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Trohman RG, Huang HD, Larsen T, Krishnan K, Sharma PS. Sensors for rate-adaptive pacing: How they work, strengths, and limitations. J Cardiovasc Electrophysiol 2020; 31:3009-3027. [PMID: 32877004 DOI: 10.1111/jce.14733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/19/2020] [Accepted: 08/19/2020] [Indexed: 12/21/2022]
Abstract
Chronotropic incompetence is the inability of the sinus node to increase heart rate commensurate with increased metabolic demand. Cardiac pacing alone may be insufficient to address exercise intolerance, fatigue, dyspnea on exertion, and other symptoms of chronotropic incompetence. Rate-responsive (adaptive) pacing employs sensors to detect physical or physiological indices and mimic the response of the normal sinus node. This review describes the development, strengths, and limitations of a variety of sensors that have been employed to address chronotropic incompetence. A mini-tutorial on programming rate-adaptive parameters is included along with emphasis that patients' lifestyles and underlying medical conditions require careful consideration. In addition, special sensor applications used to respond prophylactically to physiologic signals are detailed and an in-depth discussion of sensors as a potential aid in heart failure management is provided.
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Affiliation(s)
- Richard G Trohman
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Henry D Huang
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy Larsen
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kousik Krishnan
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Parikshit S Sharma
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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Cobb DB, Gold MR. The Role of Atrioventricular and Interventricular Optimization for Cardiac Resynchronization Therapy. Heart Fail Clin 2017; 13:209-223. [DOI: 10.1016/j.hfc.2016.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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3
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Nobre TS, Antunes-Correa LM, Groehs RV, Alves MJNN, Sarmento AO, Bacurau AV, Urias U, Alves GB, Rondon MUPB, Brum PC, Martinelli M, Middlekauff HR, Negrao CE. Exercise training improves neurovascular control and calcium cycling gene expression in patients with heart failure with cardiac resynchronization therapy. Am J Physiol Heart Circ Physiol 2016; 311:H1180-H1188. [PMID: 27591218 PMCID: PMC6347073 DOI: 10.1152/ajpheart.00275.2016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/31/2016] [Indexed: 01/06/2023]
Abstract
Heart failure (HF) is characterized by decreased exercise capacity, attributable to neurocirculatory and skeletal muscle factors. Cardiac resynchronization therapy (CRT) and exercise training have each been shown to decrease muscle sympathetic nerve activity (MSNA) and increase exercise capacity in patients with HF. We hypothesized that exercise training in the setting of CRT would further reduce MSNA and vasoconstriction and would increase Ca2+-handling gene expression in skeletal muscle in patients with chronic systolic HF. Thirty patients with HF, ejection fraction <35% and CRT for 1 mo, were randomized into two groups: exercise-trained (ET, n = 14) and untrained (NoET, n = 16) groups. The following parameters were compared at baseline and after 4 mo in each group: V̇o2 peak, MSNA (microneurography), forearm blood flow, and Ca2+-handling gene expression in vastus lateralis muscle. After 4 mo, exercise duration and V̇o2 peak were significantly increased in the ET group (P = 0.04 and P = 0.01, respectively), but not in the NoET group. MSNA was significantly reduced in the ET (P = 0.001), but not in NoET, group. Similarly, forearm vascular conductance significantly increased in the ET (P = 0.0004), but not in the NoET, group. The expression of the Na+/Ca2+ exchanger (P = 0.01) was increased, and ryanodine receptor expression was preserved in ET compared with NoET. In conclusion, the exercise training in the setting of CRT improves exercise tolerance and neurovascular control and alters Ca2+-handling gene expression in the skeletal muscle of patients with systolic HF. These findings highlight the importance of including exercise training in the treatment of patients with HF even following CRT.
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Affiliation(s)
- Thais S Nobre
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Raphaela V Groehs
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Adriana O Sarmento
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Aline V Bacurau
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Ursula Urias
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Guilherme B Alves
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Patrícia C Brum
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Martino Martinelli
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Holly R Middlekauff
- Department of Medicine (Cardiology) and Physiology, Geffen School of Medicine at UCLA, University of California, Los Angeles, California
| | - Carlos E Negrao
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil;
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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Cobb DB, Gold MR. The Role of Atrioventricular and Interventricular Optimization for Cardiac Resynchronization Therapy. Card Electrophysiol Clin 2015; 7:765-779. [PMID: 26596818 DOI: 10.1016/j.ccep.2015.08.008] [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] [Indexed: 06/05/2023]
Abstract
Many patients with left ventricular systolic dysfunction may benefit from cardiac resynchronization therapy; however, approximately 30% of patients do not experience significant clinical improvement with this treatment. AV and VV delay optimization techniques have included echocardiography, device-based algorithms, and several other novel noninvasive techniques. Using these techniques to optimize device settings has been shown to improve hemodynamic function acutely; however, the long-term clinical benefit is limited. In most cases, an empiric AV delay with simultaneous biventricular or left ventricular pacing is adequate. The value of optimization of these intervals in "nonresponders" still requires further investigation.
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Affiliation(s)
- Daniel B Cobb
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Michael R Gold
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
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Duncker D, Delnoy PP, Nägele H, Mansourati J, Mont L, Anselme F, Stengel P, Anselmi F, Oswald H, Leclercq C. First clinical evaluation of an atrial haemodynamic sensor lead for automatic optimization of cardiac resynchronization therapy. Europace 2015; 18:755-61. [PMID: 25976907 PMCID: PMC4880111 DOI: 10.1093/europace/euv114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/23/2015] [Indexed: 01/14/2023] Open
Abstract
AIMS One option to improve cardiac resynchronization therapy (CRT) responder rates lies in the optimization of pacing intervals. A haemodynamic sensor embedded in the SonRtip atrial lead measures cardiac contractility and provides a systematic automatic atrioventricular and interventricular delays optimization. This multi-centre study evaluated the safety and performance of the lead, up to 1 year. METHODS AND RESULTS A total of 99 patients were implanted with the system composed of the lead and a CRT-Defibrillator device. Patients were followed at 1, 3, 6, and 12 months post-implant. The primary safety objective was to demonstrate that the atrial lead complication free rate was superior to 90% at 3-months follow-up visit. A lead handling questionnaire was filled by implanting investigators. Lead electrical performances and the performance of the system to compute AV and VV delays were evaluated at each study visit over 1 year. The complication free rate at 3 months post-implant was 99.0% [95%CI 94.5-100.0%], P < 0.001. Electrical performances of the lead were adequate whatever the atrial lead position and remained stable over the study period. The optimization algorithm was able to compute AV and VV delays in 97% of patients, during >75% of the weeks. CONCLUSION The atrial lead is safe to implant and shows stable electrical performance over time. It therefore offers a promising tool for automatic CRT optimization to further improve responder rates to CRT.
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Affiliation(s)
- David Duncker
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | | | - Herbert Nägele
- Albertinen Hospital, Süntelstr. 11a, 22457 Hamburg, Germany
| | - Jacques Mansourati
- Cardiology Department, Brest University Hospital, Boulevard Tanguy Prigent, 29609 Brest, France
| | - Lluís Mont
- Cardiology Department - Arrhythmia Section, Thorax Institute - Hospital Clinic, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
| | - Frédéric Anselme
- Cardiology Department, Charles Nicolle University Hospital, 1 rue Germont, 76031 Rouen, France
| | - Petra Stengel
- Sorin Group Germany GmbH, Lindberghstr. 25, 80939 Munich, Germany
| | | | - Hanno Oswald
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Christophe Leclercq
- Cardiology Department Pontchaillou, University Hospital, 2 rue Henri Le Guilloux, 35033 Rennes, France
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Brugada J, Brachmann J, Delnoy PP, Padeletti L, Reynolds D, Ritter P, Borri-Brunetto A, Singh JP. Automatic optimization of cardiac resynchronization therapy using SonR-rationale and design of the clinical trial of the SonRtip lead and automatic AV-VV optimization algorithm in the paradym RF SonR CRT-D (RESPOND CRT) trial. Am Heart J 2014; 167:429-36. [PMID: 24655689 DOI: 10.1016/j.ahj.2013.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 12/03/2013] [Indexed: 11/17/2022]
Abstract
Although cardiac resynchronization therapy (CRT) is effective in most patients with heart failure (HF) and ventricular dyssynchrony, a significant minority of patients (approximately 30%) are non-responders. Optimal atrioventricular and interventricular delays often change over time and reprogramming these intervals might increase CRT effectiveness. The SonR algorithm automatically optimizes atrioventricular and interventricular intervals each week using an accelerometer to measure change in the SonR signal, which was shown previously to correlate with hemodynamic improvement (left ventricular [LV] dP/dtmax). The RESPOND CRT trial will evaluate the effectiveness and safety of the SonR optimization system in patients with HF New York Heart Association class III or ambulatory IV eligible for a CRT-D device. Enrolled patients will be randomized in a 2:1 ratio to either SonR CRT optimization or to a control arm employing echocardiographic optimization. All patients will be followed for at least 24 months in a double-blinded fashion. The primary effectiveness end point will be evaluated for non-inferiority, with a nested test of superiority, based on the proportion of responders (defined as alive, free from HF-related events, with improvements in New York Heart Association class or improvement in Kansas City Cardiomyopathy Questionnaire quality of life score) at 12 months. The required sample size is 876 patients. The two primary safety end points are acute and chronic SonR lead-related complication rates, respectively. Secondary end points include proportion of patients free from death or HF hospitalization, proportion of patients worsened, and lead electrical performance, assessed at 12 months. The RESPOND CRT trial will also examine associated reverse remodeling at 1 year.
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Affiliation(s)
- Josep Brugada
- Hospital Clinic, University of Barcelona, Barcelona, Spain.
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Heart failure monitoring with a cardiac resynchronization therapy device-based cardiac contractility sensor: a case series. J Med Case Rep 2014; 8:27. [PMID: 24467718 PMCID: PMC3917412 DOI: 10.1186/1752-1947-8-27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 11/20/2013] [Indexed: 12/04/2022] Open
Abstract
Introduction The SonR signal has been shown to reflect cardiac contractility. It is recorded with an atrial lead connected to a cardiac resynchronization therapy defibrillator. For the first time, clinical evidence on the use of the SonR signal in the monitoring of the clinical status of heart failure patients implanted with cardiac resynchronization therapy defibrillator are presented through three clinical cases. Case presentation In the two first patients (non-Hispanic/Latino white), the SonR amplitude increases concomitantly to clinical status improvement subsequent to cardiac resynchronization therapy defibrillator implantation. In the third patient (non-Hispanic/Latino white), a decrease in SonR amplitude is observed concomitantly to atrial fibrillation and clinical status deterioration. Conclusions This case series reports the association between SonR signal amplitude changes and patients’ clinical status. Combined with remote monitoring, early SonR signal amplitude remote monitoring could be a promising tool for heart failure patients’ management.
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Sacchi S, Contardi D, Pieragnoli P, Ricciardi G, Giomi A, Padeletti L. Hemodynamic Sensor in Cardiac Implantable Electric Devices: The Endocardial Accelaration Technology. JOURNAL OF HEALTHCARE ENGINEERING 2013; 4:453-64. [DOI: 10.1260/2040-2295.4.4.453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Improved coronary artery blood flow following the correction of systolic dyssynchrony with cardiac resynchronization therapy. Int J Cardiol 2013; 167:2167-71. [DOI: 10.1016/j.ijcard.2012.05.094] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/15/2012] [Accepted: 05/27/2012] [Indexed: 11/23/2022]
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BRUSICH SANDRO, TOMASIC DANKO, SOVILJ SINIŠA, MAGJAREVIC RATKO, FEREK-PETRIC BOZIDAR. New Cardiomechanic Pacing Lead Sensor Based on High Frequency Parameters: Experimental Studies in Sheep. J Cardiovasc Electrophysiol 2013; 24:338-46. [DOI: 10.1111/jce.12040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Giorgis L, Frogerais P, Amblard A, Donal E, Mabo P, Senhadji L, Hernández AI. Optimal Algorithm Switching for the Estimation of Systole Period From Cardiac Microacceleration Signals (SonR). IEEE Trans Biomed Eng 2012; 59:3009-15. [PMID: 22893366 DOI: 10.1109/tbme.2012.2212019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Ritter P, Delnoy PPHM, Padeletti L, Lunati M, Naegele H, Borri-Brunetto A, Silvestre J. A randomized pilot study of optimization of cardiac resynchronization therapy in sinus rhythm patients using a peak endocardial acceleration sensor vs. standard methods. Europace 2012; 14:1324-33. [PMID: 22549295 DOI: 10.1093/europace/eus059] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS Non-response rate to cardiac resynchronization therapy (CRT) might be decreased by optimizing device programming. The Clinical Evaluation on Advanced Resynchronization (CLEAR) study aimed to assess the effects of CRT with automatically optimized atrioventricular (AV) and interventricular (VV) delays, based on a Peak Endocardial Acceleration (PEA) signal system. METHODS AND RESULTS This multicentre, single-blind study randomized patients in a 1 : 1 ratio to CRT optimized either automatically by the PEA-based system, or according to centres' usual practices, mostly by echocardiography. Patients had heart failure (HF) New York Heart Association (NYHA) functional class III/IV, left ventricular ejection fraction (LVEF) <35%, QRS duration >150 or >120 ms with mechanical dyssynchrony. Follow-up was 1 year. The primary endpoint was the proportion of patients who improved their condition at 1 year, based on a composite of all-cause death, HF hospitalizations, NYHA class, and quality of life. In all, 268 patients in sinus rhythm (63% men; mean age: 73.1 ± 9.9 years; mean NYHA: 3.0 ± 0.3; mean LVEF: 27.1 ± 8.1%; and mean QRS duration: 160.1 ± 22.0 ms) were included and 238 patients were randomized, 123 to PEA and 115 to the control group. At 1 year, 76% of patients assigned to PEA were classified as improved, vs. 62% in the control group (P= 0.0285). The percentage of patients with improved NYHA class was significantly (P= 0.0020) higher in the PEA group than in controls. Fatal and non-fatal adverse events were evenly distributed between the groups. CONCLUSION PEA-based optimization of CRT in HF patients significantly increased the proportion of patients who improved with therapy, mainly through improved NYHA class, after 1 year of follow-up.
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AV interval optimization using pressure volume loops in dual chamber pacemaker patients with maintained systolic left ventricular function. Clin Res Cardiol 2012; 101:647-53. [DOI: 10.1007/s00392-012-0439-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 02/28/2012] [Indexed: 11/27/2022]
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Antonini L, Auriti A, Pasceri V, Meo A, Pristipino C, Varveri A, Greco S, Santini M. Optimization of the atrioventricular delay in sequential and biventricular pacing: physiological bases, critical review, and new purposes. Europace 2012; 14:929-38. [DOI: 10.1093/europace/eur425] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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CUOCO FRANKA, GOLD MICHAELR. Optimization of Cardiac Resynchronization Therapy: Importance of Programmed Parameters. J Cardiovasc Electrophysiol 2011; 23:110-8. [DOI: 10.1111/j.1540-8167.2011.02235.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The quest to discover effective methodologies to monitor the course of disease and response to therapeutic agents in patients with chronic heart failure continues. Clinical trials of specific therapeutic agents have shown efficacy in large groups of patients, but the outcome even with the most effective agents is recognized to be heterogeneous for largely unexplained reasons. The idea that the treatment of individual patients with heart failure could be guided by serial measurements of surrogate end points for mortality and morbidity remains attractive to clinicians. A new approach for clinicians is the guiding of heart failure care by hemodynamic implantable sensors, and in this paper, a brief review of the implantable technologies available to assess cardiac function for monitoring the course of chronic heart failure (CHF) is presented. Early results suggest that measurements arising from these implantable devices should help in guiding the long-term management of CHF patients. Careful consideration of measurements to make, end points to assess, and therapy in control patients will be essential in validating new approaches.
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Affiliation(s)
- G. PLICCHI
- Surgery and Transplantation Department, University of Bologna — via Massarenti no. 9, 40138 Bologna, Italy
| | - E. MARCELLI
- Surgery and Transplantation Department, University of Bologna — via Massarenti no. 9, 40138 Bologna, Italy
| | - L. CERCENELLI
- Surgery and Transplantation Department, University of Bologna — via Massarenti no. 9, 40138 Bologna, Italy
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MARCELLI E, VANOLI E, MATTERA GG, GAGGINI G, CERCENELLI L, PLICCHI G. AN ENDOCARDIAL ACCELERATION SENSOR FOR MONITORING CARDIAC FUNCTION OF ISCHEMIC HEARTS. J MECH MED BIOL 2011. [DOI: 10.1142/s0219519406001753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previous experimental studies demonstrated that in normal hearts, Peak Endocardial Acceleration (PEA), during isovolumic contraction phase, measured with an endocardial sensor (Best, Sorin) in the right ventricle (RV), tracks changes of left ventricular (LV) contractility. Aim of the study: To assess if PEA also tracks LV contractility changes in ischemic hearts resulting from coronary microembolizations (ME). Methods: Under general anaesthesia, six adult beagle dogs (12 ± 2 kg) were instrumented for chronic monitoring of LV pressure, ECG and PEA. Latex beads mixed with fluoroscopy dye were injected into the circumflex coronary artery to cause LV ischemia. Before and after ME, incremental dobutamine infusions were performed to evaluate the contractile response to adrenergic stimulation. Results: A significant correlation between PEA and LVdP /dt max was observed before and after ME. Such a strong correlation was maintained even during adrenergic stimulation (r = 0.83 to 0.99, p < 0.001). The sensor PEA appears to be an effective means for the chronic monitoring of the mechanical function of ischemic hearts.
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Affiliation(s)
- E. MARCELLI
- Surgery and Transplantation Department, University of Bologna — via Massarenti no 9, 40138 Bologna, Italy
| | - E. VANOLI
- Cardiology Department, University of Pavia, Italy
| | | | | | - L. CERCENELLI
- Surgery and Transplantation Department, University of Bologna — via Massarenti no 9, 40138 Bologna, Italy
| | - G. PLICCHI
- Surgery and Transplantation Department, University of Bologna — via Massarenti no 9, 40138 Bologna, Italy
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Houthuizen P, Bracke FALE, van Gelder BM. Atrioventricular and interventricular delay optimization in cardiac resynchronization therapy: physiological principles and overview of available methods. Heart Fail Rev 2011; 16:263-76. [PMID: 21431901 PMCID: PMC3074065 DOI: 10.1007/s10741-010-9215-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In this review, the physiological rationale for atrioventricular and interventricular delay optimization of cardiac resynchronization therapy is discussed including the influence of exercise and long-term cardiac resynchronization therapy. The broad spectrum of both invasive and non-invasive optimization methods is reviewed with critical appraisal of the literature. Although the spectrum of both invasive and non-invasive optimization methods is broad, no single method can be recommend for standard practice as large-scale studies using hard endpoints are lacking. Current efforts mainly investigate optimization during resting conditions; however, there is a need to develop automated algorithms to implement dynamic optimization in order to adapt to physiological alterations during exercise and after anatomical remodeling.
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Affiliation(s)
- Patrick Houthuizen
- Department of Cardiology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
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Tomasic D, Ferek-Petric B, Brusich S, Accardo AP. Acute animal and human study of tensiometric pacing lead sensor based on triboelectricity. IEEE Trans Biomed Eng 2011; 58. [PMID: 21536515 DOI: 10.1109/tbme.2011.2148198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cardiac contractions bend the implanted cardiac lead body, extend and compress the lead conductors, their insulation and the inserted stylet. Magnitude of lead deflection depends on cardiac muscle contraction forces. The purpose of study was to measure the charge generated due to triboelectric effect between one of the lead conductors and the inserted stylet. The charge was measured by differential charge amplifier being connected to isolation amplifier and power supply. Sensor signal, ECG and intracardiac electrograms were acquired. Three models of custom designed leads were implanted in 8 sheep. Measurements were done in 18 patients undergoing pacemaker implantation and replacement procedures. Atrial and ventricular tensiometric signals were recorded in dual chamber and in single-lead VDD patients. Recordings in sinus rhythm at various AV intervals and in supraventricular tachycardia were done. In average, charge variation between 1 and 600 pC was measured. Tensiometric stylet could be feasible hemodynamic sensor for myocardial contraction detection. Its main advantage is that it is easily exchangeable and universal for all leads.
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Donal E, Giorgis L, Cazeau S, Leclercq C, Senhadji L, Amblard A, Jauvert G, Burban M, Hernández A, Mabo P. Endocardial acceleration (sonR) vs. ultrasound-derived time intervals in recipients of cardiac resynchronization therapy systems. Europace 2011; 13:402-8. [PMID: 21212110 DOI: 10.1093/europace/euq411] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Erwan Donal
- Cardiology Department, CHU Rennes, Rennes, France.
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Affiliation(s)
- Faisal M. Merchant
- From the Cardiology Division (F.M.M.), Emory University School of Medicine, Atlanta, Ga; and the Cardiology Division (G.W.D., J.P.S.), Massachusetts General Hospital Heart Center, Harvard Medical School, Boston, Mass
| | - G. William Dec
- From the Cardiology Division (F.M.M.), Emory University School of Medicine, Atlanta, Ga; and the Cardiology Division (G.W.D., J.P.S.), Massachusetts General Hospital Heart Center, Harvard Medical School, Boston, Mass
| | - Jagmeet P. Singh
- From the Cardiology Division (F.M.M.), Emory University School of Medicine, Atlanta, Ga; and the Cardiology Division (G.W.D., J.P.S.), Massachusetts General Hospital Heart Center, Harvard Medical School, Boston, Mass
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Klimczak A, Chudzik M, Zielińska M, Budzikowski AS, Lewek J, K.Wranicz J. Optimization of atrio-ventricular delay in patients with dual-chamber pacemaker. Int J Cardiol 2010; 141:222-6. [DOI: 10.1016/j.ijcard.2009.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 10/18/2009] [Indexed: 10/20/2022]
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Bertini M, Delgado V, Bax JJ, Van de Veire NR. Why, how and when do we need to optimize the setting of cardiac resynchronization therapy? Europace 2009; 11 Suppl 5:v46-57. [DOI: 10.1093/europace/eup275] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Sciaraffia E, Malmborg H, Lonnerholm S, Blomstrom P, Blomstrom Lundqvist C. Right ventricular contractility as a measure of optimal interventricular pacing setting in cardiac resynchronization therapy. Europace 2009; 11:1496-500. [DOI: 10.1093/europace/eup288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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TASSIN AUDE, KOBEISSI ADONIS, VITALI LUCA, ROULEAU FRÉDÉRIC, RITTER PHILIPPE, GAGGINI GUIDO, DUPUIS JEANMARC. Relationship between Amplitude and Timing of Heart Sounds and Endocardial Acceleration. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 1:S101-4. [DOI: 10.1111/j.1540-8159.2008.02297.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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MIKI YUKO, ISHIKAWA TOSHIYUKI, MATSUSHITA KOHEI, YAMAKAWA YOUHEI, MATSUMOTO KATSUMI, SUMITA SHINICHI, UCHINO KAZUAKI, KIMURA KAZUO, UMEMURA SATOSHI. Optimal Programming of the Atrioventricular Delay Using the Phonocardiogram. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 1:S81-5. [DOI: 10.1111/j.1540-8159.2008.02258.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Miki Y, Ishikawa T, Matsushita K, Yamakawa Y, Matsumoto K, Sumita S, Uchino K, Kimura K, Umemura S. Novel method of predicting the optimal atrioventricular delay in patients with complete AV block, normal left ventricular function and an implanted DDD pacemaker. Circ J 2009; 73:654-7. [PMID: 19246815 DOI: 10.1253/circj.cj-08-0351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The optimal atrioventricular (AV) delay setting is important for achieving optimal AV synchrony in patients with an implanted DDD pacemaker. Using pulsed Doppler echocardiography is the most common method of predicting the optimal AV delay, but it is a complicated and time-consuming method. Therefore, an automatic optimizing function of the AV delay at different atrial rates is desirable for achieving a favorable hemodynamic state. This study aimed to predict the optimal AV delay using phonocardiography. METHODS AND RESULTS The amplitude of the first heart sound (S1) recorded on the phonocardiogram was measured with different AV delays in 6 patents with complete AV block, normal left ventricular function and an implanted DDD pacemaker. The correlation between the amplitude of S1 and the length of the AV delay was a cubic curve (y=974.15x(3)-23.084x(2)-8.0074x+0.7495, R2=0.9511). The length of the AV delay at the inflection point of the curve showed a significant positive correlation with the optimal AV delay determined by pulsed Doppler echocardiography (R=0.9254, P<0.01). CONCLUSIONS This study demonstrated a novel simple method of predicting the optimal AV delay using phono-cardiography.
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Affiliation(s)
- Yuko Miki
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
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Mangiavacchi M, Gasparini M, Genovese S, Pini D, Klersy C, Bragato R, Andreuzzi B, Municinò A, Regoli F, Galimberti P, Ceriotti C, Gronda E. Insulin-treated type 2 diabetes is associated with a decreased survival in heart failure patients after cardiac resynchronization therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 31:1425-32. [PMID: 18950300 DOI: 10.1111/j.1540-8159.2008.01206.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves cardiac performance and survival in patients with congestive heart failure. Recent observations suggest that diabetes is associated with a worse outcome in these patients. The aim of the study was to investigate the effect of diabetes and insulin treatment on outcome after CRT. METHODS Diabetic status and insulin treatment were assessed in 447 patients who underwent CRT (males 80.8%, mean age 65.7 +/- 9.7 years, ejection fraction 29.9 +/- 6.11%). Patients were stratified in three groups according to the presence or absence of diabetes and insulin treatment. RESULTS Nondiabetic patients were 366 (79.6%), noninsulin-treated diabetic patients 62 (13.9%), insulin-treated diabetic patients 29 (6.5%). The estimated death rate was 5.15 per 100 patients-year in the nondiabetic group, 8.63 in noninsulin-treated diabetics (HR 1.59, P = 0.240), and 15.84 in insulin-treated diabetics (HR 3.05, P = 0.004). Cardiac mortality accounted for 81% of deaths in nondiabetic patients and for 56% of deaths in diabetic patients. Diabetic patients tended to have a worse recovery of left ventricular ejection fraction over time (P = 0.057) and of the distance at 6-minute walking test (6MWT) (P = 0.018). CONCLUSIONS Insulin-treated diabetes is associated with a worse functional recovery and a higher mortality in patients with advanced heart failure after CRT. While cardiac death accounts for the majority of deaths in nondiabetic patients, a relevant proportion of the mortality in diabetic patients seem to result from noncardiac causes.
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YPENBURG CLAUDIA, VAN DE VEIRE NICO, WESTENBERG JOSJ, BLEEKER GABEB, MARSAN NINAAJMONE, HENNEMAN MAUREENM, VAN DER WALL ERNSTE, SCHALIJ MARTINJ, ABRAHAM THEODOREP, BAROLD SSERGE, BAX JEROENJ. Noninvasive Imaging in Cardiac Resynchronization Therapy-Part 2: Follow-up and Optimization of Settings. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1628-39. [DOI: 10.1111/j.1540-8159.2008.01237.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Akbarzadeh F, Toufan M. Atrioventricular delays, cardiac output and diastolic function in patients with implanted dual chamber pacing and sensing pacemakers. Pak J Biol Sci 2008; 11:2407-2412. [PMID: 19137850 DOI: 10.3923/pjbs.2008.2407.2412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The Cardiac Output (CO), Filling Time (FT) and Myocardial Performance Index (MPI) derived optimal atrioventricular delay (AVD), were compared and systolic and diastolic performance at every optimal AVD were analyzed. Thirty-two patients with implanted DDD pacemaker were investigated from implantation time to 6 months following PM implantation, in Cardiovascular Research Center of Tabriz University of Medical Sciences. The evaluation was performed during AV sequential pacing with different programmed AVDS ranged from 100 to 200 msec by steps of 20-30 msec. At every AVD, the following parameters were measured: FT, mitral VTI, ET, aortic VTI, ICT and IRT. CO and FT derived optimal AVDs were significantly different (146 +/- 37 and 126 +/- 35 msec, respectively), but their difference with MPI derived optimal AVDs was not significant (130 +/- 28 msec). ICT/ET was similar at CO, FT and MPI derived optimal AVD (0.24 +/- 0.10, 0.22 +/- 0.05 and 0.20 +/- 0.07, respectively). IRT/ET ratio was similar at CO, FT and MPI derived optimal AVDs (0.46 +/- 0.14, 0.45 +/- 0.10 and 0.42 +/- 0.10, respectively). Different methods indicate different optimal AVDs. However analysis of systolic and diastolic performance shows that different AVDs result in similar systolic or diastolic performance. At MPI optimized AVD, a high CO combined with the most advantageous conditions of both isovolumic contraction and relaxation phases is achieved.
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Affiliation(s)
- F Akbarzadeh
- Cardiovascular Research Center of Shahid Madani Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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WAGGONER ALAND, DE LAS FUENTES LISA, FADDIS MITCHELLN, GLEVA MARYEJ, SPENCE KARENE, DAVILA-ROMAN VICTORG. Left Ventricular Diastolic Filling Prior to Cardiac Resynchronization Therapy: Implications for Atrioventricular Delay Programming. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:838-44. [DOI: 10.1111/j.1540-8159.2008.01097.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Delnoy PP, Marcelli E, Oudeluttikhuis H, Nicastia D, Renesto F, Cercenelli L, Plicchi G. Validation of a peak endocardial acceleration-based algorithm to optimize cardiac resynchronization: early clinical results. Europace 2008; 10:801-8. [PMID: 18492682 PMCID: PMC2435018 DOI: 10.1093/europace/eun125] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) involves time-consuming procedures to achieve an optimal programming of the system, at implant as well as during follow-up, when remodelling occurs. A device equipped with an implantable sensor able to measure peak endocardial acceleration (PEA) has been recently developed to monitor cardiac function and to guide CRT programming. During scanning of the atrioventricular delay (AVD), PEA reflects both left ventricle (LV) contractility (LV dP/dtmax) and transmitral flow. A new CRT optimization algorithm, based on recording of PEA (PEAarea method) was developed, and compared with measurements of LV dP/dtmax, to identify an optimal CRT configuration. Methods and results We studied 15 patients in New York Heart Association classes II–IV and with a QRS duration >130 ms, who had undergone implantation of a biventricular (BiV) pulse generator connected to a right ventricular (RV) PEA sensor. At a mean of 39 ± 15 days after implantation of the CRT system, the patients underwent cardiac catheterization. During single-chamber LV or during BiV stimulation, with initial RV or LV stimulation, and at settings of interventricular intervals between 0 and 40 ms, the AVD was scanned between 60 and 220 ms, while LV dP/dtmax and PEA were measured. The area of PEA curve (PEAarea method) was estimated as the average of PEA values measured during AVD scanning. A ≥10% increase in LV dP/dtmax was observed in 12 of 15 patients (80%), who were classified as responders to CRT. In nine of 12 responders (75%), the optimal pacing configuration identified by the PEAarea method was associated with the greatest LV dP/dtmax. Conclusion The concordance of the PEAarea method with measurements of LV dP/dtmax suggests that this new, operator-independent algorithm is a reliable means of CRT optimization.
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Stanton T, Hawkins NM, Hogg KJ, Goodfield NE, Petrie MC, McMurray JJ. How should we optimize cardiac resynchronization therapy? Eur Heart J 2008; 29:2458-72. [DOI: 10.1093/eurheartj/ehn380] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Kloppe A, Lemke B, Zarse M. [New technologies in the optimization of CRT programming]. Herzschrittmacherther Elektrophysiol 2008; 19:19-29. [PMID: 18330672 DOI: 10.1007/s00399-008-0596-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 02/15/2008] [Indexed: 05/26/2023]
Abstract
After implanting a CRT device, consistent and scheduled patient follow-up is mandatory. Besides determining electrode parameters and reviewing arrhythmic episodes, these follow-ups focus on monitoring and optimizing congestive heart failure therapy. Therefore new CRT devices present methods for heart failure surveillance and telemetric transmission of the acquired data, which allows the physician to respond immediately to the varying needs of the respective heart failure patient. In addition to cardiac resynchronization, optimization of atrioventricular (AV) and interventricular (VV) delay provide major hemodynamic benefits. As echocardiographic optimization of AV and VV delay is time consuming it is often not feasible during daily clinical practice. Therefore implemented algorithms that automatically determine and adapt AV and VV delays with respect to the fluctuating needs of the patients are essential. This article presents the current state of monitoring and optimization methods in CRT devices.
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Affiliation(s)
- A Kloppe
- Innere Medizin III, Abteilung für Kardiologie and Angiologie, Klinikum Lüdenscheid, Paulmannshöher Str. 14, 58515 Lüdenscheid, Germany.
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Abstract
Electrical devices, Cardiac Resynchronization Therapy (CRT) pacemakers, the Implantable Cardiac Defibrillator (ICD) and a combination of both, constitute an important line of treatment in the therapy of moderate to severe chronic heart failure. The effectiveness of these devices in the treatment of acute decompensated heart failure has yet to be systematically evaluated. However, the beneficial clinical effects of CRT translate into a marked reduction of heart failure-related hospitalization. Devices also offer unique diagnostic applications by continuous measurement of clinically useful physiological parameters over time. Of particular interest, monitoring of intrathoracic impedance and right ventricular pressures allows to detect changes in volume load in an early stage prior to the development of clinical symptoms. This information could be helpful to stop further progression to acute cardiac decompensation and to avoid hospitalization and acute clinical events. Using modern telecommunication technology, patients can also be remotely monitored in their daily living environment. In consequence, the incorporation of device technology into heart failure management programs calls for a close cooperation between heart failure specialists and electrophysiologists. This review addresses therapeutic and diagnostic aspects of device therapies in the context of acute heart failure.
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Affiliation(s)
- Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, 171 76, Stockholm, Sweden.
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Morales MA, Startari U, Panchetti L, Rossi A, Piacenti M. Atrioventricular delay optimization by doppler-derived left ventricular dP/dt improves 6-month outcome of resynchronized patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 29:564-8. [PMID: 16784420 DOI: 10.1111/j.1540-8159.2006.00402.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Atrioventricular (AV) interval optimization, ensuring the best filling and the abolishment of presystolic mitral regurgitation, is crucial for the efficacy of cardiac resynchronization therapy (CRT). The methods proposed to optimize AV delay have many limitations. The maximum left ventricular pressure derivative (LV dP/dt)--an index of cardiac performance--could provide a clue for AV optimization. DP/dt can be calculated by the Doppler curve of mitral regurgitation jet and it is related to micromanometer-derived dP/dt. AIM The aim of this study was to assess whether optimal AV delay, defined as the highest noninvasive dP/dt, may provide clinical and functional benefits in CRT patients. METHODS Of 41 consecutive patients, 23 echo Doppler recordings were obtained at AV delays of 60, 80, 100, 120, 140, 160, 180 ms (Group I). Three patients were discarded because of suboptimal Doppler signal. In 15 patients an empiric AV delay of 120 ms was chosen (Group II). Both groups were programmed to atriosynchronous pacing mode and synchronous VV stimulation. RESULTS In Group I optimal AV delay was 60 ms in one patient, 80 ms in 6, 100 in 6, 120 in 8, 140 in 2. At 6 months follow-up, Group I showed a significantly lower NYHA class (2.1 +/- 0.1 vs 3 +/- 0.2 P < 0.01) and higher LV ejection fraction (LVEF): 32.1 + 1 versus 27.5 +/- 1.6% (P < 0.05) as compared to Group II. CONCLUSIONS Doppler-derived dP/dt for AV delay optimization determines better functional class and LVEF at 6 months follow-up relative to an empiric AV delay program.
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Burri H, Sunthorn H, Shah D, Lerch R. Optimization of Device Programming for Cardiac Resynchronization Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1416-25. [PMID: 17201852 DOI: 10.1111/j.1540-8159.2006.00557.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cardiac resynchronization therapy may lead to remarkable improvement in clinical status in selected patients with heart failure. However, approximately 20-30% of patients may not respond to this treatment. One of the reasons for this may be suboptimal programming of the device, which has particular considerations as compared to standard pacemakers. Hemodynamic response to pacing may be affected by timing of the atrioventricular (AV) interval, affecting synchronicity of atrial and ventricular contraction. In addition current biventricular devices have separate right and left ventricular channels that allow programming of an interventricular (VV) interval with right or left ventricular preexcitation. This article focuses on the parameters that may be optimized for biventricular pacing, and reviews the different techniques currently available for this application, with special emphasis paid to echocardiography.
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Affiliation(s)
- Haran Burri
- Cardiology Service, University Hospital of Geneva, Geneva, Switzerland.
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Gasparini M, Bocchiardo M, Lunati M, Ravazzi PA, Santini M, Zardini M, Signorelli S, Passardi M, Klersy C. Comparison of 1-year effects of left ventricular and biventricular pacing in patients with heart failure who have ventricular arrhythmias and left bundle-branch block: the Bi vs Left Ventricular Pacing: an International Pilot Evaluation on Heart Failure Patients with Ventricular Arrhythmias (BELIEVE) multicenter prospective randomized pilot study. Am Heart J 2006; 152:155.e1-7. [PMID: 16824846 DOI: 10.1016/j.ahj.2006.04.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 04/03/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little is known on the chronic effects of left ventricular pacing (LV) in heart failure. METHODS Seventy-four patients with LBBB, QRS >130 milliseconds, New York Heart Association class (Bradley DJ, Bradley EA, Braughman KL, et al. Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials. JAMA 2003;289:730-40.) II, LV ejection fraction (LVEF) <35%, and a class I cardioverter/defibrillator indication were implanted with CRT-D devices and were randomized to either LV or biventricular (BiV) pacing. Response (defined as increases of >5 points increase of LVEF and/or > or = 10% 6-minute walking test [6MWT]) between LV and BiV pacing were compared in an attempt to define the number of patients needed to claim noninferiority of LV pacing. In addition, absolute change in LVEF at 12 months in heart failure patients treated with LV pacing was evaluated. The safety of LV pacing was assessed comparing the total number of ventricular arrhythmia episodes, of hospitalizations, and of deaths between the two pacing modes. RESULTS The percentage of responders was comparable for both groups (LV = 75%, BiV = 70%, P = .788); based on the 95% CI of the difference between the groups, 1100 patients would be needed to claim noninferiority of LV pacing (with a 5% CI lower limit). LV pacing induced siginificant LVEF increase (5.2%, P = .002). These results remained unchanged after performing adjustment analyses. There were no differences in the numbers of ventricular arrhythmias, hospitalizations, and death events between the 2 pacing modes. CONCLUSIONS At 12 months, percentage of responders to LV pacing was similar to BIV pacing. Furthermore, LV pacing achieved a significant increase of ejection fraction. LV pacing is both safe and feasible.
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Kato M, Dote K, Sasaki S, Goto K, Takemoto H, Habara S, Hasegawa D, Matsuda O. Determination of the Optimal Atrioventricular Interval in Sick Sinus Syndrome During DDD Pacing. Pacing Clin Electrophysiol 2005; 28:892-7. [PMID: 16176525 DOI: 10.1111/j.1540-8159.2005.00210.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although the AAI pacing mode has been shown to be electromechanically superior to the DDD pacing mode in sick sinus syndrome (SSS), there is evidence suggesting that during AAI pacing the presence of natural ventricular activation pattern is not enough for hemodynamic benefit to occur. Myocardial performance index (MPI) is a simply measurable Doppler-derived index of combined systolic and diastolic myocardial performance. The aim of this study was to investigate whether AAI pacing mode is electromechanically superior to the DDD mode in patients with SSS by using Doppler-derived MPI. METHODS Thirty-nine SSS patients with dual-chamber pacing devices were evaluated by using Doppler echocardiography in AAI mode and DDD mode. The optimal atrioventricular (AV) interval in DDD mode was determined and atrial stimulus-R interval was measured in AAI mode. The ratio of the atrial stimulus-R interval to the optimal AV interval was defined as relative AV interval (rAVI) and the ratio of MPI in AAI mode to that in DDD mode was defined as relative MPI (rMPI). RESULTS The rMPI was significantly correlated with atrial stimulus-R interval and rAVI (r = 0.57, P = 0.0002, and r = 0.67, P < 0.0001, respectively). A cutoff point of 1.73 for rAVI provided optimum sensitivity and specificity for rMPI >1 based on the receiver operator curves. CONCLUSIONS Even though the intrinsic AV conduction is moderately prolonged, some SSS patients with dual-chamber pacing devices benefit from the ventricular pacing with optimal AV interval. MPI is useful to determine the optimal pacing mode in acute experiment.
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Affiliation(s)
- Masaya Kato
- Department of Cardiology, Hiroshima City Asa Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan.
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Erol-Yilmaz A, Tukkie R, De Boo J, Schrama T, Wilde A. Direct Comparison of a Contractility and Activity Pacemaker Sensor During Treadmill Exercise Testing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1493-9. [PMID: 15546303 DOI: 10.1111/j.1540-8159.2004.00666.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There are limited data about the chronotropic capacity of the peak endocardial acceleration (PEA) sensor. This study directly compared the chronotropic function from the PEA and the activity (ACT) sensor. The study included 18 patients (age 73 +/- 7 years) with > or = 75% pacemaker-driven heart rate (HR) and a PEA sensor and 11 healthy controls (age 67 +/- 7 years) underwent a chronotropic assessment exercise protocol (CAEP) exercise test with the pacemaker patients in VVIR mode after programming the sensors in the default setting with adjustment of the upper sensor rate as an age related maximum value (220-age). The ACT sensor was externally strapped on the thorax. Achieved exercise duration for the patients and controls was, respectively, 9.2 +/- 3 vs 18.4 +/- 4 minutes (P <0.001). The maximal achieved HR with the PEA sensor was 124 +/- 25 beats/min, versus the ACT with 140 +/- 23, versus the controls with 153 +/- 26 beats/min (P <0.001 between the groups). For the PEA, ACT, and controls, the time to peak HR was, respectively, 11 +/- 3, 7 +/- 3.6, and 18 +/- 4 (P <0.001 between groups) and HR after 10 minutes recovery was, respectively, 80 +/- 20, 65 +/- 15, and 82 +/- 4 beats/min (P <0.001 between groups). The PEA sensor functions hypochonotroop during exercise programmed as a single sensor system. It is, therefore, preferable to combine the PEA sensor with an activity-based sensor in a dual sensor system. Although both groups had normal left ventricular functions, the exercise capacity of pacemaker patients is significantly lower than in the controls.
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Affiliation(s)
- Ayten Erol-Yilmaz
- Department of Clinical and Experimental Cardiology, Academic Medical Center, Hospital Goes Amsterdam, the Netherlands.
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