therapy.
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Affiliation(s)
- J Müller-Leisse
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - C Zormpas
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - T König
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - D Duncker
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - C Veltmann
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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50
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Borgquist R. One Size Doesn't Fit All: A Closer Look at the Effects of Multipoint Pacing in Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2018; 4:890-892. [PMID: 30025688 DOI: 10.1016/j.jacep.2018.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/15/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Rasmus Borgquist
- Department of Clinical Sciences, Skane University Hospital, Cardiac Arrhythmia section, Lund University, Lund, Sweden.
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