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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.
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Affiliation(s)
| | | | | | | | | | - Lucy Calvo
- Senhora da Oliveira Hospital, Guimarães.
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Sunwoo SH, Cha MJ, Han SI, Kang H, Cho YS, Yeom DH, Park CS, Park NK, Choi SW, Kim SJ, Cha GD, Jung D, Choi S, Oh S, Nam GB, Hyeon T, Kim DH, Lee SP. Ventricular tachyarrhythmia treatment and prevention by subthreshold stimulation with stretchable epicardial multichannel electrode array. SCIENCE ADVANCES 2023; 9:eadf6856. [PMID: 37000879 PMCID: PMC10065438 DOI: 10.1126/sciadv.adf6856] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/28/2023] [Indexed: 05/24/2023]
Abstract
The implantable cardioverter-defibrillator (ICD) is an effective method to prevent sudden cardiac death in high-risk patients. However, the transvenous lead is incompatible with large-area electrophysiological mapping and cannot accommodate selective multichannel precision stimulations. Moreover, it involves high-energy shocks, resulting in pain, myocardial damage, and recurrences of ventricular tachyarrhythmia (VTA). We present a method for VTA treatment based on subthreshold electrical stimulations using a stretchable epicardial multichannel electrode array, which does not disturb the normal contraction or electrical propagation of the ventricle. In rabbit models with myocardial infarction, the infarction was detected by mapping intracardiac electrograms with the stretchable epicardial multichannel electrode array. Then, VTAs could be terminated by sequential electrical stimuli from the epicardial multichannel electrode array beginning with low-energy subthreshold stimulations. Last, we used these subthreshold stimulations to prevent the occurrence of additional VTAs. The proposed protocol using the stretchable epicardial multichannel electrode array provides opportunities toward the development of innovative methods for painless ICD therapy.
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MESH Headings
- Rabbits
- Animals
- Tachycardia, Ventricular/therapy
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/etiology
- Defibrillators, Implantable/adverse effects
- Heart Ventricles
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/epidemiology
- Myocardial Infarction/therapy
- Myocardial Infarction/etiology
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Affiliation(s)
- Sung-Hyuk Sunwoo
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
| | - Myung-Jin Cha
- Departments of Cardiology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Sang Ihn Han
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Hyejeong Kang
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Ye Seul Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Da-Hae Yeom
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Chan Soon Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Na Kyeong Park
- Department of Physiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Seong Woo Choi
- Department of Physiology, Dongguk University College of Medicine, Gyeongju 38066, Republic of Korea
| | - Sung Joon Kim
- Department of Physiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Gi Doo Cha
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Dongjun Jung
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Suji Choi
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Seil Oh
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Gi-Byoung Nam
- Departments of Cardiology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Taeghwan Hyeon
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Dae-Hyeong Kim
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
- Department of Materials Science and Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Seung-Pyo Lee
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Wu HY, Li SJ, Yang Z, Chen HC, You PH, Cheng G. A Novel Approach for Repetitive Dislocation of Transvenous Left Ventricular Leads During Cardiac Resynchronization Therapy Implantation by the Loop Technique. Front Cardiovasc Med 2022; 9:836514. [PMID: 35800169 PMCID: PMC9253391 DOI: 10.3389/fcvm.2022.836514] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/01/2022] [Indexed: 11/14/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) for heart failure requires transvenous insertion of a left ventricular pacing lead through the coronary sinus. However, repeated intraoperative dislocations often occur. Therefore, we describe a novel technique that uses the loop technique to treat patients with repeated intraoperative dislocations during transvenous left ventricular lead implantation to stabilize the lead in its final position. In five patients with repeated intraoperative dislocation during transvenous left ventricular lead implantation, the loop technique was successfully used to stabilize the lead in its final position. The pacing and sensing parameters were satisfactory in all patients at implantation and 12 months post-operatively. Compared with the pre-operative values, the 12-month post-operative values for the left ventricular ejection fraction were significantly increased and the left ventricular end systolic dimension and left ventricular end diastolic dimension were significantly decreased (P < 0.05). The left ventricular ejection fraction of these 5 patients increased by more than 15%. CRT significantly improved the left ventricular structure and function of these 5 patients. During the 1-, 3-, 6-, and 12-month follow-ups, no left ventricular lead dislocations were observed. This loop technique is safe and effective and can be considered for repeated intraoperative dislocation during transvenous left ventricular lead implantation through the coronary sinus of a CRT device.
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Zhang X, Qian Z, Tang H, Hua W, Su Y, Xu G, Liu X, Xue X, Fan J, Cai L, Zhu L, Wang Y, Hou X, Garcia EV, Zhou W, Zou J. A new method to recommend left ventricular lead positions for improved CRT volumetric response and long-term prognosis. J Nucl Cardiol 2021; 28:672-684. [PMID: 31111449 PMCID: PMC10959571 DOI: 10.1007/s12350-019-01735-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Using ECG-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), we sought to develop and validate a new method to recommend left ventricular (LV) lead positions in order to improve volumetric response and long-term prognosis after cardiac resynchronization therapy (CRT). METHODS Seventy-nine patients received gated SPECT MPI at baseline, and echocardiography at baseline and follow-up. The volumetric response referred to a reduction of ≥ 15% in LV end-systolic volume 6 months after CRT. After excluding apical, septal, and scarred segments, there were three levels of recommended segments: (1) the optimal recommendation: the latest contracting viable segment; (2) the 2nd recommendation: the late contracting viable segments whose contraction delays were within 10° of the optimal recommendation; and (3) the 3rd recommendation: the viable segments adjacent to the optimal recommendation when there was no late contracting viable segment. RESULTS After excluding 11 patients whose LV lead was placed in apical or scarred segments, 75.6% of the patients concordant to recommended LV segments (n = 41) responded to CRT while 51.9% of those with non-recommended LV lead locations (n = 27) were responders (P = .043). Response rates were 76.9%, 76.9% , and 73.3% (P = .967), respectively, when LV lead was implanted in the optimal recommendation (n = 13), the 2nd recommendation (n = 13), and the 3rd recommendation (n = 15). LV leads placed at recommended segments reduced composite events of all-cause mortality or heart failure (HF) rehospitalization compared with pacing at non-recommended segments (log-rank χ2 = 5.623, P = .018). CONCLUSIONS Pacing in the recommended LV lead segments identified on gated SPECT MPI was associated with improved volumetric response to CRT and long-term prognosis.
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Affiliation(s)
- Xinwei Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Haipeng Tang
- School of Computing, University of Southern Mississippi, 730 Beach Blvd E, Long Beach, MS, 39560, USA
| | - Wei Hua
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Geng Xu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xingbin Liu
- Department of Cardiology, Westeastern Hospital, Sichuan University, Chengdu, China
| | - Xiaolin Xue
- Department of Cardiology, Affiliated Hospital, Xian Jiaotong University, Xi'an, China
| | - Jie Fan
- Department of Cardiology, Yunnan Province Hospital, Kunming, China
| | - Lin Cai
- Department of Cardiology, Chengdu Third Hospital, Chengdu, China
| | - Li Zhu
- Department of Cardiology, Taizhou People's Hospital, Taizhou, People's Republic of China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Ernest V Garcia
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, 730 Beach Blvd E, Long Beach, MS, 39560, USA.
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China.
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5
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Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices. Ann Biomed Eng 2019; 48:26-46. [DOI: 10.1007/s10439-019-02376-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/25/2019] [Indexed: 01/29/2023]
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6
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Lee AWC, Nguyen UC, Razeghi O, Gould J, Sidhu BS, Sieniewicz B, Behar J, Mafi-Rad M, Plank G, Prinzen FW, Rinaldi CA, Vernooy K, Niederer S. A rule-based method for predicting the electrical activation of the heart with cardiac resynchronization therapy from non-invasive clinical data. Med Image Anal 2019; 57:197-213. [PMID: 31326854 PMCID: PMC6746621 DOI: 10.1016/j.media.2019.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/20/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022]
Abstract
Background Cardiac Resynchronization Therapy (CRT) is one of the few effective treatments for heart failure patients with ventricular dyssynchrony. The pacing location of the left ventricle is indicated as a determinant of CRT outcome. Objective Patient specific computational models allow the activation pattern following CRT implant to be predicted and this may be used to optimize CRT lead placement. Methods In this study, the effects of heterogeneous cardiac substrate (scar, fast endocardial conduction, slow septal conduction, functional block) on accurately predicting the electrical activation of the LV epicardium were tested to determine the minimal detail required to create a rule based model of cardiac electrophysiology. Non-invasive clinical data (CT or CMR images and 12 lead ECG) from eighteen patients from two centers were used to investigate the models. Results Validation with invasive electro-anatomical mapping data identified that computer models with fast endocardial conduction were able to predict the electrical activation with a mean distance errors of 9.2 ± 0.5 mm (CMR data) or (CT data) 7.5 ± 0.7 mm. Conclusion This study identified a simple rule-based fast endocardial conduction model, built using non-invasive clinical data that can be used to rapidly and robustly predict the electrical activation of the heart. Pre-procedural prediction of the latest electrically activating region to identify the optimal LV pacing site could potentially be a useful clinical planning tool for CRT procedures.
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Affiliation(s)
- A W C Lee
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - U C Nguyen
- Department of Physiology, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Department of Cardiology, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - O Razeghi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - J Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - B S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - B Sieniewicz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - J Behar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Bart's Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - M Mafi-Rad
- Department of Cardiology, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - G Plank
- Department of Biophysics, Medical University of Graz, Graz, Austria
| | - F W Prinzen
- Department of Physiology, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - C A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - K Vernooy
- Department of Cardiology, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - S Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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It’s not ageing, stupid: why population ageing won’t bankrupt health systems. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:195-201. [DOI: 10.1093/ehjqcco/qcz022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/15/2019] [Accepted: 04/25/2019] [Indexed: 11/14/2022]
Abstract
Abstract
An ageing population is often viewed as a factor that will increase healthcare expenditures (HCE) to unsustainable levels. With nearly half the disease burden in high-income countries arising in older people, there are concerns that caring for a burgeoning older population that is sick and dependent on support will not be possible. The aim of this narrative review is to examine how population ageing is likely to affect future HCE growth. We find that despite the increasing share of older people over the next few decades, the changing age-mix will not be a significant driver of HCE growth. While older people, on average, incur higher per person healthcare spending than younger people, the proportions of the population at the oldest and most costly age groups increase very slowly over time. In the European Union, we estimate the changing age-mix to result in the increase of the average annual growth in per person health spending by no more than 0.6 additional percentage points per year between 2015 and 2050. Therefore, price growth and technological advancements, independent of population ageing, will be the main contributors to future HCE growth.
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Galand V, Singh JP, Leclercq C. Alternative left ventricular pacing approaches for optimal cardiac resynchronization therapy. Heart Rhythm 2019; 16:1281-1289. [PMID: 30885737 DOI: 10.1016/j.hrthm.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Indexed: 11/29/2022]
Abstract
Cardiac resynchronization therapy (CRT) improves mortality, morbidity, and quality of life in selected heart failure patients with severe left ventricular (LV) ejection fraction impairment. However, between 20% and 40% of device recipients do not benefit clinically from CRT. Indeed, some anatomic and technical difficulties are related to the coronary venous implantation site via the coronary sinus (CS). Additionally, electrical constraints have been described, and CS does not always correspond to the optimal LV lead position. In the last decade, engineers and physicians have worked together to overcome the challenging LV lead implantation, and various biventricular pacing alternatives have been developed to improve CRT response. In this review, we discuss the evolution from CS pacing to wireless LV stimulation and His-bundle pacing.
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Affiliation(s)
| | - Jagmeet P Singh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Mazur M, Żabówka A, Bolechała F, Kopacz P, Klimek‐Piotrowska W, Hołda MK. Variations and angulation of the coronary sinus tributaries: Implications for left ventricular pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:423-430. [DOI: 10.1111/pace.13618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Małgorzata Mazur
- HEART‐Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Krakow Poland
| | - Anna Żabówka
- HEART‐Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Krakow Poland
| | - Filip Bolechała
- Department of Forensic MedicineJagiellonian University Medical College Krakow Poland
| | - Paweł Kopacz
- Department of Forensic MedicineJagiellonian University Medical College Krakow Poland
| | - Wiesława Klimek‐Piotrowska
- HEART‐Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Krakow Poland
| | - Mateusz K. Hołda
- HEART‐Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Krakow Poland
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10
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Qian Z, Zou F, Wang Y, Qiu Y, Chen X, Jiang H, Hou X. Permanent His bundle pacing in heart failure patients: A systematic review and meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 42:139-145. [PMID: 30515877 DOI: 10.1111/pace.13565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is the standard-of-care therapy for the patients with heart failure and left ventricular (LV) dyssynchrony. However, approximately 30% of the patients show no response. Recent studies have shown that His bundle pacing (HBP) could be an alternative for the patients with CRT indications. The purpose of this study was to evaluate the efficacy of HBP in patients with heart failure. METHODS We searched PubMed and Embase databases for studies evaluating HBP in patients with heart failure and LV dyssynchrony. The successful rate of implantation, QRS duration, pacing threshold, LV function at baseline and follow-up, and mortality rates were extracted and summarized. RESULTS Eleven studies including 494 patients were included in this analysis. The overall successful rate for implantation was 82.4%. The main indications for HBP were CRT candidates and cardiomyopathy with atrial fibrillation undergoing atrioventricular node ablation. Permanent HBP resulted in narrow QRS duration of 116.3 ± 13.9 ms after implantation. LV functions, including echocardiographic parameters and clinical outcomes, significantly improved at follow-up (P < 0.001). However, there was a trend of increased capture and bundle branch block correction thresholds at follow-up compared to baseline (P = 0.01 and 0.02, respectively). During a mean follow-up of 23.7 months, 5.9% of the patients experienced heart failure-related hospitalization and the mortality rate was 9.1%. CONCLUSION Permanent HBP has shown promising results for heart failure patients in small observational studies. Randomized controlled trials are needed to assess the efficacy of HBP in these patients.
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Affiliation(s)
- Zhiyong Qian
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing
| | - Fengwei Zou
- Georgetown University School of Medicine, Washington, Washington D.C
| | - Yao Wang
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing
| | - Yuanhao Qiu
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing
| | - Xing Chen
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing
| | - Hai Jiang
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing
| | - Xiaofeng Hou
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing
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11
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Zhou W, Tao N, Hou X, Wang Y, Folks RD, Cooke DC, Moncayo VM, Garcia EV, Zou J. Development and validation of an automatic method to detect the latest contracting viable left ventricular segments to assist guide CRT therapy from gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2018; 25:1948-1957. [PMID: 28353213 PMCID: PMC10981925 DOI: 10.1007/s12350-017-0853-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The purpose of this study is to use ECG-gated SPECT MPI to detect the latest contracting viable left ventricular (LV) segments to help guide the LV probe placement used in CRT therapy and to validate segment selection against the visual integration method by experts. METHODS For each patient, the resting ECG-gated SPECT MPI short-axis images were sampled in 3D to generate a polar map of the perfusion distribution used to determine LV myocardial viability, and to measure LV synchronicity using our phase analysis tool. In the visual integration method, two experts visually interpreted the LV viability and mechanical dyssynchrony from the short-axis images and polar maps of viability and phase, to determine the latest contracting viable segments using the 17-segment model. In the automatic method, the apical segments, septal segments, and segments with more than 50% scar were excluded as these are not candidates for CRT LV probe placement. Amongst the remaining viable segments, the segments, whose phase angles were within 10° of the latest phase angle (the most delayed contracting segment), were identified for potential CRT LV probe placement and ranked based on the phase angles of the segments. Both methods were tested in 36 pre-CRT patients who underwent ECG-gated SPECT MPI. The accuracy was determined as the percent agreement between the visual integration and automatic methods. The automatic method was performed by a second independent operator to evaluate the inter-operator processing reproducibility. RESULTS In all the 36 patients, the LV lead positions of the 1st choices recommended by the automatic and visual integration methods were in the same segments in 35 patients, which achieved an agreement rate of 97.2%. In the inter-operator reproducibility test, the LV lead positions of the 1st choices recommended by the two operators were in the same segments in 25 patients, and were in the adjacent segments in 7 patients, which achieved an overall agreement of 88.8%. CONCLUSIONS An automatic method has been developed to detect the latest contracting viable LV segments to help guide the LV probe placement used in CRT therapy. The retrospective clinical study with 36 patients suggests that this method has high agreement against the visual integration method by experts and good inter-operator reproducibility. Consequently, this method is promising to be a clinical tool to recommend the CRT LV lead positions.
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Affiliation(s)
- Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, USA
| | - Ningchao Tao
- Department of Cardiology, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Xiaofeng Hou
- Department of Cardiology, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Yao Wang
- Department of Cardiology, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Russell D Folks
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30032, USA
| | - David C Cooke
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30032, USA
| | - Valeria M Moncayo
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30032, USA
| | - Ernest V Garcia
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30032, USA.
| | - Jiangang Zou
- Department of Cardiology, Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
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12
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Mele D, Bertini M, Malagù M, Nardozza M, Ferrari R. Current role of echocardiography in cardiac resynchronization therapy. Heart Fail Rev 2018; 22:699-722. [PMID: 28714039 DOI: 10.1007/s10741-017-9636-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. Patients are usually assessed by echocardiography, which provides a number of anatomical and functional information used for cardiac dyssynchrony assessment, prognostic stratification, identification of the optimal site of pacing in the left ventricle, optimization of the CRT device, and patient follow-up. Compared to other cardiac imaging techniques, echocardiography has the advantage to be non-invasive, repeatable, and safe, without exposure to ionizing radiation or nefrotoxic contrast. In this article, we review current evidence about the role of echocardiography before, during, and after the implantation of a CRT device.
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Affiliation(s)
- Donato Mele
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy. .,Noninvasive Cardiology Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Ferrara, Cona, Italy.
| | - Matteo Bertini
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Michele Malagù
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Marianna Nardozza
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Roberto Ferrari
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, RA, Italy
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13
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Rahsepar AA, Collins JD, Knight BP, Hong K, Carr JC, Kim D. Wideband LGE MRI permits unobstructed viewing of myocardial scarring in a patient with an MR-conditional subcutaneous implantable cardioverter-defibrillator. Clin Imaging 2018; 50:294-296. [PMID: 29747127 DOI: 10.1016/j.clinimag.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/24/2018] [Accepted: 05/01/2018] [Indexed: 10/17/2022]
Abstract
A subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative device for prevention of sudden cardiac death, without any leads within the heart. Patients implanted with any type of ICD may need catheter ablation of ventricular tachycardia (VT) to reduce the overall arrhythmia burden (e.g., recurrent monomorphic VT) and lower the incidence of painful shocks induced by the device. Late gadolinium enhancement (LGE) MRI is a useful pre-test for guiding VT ablation, because it can be used to map myocardial scar and produce better outcomes. Growing evidence suggests that MRI can be performed with manageable risks on patients with a cardiac implantable electronic device (CIED). Nonetheless, the diagnostic yield of cardiac MRI is still low because of severe image artifacts, regardless of MR-conditional or non-MR conditional labeling. Image artifacts in the heart induced by an S-ICD is expected to be larger than the artifacts induced by a transvenous ICD, because the former is twice as large in size and implanted closer to the heart. This is the first reported case of successful wideband LGE MRI in a patient implanted with an MR-conditional S-ICD. A 37-year-old man with ischemic cardiomyopathy was referred for a cardiac MRI at 1.5 T ten months after S-ICD implantation, in order to rule out constrictive pericarditis. Clinical standard LGE MRI produced severe image artifacts, rendering it useless. In contrast, wideband LGE MRI provided unobstructed viewing of myocardial scarring. This case illustrates the usefulness of wideband LGE MRI for assessment of myocardial scarring in a patient with an MR-conditional S-ICD.
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Affiliation(s)
- Amir Ali Rahsepar
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeremy D Collins
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bradley P Knight
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - KyungPyo Hong
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James C Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel Kim
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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14
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Chousou PA, Pugh PJ. How to deliver optimal cardiac resynchronisation therapy. Heart 2017; 104:1300-1307. [PMID: 29217631 DOI: 10.1136/heartjnl-2017-311210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/24/2017] [Accepted: 11/02/2017] [Indexed: 01/06/2023] Open
Affiliation(s)
- Panagiota Anna Chousou
- Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter J Pugh
- Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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15
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van Dijk VF, Fanggiday J, Balt JC, Wijffels MC, Daeter EJ, Kelder JC, Boersma LV. Effects of epicardial versus transvenous left ventricular lead placement on left ventricular function and cardiac perfusion in cardiac resynchronization therapy: A randomized clinical trial. J Cardiovasc Electrophysiol 2017; 28:917-923. [DOI: 10.1111/jce.13242] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jim Fanggiday
- Department of Nuclear medicine; St Antonius Hospital
| | | | | | - Edgar J. Daeter
- Department of Cardiothoracic surgery; St Antonius Hospital; Koekoekslaan 1 3435 CM Nieuwegein The Netherlands
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16
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LEE ANGELAWC, CROZIER ANDREW, HYDE EOINR, LAMATA PABLO, TRUONG MICHAEL, SOHAL MANAV, JACKSON THOMAS, BEHAR JONATHANM, CLARIDGE SIMON, SHETTY ANOOP, SAMMUT EVA, PLANK GERNOT, RINALDI CHRISTOPHERALDO, NIEDERER STEVEN. Biophysical Modeling to Determine the Optimization of Left Ventricular Pacing Site and AV/VV Delays in the Acute and Chronic Phase of Cardiac Resynchronization Therapy. J Cardiovasc Electrophysiol 2017; 28:208-215. [PMID: 27885749 PMCID: PMC5535003 DOI: 10.1111/jce.13134] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/16/2016] [Accepted: 11/18/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cardiac anatomy and function adapt in response to chronic cardiac resynchronization therapy (CRT). The effects of these changes on the optimal left ventricle (LV) lead location and timing delay settings have yet to be fully explored. OBJECTIVE To predict the effects of chronic CRT on the optimal LV lead location and device timing settings over time. METHODS Biophysical computational cardiac models were generated for 3 patients, immediately post-implant (ACUTE) and after at least 6 months of CRT (CHRONIC). Optimal LV pacing area and device settings were predicted by pacing the ACUTE and CHRONIC models across the LV epicardium (49 sites each) with a range of 9 pacing settings and simulating the acute hemodynamic response (AHR) of the heart. RESULTS There were statistically significant differences between the distribution of the AHR in the ACUTE and CHRONIC models (P < 0.0005 in all cases). The site delivering the maximal AHR shifted location between the ACUTE and CHRONIC models but provided a negligible improvement (<2%). The majority of the acute optimal LV pacing regions (76-100%) and device settings (76-91%) remained optimal chronically. CONCLUSION Optimization of the LV pacing location and device settings were important at the time of implant, with a reduced benefit over time, where the majority of the acute optimal LV pacing region and device settings remained optimal with chronic CRT.
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Affiliation(s)
- ANGELA W. C. LEE
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - ANDREW CROZIER
- Institute of BiophysicsMedical University of GrazGrazAustria
| | - EOIN R. HYDE
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - PABLO LAMATA
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - MICHAEL TRUONG
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - MANAV SOHAL
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - THOMAS JACKSON
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - JONATHAN M. BEHAR
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - SIMON CLARIDGE
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - ANOOP SHETTY
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - EVA SAMMUT
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - GERNOT PLANK
- Institute of BiophysicsMedical University of GrazGrazAustria
| | - CHRISTOPHER ALDO RINALDI
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiovascular DepartmentGuy's and St. Thomas’ NHS Foundation TrustLondonUK
| | - STEVEN NIEDERER
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
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17
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Galli E, Leclercq C, Donal E. Mechanical dyssynchrony in heart failure: Still a valid concept for optimizing treatment? Arch Cardiovasc Dis 2017; 110:60-68. [DOI: 10.1016/j.acvd.2016.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 12/15/2022]
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18
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Tang H, Tang S, Zhou W. A Review of Image-guided Approaches for Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2017; 6:69-74. [PMID: 28845234 DOI: 10.15420/aer.2016.32.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cardiac resynchronisation therapy (CRT) is a standard treatment for patients with heart failure; however, the low response rate significantly reduces its cost-effectiveness. A favourable CRT response primarily depends on whether implanters can identify the optimal left ventricular (LV) lead position and accurately place the lead at the recommended site. Myocardial imaging techniques, including echocardiography, cardiac magnetic resonance imaging and nuclear imaging, have been used to assess LV myocardial viability and mechanical dyssynchrony, and deduce the optimal LV lead position. The optimal position, presented as a segment of the myocardial wall, is then overlaid with images of the coronary veins from fluoroscopy to aid navigation of the LV lead to the target venous site. Once validated by large clinical trials, these image-guided techniques for CRT lead placement may have an impact on current clinical practice.
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Affiliation(s)
- Haipeng Tang
- School of Computing, University of Southern Mississippi, Long Beach, MS, USA
| | - Shaojie Tang
- School of Automation, Xi'an University of Posts and Telecommunications, Xi'an, Shaanxi, China
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, USA
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19
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X-ray and magnetic resonance imaging fusion for cardiac resynchronization therapy. Med Image Anal 2016; 31:98-107. [DOI: 10.1016/j.media.2016.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 12/22/2015] [Accepted: 03/10/2016] [Indexed: 11/23/2022]
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20
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Crossley GH, Sorrentino RA, Exner DV, Merliss AD, Tobias SM, Martin DO, Augostini R, Piccini JP, Schaerf R, Li S, Miller CT, Adler SW. Extraction of chronically implanted coronary sinus leads active fixation vs passive fixation leads. Heart Rhythm 2016; 13:1253-9. [DOI: 10.1016/j.hrthm.2016.01.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Indexed: 11/30/2022]
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21
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Colella A, Giaccardi M, Colella T, Modesti PA. Zero x-ray cardiac resynchronization therapy device implantation guided by a nonfluoroscopic mapping system: A pilot study. Heart Rhythm 2016; 13:1481-8. [PMID: 26976037 DOI: 10.1016/j.hrthm.2016.03.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fluoroscopic guidance is the standard tool used in device implantation. This means that both the patient and the operator are exposed to radiation, which may sometimes be high. The possibility of single-lead permanent pacemaker implantation without fluoroscopy has already been demonstrated. OBJECTIVE The aim of our study was to investigate the feasibility and reliability of biventricular device implantation guided only by an electroanatomic navigation system. METHODS Sixty-one patients with heart failure underwent implantation of a cardiac resynchronization therapy (CRT) device with or without defibrillator (CRT-D; CRT-P). The procedure was performed with or without fluoroscopy guidance (Rx+; Rx0). In the latter case, the EnSite Velocity system was used; this system is able to reconstruct the anatomy and activation of the cardiac chambers by simultaneously collecting a "cloud" of anatomical points from multiple electrodes. RESULTS Lead positioning was achieved in 24 of 26 patients undergoing CRT implantation without fluoroscopy (92% success). No complications were observed during the procedure and no catheter dislodgment occurred the day after the implantation or during 1-month follow-up. Procedure time progressively decreased from 136 minutes in the first case to 59 minutes in the last one, suggesting that operators gradually gained confidence while using the new technique. CONCLUSION Our study demonstrates the feasibility, efficacy, and safety of lead positioning guided only by the nonfluoroscopic EnSite Velocity mapping system without the use of fluoroscopy in CRT-P or CRT-D implantation. The benefits in terms of significantly reduced fluoroscopy exposure are associated with technical and clinical advantages.
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Affiliation(s)
- Andrea Colella
- Dipartimento del Cuore e dei Vasi - Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
| | - Marzia Giaccardi
- UOS di Cardiologia ed Elettrofisiologia - ASL 10, Florence, Italy
| | - Tommaso Colella
- Dipartimento di Medicina Sperimentale e Clinica, Universita' degli Studi di Firenze, Florence, Italy
| | - Pietro Amedeo Modesti
- Dipartimento del Cuore e dei Vasi - Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Dipartimento di Medicina Sperimentale e Clinica, Universita' degli Studi di Firenze, Florence, Italy
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22
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ASBACH STEFAN, LENNERZ CARSTEN, SEMMLER VERENA, GREBMER CHRISTIAN, SOLZBACH ULRICH, KLOPPE AXEL, KLEIN NORBERT, SZENDEY ISTVAN, ANDRIKOPOULOS GEORGE, TZEIS STYLIANOS, BODE CHRISTOPH, KOLB CHRISTOF. Impact of the Right Ventricular Lead Position on Clinical End Points in CRT Recipients-A Subanalysis of the Multicenter Randomized SPICE Trial. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:261-7. [DOI: 10.1111/pace.12793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/30/2015] [Accepted: 12/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- STEFAN ASBACH
- Cardiology and Angiology I; University Heart Center; Freiburg Germany
| | - CARSTEN LENNERZ
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine; Technische Universität München; Munich Germany
| | - VERENA SEMMLER
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine; Technische Universität München; Munich Germany
| | - CHRISTIAN GREBMER
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine; Technische Universität München; Munich Germany
| | - ULRICH SOLZBACH
- Ostalbklinikum; Abteilung für Innere Medizin II; Aalen Germany
| | - AXEL KLOPPE
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Medizinische Klinik II; Ruhr Universität Bochum; Bochum Germany
| | - NORBERT KLEIN
- Abteilung für Kardiologie und Angiologie; Universitaetsklinikum Leipzig; Leipzig Germany
| | - ISTVAN SZENDEY
- Kliniken Maria Hilf; Klinik für Kardiologie; Mönchengladbach Germany
| | | | - STYLIANOS TZEIS
- Department of Cardiology; Henry Dunant Hospital; Athens Greece
| | - CHRISTOPH BODE
- Cardiology and Angiology I; University Heart Center; Freiburg Germany
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Abstract
Cardiac resynchronization therapy (CRT) is a standard treatment for patients with heart failure. However, 30-40 % of the patients having CRT do not respond to CRT with improved clinical symptom and cardiac functions. It is important for CRT response that left ventricular (LV) lead is placed away from scar and at or near the site of the latest mechanical activation. Nuclear image-guided approaches for CRT have shown significant clinical value to assess LV myocardial viability and mechanical dyssynchrony, recommend the optimal LV lead position, and navigate the LV lead to the target coronary venous site. All these techniques, once validated and implemented, should impact the current clinical practice.
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Affiliation(s)
- Weihua Zhou
- School of Computing, University of Southern Mississippi, 730 East Beach Blvd, Long Beach, MS, 39560, USA.
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA, USA.
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24
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CHEN LU, FU HAIXIA, PRETORIUS VICTORG, YANG DACHUN, WISTE HEATHERJ, YUAN HONGTAO, FELD GREGORYK, CHA YONGMEI, BIRGERSDOTTER-GREEN ULRIKAM. Clinical Outcomes of Cardiac Resynchronization with Epicardial Left Ventricular Lead. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1201-9. [DOI: 10.1111/pace.12687] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/26/2015] [Accepted: 07/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- LU CHEN
- Division of Cardiology, Department of Medicine; University of California; San Diego California
| | - HAIXIA FU
- Department of Cardiovascular Diseases; Henan Provincial People's Hospital, Zhengzhou University; Henan China
- Department of Cardiovascular Diseases; Mayo Clinics; Rochester Minnesota
| | - VICTOR G. PRETORIUS
- Department of Surgery, Division of Cardiothoracic Surgery; University of California; San Diego California
| | - DACHUN YANG
- Department of Cardiovascular Diseases; Mayo Clinics; Rochester Minnesota
| | - HEATHER J. WISTE
- Department of Health Science Research; Mayo Clinics; Rochester Minnesota
| | - HONGTAO YUAN
- Department of Cardiovascular Diseases; Mayo Clinics; Rochester Minnesota
| | - GREGORY K. FELD
- Division of Cardiology, Department of Medicine; University of California; San Diego California
| | - YONG-MEI CHA
- Department of Cardiovascular Diseases; Mayo Clinics; Rochester Minnesota
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25
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Varma PK, Namboodiri N, Raman SP, Pappu UK, Gadhinglajkar SV, Ho J, Owais K, Mahmood F. CASE 10—2015: Cardiac Resynchronization Therapy: Role of Intraoperative Real-Time Three-Dimensional Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2015; 29:1365-75. [PMID: 26159744 DOI: 10.1053/j.jvca.2015.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Suneel Puthuvassery Raman
- Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | - Jonathan Ho
- Department of Anesthesiology, University of California, Los Angeles, Los Angeles, CA
| | - Khurram Owais
- Department of Anaesthesia, Beth Israel Deaconess Medical Center, Boston, MA
| | - Feroze Mahmood
- Department of Anaesthesia, Beth Israel Deaconess Medical Center, Boston, MA
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26
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Crossley GH, Biffi M, Johnson B, Lin A, Gras D, Hussin A, Cuffio A, Collier JL, El-Chami M, Li S, Holloman K, Exner DV. Performance of a novel left ventricular lead with short bipolar spacing for cardiac resynchronization therapy: Primary results of the Attain Performa Quadripolar Left Ventricular Lead Study. Heart Rhythm 2015; 12:751-8. [DOI: 10.1016/j.hrthm.2014.12.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Indexed: 10/24/2022]
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27
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Zhou W, Hou X, Piccinelli M, Tang X, Tang L, Cao K, Garcia EV, Zou J, Chen J. 3D fusion of LV venous anatomy on fluoroscopy venograms with epicardial surface on SPECT myocardial perfusion images for guiding CRT LV lead placement. JACC Cardiovasc Imaging 2014; 7:1239-48. [PMID: 25440593 DOI: 10.1016/j.jcmg.2014.09.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/29/2014] [Accepted: 09/02/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to develop a 3-dimensional (3D) fusion tool kit to integrate left ventricular (LV) venous anatomy on fluoroscopy venograms with LV epicardial surface on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for guiding cardiac resynchronization therapy (CRT) LV lead placement. BACKGROUND LV lead position is important for CRT response. For LV lead placement into viable regions with late activation, it is important to visualize both LV venous anatomy and myocardium. METHODS Major LV veins were manually identified on fluoroscopic venograms and automatically reconstructed into a 3D anatomy. 3D LV epicardial surface was extracted from SPECT MPI. SPECT-vein fusion that consisted of geometric alignment, landmark-based registration, and vessel-surface overlay was developed to fuse the 3D venous anatomy with the epicardial surface. The accuracy of this tool was evaluated using computed tomography (CT) venograms. LV epicardial surfaces and veins were manually identified on the CT images and registered with the SPECT image by an independent operator. The locations of the fluoroscopic and CT veins on the SPECT epicardial surfaces were compared using absolute distances on SPECT short-axis slice and the 17-segment model. RESULTS Ten CRT patients were enrolled. The distance between the corresponding fluoroscopic and CT veins on the short-axis epicardial surfaces was 4.6 ± 3.6 mm (range 0 to 16.9 mm). The presence of the corresponding fluoroscopic and CT veins in the 17-segment model agreed well with a kappa value of 0.87 (95% confidence interval: 0.82 to 0.93). The tool kit was used to guide LV lead placement in a catheter laboratory and showed clinical feasibility and benefit to the patient. CONCLUSIONS A tool kit has been developed to reconstruct 3D LV venous anatomy from dual-view fluoroscopic venograms and to fuse it with LV epicardial surface on SPECT MPI. It is technically accurate for guiding LV lead placement by the 17-segment model and is feasible for clinical use in the catheterization laboratory.
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Affiliation(s)
- Weihua Zhou
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Xiangyang Tang
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Lijun Tang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kejiang Cao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Ji Chen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
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28
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Mafi Rad M, Blaauw Y, Dinh T, Pison L, Crijns HJ, Prinzen FW, Vernooy K. Different regions of latest electrical activation during left bundle-branch block and right ventricular pacing in cardiac resynchronization therapy patients determined by coronary venous electro-anatomic mapping. Eur J Heart Fail 2014; 16:1214-22. [DOI: 10.1002/ejhf.178] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/10/2014] [Accepted: 08/29/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Masih Mafi Rad
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Yuri Blaauw
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Trang Dinh
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Laurent Pison
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Harry J. Crijns
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Frits W. Prinzen
- Maastricht University, Cardiovascular Research Institute Maastricht (CARIM); Department of Physiology; PO Box 616 6200 MD Maastricht the Netherlands
| | - Kevin Vernooy
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
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Lin X, Xu H, Zhao X, Chen J. Sites of latest mechanical activation as assessed by SPECT myocardial perfusion imaging in ischemic and dilated cardiomyopathy patients with LBBB. Eur J Nucl Med Mol Imaging 2014; 41:1232-9. [PMID: 24577952 DOI: 10.1007/s00259-014-2718-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Sites of latest mechanical activation (SOLA) have been recognized as optimal left-ventricular (LV) lead positions for cardiac resynchronization therapy (CRT). This study was aimed to investigate SOLA in ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM) patients with left bundle branch block (LBBB). METHODS Sixty-four consecutive LBBB patients (47 DCM, 17 ICM), who met the standard indications for CRT and underwent resting SPECT myocardial perfusion imaging (MPI), were selected. Phase analysis was used to assess LV dyssynchrony and SOLA. The Emory Cardiac Toolbox was used to measure perfusion defects. LV dyssynchrony and SOLA were compared between the DCM patients with wide (≥150 ms) and moderate (120-150 ms) QRS durations (QRSd). The relationship between SOLA and perfusion defects was analyzed in the ICM patients. RESULTS The DCM patients with wide QRSd had significantly more LV dyssynchrony than those with moderate QRSd. Lateral SOLA were significantly more frequent in the DCM patients with wide QRSd than those with moderate QRSd (96% vs. 62%, p = 0.010). In the ICM patients, SOLA were either in the scar segments (82%) or in the segments immediately adjacent to the scar segments (18%), regardless of QRSd. CONCLUSION Lateral SOLA were more frequent in the DCM patients with wide QRSd than those with moderate QRSd. Such relationship was not observed in the ICM patients, where SOLA were associated with scar location rather than QRSd. These findings support the use of SPECT MPI to aid the selection of potential CRT responders and guide LV lead placement.
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Affiliation(s)
- Xianhe Lin
- Department of Cardiology, Anhui Medical University, 218 Jixi Road, Hefei, Anhui, 230022, China
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Bongiorni MG, Proclemer A, Dobreanu D, Marinskis G, Pison L, Blomstrom-Lundqvist C, Blomstrom-Lundqvist C, Bongiorni MG, Chen J, Dagres N, Estner H, Hernandez-Madrid A, Hocini M, Larsen TB, Pison L, Potpara T, Proclemer A, Sciraffia E, Todd D. Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European Heart Rhythm Association survey. Europace 2013; 15:1664-8. [DOI: 10.1093/europace/eut345] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pison L, Proclemer A, Bongiorni MG, Marinskis G, Hernandez-Madrid A, Blomstrom-Lundqvist C. Imaging techniques in electrophysiology and implantable device procedures: results of the European Heart Rhythm Association survey. Europace 2013; 15:1333-6. [DOI: 10.1093/europace/eut259] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mele D, Agricola E, Monte AD, Galderisi M, D'Andrea A, Rigo F, Citro R, Chiodi E, Marchese G, Valentina PD, Calabrese A, Ferrari R. Pacing transmural scar tissue reduces left ventricle reverse remodeling after cardiac resynchronization therapy. Int J Cardiol 2013; 167:94-101. [DOI: 10.1016/j.ijcard.2011.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 08/22/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
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Auricchio A, Delnoy PP, Regoli F, Seifert M, Markou T, Butter C. First-in-man implantation of leadless ultrasound-based cardiac stimulation pacing system: novel endocardial left ventricular resynchronization therapy in heart failure patients. Europace 2013; 15:1191-7. [DOI: 10.1093/europace/eut124] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mhajna M, Abboud S. Assessment of cardiac stroke volume in patients with implanted cardiac pacemaker using parametric electrical impedance tomography: a theoretical 2D study. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2013; 29:630-640. [PMID: 23606371 DOI: 10.1002/cnm.2550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/04/2013] [Accepted: 02/25/2013] [Indexed: 06/02/2023]
Abstract
The present theoretical study examines the ability to estimate cardiac stroke volume (CSV) in patients with implanted cardiac pacemaker using parametric electrical impedance tomography (pEIT) in a 2D computerized model of the thorax. CSV is a direct indicator of the cardiac pumping efficiency. The commonly used methods for measuring CSV require the invasive procedure of right heart catheterization or use expensive imaging techniques (i.e., MRI). Hence, experience with these techniques for diagnosis and monitoring has been limited to hospitalized patients. In the present study, pEIT scheme was applied in a computerized 2D model of the human thorax with implanted cardiac device to determine the left ventricular (LV) volume at different cardiac cycle phases. The LV was simulated as a prolate ellipse with its axes' lengths as the reconstruction parameters while all other geometries and conductivity values remained constant. An optimization was carried out in order to ensure that the ellipse is the appropriate model for the LV at each cardiac cycle phase. LV volumes calculated by both the pEIT algorithm and the ellipsoid model are consistent. A high correlation (ρ = 0.99) between the true and reconstructed volumes was found. The SV calculation error was ∼1%. The results suggest that the LV volume can be estimated using the pEIT method in a 2D computerized model, and that the method has the potential to be used for monitoring patients with implanted cardiac pacemaker.
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Affiliation(s)
- Muhammad Mhajna
- Department of Biomedical Engineering, Tel-Aviv University, Israel
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Kristiansen HM, Vollan G, Hovstad T, Keilegavlen H, Faerestrand S. The impact of left ventricular lead position on left ventricular reverse remodelling and improvement in mechanical dyssynchrony in cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2012; 13:991-1000. [PMID: 22677455 DOI: 10.1093/ehjci/jes114] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS To investigate the influence of left ventricular (LV) lead position on LV dyssynchrony in cardiac resynchronization therapy (CRT). METHODS AND RESULTS The LV lead was prospectively targeted to the latest activated LV segment (concordant) evaluated by two-dimensional speckle tracking radial strain (ST-RS) echocardiography in 103 CRT recipients (67 ± 12 years). Mechanical dyssynchrony was assessed by anteroseptal-to-posterior (AS-P) delay and interventricular mechanical delay (IVMD). Concordant LV leads were obtained in 72 (70%) patients. Superior LV reverse remodelling (LV-RR; ≥ 15% LV end-systolic volume reduction at 6-month follow-up) was observed in the concordant LV leads compared with the discordant LV leads [51 (76%) vs. 13 (45%); P = 0.003]. Mechanical resynchronization responders (≥ 50% AS-P delay reduction at 6-month follow-up) obtained in the concordant LV leads [44 (66%)] was greater than in the discordant LV leads [10 (34%); P = 0.005]. The discordant LV leads located adjacent to the concordant LV leads (+1 segment; n = 22) and 2 segments apart (+2 segments; n = 9) were evaluated in a subgroup analysis. Mechanical resynchronization responders 6 months after CRT were as follows: in +1 segment [n = 10 (48%)] and in +2 segments (n = 0; P = 0.001). The concordant LV lead was the only independent predictor of LV-RR at 6-month follow-up (odds ratio, 4.177; P = 0.004). Independent predictors of mechanical resynchronization responders were AS-P delay (odds ratio, 1.007; P = 0.032), IVMD (odds ratio, 1.024; P = 0.038), and concordant LV lead (odds ratio, 4.691; P = 0.004). CONCLUSION Concordant LV leads in CRT provided more responders according to both LV reverse remodelling and mechanical resynchronization.
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Affiliation(s)
- H M Kristiansen
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway.
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Thibault B, Harel F, Ducharme A, White M, Frasure-Smith N, Roy D, Philippon F, Dorian P, Talajic M, Dubuc M, Gagné P, Guerra PG, Macle L, Rivard L, Khairy P. Evaluation of Resynchronization Therapy for Heart Failure in Patients With a QRS Duration Greater Than 120 ms (GREATER-EARTH) Trial: Rationale, Design, and Baseline Characteristics. Can J Cardiol 2011; 27:779-86. [DOI: 10.1016/j.cjca.2011.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 02/27/2011] [Indexed: 10/17/2022] Open
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Sperzel J, Dänschel W, Gutleben KJ, Kranig W, Mortensen P, Connelly D, Trappe HJ, Seidl K, Duray G, Pieske B, Stockinger J, Boriani G, Jung W, Schilling R, Saberi L, Hallier B, Simon M, Rinaldi CA. First prospective, multi-centre clinical experience with a novel left ventricular quadripolar lead. Europace 2011; 14:365-72. [PMID: 21993431 DOI: 10.1093/europace/eur322] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) is sometimes complicated by elevated pacing thresholds and phrenic nerve stimulation (PNS), both of which may require that the coronary sinus lead be repositioned. The purpose of this study was to evaluate the performance of a novel quadripolar electrode lead and cardiac resynchronization therapy-defibrillator (CRT-D) device that enables electrical repositioning, potentially obviating a lead reposition procedure. METHODS AND RESULTS Patients indicated for CRT were enrolled and received a quadripolar electrode lead and CRT-D device (Quartetmodel 1458Q and Promote Q; St Jude Medical, Sylmar, CA, USA). Electrical data, and the presence of PNS during pacing from each left ventricular (LV) configuration, were documented at pre-hospital discharge and at 1 month. Seventy-five patients were enrolled and 71 were successfully implanted with a Quartetlead. Electrical measurements were stable over the follow-up period. Ninety-seven per cent (64 of 66) of patients had one or more programmable configurations with a threshold < 2.5 V and no PNS vs. 86% (57 of 66) if only conventional bipolar configurations were considered. Physicians were able to use the increased programming options to manage threshold changes and PNS. CONCLUSION The new quadripolar electrode LV lead provides more programming options to address common problems faced when managing CRT patients. Electrical measurements from new vectors are comparable with conventional configurations. Furthermore, 11% of patients in the study suffered PNS on all conventional bipolar vectors.
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Affiliation(s)
- Johannes Sperzel
- Cardiology Department, Kerckhoff-Klinik GmbH, Benekestr 2-8, 61231, Bad Nauheim, Germany.
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Del Greco M, Marini M, Bonmassari R. Implantation of a biventricular implantable cardioverter-defibrillator guided by an electroanatomic mapping system. Europace 2011; 14:107-11. [PMID: 21856676 PMCID: PMC3236659 DOI: 10.1093/europace/eur250] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims The aim of this study is to show the feasibility of a biventricular implantable cardioverter-defibrillator [cardiac resynchronization therapy (CRT)–ICD] implantation using an electroanatomic navigation system and a low dose of fluoroscopy. Here four case reports of patients affected by dilated cardiomyopathy, who underwent cardiac resynchronization therapy, are described. Methods and results During 2010, four patients were admitted to our Cardiology Department for implantation of an CRT–ICD device in primary prevention. All had an ejection fraction of <35% and were in New York Heart Association class III despite optimal medical therapy. The implantations were performed using the EnSite NavX system. All the leads were positioned in the cardiac chambers utilizing the three-dimensional navigation system and only using X-ray to check that the leads had been positioned correctly. To our knowledge, these cases are the first use of an electroanatomic system for implantation of an CRT–ICD device and in all four cases the cannulation of the coronary sinus (CS) was performed only using the mapping system. Electroanatomic navigation made it possible to minimize X-ray exposure during the implantation of the CRT–ICD device; in addition, the mapping system was used to choose the optimum position of the CS catheter using as reference the maximum activation delay between the two ventricles. Conclusions The NavX system shows great potential during the implantation of an CRT–ICD device. It seems to be feasible, safe, and extremely beneficial in terms of a reduction in X-ray exposure. Furthermore, there is benefit of more detailed information and accuracy during the CS lead placement.
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Anderson SE, Eggum JH, Iaizzo PA. Modeling of Induced Electric Fields as a Function of Cardiac Anatomy and Venous Pacing Lead Location. Cardiovasc Eng Technol 2011. [DOI: 10.1007/s13239-011-0057-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Non-contrast magnetic resonance imaging for guiding left ventricular lead position in cardiac resynchronization therapy. J Interv Card Electrophysiol 2011; 33:27-35. [DOI: 10.1007/s10840-011-9599-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 06/14/2011] [Indexed: 10/18/2022]
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Corsi C, Tomasi C, Turco D, Margheri M, Lamberti C, Severi S. 3D dynamic position assessment of the coronary sinus lead in cardiac resynchronization therapy. Med Biol Eng Comput 2011; 49:901-8. [DOI: 10.1007/s11517-011-0794-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 06/18/2011] [Indexed: 12/24/2022]
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Sung RK, Foster E. Assessment of Systolic Dyssynchrony for Cardiac Resynchronization Therapy Is Not Clinically Useful. Circulation 2011; 123:656-62. [DOI: 10.1161/circulationaha.110.954420] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Raphael K. Sung
- From the Division of Cardiology, University of California, San Francisco
| | - Elyse Foster
- From the Division of Cardiology, University of California, San Francisco
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Chauvin M. Difficulties in implantation of a cardiac resynchronization therapy system: causes of failure and importance of operator's experience. Europace 2010; 12:1059-60. [PMID: 20663785 DOI: 10.1093/europace/euq253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schwartzman D, Schelbert E, Adelstein E, Gorcsan J, Soman P, Saba S. Image-guided cardiac resynchronization. Europace 2010; 12:877-80. [DOI: 10.1093/europace/euq103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Dreger H, Borges AC, Ismer B, Schattke S, Stegemann B, Baumann G, Melzer C. A modified echocardiographic protocol with intrinsic plausibility control to determine intraventricular asynchrony based on TDI and TSI. Cardiovasc Ultrasound 2009; 7:46. [PMID: 19781060 PMCID: PMC2767344 DOI: 10.1186/1476-7120-7-46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 09/25/2009] [Indexed: 11/10/2022] Open
Abstract
Background Established methods to determine asynchrony suffer from high intra- and interobserver variability and failed to improve patient selection for cardiac resynchronization therapy (CRT). Thus, there is a need for easy and robust approaches to reliably assess cardiac asynchrony. Methods and Results We performed echocardiography in 100 healthy subjects and 33 patients with left bundle branch block (LBBB). To detect intraventricular asynchrony, we combined two established methods, i.e., tissue synchronization imaging (TSI) and tissue Doppler imaging (TDI). The time intervals from the onset of aortic valve opening (AVO) to the peak systolic velocity (S') were measured separately in six basal segments in the apical four-, two-, and three-chamber view. Color-coded TSI served as an intrinsic plausibility control and helped to identify the correct S' measuring point in the TDI curves. Next, we identified the segment with the shortest AVO-S' interval. Since this segment most likely represents vital and intact myocardium it served as a reference for other segments. Segments were considered asynchronous when the delay between the segment in question and the reference segment was above the upper limit of normal delays derived from the control population. Intra- and interobserver variability were 7.0% and 7.7%, respectively. Conclusion Our results suggest that combination of TDI and TSI with intrinsic plausibility control improves intra- and interobserver variability and allows easy and reliable assessment of cardiac asynchrony.
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Affiliation(s)
- Henryk Dreger
- Medizinische Klinik für Kardiologie und Angiologie, Campus Mitte, Charité-Universitätsmedizin Berlin, Germany.
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