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Efficacy of His Bundle Pacing on LV Relaxation and Clinical Improvement in Heart Failure and LBBB. JACC Clin Electrophysiol 2021; 8:59-69. [PMID: 34454880 DOI: 10.1016/j.jacep.2021.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed to compare acute hemodynamic improvements and responses to His bundle pacing (HBP) and conventional biventricular pacing (BVP). BACKGROUND HBP can correct left bundle branch block (LBBB) and may be an alternative cardiac resynchronization therapy (CRT) to BVP. METHODS Fourteen consecutive patients with heart failure (HF) and typical LBBB who required CRT were enrolled. The acute hemodynamic responses during HBP and BVP were compared using a micromanometer-tipped catheter inserted into the left ventricle (LV) before CRT. Each configuration was compared with AAI mode. A permanent HBP device was implanted when LBBB correction threshold was ≤1.5 V at 1.0 ms, and remaining patients were treated with BVP. Clinical and echocardiographic improvements were assessed during a 12-month follow-up period. RESULTS The LV contractile index (positive maximal rate of LV pressure rise [dP/dtmax]) increased similarly during HBP and BVP (18.8 ± 6.4% vs 18.0 ± 10.2%; P = 0.810). LV relaxation indices (negative dP/dtmax and tau) were significantly improved during HBP compared with BVP (negative dP/dtmax: 14.3% ± 5.5% vs 3.1% ± 8.1%; P < 0.001; tau: 7.2% ± 4.3% vs -0.8% ± 8.1%; P = 0.001). Nine (64%) patients received permanent HBP devices, while 5 patients were treated with BVP. The New York Heart Association functional class, LV ejection fraction, LV end-systolic volume, and B-type natriuretic peptide level improved in patients treated with HBP and BVP (all P < 0.05 vs baseline). Patients treated with HBP exhibited earlier and greater improvements of the LV ejection fraction and LV end-systolic volume than did those with BVP. CONCLUSIONS HBP improves systolic function and LV relaxation in patients with HF and LBBB. CRT via HBP produced earlier and greater clinical responses than BVP.
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Su H, Bao P, Chen KY, Yan J, Xu J, Yu F, Yang DM. Influence of the Right Ventricular Lead Location on Ventricular Arrhythmias in Cardiac Resynchronization Therapy. Chin Med J (Engl) 2018; 131:2402-2409. [PMID: 30334524 PMCID: PMC6202593 DOI: 10.4103/0366-6999.243560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The influence of different right ventricular lead locations on ventricular arrhythmias (VTA) in patients with a cardiac resynchronization therapy (CRT) is not clear. This study aimed to evaluate the influence on VTA in patients with a CRT when right ventricular lead was positioned at the right ventricular middle septum (RVMS) and the right ventricular apical (RVA). Methods: A total of 352 patients implanted with a CRT-defibrillator (CRT-D) between May 2012 and July 2016 in the Department of Cardiology of Anhui Provincial Hospital were included. Two-year clinical and pacemaker follow-up data were collected to evaluate the influence of the right ventricular lead location on VTA. Patients were divided into the RVMS group (n = 155) and the RVA group (n = 197) based on the right ventricular lead position. The VTA were compared between these two groups using a Kaplan-Meier curve and Cox multivariate analysis. Results: When the left ventricular lead location was not considered, RVMS and RVA locations did not affect VTA. However, the subgroup analysis results showed that when the left ventricular lead was positioned at the anterolateral cardiac vein (ALCV), the RVMS group had an increased risk of ventricular arrhythmias and appropriate defibrillation (hazard ratio [HR] = 3.29, P = 0.01 and HR = 4.33, P < 0.01, respectively); when the left ventricular lead was at the posterolateral cardiac vein (PLCV), these risks in the RVMS group decreased (HR = 0.45, P = 0.02 and HR = 0.33, P < 0.01, respectively), and when the left ventricular lead was at the lateral cardiac vein, there was no difference between the two groups. In regard to inappropriate defibrillation, there was no significant difference among all these groups. Conclusions: When the left ventricular lead was positioned at ALCV or PLCV, the right ventricular lead location was associated with VTA and appropriate defibrillation after CRT. Greater distances between leads not only improved cardiac function but also may reduce the risk of VTA.
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Clementy N, Laborie G, Pierre B, Benhenda N, Babuty D, Fauchier L. Three-dimensional interlead distance predicts response and outcomes after cardiac resynchronization therapy. Arch Cardiovasc Dis 2017; 110:590-598. [PMID: 28734687 DOI: 10.1016/j.acvd.2017.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/30/2016] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Approximately one-third of patients do not respond favourably to cardiac resynchronization therapy (CRT). A longer distance between ventricular leads may improve response. AIM To study the impact of the true three-dimensional interlead distance (ILD) on outcomes. METHODS Consecutive patients undergoing CRT device implantation were included prospectively. Interlead separation was measured from postprocedural anterior-posterior and lateral chest X-rays. The three-dimensional ILD was calculated using the Pythagorean theorem. Response to CRT was defined using a composite clinical score at 6 months. RESULTS Forty-two patients were included (mean age 70±9 years; QRS duration 154±31ms; left ventricular ejection fraction 26±7%; 50% ischaemic). At 6 months, 71% of patients were considered to be responders. Responders had a significantly longer ILD (108±17 vs. 87±21mm; P=0.002). When the ILD was corrected for cardiac size, the optimal cut-off value was ≥ 0.53 for predicting response (sensitivity 83%, specificity 75%, area under the curve 0.84; P=0.0002). Similar results were obtained in a historical retrospective cohort. The use of proximal electrodes on the left ventricular lead was associated with a longer ILD in 95% of patients, compared with more distal pacing configurations. In the total cohort of 74 patients (median follow-up, 420 days), those with an indexed ILD ≥ 0.53 had a 70% reduction in risk of hospitalization for heart failure (P=0.004). CONCLUSION Longer three-dimensional ILD corrected for cardiac size measured on chest radiographs can accurately predict response to CRT and outcomes. This simple variable may be used to identify optimal lead placement and pacing configuration during CRT implantation.
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Affiliation(s)
- Nicolas Clementy
- Cardiology Department, François Rabelais University, Tours, France.
| | | | - Bertrand Pierre
- Cardiology Department, François Rabelais University, Tours, France
| | - Nazih Benhenda
- Cardiology Department, François Rabelais University, Tours, France
| | - Dominique Babuty
- Cardiology Department, François Rabelais University, Tours, France
| | - Laurent Fauchier
- Cardiology Department, François Rabelais University, Tours, France
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Kronborg MB, Johansen JB, Riahi S, Petersen HH, Haarbo J, Jørgensen OD, Nielsen JC. Association between right ventricular lead position and clinical outcomes in patients with cardiac resynchronization therapy. Europace 2017; 20:629-635. [DOI: 10.1093/europace/euw424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/01/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Skejby Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Den
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Helen Hoegh Petersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Haarbo
- Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Dan Jørgensen
- Department of Heart, Lung and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Skejby Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Den
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Leclercq C, Sadoul N, Mont L, Defaye P, Osca J, Mouton E, Isnard R, Habib G, Zamorano J, Derumeaux G, Fernandez-Lozano I. Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators: the SEPTAL CRT Study. Eur Heart J 2016; 37:473-83. [PMID: 26374852 PMCID: PMC5841219 DOI: 10.1093/eurheartj/ehv422] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 07/17/2015] [Accepted: 08/10/2015] [Indexed: 11/29/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) is a recommended treatment of heart failure (HF) patients with depressed left ventricular ejection fraction and wide QRS. The optimal right ventricular (RV) lead position being a matter of debate, we sought to examine whether RV septal (RVS) pacing was not inferior to RV apical (RVA) pacing on left ventricular reverse remodelling in patients receiving a CRT-defibrillator. METHODS AND RESULTS Patients (n = 263, age = 63.4 ± 9.5 years) were randomly assigned in a 1:1 ratio to RVS (n = 131) vs. RVA (n = 132) pacing. Left ventricular end-systolic volume (LVESV) reduction between baseline and 6 months was not different between the two groups (-25.3 ± 39.4 mL in RVS group vs. -29.3 ± 44.5 mL in RVA group, P = 0.79). Right ventricular septal pacing was not non-inferior (primary endpoint) to RVA pacing with regard to LVESV reduction (average difference = -4.06 mL; P = 0.006 with a -20 mL non-inferiority margin). The percentage of 'echo-responders' defined by LVESV reduction >15% between baseline and 6 months was similar in both groups (50%) with no difference in the time to first HF hospitalization or death (P = 0.532). Procedural or device-related serious adverse events occurred in 68 patients (RVS = 37) with no difference between the two groups (P = 0.401). CONCLUSION This study demonstrates that septal RV pacing in CRT is non-inferior to apical RV pacing for LV reverse remodelling at 6 months with no difference in the clinical outcome. No recommendation for optimal RV lead position can hence be drawn from this study. CLINICALTRIALS GOV NUMBER NCT 00833352.
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Affiliation(s)
- Christophe Leclercq
- Centre Hospitalier Universitaire, Rennes, France Université Rennes 1, Rennes, France Université Inserm U642, Rennes, France
| | | | - Lluis Mont
- Hospital Clinic Universitat de Barcelona, Catalonia, Spain
| | | | | | | | - Richard Isnard
- Centre Hospitalier Universitaire la Pitié-Salpêtrière, Paris, France
| | - Gilbert Habib
- Centre Hospitalier Universitaire La Timone, Marseille, France
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Jones MA, Khiani R, Foley P, Webster D, Qureshi N, Wong KCK, Rajappan K, Bashir Y, Betts TR. Inter- and intravein differences in cardiac output with cardiac resynchronization pacing using a multipolar LV pacing lead. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:267-74. [PMID: 25414088 DOI: 10.1111/pace.12531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 08/20/2014] [Accepted: 09/09/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Quadripolar left ventricular pacing leads permit a variety of pacing configurations from different sites within a coronary vein. There may be advantages to selecting a specific pacing vector. This study examines whether the range of cardiac outputs obtained at cardiac resynchronization therapy (CRT) implantation is greater between different poles within a vein, or greater between two different veins. METHODS AND RESULTS The cardiac index (CI, L/min/m(2) ) was measured during CRT implantation using a noninvasive cardiac output monitor (NICOM™, Cheetah Medical Inc., Newton Center, MA, USA) and a quadripolar left ventricle (LV) lead, in 22 patients with sinus rhythm. CI was recorded during right atrial-biventricular pacing at 70/min with fixed atrioventricular and ventriculo-ventricular delay, from each LV electrode in one vein, and then from an alternate vein. Phrenic nerve stimulation (PNS) occurred in nine of 15 posterior and three of 21 anterior veins (P = 0.005). At least one electrode in each vein had no PNS. The mean (standard deviation [SD]) difference between best and worst CI within any one vein was 13.1% (±9%). The mean (SD) difference between the best CI in one vein compared to the other was 9.8% (±8%; P = 0.043). In 16 of 22 patients, the range of CI was greater between poles within one vein, rather than between two veins (best of one vein compared to best from the other). In four of 22 patients, the range was greater between veins (P = 0.0003). CONCLUSION A greater range of CI is found within a single vein than between two different veins. This finding has implications both for the approach to implant technique and postimplant programming and optimization.
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Affiliation(s)
- Michael A Jones
- From the Cardiology Department, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headington, Oxfordshire, UK
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Kato H, Shimano M, Sumi T, Murakami H, Kada K, Inden Y, Tsuboi N, Murohara T. Acute improvement of left ventricular relaxation as a predictor of volume reduction after cardiac resynchronization therapy: a pilot study assessing the value of left ventricular hemodynamic parameter. Pacing Clin Electrophysiol 2014; 37:1544-52. [PMID: 25113752 DOI: 10.1111/pace.12478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 05/31/2014] [Accepted: 06/09/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves cardiac function, but CRT recipients with advanced heart failure (HF) do not always respond well. Because the best parameters for the prediction of CRT response are not established, we investigated whether improvement of invasive left ventricular (LV) hemodynamic diastolic parameters could identify CRT responders. METHODS A total of 34 consecutive patients (age, 69 ± 9 years; 70% men) who received CRT devices for HF were assessed as to whether acute invasive hemodynamic parameters with and without CRT function could predict LV volume responders. RESULTS These patients demonstrated an improvement in LV dP/dtmax (11.1 ± 11.7%), LV dP/dtmin (4.6 ± 12.1%), and tau (3.7 ± 11.6%) by biventricular pacing. Nineteen patients (55%) were classified as CRT responders, which was defined by a >15% decrease in LV end-systolic volume (ESV) at the 6-month follow-up evaluation. The area under the receiver operator characteristic curve to detect CRT volume response was 0.93 for the shortening of tau, which was superior to any other hemodynamic parameter. The multivariate analysis revealed that this improvement in tau was the strongest predictive factor for identifying CRT volume responders. Of note, the magnitude of tau shortening during biventricular pacing was significantly correlated with the reduction in LVESV at the 6-month follow-up evaluation. CONCLUSIONS The extent of acute improvement in LV isovolumic relaxation time, as assessed by tau, was associated with favorable response to CRT. The assessment of invasive diastolic function could provide valuable information about CRT volume response.
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Affiliation(s)
- Hiroyuki Kato
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
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Impact of the right ventricular lead position on clinical outcome and on the incidence of ventricular tachyarrhythmias in patients with CRT-D. Heart Rhythm 2013; 10:1770-7. [DOI: 10.1016/j.hrthm.2013.08.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Indexed: 11/20/2022]
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Kydd AC, McCormick LM, Dutka DP. Optimizing benefit from CRT: role of speckle tracking echocardiography, the importance of LV lead position and scar. Expert Rev Med Devices 2013; 9:521-36. [PMID: 23116079 DOI: 10.1586/erd.12.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac resynchronization therapy is demonstrated to be effective in patients with advanced heart failure. Correcting mechanical dyssynchrony is proposed as the predominant mechanism of response. Achieving optimum left ventricular lead position, at the site of maximal mechanical dyssynchrony but away from transmural scar, is identified as one of the main determinants of both symptomatic and prognostic benefit. Strategies employing multimodality cardiac imaging techniques have been used to identify this optimal pacing site, in addition to any potential anatomical limitations to successful implantation. Speckle tracking echocardiography offers prospective lead targeting, incorporating pathophysiological determinants of cardiac resynchronization therapy response. This review considers the key factors in defining optimum left ventricular lead location, emphasizing the role of myocardial scar. The use of speckle tracking echocardiography and the potential for this technique to be incorporated into routine practice to guide the implant strategy in an individual patient is discussed.
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Affiliation(s)
- Anna C Kydd
- Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, UK
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Kumar P, Upadhyay GA, Cavaliere-Ogus C, Heist EK, Altman RK, Chatterjee NA, Parks KA, Singh JP. Right ventricular lead adjustment in cardiac resynchronization therapy and acute hemodynamic response: a pilot study. J Interv Card Electrophysiol 2012; 36:223-31. [DOI: 10.1007/s10840-012-9759-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/05/2012] [Indexed: 11/25/2022]
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Duckett SG, Ginks M, Shetty A, Kirubakaran S, Bostock J, Kapetanakis S, Gill J, Carr-White G, Razavi R, Rinaldi CA. Adverse response to cardiac resynchronisation therapy in patients with septal scar on cardiac MRI preventing a septal right ventricular lead position. J Interv Card Electrophysiol 2012; 33:151-60. [PMID: 22127378 DOI: 10.1007/s10840-011-9630-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 09/28/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Myocardial scar is an adverse factor when considering which patients are likely to respond to cardiac resynchronisation therapy (CRT). We hypothesized that septal scarring on magnetic resonance imaging (MRI) may be associated with a poor outcome from CRT, which may relate to the inability to place the right ventricular (RV) lead in the septum. METHODS Fifty patients (ejection fractions, 25 ± 8%; 45 men, 62.8 ± 14 years; 26 dilated cardiomyopathy; and 24 ischaemic cardiomyopathy (ICM)) receiving CRT underwent delayed enhancement cardiac MRI to assess location and burden of myocardial scar. Acute hemodynamic response (AHR) was evaluated at implant with a pressure wire in the left ventricular (LV) cavity. LV remodelling was determined by reduction in LV end-systolic volume at 6 months. RESULTS The presence of ICM with septal scar was associated with a poor acute and chronic response to CRT. This was predominantly due to a worse response in patients with septal scar. Patients without septal scar had a better AHR with a 26.7 ± 28.9% rise in LV dP/dt (max) from baseline vs. -2.8 ± 14.5% for patients with septal scar (P = 0.01) with Biventricular (BIV) pacing. A greater proportion remodelled (56% vs. 20% (P = 0.02)). Furthermore, only 33% of patients with septal scar had an RV septal lead compared with 66% with no septal scar (P = 0.03). CONCLUSIONS The presence of septal scar was associated with a poor acute and chronic response to CRT. This may relate to the inability to achieve a RV septal lead placement.
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Affiliation(s)
- Simon G Duckett
- Department of Imaging Sciences, The Rayne Institute, Kings College London, London, Great Britain, UK.
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Niederer SA, Shetty AK, Plank G, Bostock J, Razavi R, Smith NP, Rinaldi CA. Biophysical modeling to simulate the response to multisite left ventricular stimulation using a quadripolar pacing lead. Pacing Clin Electrophysiol 2012; 35:204-14. [PMID: 22040178 PMCID: PMC5378306 DOI: 10.1111/j.1540-8159.2011.03243.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Response to cardiac resynchronization therapy (CRT) is reduced in patients with posterolateral scar. Multipolar pacing leads offer the ability to select desirable pacing sites and/or stimulate from multiple pacing sites concurrently using a single lead position. Despite this potential, the clinical evaluation and identification of metrics for optimization of multisite CRT (MCRT) has not been performed. METHODS The efficacy of MCRT via a quadripolar lead with two left ventricular (LV) pacing sites in conjunction with right ventricular pacing was compared with single-site LV pacing using a coupled electromechanical biophysical model of the human heart with no, mild, or severe scar in the LV posterolateral wall. RESULT The maximum dP/dt(max) improvement from baseline was 21%, 23%, and 21% for standard CRT versus 22%, 24%, and 25% for MCRT for no, mild, and severe scar, respectively. In the presence of severe scar, there was an incremental benefit of multisite versus standard CRT (25% vs 21%, 19% relative improvement in response). Minimizing total activation time (analogous to QRS duration) or minimizing the activation time of short-axis slices of the heart did not correlate with CRT response. The peak electrical activation wave area in the LV corresponded with CRT response with an R(2) value between 0.42 and 0.75. CONCLUSION Biophysical modeling predicts that in the presence of posterolateral scar MCRT offers an improved response over conventional CRT. Maximizing the activation wave area in the LV had the most consistent correlation with CRT response, independent of pacing protocol, scar size, or lead location.
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Affiliation(s)
- Steven A Niederer
- Imaging Sciences & Biomedical Engineering Division, King's College London, London, United Kingdom.
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Cowburn PJ, Leclercq C. How to improve outcomes with cardiac resynchronisation therapy: importance of lead positioning. Heart Fail Rev 2011; 17:781-9. [DOI: 10.1007/s10741-011-9287-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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STOCKINGER JOCHEM, STAIER KLAUS, SCHIEBELING-RÖMER JOCHEN, KEYL CORNELIUS. Acute Hemodynamic Effects of Right and Left Ventricular Lead Positions during the Implantation of Cardiac Resynchronization Therapy Defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1537-43. [DOI: 10.1111/j.1540-8159.2011.03181.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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KHAN FAKHARZ, SALAHSHOURI PEGAH, DUEHMKE RUDY, READ PHILIPA, PUGH PETERJ, ELSIK MAROS, BEGLEY DAVID, FYNN SIMONP, DUTKA DAVIDP, VIRDEE MUNMOHANS. The Impact of the Right Ventricular Lead Position on Response to Cardiac Resynchronization Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:467-74. [DOI: 10.1111/j.1540-8159.2010.02995.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Suzuki H, Shimano M, Yoshida Y, Inden Y, Muramatsu T, Tsuji Y, Tsuboi N, Hirayama H, Shibata R, Murohara T. Maximum derivative of left ventricular pressure predicts cardiac mortality after cardiac resynchronization therapy. Clin Cardiol 2010; 33:E18-23. [PMID: 21184541 DOI: 10.1002/clc.20683] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has been reported to improve cardiac performance. However, CRT in patients with advanced heart failure is not always accompanied by an improvement in survival rates. We investigated the association between hemodynamic studies and long-term prognosis after CRT. METHODS A total of 68 consecutive patients receiving CRT devices due to advanced heart failure were assessed by hemodynamic study and long-term outcome after implantation of the device. Hemodynamic parameters were measured both with the CRT on and off. RESULTS Patients demonstrated significant improvement in the maximum first derivative of left ventricular (LV) pressure (LV dP/dt(max) ) and QRS duration after periods with the CRT on. During the follow-up period of 34.9 ± 17.6 months, basal LV dP/dt(max) and isovolemic LV pressure half-time (T½), but not percent change in LV dP/dt(max) , were independent predictors of cardiac mortality or hospitalization due to heart failure after multivariate Cox regression analysis. The Kaplan-Meier survival analysis revealed that patients in the lowest basal LV dP/dt(max) tertile or the longest basal T½ tertile exhibited a significantly higher cardiac-caused mortality or heart failure hospitalization. CONCLUSIONS Lower LV dP/dt(max) or longer T½ independently predicts cardiac mortality or heart failure hospitalization in patients receiving CRT. The assessment of the basal LV dP/dt(max) and T½ could provide useful information in long-term prognosis after CRT.
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Kondo K, Shibata R, Unno K, Shimano M, Ishii M, Kito T, Shintani S, Walsh K, Ouchi N, Murohara T. Impact of a single intracoronary administration of adiponectin on myocardial ischemia/reperfusion injury in a pig model. Circ Cardiovasc Interv 2010; 3:166-73. [PMID: 20332381 DOI: 10.1161/circinterventions.109.872044] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Adiponectin plays a protective role in the development of obesity-linked disorders. We demonstrated that adiponectin exerts beneficial actions on acute ischemic injury in mice hearts. However, the effects of adiponectin treatment in large animals and its feasibility in clinical practice have not been investigated. This study investigated the effects of intracoronary administration of adiponectin on myocardial ischemia-reperfusion (I/R) injury in pigs. METHODS AND RESULTS The left anterior descending coronary artery was occluded in pigs for 45 minutes and then reperfused for 24 hours. Recombinant adiponectin protein was given as a bolus intracoronary injection during ischemia. Cardiac functional parameters were measured by a manometer-tipped catheter. Apoptosis was evaluated by terminal deoxynucleotidyltransferase-mediated dUTP nick end-labeling staining. Tumor necrosis factor-alpha and interleukin-10 transcripts were analyzed by real-time polymerase chain reaction. Serum levels of derivatives of reactive oxygen metabolites and biological antioxidant potential were measured. Adiponectin protein was determined by immunohistochemical and Western blot analyses. Intracoronary administration of adiponectin protein led to a reduction in myocardial infarct size and improvement of left ventricular function in pigs after I/R. Injected adiponectin protein accumulated in the I/R-injured heart. Adiponectin treatment resulted in decreased tumor necrosis factor-alpha and increased interleukin-10 mRNA levels in the myocardium after I/R. Adiponectin-treated pigs had reduced apoptotic activity in the I/R-injured heart and showed increased biological antioxidant potential levels and decreased derivatives of reactive oxygen metabolite levels in the blood stream after I/R. CONCLUSIONS These data suggest that adiponectin protects against I/R injury in a preclinical pig model through its ability to suppress inflammation, apoptosis, and oxidative stress. Administration of intracoronary adiponectin could be a useful adjunctive therapy for acute myocardial infarction.
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Affiliation(s)
- Kazuhisa Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya, Japan
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BULAVA ALAN, LUKL JAN. Similar Long-Term Benefits Conferred by Apical Versus Mid-Septal Implantation of the Right Ventricular Lead in Recipients of Cardiac Resynchronization Therapy Systems. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 1:S32-7. [DOI: 10.1111/j.1540-8159.2008.02224.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Haghjoo M, Bonakdar HR, Jorat MV, Fazelifar AF, Alizadeh A, Ojaghi-Haghjghi Z, Esmaielzadeh M, Sadr-Ameli MA. Effect of right ventricular lead location on response to cardiac resynchronization therapy in patients with end-stage heart failure. Europace 2009; 11:356-63. [DOI: 10.1093/europace/eun375] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Butter C, Hindricks G. Cardiac resynchronization therapy: haemodynamic background and perspectives. Eur Heart J Suppl 2007. [DOI: 10.1093/eurheartj/sum064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Physiologic pacing is an evolving term used to describe different concepts and technologic developments in implantable devices (including pacemakers and defibrillators) over the past several decades. Currently much of the discussion about optimal physiologic pacing involves fairly recently appreciated deleterious effects of traditional right ventricular pacing. Technologic solutions to the goal of avoiding unnecessary ventricular pacing appear to be available and successful. Although much work is being done to find more physiologic ways to pace the ventricles when necessary, the solutions for this goal are less clear.
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Affiliation(s)
- Dwight W Reynolds
- Cardiovascular Section, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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