1
|
Hautamäki M, Järvensivu-Koivunen M, Lyytikäinen LP, Eskola M, Lehtimäki T, Nikus K, Oksala N, Tynkkynen J, Hernesniemi J. The association between GRACE score at admission for myocardial infarction and the incidence of sudden cardiac arrests in long-term follow-up - the MADDEC study. SCAND CARDIOVASC J 2024; 58:2335905. [PMID: 38557164 DOI: 10.1080/14017431.2024.2335905] [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: 09/21/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
Background. Sudden cardiac arrest (SCA), often also leading to sudden cardiac death (SCD), is a common complication in coronary artery disease. Despite the effort there is a lack of applicable prediction tools to identify those at high risk. We tested the association between the validated GRACE score and the incidence of SCA after myocardial infarction. Material and methods. A retrospective analysis of 1,985 patients treated for myocardial infarction (MI) between January 1st 2015 and December 31st 2018 and followed until the 31st of December of 2021. The main exposure variable was patients' GRACE score at the point of admission and main outcome variable was incident SCA after hospitalization. Their association was analyzed by subdistribution hazard (SDH) model analysis. The secondary endpoints included SCA in patients with no indication to implantable cardioverter-defibrillator (ICD) device and incident SCD. Results. A total of 1985 patients were treated for MI. Mean GRACE score at baseline was 118.7 (SD 32.0). During a median follow-up time of 5.3 years (IQR 3.8-6.1 years) 78 SCA events and 52 SCDs occurred. In unadjusted analyses one SD increase in GRACE score associated with over 50% higher risk of SCA (SDH 1.55, 95% CI 1.29-1.85, p < 0.0001) and over 40% higher risk for SCD (1.42, 1.12-1.79, p = 0.0033). The associations between SCA and GRACE remained statistically significant even with patients without indication for ICD device (1.57, 1.30-1.90, p < 0.0001) as well as when adjusting with patients LVEF and omitting the age from the GRACE score to better represent the severity of the cardiac event. The association of GRACE and SCD turned statistically insignificant when adjusting with LVEF. Conclusions. GRACE score measured at admission for MI associates with long-term risk for SCA.
Collapse
Affiliation(s)
- Markus Hautamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | | | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Juho Tynkkynen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| |
Collapse
|
2
|
Shivakumar N, Friedman DJ, Fudim M, Abraham WT, Cleland JGF, Curtis AB, Gold MR, Kutyifa V, Linde C, Young J, Tang A, Olivas-Martinez A, Inoue LYT, Sanders GD, Al-Khatib SM. Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient-Level Meta-Analysis. J Am Heart Assoc 2024; 13:e031785. [PMID: 39082424 DOI: 10.1161/jaha.123.031785] [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: 02/19/2024] [Accepted: 06/11/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Data on the benefits of cardiac resynchronization therapy (CRT) in patients with severe heart failure symptoms are limited. We investigated the relative effects of CRT in patients with ambulatory New York Heart Association (NYHA) IV versus III functional class at the time of device implantation. METHODS AND RESULTS In this meta-analysis, we pooled patient-level data from the MIRACLE (Multicenter InSync Randomized Clinical Evaluation), MIRACLE-ICD (Multicenter InSync Implantable Cardioversion Defibrillation Randomized Clinical Evaluation), and COMPANION (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure) trials. Outcomes evaluated were time to the composite end point of the first heart failure hospitalization or all-cause mortality, and time to all-cause mortality alone. The association between CRT and outcomes was evaluated using a Bayesian hierarchical Weibull survival regression model. We assessed if this association differed between NYHA III and IV groups by adding an interaction term between CRT and NYHA class as a random effect. A sensitivity analysis was performed by including data from RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure). Our pooled analysis included 2309 patients. Overall, CRT was associated with a longer time to heart failure hospitalization or all-cause mortality (adjusted hazard ratio [aHR], 0.79 [95% credible interval [CI], 0.64-0.99]; posterior probability or P=0.044), with a similar association with time to all-cause mortality (aHR, 0.78 [95% CI, 0.59-1.03]; P=0.083). Associations of CRT with outcomes were not significantly different for those in NYHA III and IV classes (ratio of aHR, 0.72 [95% CI, 0.30-1.27]; P=0.23 for heart failure hospitalization/mortality; ratio of aHR, 0.70 [95% CI, 0.35-1.34]; P=0.27 for all-cause mortality alone). The sensitivity analysis, including RAFT data, did not show a significant relative CRT benefit between NYHA III and IV classes. CONCLUSIONS Overall, there was no significant difference in the association of CRT with either outcome for patients in NYHA functional class III compared with functional class IV.
Collapse
Affiliation(s)
| | - Daniel J Friedman
- Division of Cardiology, Department of Medicine Duke University School of Medicine Durham NC USA
- Duke Clinical Research Institute Duke University School of Medicine Durham NC USA
| | - Marat Fudim
- Division of Cardiology, Department of Medicine Duke University School of Medicine Durham NC USA
- Duke Clinical Research Institute Duke University School of Medicine Durham NC USA
- Institute of Heart Diseases Wroclaw Medical University Wroclaw Poland
| | - William T Abraham
- Division of Cardiovascular Medicine The Ohio State University Columbus OH USA
| | - John G F Cleland
- National Heart and Lung Institute, Royal Brompton & Harefield Hospitals Imperial College London United Kingdom
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health University of Glasgow Glasgow UK
| | - Anne B Curtis
- Department of Medicine University at Buffalo Buffalo NY USA
| | - Michael R Gold
- Department of Medicine Medical University of South Carolina Charleston SC USA
| | - Valentina Kutyifa
- Division of Cardiology, Department of Medicine University of Rochester Medical Center Rochester NY USA
| | - Cecilia Linde
- Karolinska Institutet and Department of Cardiology Karolinska University Stockholm Sweden
| | - James Young
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland OH USA
| | - Anthony Tang
- Department of Medicine Western University Ontario Canada
| | | | - Lurdes Y T Inoue
- Department of Biostatistics University of Washington Seattle WA USA
| | - Gillian D Sanders
- Duke Clinical Research Institute Duke University School of Medicine Durham NC USA
- Duke-Margolis Center for Health Policy Duke University Durham NC USA
- Evidence Synthesis Group, Duke Clinical Research Institute Duke University School of Medicine Durham NC USA
- Department of Population Health Sciences Duke University School of Medicine Durham NC USA
| | - Sana M Al-Khatib
- Division of Cardiology, Department of Medicine Duke University School of Medicine Durham NC USA
- Duke Clinical Research Institute Duke University School of Medicine Durham NC USA
| |
Collapse
|
3
|
Beyer SE, Imnadze G, Sommer P. [New pacing strategies for heart failure]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:778-786. [PMID: 38967707 DOI: 10.1007/s00108-024-01747-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
In patients with a reduced left ventricular (LV) systolic function (ejection fraction < 35%) and a left bundle branch block with a QRS duration > 130 ms, cardiac resynchronization therapy (CRT) can contribute to an improvement in the quality of life and a reduction in mortality. The resynchronization is mostly achieved by pacing via an epicardial LV lead in the coronary sinus; however, this approach is often limited by the patient's venous anatomy and an increase in the stimulation threshold over time. In addition, up to 30% of patients do not respond to the intervention. New treatment approaches involve direct stimulation of the conduction system by pacing of the bundle of His or left bundle branch. This enables a more physiological propagation of the stimulus. Pacing of the left bundle branch is achieved by advancing the lead into the right ventricle and screwing it deep into the interventricular septum. Due to the relatively large target area of the left bundle branch the success rate is very high (currently > 90%). Observational studies have shown a greater reduction in the QRS duration, a more pronounced improvement in systolic function and a lower hospitalization rate for heart failure associated with conduction system pacing compared to CRT using a coronary sinus lead. These findings have been confirmed in small randomized trials. Therefore, the use of left bundle branch pacing should be considered not only as a bail out in the case of failed resynchronization using coronary sinus lead placement but increasingly also as an initial pacing strategy. The results of the first large randomized trials are expected to be released in late 2024.
Collapse
Affiliation(s)
- Sebastian E Beyer
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - Guram Imnadze
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland.
- Herz- und Diabeteszentrum NRW, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland.
| |
Collapse
|
4
|
Abdin A, Kondo T, Böhm M, Jhund PS, Claggett BL, Vaduganathan M, Hernandez AF, Lam CSP, Inzucchi SE, Martinez FA, de Boer RA, Desai AS, Køber L, Sabatine MS, Petersson M, Bachus E, Solomon SD, McMurray JJV. Effects of dapagliflozin according to QRS duration across the spectrum of left ventricular ejection fraction: An analysis of DAPA-HF and DELIVER. Eur J Heart Fail 2024. [PMID: 39016033 DOI: 10.1002/ejhf.3350] [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] [Received: 02/02/2024] [Revised: 05/08/2024] [Accepted: 06/02/2024] [Indexed: 07/18/2024] Open
Abstract
AIMS The primary aim was to evaluate the effect of dapagliflozin according to QRS duration across the spectrum of left ventricular ejection fraction (LVEF), given that prolongation of QRS duration is associated with less favourable ventricular remodelling with pharmacological therapy and worse outcomes. METHODS AND RESULTS A pooled analysis of the DAPA-HF and DELIVER trials, excluding patients with a paced rhythm and cardiac resynchronization therapy. Overall, 4008 patients had heart failure (HF) with reduced ejection fraction (HFrEF), and 5816 had HF with mildly reduced/preserved ejection fraction (HFmrEF/HFpEF). QRS duration was <120 ms in 7039 patients (71.7%), 120-149 ms in 1725 (17.6%), and ≥150 ms in 1060 patients (10.8%). The median follow-up time was 23 months. The rate of the primary composite outcome of cardiovascular death or worsening HF was 9.2 (95% confidence interval [CI] 8.7-9.7), 14.3 (13.0-15.7), and 15.9 (14.1-17.9) per 100 patient-years in the <120, 120-149, and ≥150 ms groups, respectively. This gradient in event rates was observed both in HFrEF and HFmrEF/HFpEF. Dapagliflozin, compared with placebo, reduced the risk of the primary outcome consistently across the QRS duration subgroups (hazard ratio [95% CI] 0.75 [0.67-0.85], 0.79 [0.65-0.96], and 0.89 [0.70-1.13] in the <120, 120-149, and ≥150 ms groups, respectively; p for interaction = 0.28). The effect of dapagliflozin on the primary outcome was consistent across the QRS duration regardless of HF phenotype that is, HFrEF or HFmrEF/HFpEF. CONCLUSIONS Prolongation of QRS duration is associated with worse outcomes irrespective of HF phenotype. Dapagliflozin reduced the risk of the primary outcome, regardless of QRS duration, in DAPA-HF and DELIVER.
Collapse
Affiliation(s)
- Amr Abdin
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University, Saarland University Medical Center, Homburg/Saar, Germany
| | - Toru Kondo
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University, Saarland University Medical Center, Homburg/Saar, Germany
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore, Singapore
| | | | | | | | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, Gothenburg, Sweden
| | - Erasmus Bachus
- Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, Gothenburg, Sweden
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| |
Collapse
|
5
|
Huang H, Fu B, Long T, Yu Y, Cheng S, Gu M, Cai C, Chen X, Niu H, Hua W. Implication of geriatric nutritional risk index on treatment response and long-term prognosis in patients with cardiac resynchronization therapy. Int J Cardiol 2024; 407:132064. [PMID: 38670460 DOI: 10.1016/j.ijcard.2024.132064] [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: 02/20/2024] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE Geriatric Nutritional Risk Index (GNRI) is a simple tool for assessing the nutritional status of the aging population. This study aims to explore the clinical implication of GNRI on treatment response and long-term clinical outcomes in heart failure (HF) patients receiving cardiac resynchronization therapy (CRT). METHODS Patients who underwent CRT implantation or upgrade at our hospital were retrospectively included. The association of GNRI and its tertiles with the echocardiographic response, all-cause mortality or heart transplantation, and the first hospitalization due to HF were investigated. RESULTS Totally, 647 patients were enrolled, with a median age of 60 [Interquartile Range (IQR): 52-67] years and mean score of GNRI at 107.9 ± 23.7. Super-response rates increased significantly among the GNRI T1, T2, and T3 groups (25.1%, 29.8% vs. 41.1%, P = 0.002). Patients with higher GNRI were more likely to have better LVEF improvement after multiple adjustments (OR = 1.13, 95% CI: 1.04-1.23, P = 0.010). Higher GNRI was independently associated with a lower risk of all-cause mortality or heart implantation (HR = 0.95, 95% CI: 0.93-0.96, P < 0.001) and HF hospitalization (HR = 0.96, 95% CI: 0.95-0.98, P < 0.001). The inclusion of GNRI enhanced the predictability of all-cause mortality based on traditional model, including sex, New York Heart Association functional class, left bundle branch block, QRS reduction, and N-terminal pro-B-type natriuretic peptide level (C statistics improved from 0.785 to 0.813, P = 0.007). CONCLUSION Higher GNRI was associated with better treatment response and long-term prognosis in HF patients with CRT. Evaluation of nutritional status among CRT population is necessary for individualized choice of potential responders.
Collapse
Affiliation(s)
- Hao Huang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bingqi Fu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianxin Long
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Yu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sijing Cheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Gu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chi Cai
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuhua Chen
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongxia Niu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
6
|
Zamorano JL, González Leal A. Advances in heart failure management. Med Clin (Barc) 2024; 163:32-39. [PMID: 38418309 DOI: 10.1016/j.medcli.2023.12.026] [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: 10/14/2023] [Revised: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 03/01/2024]
Abstract
Heart failure is a pathological condition characterized by substantial prevalence and mortality, particularly in the Western world. Over recent decades, both pharmacological and non-pharmacological interventions have emerged, significantly enhancing patient survival and overall quality of life. Moreover, advancements in diverse imaging modalities facilitate precise diagnosis and comprehensive investigation into the fundamental etiology, enabling the development of more precise therapeutic approaches. Nonetheless, discernible gaps persist in comprehending specific facets of this condition, albeit persistent research endeavors seek to elucidate these inquiries.
Collapse
Affiliation(s)
- José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | |
Collapse
|
7
|
Chyou JY, Qin H, Butler J, Voors AA, Lam CSP. Sex-related similarities and differences in responses to heart failure therapies. Nat Rev Cardiol 2024; 21:498-516. [PMID: 38459252 DOI: 10.1038/s41569-024-00996-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/10/2024]
Abstract
Although sex-related differences in the epidemiology, risk factors, clinical characteristics and outcomes of heart failure are well known, investigations in the past decade have shed light on an often overlooked aspect of heart failure: the influence of sex on treatment response. Sex-related differences in anatomy, physiology, pharmacokinetics, pharmacodynamics and psychosocial factors might influence the response to pharmacological agents, device therapy and cardiac rehabilitation in patients with heart failure. In this Review, we discuss the similarities between men and women in their response to heart failure therapies, as well as the sex-related differences in treatment benefits, dose-response relationships, and tolerability and safety of guideline-directed medical therapy, device therapy and cardiac rehabilitation. We provide insights into the unique challenges faced by men and women with heart failure, highlight potential avenues for tailored therapeutic approaches and call for sex-specific evaluation of treatment efficacy and safety in future research.
Collapse
Affiliation(s)
- Janice Y Chyou
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hailun Qin
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-NUS Medical School, Singapore, Singapore.
| |
Collapse
|
8
|
Filippatos G, Gold MR, Mullens W, Kusano K, Hersi AS, Birnie D, Gerritse B, Leclercq C. Clinical outcomes of the AdaptResponse trial - Authors' reply. Lancet 2024; 403:2484-2485. [PMID: 38851281 DOI: 10.1016/s0140-6736(24)00866-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/22/2024] [Indexed: 06/10/2024]
Affiliation(s)
- Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens 124 61, Greece.
| | - Michael R Gold
- Medical University of South Carolina, Charleston, SC, USA
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Hasselt University, Hasselt, Belgium
| | - Kengo Kusano
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ahmad S Hersi
- King Saud University, Faculty of Medicine, Riyadh, Saudi Arabia
| | - David Birnie
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Bart Gerritse
- Medtronic Bakken Research Center, Maastricht, Netherlands
| | | |
Collapse
|
9
|
Yamamoto N, Noda T, Nakano M, Ito T, Sato H, Hayashi H, Chiba T, Hasebe Y, Ueda N, Kamakura T, Ishibashi K, Miyata S, Kusano K, Yasuda S. Clinical utility of QRS duration normalized to left ventricular volume for predicting cardiac resynchronization therapy efficacy in patients with "mid-range" QRS duration. Heart Rhythm 2024; 21:855-862. [PMID: 38367890 DOI: 10.1016/j.hrthm.2024.02.019] [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: 10/05/2023] [Revised: 01/30/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is effective for patients with heart failure with QRS duration (QRSd) ≥150 ms. However, its beneficial effect seems to be limited for those with "mid-range" QRSd (120-149 ms). Recent studies have demonstrated that modifying QRSd to left ventricular end-diastolic volume (LVEDV)-modified QRSd-improves the prediction of clinical outcomes of CRT. OBJECTIVE The purpose of this study was to investigate the clinical impact of the modified QRSd on the efficacy of CRT in patients with "mid-range" QRSd. METHODS We conducted a retrospective, multicenter, observational study, with heart failure hospitalization (HFH) after CRT as the primary endpoint. Modified QRSd is defined as QRSd divided by LVEDV, determined through the Teichholtz method of echocardiography. RESULTS Among the 506 consecutive patients considered, 119 (mean age 61 ± 15 years; 80% male, QRSd 135 ± 9 ms) with a "mid-range" QRSd who underwent de novo CRT device implantation were included for analysis. During median follow-up of 878 days [interquartile range 381-1663 days], HFH occurred in 45 patients (37%). Fine-Gray analysis revealed modified QRSd was an independent predictor of HFH (hazard ratio [HR] 0.97; 95% confidence interval [CI] 0.96-0.99; P <.01). Receiver operating characteristic curve analysis revealed a cutoff value of 0.65 ms/mL for the modified QRSd in predicting HFH. Patients above the threshold exhibited a significantly lower incidence of HFH than patients below the threshold (HR 0.46; 95% CI 0.25-0.86; P = .01). CONCLUSION Modified QRSd can effectively predict the efficacy of CRT in patients with a "mid-range" QRSd.
Collapse
Affiliation(s)
- Nobuhiko Yamamoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Nakano
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiro Ito
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroyuki Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideka Hayashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahiko Chiba
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuhi Hasebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Miyata
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| |
Collapse
|
10
|
Noheria A, Shahab A, Andrews C, Cuculich PS, Rudy Y. Pilot study to evaluate left-to-right ventricular offset in biventricular pacing-comparison of electrocardiographic imaging and ECG. J Cardiovasc Electrophysiol 2024; 35:1185-1195. [PMID: 38591763 DOI: 10.1111/jce.16272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/14/2024] [Accepted: 03/23/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Biventricular pacing (BiVp) improves outcomes in systolic heart failure patients with electrical dyssynchrony. BiVp is delivered from epicardial left ventricular (LV) and endocardial right ventricular (RV) electrodes. Acute electrical activation changes with different LV-RV stimulation offsets can help guide individually optimized BiVp programming. We sought to study the BiVp ventricular activation with different LV-RV offsets and compare with 12-lead ECG. METHODS In five patients with BiVp (63 ± 17-year-old, 80% male, LV ejection fraction 27 ± 6%), we evaluated acute ventricular epicardial activation, varying LV-RV offsets in 20 ms increments from -40 to 80 ms, using electrocardiographic imaging (ECGI) to obtain absolute ventricular electrical uncoupling (VEUabs, absolute difference in average LV and average RV activation time) and total activation time (TAT). For each patient, we calculated the correlation between ECGI and corresponding ECG (3D-QRS-area and QRS duration) with different LV-RV offsets. RESULTS The LV-RV offset to attain minimum VEUabs in individual patients ranged 20-60 ms. In all patients, a larger LV-RV offset was required to achieve minimum VEUabs (36 ± 17 ms) or 3D-QRS-area (40 ± 14 ms) than that for minimum TAT (-4 ± 9 ms) or QRS duration (-8 ± 11 ms). In individual patients, 3D-QRS-area correlated with VEUabs (r 0.65 ± 0.24) and QRS duration correlated with TAT (r 0.95 ± 0.02). Minimum VEUabs and minimum 3D-QRS-area were obtained by LV-RV offset within 20 ms of each other in all five patients. CONCLUSIONS LV-RV electrical uncoupling, as assessed by ECGI, can be minimized by optimizing LV-RV stimulation offset. 3D-QRS-area is a surrogate to identify LV-RV offset that minimizes LV-RV uncoupling.
Collapse
Affiliation(s)
- Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ahmed Shahab
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Christopher Andrews
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Phillip S Cuculich
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Yoram Rudy
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| |
Collapse
|
11
|
Shroff JP, Chandh Raja D, Tuan LQ, Abhilash SP, Mehta A, Abhayaratna WP, Sanders P, Pathak RK. Efficacy of left bundle branch area pacing versus biventricular pacing in patients treated with cardiac resynchronization therapy: Select site - cohort study. Heart Rhythm 2024; 21:893-900. [PMID: 38367889 DOI: 10.1016/j.hrthm.2024.02.024] [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: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is typically attempted with biventricular (BiV) pacing. One-third of patients are nonresponders. Left bundle branch area pacing (LBBAP) has been evaluated as an alternative means. OBJECTIVE The purpose of this study was to assess the feasibility and clinical response of permanent LBBAP as an alternative to BiV pacing. METHODS Of 479 consecutive patients referred with heart failure, 50 with BiV-CRT and 51 with LBBAP-CRT were included in this analysis after study exclusions. Quality-of-Life (QoL) assessments, echocardiographic measurements, and New York Heart Association (NYHA) class were obtained at baseline and at 6-monthly intervals. RESULTS There were no differences in baseline characteristics between groups (all P > .05). Clinical outcomes such as left ventricular ejection fraction, left ventricular end-systolic volume, QoL, and NYHA class were significantly improved for both pacing groups compared to baseline. The LBBAP-CRT group showed greater improvement in left ventricular ejection fraction at 6 months (P = .001) and 12 months (P = .021), accompanied by greater reduction in left ventricular end-systolic volume (P = .007). QRS duration < 120 ms (baseline 160.82 ± 21.35 ms vs 161.08 ± 24.48 ms) was achieved in 30% in the BiV-CRT group vs 71% in the LBBAP-CRT group (P ≤ .001). Improvement in NYHA class (P = .031) and QoL index was greater (P = .014). Reduced heart failure admissions (P = .003) and health care utilization (P < .05) and improved lead performance (P < .001) were observed in the LBBAP-CRT group. CONCLUSION LBBAP-CRT is feasible and effective CRT. It results into a meaningful improvement in QoL and reduction in health care utilization. This can be offered as an alternative to BiV-CRT or potentially as first-line therapy.
Collapse
Affiliation(s)
- Jenish P Shroff
- School of Medicine and Psychology, Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm, Australian Capital Territory, Australia
| | - Deep Chandh Raja
- School of Medicine and Psychology, Australian National University, Australian Capital Territory, Australia
| | - Lukah Q Tuan
- School of Medicine and Psychology, Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm, Australian Capital Territory, Australia
| | | | - Abhinav Mehta
- School of Medicine and Psychology, Australian National University, Australian Capital Territory, Australia
| | - Walter P Abhayaratna
- School of Medicine and Psychology, Australian National University, Australian Capital Territory, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Rajeev K Pathak
- School of Medicine and Psychology, Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm, Australian Capital Territory, Australia.
| |
Collapse
|
12
|
Kerr N, Miller RJH, Chew DS. Can nuclear cardiology optimize cardiac resynchronization therapy lead placement: Paving the way to precision medicine? J Nucl Cardiol 2024; 36:101873. [PMID: 38704017 DOI: 10.1016/j.nuclcard.2024.101873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Nicholas Kerr
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Robert J H Miller
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Derek S Chew
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, AB, Canada.
| |
Collapse
|
13
|
Liang Y, Xiao Z, Liu X, Wang J, Yu Z, Gong X, Lu H, Yang S, Gu M, Zhang L, Li M, Pan L, Li X, Chen X, Su Y, Hua W, Ge J. Left Bundle Branch Area Pacing versus Biventricular Pacing for Cardiac Resynchronization Therapy on Morbidity and Mortality. Cardiovasc Drugs Ther 2024; 38:471-481. [PMID: 36459266 DOI: 10.1007/s10557-022-07410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) has emerged as an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). We aimed to compare the morbidity and mortality associated with LBBAP versus BVP in patients undergoing CRT implantation. METHODS Consecutive patients who received CRT from two high-volume implantation centers were retrospectively recruited. The primary endpoint was a composite of all-cause death and heart failure hospitalization, and the secondary endpoint was all-cause death. RESULTS A total of 491 patients receiving CRT (154 via LBBAP and 337 via BVP) were included, with a median follow-up of 31 months. The primary endpoint was reached by 21 (13.6%) patients in the LBBAP group, as compared with 74 (22.0%) patients in the BVP group [hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.43-1.14, P = 0.15]. There were 10 (6.5%) deaths in the LBBAP group, as compared with 31 (9.2%) in the BVP group (HR 0.91, 95% CI 0.44-1.86, P = 0.79). No significant difference was observed in the risk of either the primary or secondary endpoint between LBBAP and BVP after multivariate Cox regression (HR 0.74, 95% CI 0.45-1.23, P = 0.24, and HR 0.77, 95% CI 0.36-1.67, P = 0.51, respectively) or propensity score matching (HR 0.72, 95% CI 0.41-1.29, P = 0.28, and HR 0.69, 95% CI 0.29-1.65, P = 0.40, respectively). CONCLUSION LBBAP was associated with a comparable effect on morbidity and mortality relative to BVP in patients with indications for CRT.
Collapse
Affiliation(s)
- Yixiu Liang
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zilong Xiao
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xi Liu
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingfeng Wang
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Ziqing Yu
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xue Gong
- Department of Cardiology, Deltahealth Hospital, Shanghai, China
| | - Hongyang Lu
- Cardiac Rhythm Management, Medtronic Technology Center, Medtronic (Shanghai) Ltd., Shanghai, China
| | - Shengwen Yang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Min Gu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Zhang
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Minghui Li
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lei Pan
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiao Li
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xueying Chen
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Wei Hua
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| |
Collapse
|
14
|
Chick W, Monkhouse C, Muthumala A, Ahsan S, Papageorgiou N. Implantable Cardiac Devices in Patients with Brady- and Tachy-Arrhythmias: An Update of the Literature. Rev Cardiovasc Med 2024; 25:162. [PMID: 39076493 PMCID: PMC11267218 DOI: 10.31083/j.rcm2505162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/15/2024] [Accepted: 02/26/2024] [Indexed: 07/31/2024] Open
Abstract
Implantable cardiac devices are a vital treatment option in the management of tachy/brady-arrhythmias and heart failure with conduction disease. In the recent years, these devices have become increasingly sophisticated, with high implantation success rates and longevity. However, these devices are not without risks and complications, which need to be carefully considered before implantation. In an era of rapidly evolving cardiac device therapies, this review article will provide an update on the literature and outline some of the emerging technologies that aim to maximise the efficiency of implantable devices and reduce complications. We discuss novel pacing techniques, including alternative pacing sites in anti-bradycardia and biventricular pacing, as well as the latest evidence surrounding leadless device technologies and patient selection for implantable device therapies.
Collapse
Affiliation(s)
- William Chick
- Cardiology Department, Lister Hospital, East and North NHS Hertfordshire NHS Trust, SG1 4AB Stevenage, UK
| | - Christopher Monkhouse
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital London, Barts Health NHS Trust, EC1A 7BE London, UK
| | - Amal Muthumala
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital London, Barts Health NHS Trust, EC1A 7BE London, UK
| | - Syed Ahsan
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital London, Barts Health NHS Trust, EC1A 7BE London, UK
| | - Nikolaos Papageorgiou
- Cardiology Department, Lister Hospital, East and North NHS Hertfordshire NHS Trust, SG1 4AB Stevenage, UK
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital London, Barts Health NHS Trust, EC1A 7BE London, UK
- Institute of Cardiovascular Science, University College London, WC1E 6BT London, UK
| |
Collapse
|
15
|
Roskvist R, Eggleton K, Arroll B, Stewart R. Non-acute heart failure management in primary care. BMJ 2024; 385:e077057. [PMID: 38580384 DOI: 10.1136/bmj-2023-077057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
- Rachel Roskvist
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Kyle Eggleton
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Ralph Stewart
- Department of Medicine, School of Medicine, University of Auckland, New Zealand
| |
Collapse
|
16
|
Bijnens J, Trenson S, Voros G, Martens P, Ingelaere S, Betschart P, Voigt JU, Dupont M, Breitenstein A, Steffel J, Willems R, Ruschitzka F, Mullens W, Winnik S, Vandenberk B. Landmark Evolutions in Time and Indication for Cardiac Resynchronization Therapy: Results from a Multicenter Retrospective Registry. J Clin Med 2024; 13:1903. [PMID: 38610667 PMCID: PMC11012510 DOI: 10.3390/jcm13071903] [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: 02/19/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Cardiac resynchronization therapy (CRT) has evolved into an established therapy for patients with chronic heart failure and a wide QRS complex. Data on long-term outcomes over time are scarce and the criteria for implantation remain a subject of investigation. Methods: An international, multicenter, retrospective registry includes 2275 patients who received CRT between 30 November 2000 and 31 December 2019, with a mean follow-up of 3.6 ± 2.7 years. Four time periods were defined, based on landmark trials and guidelines. The combined endpoint was a composite of all-cause mortality, heart transplantation, or left ventricular assist device implantation. Results: The composite endpoint occurred in 656 patients (29.2%). The mean annual implantation rate tripled from 31.5 ± 17.4/year in the first period to 107.4 ± 62.4/year in the last period. In the adjusted Cox regression analysis, the hazard ratio for the composite endpoint was not statistically different between time periods. When compared to sinus rhythm with left bundle branch block (LBBB), a non-LBBB conduction pattern (sinus rhythm: HR 1.51, 95% CI 1.12-2.03; atrial fibrillation: HR 2.08, 95% CI 1.30-3.33) and a QRS duration below 130 ms (HR 1.64, 95% CI 1.29-2.09) were associated with a higher hazard ratio. Conclusions: Despite innovations, an adjusted regression analysis revealed stable overall survival over time, which can at least partially be explained by a shift in patient characteristics.
Collapse
Affiliation(s)
- Jeroen Bijnens
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium (G.V.)
| | - Sander Trenson
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium (G.V.)
- Department of Cardiology, Sint-Jan Hospital Bruges, 8000 Bruges, Belgium
- Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Gabor Voros
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium (G.V.)
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium (M.D.)
| | | | - Pascal Betschart
- Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Jens-Uwe Voigt
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium (G.V.)
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium (M.D.)
| | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Hirslanden Heart Clinic, 8008 Zurich, Switzerland
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium (G.V.)
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium (M.D.)
- Department of Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Stephan Winnik
- Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Zurich Regional Health Center Wetzikon, 8620 Zurich, Switzerland
| | - Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium (G.V.)
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| |
Collapse
|
17
|
Wang CL, Wu LS, Wu CT, Yeh YH, Cheng YW, Yen KC, Chan YH, Chuang C, Kuo CT, Chu PH. Clinical significance of regional constructive and wasted work in patients receiving cardiac resynchronization therapy. Front Cardiovasc Med 2024; 11:1301140. [PMID: 38510200 PMCID: PMC10950977 DOI: 10.3389/fcvm.2024.1301140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
Background Previous studies have shown that global constructive work (CW) and wasted work (WW) predict response to cardiac resynchronization therapy (CRT). This study evaluated the predictive value of regional CW and WW for reverse remodeling and clinical outcomes after CRT. Methods We performed a prospective study involving 134 CRT candidates with left bundle branch block and left ventricular ejection fraction ≤35%. Global and regional CW and WW were calculated using pressure-strain loop analysis. CRT response was defined by reverse remodeling as a reduction of ≥15% in left ventricular end-systolic volume after six months. Results At six-month follow-up, 92 (69%) patients responded to CRT. Of the regional CW and WW measures, lateral wall (LW) CW and septal WW were most strongly and significantly correlated with reverse remodeling. At multivariate analysis, LW CW and septal WW were both independent determinants of reverse remodeling. When LW CW and septal WW were included in the model, global CW and WW were not independently associated with reverse remodeling. LW CW and septal WW predicted reverse remodeling with an area under the curve (AUC) of 0.783 (95% CI: 0.700-0.866) and 0.737 (95% CI: 0.644-0.831), respectively. Using both variables increased the AUC to 0.832 (95% CI: 0.755-0.908). Both LW CW ≤878 mmHg% (HR 2.01; 95% CI: 1.07-3.79) and septal WW ≤181 mmHg% (HR 2.60; 95% CI: 1.38-4.90) were significant predictors of combined death and HF hospitalization at two-year follow-up. Conclusion LW CW and septal WW before CRT are important determinants of reverse remodeling and clinical outcomes.
Collapse
Affiliation(s)
- Chun-Li Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lung-Sheng Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Tung Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Hsin Yeh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wen Cheng
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kun-Chi Yen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsin Chan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chi Chuang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Cardiology, Department of Internal Medicine, New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chi-Tai Kuo
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
18
|
Linde C. Electrical therapies in heart failure: Evolving technologies and indications. Presse Med 2024; 53:104192. [PMID: 37898311 DOI: 10.1016/j.lpm.2023.104192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/06/2023] [Indexed: 10/30/2023] Open
Abstract
Device therapy for heart failure has rapidly evolved over 2 decades. The knowledge of indications, assessment lead and device technology has expanded to include CRT, leadless pacing and conduction system pacing such as His bundle and left bundle branch area pacing. But there is still a lack of evidence for these new technologies as well as for common indications such as atrial fibrillation and upgrading from a previous device. The role of personalized medicine will become increasingly important when selecting candidates for CRT, primary preventive ICD ablation procedures and emerging new devices such as cardiac contractility modulation (CCM). Rapidity of therapy is associated with outcome which will be a challenge. If properly implemented devices and drugs will have a large positive affect of HF outcomes.
Collapse
Affiliation(s)
- Cecilia Linde
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Karolinska Universitetssjukhuset, Stockholm, Sweden.
| |
Collapse
|
19
|
Neves Pereira MT, Tinoco M, Castro M, Pinheiro L, Cardoso F, Calvo L, Ribeiro S, Monteiro V, Sanfins V, Lourenço A. Assessing cardiac resynchronization therapy response in heart failure patients: a comparative analysis of efficacy and outcomes between transvenous and epicardial leads. Monaldi Arch Chest Dis 2024. [PMID: 38332712 DOI: 10.4081/monaldi.2024.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
Cardiac resynchronization therapy (CRT) is an effective treatment for selected heart failure (HF) patients. Although transvenous implantation is the standard method, it is not feasible in some patients, so the epicardial lead emerges as an alternative. We aim to compare CRT response, procedure-related complications, and the occurrence of clinical outcomes between patients with transvenous and epicardial leads. In a single-center retrospective study, we enrolled consecutive HF patients submitted to CRT implantation with a defibrillator between 2013 and 2022. Clinical response was defined as an improvement of at least one of the New York Heart Association classes with no occurrence of cardiovascular death or HF hospitalization in the first year of follow-up. Echocardiographic response was attained with an increase in left ventricular ejection fraction 10% or a reduction of left ventricular end-diastolic volume >15% at 6-12 months after CRT implantation. Major adverse cardiovascular events (MACE) (cardiovascular mortality and HF hospitalization) and all-cause mortality were evaluated. From a total of 149 patients, 38% (n=57) received an epicardial lead. Clinical (63% versus 60%, p=0.679) and echocardiographic (63% versus 60%, p=0.679) responses were similar between the transvenous and epicardial groups. Patients in the transvenous group had a shorter hospital stay (2 versus 7 days, p<0.001). Procedure-related complications were comparable between groups (24% versus 28%, p=0.572), but left ventricular lead-related complications were more frequent in the transvenous group (14% versus 2%). During a median follow-up of 4.7 years, the rate of MACE was 30% (n=44), with no differences in both groups (p=0.591), neither regarding HF hospitalization (p=0.917) nor cardiovascular mortality (p=0.060). Nevertheless, the epicardial group had a higher rate of all-cause mortality (35% versus 20%, p=0.005), the majority occurring during long-term follow-up (>12 months), with no deaths in the postoperative period. Considering the comparable rates of CRT response, procedure-related complications, and MACE between groups, we conclude that epicardial lead is a feasible alternative for CRT when transvenous lead implantation is not possible. The occurrence of a higher number of all-cause deaths in epicardial patients in the long-term follow-up was mainly due to infectious complications (unrelated to the lead) and the progression of oncological/chronic diseases.
Collapse
Affiliation(s)
| | | | | | | | | | - Lucy Calvo
- Senhora da Oliveira Hospital, Guimarães.
| | | | | | | | | |
Collapse
|
20
|
Könemann H, Güler-Eren S, Ellermann C, Frommeyer G, Eckardt L. Antiarrhythmic Treatment in Heart Failure. Curr Heart Fail Rep 2024; 21:22-32. [PMID: 38224446 PMCID: PMC10828006 DOI: 10.1007/s11897-023-00642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW Arrhythmias are common in patients with heart failure (HF) and are associated with a significant risk of mortality and morbidity. Optimal antiarrhythmic treatment is therefore essential. Here, we review current approaches to antiarrhythmic treatment in patients with HF. RECENT FINDINGS In atrial fibrillation, rhythm control and ventricular rate control are accepted therapeutic strategies. In recent years, clinical trials have demonstrated a prognostic benefit of early rhythm control strategies and AF catheter ablation, especially in patients with HF with reduced ejection fraction. Prevention of sudden cardiac death with ICD therapy is essential, but optimal risk stratification is challenging. For ventricular tachycardias, recent data support early consideration of catheter ablation. Antiarrhythmic drug therapy is an adjunctive therapy in symptomatic patients but has no prognostic benefit and well-recognized (proarrhythmic) adverse effects. Antiarrhythmic therapy in HF requires a systematic, multimodal approach, starting with guideline-directed medical therapy for HF and integrating pharmacological, device, and interventional therapy.
Collapse
Affiliation(s)
- Hilke Könemann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany.
| | - Sati Güler-Eren
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Christian Ellermann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| |
Collapse
|
21
|
Roccisano L, Voskoboinik A, Mariani J, Marwick TH, Patel HC. Cardiac Resynchronisation Therapy: How Medicare Criteria Might Inadvertently Promote Disparate Healthcare. Heart Lung Circ 2024; 33:e10-e11. [PMID: 38453294 DOI: 10.1016/j.hlc.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Laura Roccisano
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia.
| | - Aleksandr Voskoboinik
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Justin Mariani
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Central Clinical School, Monash University, Melbourne, Vic, Australia
| | | | - Hitesh C Patel
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| |
Collapse
|
22
|
Sapp JL, Sivakumaran S, Redpath CJ, Khan H, Parkash R, Exner DV, Healey JS, Thibault B, Sterns LD, Lam NHN, Manlucu J, Mokhtar A, Sumner G, McKinlay S, Kimber S, Mondesert B, Talajic M, Rouleau J, McCarron CE, Wells G, Tang ASL. Long-Term Outcomes of Resynchronization-Defibrillation for Heart Failure. N Engl J Med 2024; 390:212-220. [PMID: 38231622 DOI: 10.1056/nejmoa2304542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND The Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT) showed a greater benefit with respect to mortality at 5 years among patients who received cardiac-resynchronization therapy (CRT) than among those who received implantable cardioverter-defibrillators (ICDs). However, the effect of CRT on long-term survival is not known. METHODS We randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more (or a paced QRS duration of 200 msec or more) to receive either an ICD alone or a CRT defibrillator (CRT-D). We assessed long-term outcomes among patients at the eight highest-enrolling participating sites. The primary outcome was death from any cause; the secondary outcome was a composite of death from any cause, heart transplantation, or implantation of a ventricular assist device. RESULTS The trial enrolled 1798 patients, of whom 1050 were included in the long-term survival trial; the median duration of follow-up for the 1050 patients was 7.7 years (interquartile range, 3.9 to 12.8), and the median duration of follow-up for those who survived was 13.9 years (interquartile range, 12.8 to 15.7). Death occurred in 405 of 530 patients (76.4%) assigned to the ICD group and in 370 of 520 patients (71.2%) assigned to the CRT-D group. The time until death appeared to be longer for those assigned to receive a CRT-D than for those assigned to receive an ICD (acceleration factor, 0.80; 95% confidence interval, 0.69 to 0.92; P = 0.002). A secondary-outcome event occurred in 412 patients (77.7%) in the ICD group and in 392 (75.4%) in the CRT-D group. CONCLUSIONS Among patients with a reduced ejection fraction, a widened QRS complex, and NYHA class II or III heart failure, the survival benefit associated with receipt of a CRT-D as compared with ICD appeared to be sustained during a median of nearly 14 years of follow-up. (RAFT ClinicalTrials.gov number, NCT00251251.).
Collapse
Affiliation(s)
- John L Sapp
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Soori Sivakumaran
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Calum J Redpath
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Habib Khan
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Ratika Parkash
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Derek V Exner
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Jeff S Healey
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Bernard Thibault
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Laurence D Sterns
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Nhat Hung N Lam
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Jaimie Manlucu
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Ahmed Mokhtar
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Glen Sumner
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Stuart McKinlay
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Shane Kimber
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Blandine Mondesert
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Mario Talajic
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Jean Rouleau
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - C Elizabeth McCarron
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - George Wells
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Anthony S L Tang
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| |
Collapse
|
23
|
Qin D, Singh JP. Cardiac Resynchronization Therapy for Non-Left Bundle Branch Block: Time for Change? JACC Clin Electrophysiol 2024; 10:27-30. [PMID: 38267169 DOI: 10.1016/j.jacep.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Dingxin Qin
- Telemachus and Irene Demoulas Family Foundation Center for Cardiac Arrhythmias, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jagmeet P Singh
- Telemachus and Irene Demoulas Family Foundation Center for Cardiac Arrhythmias, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Tokmak F, Koivisto T, Lahdenoja O, Vasankari T, Jaakkola S, Airaksinen KEJ. Mechanocardiography detects improvement of systolic function caused by resynchronization pacing. Physiol Meas 2023; 44:125009. [PMID: 38041869 DOI: 10.1088/1361-6579/ad1197] [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: 06/16/2023] [Accepted: 12/01/2023] [Indexed: 12/04/2023]
Abstract
Objective.Cardiac resynchronization therapy (CRT) is commonly used to manage heart failure with dyssynchronous ventricular contraction. CRT pacing resynchronizes the ventricular contraction, while AAI (single-chamber atrial) pacing does not affect the dyssynchronous function. This study compared waveform characteristics during CRT and AAI pacing at similar pacing rates using seismocardiogram (SCG) and gyrocardiogram (GCG), collectively known as mechanocardiogram (MCG).Approach.We included 10 patients with heart failure with reduced ejection fraction and previously implanted CRT pacemakers. ECG and MCG recordings were taken during AAI and CRT pacing at a heart rate of 80 bpm. Waveform characteristics, including energy, vertical range (amplitude) during systole and early diastole, electromechanical systole (QS2) and left ventricular ejection time (LVET), were derived by considering 6 MCG axes and 3 MCG vectors across frequency ranges of >1 Hz, 20-90 Hz, 6-90 Hz and 1-20 Hz.Main results.Significant differences were observed between CRT and AAI pacing. CRT pacing consistently exhibited higher energy and vertical range during systole compared to AAI pacing (p< 0.05). However, QS2, LVET and waveform characteristics around aortic valve closure did not differ between the pacing modes. Optimal differences were observed in SCG-Y, GCG-X, and GCG-Y axes within the frequency range of 6-90 Hz.Significance.The results demonstrate significant differences in MCG waveforms, reflecting improved mechanical cardiac function during CRT. This information has potential implications for predicting the clinical response to CRT. Further research is needed to explore the differences in signal characteristics between responders and non-responders to CRT.
Collapse
Affiliation(s)
- Fadime Tokmak
- Department of Computing, University of Turku, Vesilinnantie 5, FI-20500 Turku, Finland
| | - Tero Koivisto
- Department of Computing, University of Turku, Vesilinnantie 5, FI-20500 Turku, Finland
| | - Olli Lahdenoja
- Department of Computing, University of Turku, Vesilinnantie 5, FI-20500 Turku, Finland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital, Hämeentie 11, FI-20520 Turku, Finland
| | - Samuli Jaakkola
- Heart Center, Turku University Hospital, Hämeentie 11, FI-20520 Turku, Finland
| | | |
Collapse
|
26
|
Toon LT, Roberts PR. The Micra Transcatheter Pacing System: past, present and the future. Future Cardiol 2023; 19:735-746. [PMID: 38059460 DOI: 10.2217/fca-2023-0093] [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: 07/03/2023] [Accepted: 10/13/2023] [Indexed: 12/08/2023] Open
Abstract
Leadless permanent pacemakers represent an important innovation in cardiac device developments. Although transvenous permanent pacemakers have become indispensable in managing bradyarrhythmia and saving numerous lives, the use of transvenous systems comes with notable risks tied to intravascular leads and subcutaneous pockets. This drawback has spurred the creation of leadless cardiac pacemakers. Within this analysis, we compile existing clinical literature and proceed to evaluate the efficacy and safety of the Micra Transcatheter Pacing System. We also delve into the protocols for addressing a malfunctioning or end-of-life Micra as well as device extraction. Lastly, we explore prospects in this domain, such as the emergence of entirely leadless cardiac resynchronization therapy-defibrillator devices.
Collapse
Affiliation(s)
- Lin-Thiri Toon
- Cardiac Rhythm Management, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Paul R Roberts
- Cardiac Rhythm Management, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| |
Collapse
|
27
|
Daubert JC. CRT-D or CRT-P?: the endless debate! Europace 2023; 25:euad285. [PMID: 37713248 PMCID: PMC10585353 DOI: 10.1093/europace/euad285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
- J Claude Daubert
- Faculté de Médecine, Université de Rennes 1, 2 Av. du Professeur Léon Bernard, 35000 Rennes, France
| |
Collapse
|
28
|
Canepa M, De Marzo V, Ameri P, Ferrari R, Tavazzi L, Rapezzi C, Porto I, Maggioni AP. Temporal trends in evidence supporting therapeutic interventions in heart failure and other European Society of Cardiology guidelines. ESC Heart Fail 2023; 10:3019-3027. [PMID: 37550897 PMCID: PMC10567640 DOI: 10.1002/ehf2.14459] [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: 12/07/2022] [Revised: 05/20/2023] [Accepted: 06/21/2023] [Indexed: 08/09/2023] Open
Abstract
AIMS This study aimed to determine whether any change occurred over time in level of evidence (LoE) of therapeutic interventions supporting heart failure (HF) and other European Society of Cardiology guideline recommendations. METHODS AND RESULTS We selected topics with at least three documents released between 2008 and April 2022. Classes of recommendations (CoR) and supporting LoE related to therapeutic interventions within each document were collected and compared over time. A total of 1822 recommendations from 18 documents on 6 topics [median number per document = 112, 867 (48%) CoR I] were included in the analysis. There was a trend towards a reduction over time in the percentage of CoR I in HF (46-36-34%), non-ST elevation myocardial infarction (NSTEMI; 78-58-54%), and pulmonary embolism (PE; 65-50-39%) guidelines, with a decrease in the total number of recommendations for HF only. Percentage of CoR I was stable over time around 40% for valvular heart disease (VHD) and atrial fibrillation (AF), and around 60% for cardiovascular prevention (CVP), with an increase in the total number of recommendations for VHD and CVP and a decrease for AF. Among CoR I, 319 (37%) were supported by LoE A, with a decrease over time for HF (56-46-42%), an increase for NSTEMI (29-38-48%) and AF (28-31-36%), a bimodal distribution for PE and CVP, and a lack for VHD. CONCLUSIONS LoE supporting therapeutic recommendations in contemporary European guidelines is generally low. Physicians should be aware of these limitations, and scientific societies promote a greater understanding of their significance and drive future research directions.
Collapse
Affiliation(s)
- Marco Canepa
- Cardiology UnitOspedale Policlinico San Martino IRCCSGenoaItaly
- Department of Internal MedicineUniversity of GenovaGenoaItaly
| | | | - Pietro Ameri
- Cardiology UnitOspedale Policlinico San Martino IRCCSGenoaItaly
- Department of Internal MedicineUniversity of GenovaGenoaItaly
| | - Roberto Ferrari
- Scientific DepartmentMTA GroupLuganoSwitzerland
- Azienda Ospedaliero‐Universitaria di Ferrara ‘Arcispedale S. Anna’FerraraItaly
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
| | - Claudio Rapezzi
- Azienda Ospedaliero‐Universitaria di Ferrara ‘Arcispedale S. Anna’FerraraItaly
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
| | - Italo Porto
- Cardiology UnitOspedale Policlinico San Martino IRCCSGenoaItaly
- Department of Internal MedicineUniversity of GenovaGenoaItaly
| | - Aldo Pietro Maggioni
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
- Centro Studi ANMCO, Heart Care FoundationFlorenceItaly
| |
Collapse
|
29
|
Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP, Lopez-Cabanillas N, Ellenbogen KA, Hua W, Ikeda T, Mackall JA, Mason PK, McLeod CJ, Mela T, Moore JP, Racenet LK. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. J Arrhythm 2023; 39:681-756. [PMID: 37799799 PMCID: PMC10549836 DOI: 10.1002/joa3.12872] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Eugene H Chung
- University of Michigan Medical School Ann Arbor Michigan USA
| | | | | | | | | | - Anne M Dubin
- Stanford University, Pediatric Cardiology Palo Alto California USA
| | - Douglas P Ensch
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Taya V Glotzer
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
| | - Michael R Gold
- Medical University of South Carolina Charleston South Carolina USA
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
| | | | | | - Weijian Huang
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Peter B Imrey
- Cleveland Clinic Cleveland Ohio USA
- Case Western Reserve University Cleveland Ohio USA
| | - Julia H Indik
- University of Arizona, Sarver Heart Center Tucson Arizona USA
| | - Saima Karim
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
| | - Peter P Karpawich
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
| | - Yaariv Khaykin
- Southlake Regional Health Center Newmarket Ontario Canada
| | | | - Jordana Kron
- Virginia Commonwealth University Richmond Virginia USA
| | | | - Mark S Link
- University of Texas Southwestern Medical Center Dallas Texas USA
| | - Joseph E Marine
- Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
| | - Seung-Jung Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
| | | | | | - Rajeev Kumar Pathak
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
| | | | | | | | | | | | - Morio Shoda
- Tokyo Women's Medical University Tokyo Japan
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - David J Slotwiner
- Weill Cornell Medicine Population Health Sciences New York New York USA
| | | | - Uma N Srivatsa
- University of California Davis Sacramento California USA
| | | | | | | | | | - Cynthia M Tracy
- George Washington University Washington District of Columbia USA
| | | | | | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
| | | | | | - Wojciech Zareba
- University of Rochester Medical Center Rochester New York USA
| | | | - Nestor Lopez-Cabanillas
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Kenneth A Ellenbogen
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Wei Hua
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Takanori Ikeda
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Judith A Mackall
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Pamela K Mason
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Christopher J McLeod
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Theofanie Mela
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Jeremy P Moore
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Laurel Kay Racenet
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| |
Collapse
|
30
|
Wilkoff BL, Filippatos G, Leclercq C, Gold MR, Hersi AS, Kusano K, Mullens W, Felker GM, Kantipudi C, El-Chami MF, Essebag V, Pierre B, Philippon F, Perez-Gil F, Chung ES, Sotomonte J, Tung S, Singh B, Bozorgnia B, Goel S, Ebert HH, Varma N, Quan KJ, Salerno F, Gerritse B, van Wel J, Schaber DE, Fagan DH, Birnie D. Adaptive versus conventional cardiac resynchronisation therapy in patients with heart failure (AdaptResponse): a global, prospective, randomised controlled trial. Lancet 2023; 402:1147-1157. [PMID: 37634520 DOI: 10.1016/s0140-6736(23)00912-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Continuous automatic optimisation of cardiac resynchronisation therapy (CRT), stimulating only the left ventricle to fuse with intrinsic right bundle conduction (synchronised left ventricular stimulation), might offer better outcomes than conventional CRT in patients with heart failure, left bundle branch block, and normal atrioventricular conduction. This study aimed to compare clinical outcomes of adaptive CRT versus conventional CRT in patients with heart failure with intact atrioventricular conduction and left bundle branch block. METHODS This global, prospective, randomised controlled trial was done in 227 hospitals in 27 countries across Asia, Australia, Europe, and North America. Eligible patients were aged 18 years or older with class 2-4 heart failure, an ejection fraction of 35% or less, left bundle branch block with QRS duration of 140 ms or more (male patients) or 130 ms or more (female patients), and a baseline PR interval 200 ms or less. Patients were randomly assigned (1:1) via block permutation to adaptive CRT (an algorithm providing synchronised left ventricular stimulation) or conventional biventricular CRT using a device programmer. All patients received device programming but were masked until procedures were completed. Site staff were not masked to group assignment. The primary outcome was a composite of all-cause death or intervention for heart failure decompensation and was assessed in the intention-to-treat population. Safety events were collected and reported in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT02205359, and is closed to accrual. FINDINGS Between Aug 5, 2014, and Jan 31, 2019, of 3797 patients enrolled, 3617 (95·3%) were randomly assigned (1810 to adaptive CRT and 1807 to conventional CRT). The futility boundary was crossed at the third interim analysis on June 23, 2022, when the decision was made to stop the trial early. 1568 (43·4%) of 3617 patients were female and 2049 (56·6%) were male. Median follow-up was 59·0 months (IQR 45-72). A primary outcome event occurred in 430 of 1810 patients (Kaplan-Meier occurrence rate 23·5% [95% CI 21·3-25·5] at 60 months) in the adaptive CRT group and in 470 of 1807 patients (25·7% [23·5-27·8] at 60 months) in the conventional CRT group (hazard ratio 0·89, 95% CI 0·78-1·01; p=0·077). System-related adverse events were reported in 452 (25·0%) of 1810 patients in the adaptive CRT group and 440 (24·3%) of 1807 patients in the conventional CRT group. INTERPRETATION Compared with conventional CRT, adaptive CRT did not significantly reduce the incidence of all-cause death or intervention for heart failure decompensation in the included population of patients with heart failure, left bundle branch block, and intact AV conduction. Death and heart failure decompensation rates were low with both CRT therapies, suggesting a greater response to CRT occurred in this population than in patients in previous trials. FUNDING Medtronic.
Collapse
Affiliation(s)
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.
| | | | - Michael R Gold
- Medical University of South Carolina, Charleston, SC, USA
| | - Ahmad S Hersi
- King Saud University, Faculty of Medicine, Riyadh, Saudi Arabia
| | - Kengo Kusano
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Hasselt University, Hasselt, Belgium
| | | | | | | | - Vidal Essebag
- McGill University Health Centre, Montreal, QC, Canada; Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Bertrand Pierre
- Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, Tours, France
| | - Francois Philippon
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | | | - Eugene S Chung
- The Lindner Research Center at The Christ Hospital, Cincinnati, OH, USA
| | - Juan Sotomonte
- Cardiovascular Center of Puerto Rico and the Caribbean, San Juan, Puerto Rico
| | - Stanley Tung
- St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; Royal Columbian Hospital, New Westminster, BC, Canada
| | - Balbir Singh
- Medanta-The Medicity Hospital, Gurugram, Haryana, India
| | | | - Satish Goel
- First Coast Cardiovascular Institute, Jacksonville, FL, USA
| | | | | | - Kara J Quan
- Harrington Heart and Vascular Institute, University Hospitals of Cleveland, Cleveland, OH, USA
| | | | - Bart Gerritse
- Medtronic Bakken Research Center, Maastricht, Netherlands
| | | | | | | | - David Birnie
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| |
Collapse
|
31
|
Katritsis DG, Calkins H. Septal and Conduction System Pacing. Arrhythm Electrophysiol Rev 2023; 12:e25. [PMID: 37860698 PMCID: PMC10583155 DOI: 10.15420/aer.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023] Open
|
32
|
Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. Heart Rhythm 2023; 20:e17-e91. [PMID: 37283271 PMCID: PMC11062890 DOI: 10.1016/j.hrthm.2023.03.1538] [Citation(s) in RCA: 105] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 06/08/2023]
Abstract
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Eugene H Chung
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | | | | | - Anne M Dubin
- Stanford University, Pediatric Cardiology, Palo Alto, California
| | | | - Taya V Glotzer
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Michael R Gold
- Medical University of South Carolina, Charleston, South Carolina
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | | | - Weijian Huang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peter B Imrey
- Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University, Cleveland, Ohio
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Saima Karim
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Peter P Karpawich
- The Children's Hospital of Michigan, Central Michigan University, Detroit, Michigan
| | - Yaariv Khaykin
- Southlake Regional Health Center, Newmarket, Ontario, Canada
| | | | - Jordana Kron
- Virginia Commonwealth University, Richmond, Virginia
| | | | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joseph E Marine
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg Genk, Belgium and Hasselt University, Hasselt, Belgium
| | - Seung-Jung Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Ratika Parkash
- QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | | | - Rajeev Kumar Pathak
- Australian National University, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | | | | | | | | | | | - Morio Shoda
- Tokyo Women's Medical University, Tokyo, Japan
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Slotwiner
- Weill Cornell Medicine Population Health Sciences, New York, New York
| | | | | | | | | | | | | | - Cynthia M Tracy
- George Washington University, Washington, District of Columbia
| | | | | | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | | | | |
Collapse
|
33
|
Feijen M, Egorova AD, Kuijken T, Bootsma M, Schalij MJ, van Erven L. One-Year Mortality in Patients Undergoing an Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy Pulse Generator Replacement: Identifying Patients at Risk. J Clin Med 2023; 12:5654. [PMID: 37685719 PMCID: PMC10489035 DOI: 10.3390/jcm12175654] [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: 07/31/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Implantable cardioverter defibrillators (ICDs) significantly contribute to the prevention of sudden cardiac death in selected patients. However, it is essential to identify those who are likely to not have benefit from an ICD and to defer a pulse generator exchange. Easily implementable guidelines for individual risk stratification and decision making are lacking. This study investigates the 1-year mortality of patients who underwent an ICD or cardiac resynchronization therapy with defibrillator function (CRT-D) pulse generator replacement in a contemporary real-world tertiary hospital setting. The cause of death and patient- and procedure-related factors are stratified, and predictive values for 1-year mortality are evaluated. Patients with a follow-up of ≥365 days (or prior mortality) after an ICD or CRT-D exchange at the Leiden University Medical Center from 1 January 2018 until 31 December 2021 were eligible. In total, 588 patients were included (77% male, 69 [60-76] years old, 59% primary prevention, 46% ischemic cardiomyopathy and 37% mildly reduced left ventricular ejection fraction (LVEF)). Patients undergoing a CRT-D replacement or upgrade had a significantly higher 1-year all-cause mortality (10.7% and 11.9%, respectively) compared to patients undergoing ICD (2.8%) exchange (p = 0.002). LVEF ≤ 30%, New York Heart Association class ≥ 3, estimated glomerular filtration rate ≤ 30 mL/min/m2 and haemoglobin ≤ 7 mmol/L were independently associated with mortality within 1 year after pulse generator replacement. There is a growing need for prospectively validated risk scores to weight individualized risk of mortality with the expected ICD therapy benefit and to support a well-informed, shared decision-making process.
Collapse
Affiliation(s)
| | - Anastasia D. Egorova
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (M.F.); (L.v.E.)
| | | | | | | | | |
Collapse
|
34
|
Pola K, Roijer A, Borgquist R, Ostenfeld E, Carlsson M, Bakos Z, Arheden H, Arvidsson PM. Hemodynamic forces from 4D flow magnetic resonance imaging predict left ventricular remodeling following cardiac resynchronization therapy. J Cardiovasc Magn Reson 2023; 25:45. [PMID: 37620886 PMCID: PMC10463519 DOI: 10.1186/s12968-023-00955-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patients with heart failure and left bundle branch block (LBBB) may receive cardiac resynchronization therapy (CRT), but current selection criteria are imprecise, and many patients have limited treatment response. Hemodynamic forces (HDF) have been suggested as a marker for CRT response. The aim of this study was therefore to investigate left ventricular (LV) HDF as a predictive marker for LV remodeling after CRT. METHODS Patients with heart failure, EF < 35% and LBBB (n = 22) underwent CMR with 4D flow prior to CRT. LV HDF were computed in three directions using the Navier-Stokes equations, reported in median N [interquartile range], and the ratio of transverse/longitudinal HDF was calculated for systole and diastole. Transthoracic echocardiography was performed before and 6 months after CRT. Patients with end-systolic volume reduction ≥ 15% were defined as responders. RESULTS Non-responders had smaller HDF than responders in the inferior-anterior direction in systole (0.06 [0.03] vs. 0.07 [0.03], p = 0.04), and in the apex-base direction in diastole (0.09 [0.02] vs. 0.1 [0.05], p = 0.047). Non-responders had larger diastolic HDF ratio compared to responders (0.89 vs. 0.67, p = 0.004). ROC analysis of diastolic HDF ratio for identifying CRT non-responders had AUC of 0.88 (p = 0.005) with sensitivity 57% and specificity 100% for ratio > 0.87. Intragroup comparison found higher HDF ratio in systole compared to diastole for responders (p = 0.003), but not for non-responders (p = 0.8). CONCLUSION Hemodynamic force ratio is a potential marker for identifying patients with heart failure and LBBB who are unlikely to benefit from CRT. Larger-scale studies are required before implementation of HDF analysis into clinical practice.
Collapse
Affiliation(s)
- Karin Pola
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anders Roijer
- Heart Failure and Valvular Heart Disease Section, Skåne University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Cardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Zoltan Bakos
- Cardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Per M Arvidsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
| |
Collapse
|
35
|
Ezzeddine FM, Leon IG, Cha YM. Cardiac Resynchronisation with Conduction System Pacing. Arrhythm Electrophysiol Rev 2023; 12:e22. [PMID: 37654672 PMCID: PMC10466271 DOI: 10.15420/aer.2023.03] [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] [Received: 01/26/2023] [Accepted: 04/12/2023] [Indexed: 09/02/2023] Open
Abstract
To date, biventricular pacing (BiVP) has been the standard pacing modality for cardiac resynchronisation therapy. However, it is non-physiological, with the activation spreading between the left ventricular epicardium and right ventricular endocardium. Up to one-third of patients with heart failure who are eligible for cardiac resynchronisation therapy do not derive benefit from BiVP. Conduction system pacing (CSP), which includes His bundle pacing and left bundle branch area pacing, has emerged as an alternative to BiVP for cardiac resynchronisation. There is mounting evidence supporting the benefits of CSP in achieving synchronous ventricular activation and repolarisation. The aim of this review is to summarise the current options and outcomes of CSP when used for cardiac resynchronisation in patients with heart failure.
Collapse
Affiliation(s)
| | - Isaac G Leon
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, US
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, US
| |
Collapse
|
36
|
Padala SK, Ellenbogen KA. Pacing of Specialized Conduction System. Cardiol Clin 2023; 41:463-489. [PMID: 37321695 DOI: 10.1016/j.ccl.2023.03.005] [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: 06/17/2023]
Abstract
Right ventricular pacing for bradycardia remains the mainstay of pacing therapy. Chronic right ventricular pacing may lead to pacing-induced cardiomyopathy. We focus on the anatomy of the conduction system and the clinical feasibility of pacing the His bundle and/or left bundle conduction system. We review the hemodynamics of conduction system pacing, the techniques to capture the conduction system and the electrocardiogram and pacing definitions of conduction system capture. Clinical studies of conduction system pacing in the setting of atrioventricular block and after AV junction ablation are reviewed and the evolving role of conduction system pacing is compared with biventricular pacing.
Collapse
Affiliation(s)
- Santosh K Padala
- Department of Cardiac Electrophysiology, Virginia Commonwealth University, Gateway Building, 3 Road Floor, 3-216, 1200 East Marshall Street, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Department of Cardiac Electrophysiology, Virginia Commonwealth University, Gateway Building, 3 Road Floor, 3-216, 1200 East Marshall Street, Richmond, VA, USA.
| |
Collapse
|
37
|
Malaty MM, Sivagangabalan G, Qian PC. Beyond Conventional Cardiac Resynchronisation Therapy: A Review of Electrophysiological Options in the Management of Chronic Heart Failure. Heart Lung Circ 2023; 32:905-913. [PMID: 37286460 DOI: 10.1016/j.hlc.2023.05.005] [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: 12/06/2022] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023]
Abstract
The incidence of heart failure (HF) continues to grow and burden our health care system. Electrophysiological aberrations are common amongst patients with heart failure and can contribute to worsening symptoms and prognosis. Targeting these abnormalities with cardiac and extra-cardiac device therapies and catheter ablation procedures augments cardiac function. Newer technologies aimed to improvement procedural outcomes, address known procedural limitations and target newer anatomical sites have been trialled recently. We review the role and evidence base for conventional cardiac resynchronisation therapy (CRT) and its optimisation, catheter ablation therapies for atrial arrhythmias, cardiac contractility and autonomic modulation therapies.
Collapse
Affiliation(s)
- Michael M Malaty
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Gopal Sivagangabalan
- Department of Cardiology, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; School of Medicine, Sydney Campus, University of Notre Dame, Sydney, NSW, Australia
| | - Pierre C Qian
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
38
|
Shivakumar N, Friedman DJ, Fudim M, Abraham WT, Cleland JGF, Curtis AB, Gold MR, Kutyifa V, Linde C, Young J, Tang A, Olivas-Martinez A, Inoue LYT, Sanders GD, Al-Khatib SM. Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient-Level Meta-Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.05.23292279. [PMID: 37461448 PMCID: PMC10350149 DOI: 10.1101/2023.07.05.23292279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Data on the benefits of cardiac resynchronization therapy (CRT) in patients with severe heart failure (HF) symptoms are limited. We investigated the relative effects of CRT in patients with ambulatory NYHA IV vs. III functional class at the time of device implantation. In this meta-analysis, we pooled patient-level data from the MIRACLE, MIRACLE-ICD, and COMPANION trials. Outcomes evaluated were time to the composite endpoint of first HF hospitalization (HFH) or all-cause mortality and time to all-cause mortality alone. The association between CRT and outcomes was evaluated using a Bayesian Hierarchical Weibull survival regression model. We assessed if this association differs between NYHA III and IV groups by adding an interaction term between CRT and NYHA class as a random effect. A sensitivity analysis was performed by including data from the RAFT trial. Our pooled analysis included 2309 patients. Overall, CRT was associated with a longer time to HFH or all-cause mortality (adjusted hazard ratio [aHR] 0.79, 95%CI 0.64 - 0.99, p = 0.044), with a similar association with time to all-cause mortality (aHR 0.78, 95% CI 0.59 - 1.03, p = 0.083). Associations of CRT with outcomes were not significantly different for those in NYHA III and IV classes (ratio of aHR 0.72, 95% CI 0.30 - 1.27, p = 0.23 for HFH/mortality; ratio of aHR 0.70, 95% CI 0.35 - 1.34, p = 0.27 for all-cause mortality alone). The sensitivity analysis, including RAFT data, did not show a significant relative CRT benefit between NYHA III and IV classes. Overall, there was no significant difference in the association of CRT with either outcome for patients in NYHA functional class III compared with functional class IV.
Collapse
Affiliation(s)
| | - Daniel J Friedman
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH
| | - John G F Cleland
- National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, United Kingdom (J.G.F.C.)
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (J.G.F.C.)
| | - Anne B Curtis
- Department of Medicine, University at Buffalo, Buffalo, NY
| | - Michael R Gold
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Valentina Kutyifa
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center Rochester, NY
| | - Cecilia Linde
- Karolinska Institutet and Department of Cardiology, Karolinska University, Stockholm, Sweden
| | - James Young
- Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Anthony Tang
- Department of Medicine, Western University, Ontario, Canada
| | | | - Lurdes Y T Inoue
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Gillian D Sanders
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC
- Evidence Synthesis Group, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Sana M Al-Khatib
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| |
Collapse
|
39
|
Agricola E, Ancona F. Is There Any Room Left for Echocardiographic-Dyssynchrony Parameters in the Field of CRT? JACC Cardiovasc Imaging 2023; 16:885-888. [PMID: 37407121 DOI: 10.1016/j.jcmg.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
40
|
Ma C, Wang Z, Ma Z, Ma P, Dai S, Wang N, Yang Y, Li G, Gao L, Xia Y, Xiao X, Dong Y. The feasibility and safety of his-purkinje conduction system pacing in patients with heart failure with severely reduced ejection fraction. Front Cardiovasc Med 2023; 10:1187169. [PMID: 37283576 PMCID: PMC10239933 DOI: 10.3389/fcvm.2023.1187169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Objective The purpose of this study was to evaluate the feasibility and outcomes of conduction system pacing (CSP) in patients with heart failure (HF) who had a severely reduced left ventricular ejection fraction (LVEF) of less than 30% (HFsrEF). Methods Between January 2018 and December 2020, all consecutive HF patients with LVEF < 30% who underwent CSP at our center were evaluated. Clinical outcomes and echocardiographic data [LVEF and left ventricular end-systolic volume (LVESV)], and complications were all recorded. In addition, clinical and echocardiographic (≥5% improvement in LVEF or ≥15% decrease in LVESV) responses were assessed. The patients were classified into a complete left bundle branch block (CLBBB) morphology group and a non-CLBBB morphology group according to the baseline QRS configuration. Results Seventy patients (66 ± 8.84 years; 55.7% male) with a mean LVEF of 23.2 ± 3.23%, LVEDd of 67.33 ± 7.47 mm and LVESV of 212.08 ± 39.74 ml were included. QRS configuration at baseline was CLBBB in 67.1% (47/70) of patients and non-CLBBB in 32.9%. At implantation, the CSP threshold was 0.6 ± 0.3 V @ 0.4 ms and remained stable during a mean follow-up of 23.43 ± 11.44 months. CSP resulted in significant LVEF improvement from 23.2 ± 3.23% to 34.93 ± 10.34% (P < 0.001) and significant QRS narrowing from 154.99 ± 34.42 to 130.81 ± 25.18 ms (P < 0.001). Clinical and echocardiographic responses were observed in 91.4% (64/70) and 77.1% (54/70) of patients. Super-response to CSP (≥15% improvement in LVEF or ≥30% decrease in LVESV) was observed in 52.9% (37/70) of patients. One patient died due to acute HF and following severe metabolic disorders. Baseline BNP (odds ratio: 0.969; 95% confidence interval: 0.939-0.989; P = 0.045) was associated with echocardiographic response. The proportions of clinical and echocardiographic responses in the CLBBB group were higher than those in the non-CLBBB group but without significant statistical differences. Conclusions CSP is feasible and safe in patients with HFsrEF. CSP is associated with a significant improvement in clinical and echocardiographic outcomes, even for patients with non-CLBBB widened QRS.
Collapse
Affiliation(s)
- Chengming Ma
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhongzhen Wang
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhulin Ma
- Department of Graduate School, Dalian Medical University, Dalian, China
| | - Peipei Ma
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shiyu Dai
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Nan Wang
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yiheng Yang
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guocao Li
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lianjun Gao
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xianjie Xiao
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yingxue Dong
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
41
|
Sisinni A, Casenghi M, Popolo Rubbio A, Berni A, Bedogni F, Barbato E. Update on Percutaneous Treatment for HFrEF: A Great Armamentarium for a Poor Ventricular Function. Rev Cardiovasc Med 2023; 24:128. [PMID: 39076731 PMCID: PMC11273015 DOI: 10.31083/j.rcm2405128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/16/2023] [Accepted: 02/14/2023] [Indexed: 07/31/2024] Open
Abstract
Pharmacological treatment is the cornerstone therapy of heart failure with reduced ejection fraction (HFrEF). In addition, several percutaneous techniques have been developed to treat symptomatic patients, with specific heart failure (HF) phenotypes (e.g., valvular heart disease) that require non-pharmacological treatment. Given their prognostic relevance, it is imperative to deliver high-level patient care. This review provides a clinical overview on the available data regarding transcatheter devices in the armamentarium of contemporary interventional cardiologists, focusing on the clinical and anatomical selection criteria.
Collapse
Affiliation(s)
- Antonio Sisinni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Matteo Casenghi
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, University of Rome “La Sapienza”, 1035 Rome, Italy
| | - Antonio Popolo Rubbio
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Andrea Berni
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, University of Rome “La Sapienza”, 1035 Rome, Italy
| | - Francesco Bedogni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, University of Rome “La Sapienza”, 1035 Rome, Italy
| |
Collapse
|
42
|
Gao R, Qu Q, Guo Q, Sun J, Liao S, Zhu Q, Zhu X, Cheang I, Yao W, Zhang H, Li X, Zhou Y. Construction of a web-based dynamic nomogram for predicting the prognosis in acute heart failure. ESC Heart Fail 2023. [PMID: 37076115 PMCID: PMC10375097 DOI: 10.1002/ehf2.14371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
AIMS The early identification and appropriate management may provide clinically meaningful and substained benefits in patients with acute heart failure (AHF). This study aimed to develop an integrative nomogram with myocardial perfusion imaging (MPI) for predicting the risk of all-cause mortality in AHF patients. METHODS AND RESULTS Prospective study of 147 patients with AHF who received gated MPI (59.0 [47.5, 68.0] years; 78.2% males) were enrolled and followed for the primary endpoint of all-cause mortality. We analysed the demographic information, laboratory tests, electrocardiogram, and transthoracic echocardiogram by the least absolute shrinkage and selection operator (LASSO) regression for selection of key features. A multivariate stepwise Cox analysis was performed to identify independent risk factors and construct a nomogram. The predictive values of the constructed model were compared by Kaplan-Meier curve, area under the curves (AUCs), calibration plots, continuous net reclassification improvement, integrated discrimination improvement, and decision curve analysis. The 1, 3, and 5 year cumulative rates of death were 10%, 22%, and 29%, respectively. Diastolic blood pressure [hazard ratio (HR) 0.96, 95% confidence interval (CI) 0.93-0.99; P = 0.017], valvular heart disease (HR 3.05, 95% CI 1.36-6.83; P = 0.007), cardiac resynchronization therapy (HR 0.37, 95% CI 0.17-0.82; P = 0.014), N-terminal pro-B-type natriuretic peptide (per 100 pg/mL; HR 1.02, 95% CI 1.01-1.03; P < 0.001), and rest scar burden (HR 1.03, 95% CI 1.01-1.06; P = 0.008) were independent risk factors for patients with AHF. The cross-validated AUCs (95% CI) of nomogram constructed by diastolic blood pressure, valvular heart disease, cardiac resynchronization therapy, N-terminal pro-B-type natriuretic peptide, and rest scar burden were 0.88 (0.73-1.00), 0.83 (0.70-0.97), and 0.79 (0.62-0.95) at 1, 3, and 5 years, respectively. Continuous net reclassification improvement and integrated discrimination improvement were also observed, and the decision curve analysis identified the greater net benefit of the nomogram across a wide range of threshold probabilities (0-100% at 1 and 3 years; 0-61% and 62-100% at 5 years) compared with dismissing the included factors or using either factor alone. CONCLUSIONS A predictive nomogram for the risk of all-cause mortality in patients with AHF was developed and validated in this study. The nomogram incorporated the rest scar burden by MPI is highly predictive, and may help to better stratify clinical risk and guide treatment decisions in patients with AHF.
Collapse
Affiliation(s)
- Rongrong Gao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qiang Qu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qixin Guo
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jinyu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Shengen Liao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qingqing Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xu Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Wenming Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Haifeng Zhang
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, 26 Daoqian Street, Suzhou, 215002, China
- Department of Cardiology, Jiangsu Province Hospital, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| |
Collapse
|
43
|
Ballantyne BA, Chew DS, Vandenberk B. Paradigm Shifts in Cardiac Pacing: Where Have We Been and What Lies Ahead? J Clin Med 2023; 12:jcm12082938. [PMID: 37109274 PMCID: PMC10146747 DOI: 10.3390/jcm12082938] [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: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
The history of cardiac pacing dates back to the 1930s with externalized pacing and has evolved to incorporate transvenous, multi-lead, or even leadless devices. Annual implantation rates of cardiac implantable electronic devices have increased since the introduction of the implantable system, likely related to expanding indications, and increasing global life expectancy and aging demographics. Here, we summarize the relevant literature on cardiac pacing to demonstrate the enormous impact it has had within the field of cardiology. Further, we look forward to the future of cardiac pacing, including conduction system pacing and leadless pacing strategies.
Collapse
Affiliation(s)
- Brennan A Ballantyne
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Derek S Chew
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
| |
Collapse
|
44
|
Radu AD, Zlibut A, Scarlatescu A, Cojocaru C, Bogdan S, Scafa-Udriște A, Dorobantu M. Cardiac Resynchronization Therapy and Left Atrial Remodeling: A Novel Insight? Biomedicines 2023; 11:1156. [PMID: 37189774 PMCID: PMC10136256 DOI: 10.3390/biomedicines11041156] [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: 03/06/2023] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) restores ventricular dyssynchrony, improving left ventricle (LV) systolic function, symptoms, and outcome in patients with heart failure, systolic dysfunction, and prolonged QRS interval. The left atrium (LA) plays tremendous roles in maintaining cardiac function, being often inflicted in various cardiovascular diseases. LA remodeling implies structural-dilation, functional-altered phasic functions, and strain and electrical-atrial fibrillation remodeling. Until now, several important studies have approached the relationship between LA and CRT. LA volumes can predict responsiveness to CRT, being also associated with improved outcome in these patients. LA function and strain parameters have been shown to improve after CRT, especially in those who were positive responders to it. Further studies still need to be conducted to comprehensively characterize the impact of CRT on LA phasic function and strain, and, also, in conjunction with its impact on functional mitral regurgitation and LV diastolic dysfunction. The aim of this review was to provide an overview of current available data regarding the relation between CRT and LA remodeling.
Collapse
Affiliation(s)
- Andrei Dan Radu
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Alexandru Zlibut
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Alina Scarlatescu
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cosmin Cojocaru
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Stefan Bogdan
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Cardiology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Alexandru Scafa-Udriște
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Maria Dorobantu
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| |
Collapse
|
45
|
Chui PW, Lan Z, Freeman JV, Enriquez AD, Khera R, Akar JG, Masoudi FA, Ong EL, Curtis JP. Variation in hospital use of cardiac resynchronization therapy-defibrillator among eligible patients and association with clinical outcomes. Heart Rhythm 2023:S1547-5271(23)00293-X. [PMID: 36963741 DOI: 10.1016/j.hrthm.2023.03.022] [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] [Received: 11/14/2022] [Revised: 02/23/2023] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Despite strong guideline recommendations for cardiac resynchronization therapy-defibrillator (CRT-D) In select patients, this therapy is underutilized with substantial variation among hospitals, and the association of this variation with outcomes is unknown. OBJECTIVE To assess if facility variation in CRT-D utilization is associated with differences in hospital-level outcomes METHODS: We linked Medicare claims data with the NCDR ICD Registry from 2010 to 2015. We assessed the intraclass correlation coefficient to quantify the degree of variation in patient-level CRT usage that can be explained by interfacility variation on a hospital level. To quantify the degree of hospital variation in patient-level outcomes (all-cause mortality, readmissions, and cardiac readmissions) that can be attributed to variations in CRT-D usage, we utilized multi-level modeling. RESULTS The study included 30,134 patients across 1,377 hospitals. The median rate of CRT-D implantation among those meeting guideline indications was 89%, but there was a wide variation across hospitals. After adjustment, most of the variation (74%) in hospital rates of CRT-D utilization was attributable to the hospital in which the patient was treated. Differences in hospital CRT-D utilization was associated with 8.76%, 5.26%, and 4.71% of differences in hospital mortality, readmissions, and cardiac readmission rates, respectively (p<0.001 for all outcomes). CONCLUSIONS There is wide variation in the use of CRT-D across hospitals that was not explained by case mix. Hospital-level variation in CRT-D utilization was associated with clinically significant differences in outcomes. A measure of CRT-D utilization in eligible patients may serve as a useful metric for quality improvement efforts.
Collapse
Affiliation(s)
- Philip W Chui
- Kaiser Permanente Los Angeles Medical Center; Department of Cardiology, Los Angeles, CA 90027; Yale School of Medicine; Department of Cardiology, New Haven, CT 06510.
| | - Zhou Lan
- Brigham and Women's Hospital; Department of Radiology, Boston 02115
| | - James V Freeman
- Yale School of Medicine; Department of Cardiology, New Haven, CT 06510
| | - Alan D Enriquez
- Yale School of Medicine; Department of Cardiology, New Haven, CT 06510
| | - Rohan Khera
- Yale School of Medicine; Department of Cardiology, New Haven, CT 06510
| | - Joseph G Akar
- Yale School of Medicine; Department of Cardiology, New Haven, CT 06510
| | - Fred A Masoudi
- University of Colorado School of Medicine; Aurora CO, 80045
| | - Emily L Ong
- Yale School of Medicine; Department of Cardiology, New Haven, CT 06510
| | - Jeptha P Curtis
- Yale School of Medicine; Department of Cardiology, New Haven, CT 06510
| |
Collapse
|
46
|
Edlinger C, Bannehr M, Georgi C, Reiners D, Lichtenauer M, Haase-Fielitz A, Butter C. Which Factors Influence the Immensely Fluctuating CRT Implantation Rates in Europe? A Mixed Methods Approach Using Qualitative Content Analysis Based on Expert Interviews. J Clin Med 2023; 12:2099. [PMID: 36983101 PMCID: PMC10058506 DOI: 10.3390/jcm12062099] [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: 12/19/2022] [Revised: 02/14/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023] Open
Abstract
(1) Background: Cardiac resynchronisation therapy (CRT) is nowadays an indispensable treatment option for heart failure. Although the indication is subject to clear cross-national guidelines by the European Society of Cardiology (ESC), there is immense variation in the number of implantations per 100,000 inhabitants in Europe, especially in German-speaking countries (Germany, Austria and Switzerland). The aim of the present study was to identify possible factors for these differences using a qualitative research approach. (2) Methods: Semi-standardized interviews were conducted with 11 experts in the field of CRT therapy (3 experts from Germany, 4 from Austria and 4 from Switzerland) using a pre-prepared interview template and analysed according to Mayring's qualitative content analysis. (3) Results: The main factors identified were the costs of purchasing the devices and the financing systems of the respective healthcare systems, although cost pressure still seems to play a subordinate role in the German-speaking countries. Moreover, "lack of implementation of ESC guidelines", "insufficient training" and "lack of medical infrastructure" could be excluded as potential reasons. (4) Conclusions: Economic factors, but not a lack of adherence to ESC guidelines, seem to have a major influence on the fluctuating implantation figures in German-speaking countries, according to the unanimous assessment of renowned experts.
Collapse
Affiliation(s)
- Christoph Edlinger
- Department of Cardiology, Heart Center Brandenburg, 16321 Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (MHB) “Theodor Fontane”, 16816 Neuruppin, Germany
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Marwin Bannehr
- Department of Cardiology, Heart Center Brandenburg, 16321 Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (MHB) “Theodor Fontane”, 16816 Neuruppin, Germany
| | - Christian Georgi
- Department of Cardiology, Heart Center Brandenburg, 16321 Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (MHB) “Theodor Fontane”, 16816 Neuruppin, Germany
| | - David Reiners
- Department of Cardiology, Heart Center Brandenburg, 16321 Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (MHB) “Theodor Fontane”, 16816 Neuruppin, Germany
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Anja Haase-Fielitz
- Department of Cardiology, Heart Center Brandenburg, 16321 Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (MHB) “Theodor Fontane”, 16816 Neuruppin, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, 16321 Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (MHB) “Theodor Fontane”, 16816 Neuruppin, Germany
| |
Collapse
|
47
|
Rauf MA, Kalla M, Leyva F. Successful Catheter Ablation of Ventricular Tachycardia Precipitated by Cardiac Resynchronization Therapy. J Innov Card Rhythm Manag 2023; 14:5379-5382. [PMID: 36998414 PMCID: PMC10044777 DOI: 10.19102/icrm.2023.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/07/2022] [Indexed: 04/01/2023] Open
Abstract
A patient with ischemic cardiomyopathy and an implantable cardioverter-defibrillator underwent an upgrade with an epicardial left ventricular lead, which precipitated recurrent ventricular tachycardia (VT). An electrophysiological study with electroanatomic mapping showed the site of the left ventricular lead to be part of the re-entrant circuit, and substrate modification of an endocardial channel led to the resolution of VT and an improvement in symptoms.
Collapse
Affiliation(s)
- Muhammad Atif Rauf
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Address correspondence to: Muhammad Atif Rauf, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, UK.
| | - Manish Kalla
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | |
Collapse
|
48
|
Haqqani HM, Burri H, Kayser T, Carter N, Gold MR. Association of interventricular activation delay with clinical outcomes in cardiac resynchronization therapy. Heart Rhythm 2023; 20:385-392. [PMID: 36436813 DOI: 10.1016/j.hrthm.2022.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pacing at sites of longest interventricular delay has been associated with greater reverse remodeling in cardiac resynchronization therapy (CRT). However, the effects of pacing at such sites on clinical outcomes is less well studied. OBJECTIVE The purpose of this study was to assess the association between interventricular delay and clinical outcomes in CRT patients implanted with quadripolar left ventricular (LV) leads. METHODS RALLY-X4 was a registry study of the Acuity X4 quadripolar LV leads. Interventricular delay was measured during unpaced basal rhythm from the right ventricular (RV) lead to the LV lead electrode (E1 to E4) chosen for CRT pacing. Patients were stratified by median RV-LV delay (80 ms) into short and long delay groups; they also were analyzed by multivariable modeling. The primary composite outcome measure was all-cause mortality and heart failure hospitalization (HFH) at 18 months. RESULTS A total of 581 patients had complete RV-LV delay data. Mean LV ejection fraction was 27%, and 73% had typical left bundle branch block. Predictors of long RV-LV delay included female sex, left bundle branch block, and QRS duration >150 ms. Survival free of the primary outcome at 18-month follow-up was 87% in the long activation delay group compared with 77% in the short delay group (P = .0042). Multivariate analysis showed that RV-LV delay was an independent predictor of survival free of HFH (P = .028). CONCLUSION Among CRT patients with quadripolar LV pacing leads, longer baseline interventricular activation delay was significantly associated with the composite endpoint of all-cause mortality and HFH.
Collapse
Affiliation(s)
- Haris M Haqqani
- Department of Cardiology, The Prince Charles Hospital, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Haran Burri
- Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | | | | | - Michael R Gold
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
| |
Collapse
|
49
|
Waddingham PH, Mangual JO, Orini M, Badie N, Muthumala A, Sporton S, McSpadden LC, Lambiase PD, Chow AWC. Electrocardiographic imaging demonstrates electrical synchrony improvement by dynamic atrioventricular delays in patients with left bundle branch block and preserved atrioventricular conduction. Europace 2023; 25:536-545. [PMID: 36480445 PMCID: PMC9935053 DOI: 10.1093/europace/euac224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022] Open
Abstract
AIMS Cardiac resynchronization therapy programmed to dynamically fuse pacing with intrinsic conduction using atrioventricular (AV) timing algorithms (e.g. SyncAV) has shown promise; however, mechanistic data are lacking. This study assessed the impact of SyncAV on electrical dyssynchrony across various pacing modalities using non-invasive epicardial electrocardiographic imaging (ECGi). METHODS AND RESULTS Twenty-five patients with left bundle-branch block (median QRS duration (QRSd) 162.7 ms) and intact AV conduction (PR interval 174.0 ms) were prospectively enrolled. ECGi was performed acutely during biventricular pacing with fixed nominal AV delays (BiV) and using SyncAV (optimized for the narrowest QRSd) during: BiV + SyncAV, LV-only single-site (LVSS + SyncAV), MultiPoint pacing (MPP + SyncAV), and LV-only MPP (LVMPP + SyncAV). Dyssynchrony was quantified via ECGi (LV activation time, LVAT; RV activation time, RVAT; LV electrical dispersion index, LVEDi; ventricular electrical uncoupling index, VEU; and biventricular total activation time, VVtat). Intrinsic conduction LVAT (124 ms) was significantly reduced by BiV pacing (109 ms) (P = 0.001) and further reduced by LVSS + SyncAV (103 ms), BiV + SyncAV (103 ms), LVMPP + SyncAV (95 ms), and MPP + SyncAV (90 ms). Intrinsic RVAT (93 ms), VVtat (130 ms), LVEDi (36 ms), VEU (50 ms), and QRSd (163 ms) were reduced by SyncAV across all pacing modes. More patients exhibited minimal LVAT, VVtat, LVEDi, and QRSd with MPP + SyncAV than any other modality. CONCLUSION Dynamic AV delay programming targeting fusion with intrinsic conduction significantly reduced dyssynchrony, as quantified by ECGi and QRSd for all evaluated pacing modes. MPP + SyncAV achieved the greatest synchrony overall but not for all patients, highlighting the value of pacing mode individualization during fusion optimization.
Collapse
Affiliation(s)
- Peter H Waddingham
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.,William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London EC1M 6BQ, UK
| | | | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Amal Muthumala
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | | | - Pier D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.,Institute of Cardiovascular Science, University College London, London, UK
| | - Anthony W C Chow
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.,William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London EC1M 6BQ, UK
| |
Collapse
|
50
|
Batchelor RJ, Nan Tie E, Romero L, Hopper I, Kaye DM. Meta-Analysis on Drug and Device Therapy of New York Heart Association Functional Class IV Heart Failure With Reduced Ejection Fraction. Am J Cardiol 2023; 188:52-60. [PMID: 36473305 DOI: 10.1016/j.amjcard.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 12/09/2022]
Abstract
Heart failure with reduced ejection fraction (HFrEF) is associated with significant morbidity and mortality, particularly in patients with New York Heart Association (NYHA) functional class IV symptoms. Decades of discovery have heralded significant advancements in the pharmacologic management of HFrEF. However, patients with NYHA IV symptoms remain an under-represented population in almost every clinical trial to date, leaving clinicians with limited evidence with which to guide drug treatment decisions in this patient group with severe heart failure. Randomized controlled trials of adult patients with NYHA IV symptoms of HFrEF randomized to current guideline-recommended medical therapy were included in this systematic review and meta-analysis. The outcomes of interest included the rate of all-cause mortality, cardiovascular mortality, and heart failure hospitalization. A total of 39 randomized controlled trials were included. A total of 6 studies examined angiotensin converting enzyme inhibitors, with meta-analyses of 2 demonstrating a reduced risk of all-cause mortality (relative risk (RR) 0.76, 95% confidence interval 0.59 to 0.97, p = 0.03). A total of 11 studies examined β blockers, with meta-analysis of 6 demonstrating a reduced risk of all-cause mortality (risk ratio 0.74, 95% confidence interval 0.60 to 0.92, p = 0.008). A study examined the mineralocorticoid antagonist spironolactone, reporting a reduced risk of all-cause mortality in the NYHA IV subgroup. A total of 6 studies examined device therapy, demonstrating the benefit of cardiac resynchronization therapy with or without an implantable cardiac defibrillator in reducing hospitalization in the NYHA IV subgroup. Although trial evidence exists for angiotensin converting enzyme inhibitors, β-blockers, and mineralocorticoid antagonist therapy in the NYHA IV population, the role of angiotensin receptor blockers is unclear. Ivabradine, angiotensin receptor neprilysin inhibitors, and sodium-glucose transport protein 2 inhibitors remain underinvestigated and have not been proved to provide any benefit above standard heart failure therapy in patients with HFrEF and NYHA IV symptoms.
Collapse
Affiliation(s)
- Riley J Batchelor
- Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine Monash University, Melbourne, Australia
| | - Emilia Nan Tie
- Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine Monash University, Melbourne, Australia
| | - Lorena Romero
- The Ian Potter Library, Alfred Health, Melbourne, Australia
| | - Ingrid Hopper
- Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine Monash University, Melbourne, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine Monash University, Melbourne, Australia; Heart Failure Research, Baker Heart and Diabetes Institute, Melbourne, Australia.
| |
Collapse
|