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Huntsinger ME, Rabara R, Peralta I, Doshi RN. Current Technology to Maximize Cardiac Resynchronization Therapy Benefit for Patients With Symptomatic Heart Failure. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The incidence of heart failure (HF) continues to increase, affecting millions of people in the United States each year. Cardiac resynchronization therapy (CRT) has been used and studied for patients with symptomatic HF for more than 20 years. The purpose of this article is to review technologies and developments to help maximize CRT for patients with symptomatic HF. Although most interventions to optimize CRT are physician directed, nurses also have an important role in the care and education of patients with symptomatic HF and can affect clinical outcomes. Therefore, nurses’ understanding of CRT and measures to maximize this lifesaving therapy is critical in HF management.
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Affiliation(s)
- Mary Eng Huntsinger
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Roselou Rabara
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Irene Peralta
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Rahul N. Doshi
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
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Shah SJ, Michaels AD. Hemodynamic correlates of the third heart sound and systolic time intervals. ACTA ACUST UNITED AC 2009; 12 Suppl 1:8-13. [PMID: 16894268 DOI: 10.1111/j.0889-7204.2006.05767.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bedside diagnostic tools remain important in the care of patients with heart failure. Over the past two centuries, cardiac auscultation and phonocardiography have been essential in understanding cardiac pathophysiology and caring for patients with heart disease. Diastolic heart sounds (S3 and S4) and systolic time intervals have been particularly useful in this regard. Unfortunately, auscultation skills have declined considerably, and systolic time intervals have traditionally required carotid pulse tracings. Newer technology allows the automated detection of heart sounds and measurement of systolic time intervals in a simple, inexpensive, noninvasive system. Using the newer system, the authors present data on the hemodynamic correlates of the S3 and abnormal systolic time intervals. These data serve as the foundation for using the system to better understand the test characteristics and pathophysiology of the S3 and systolic time intervals, and help to define their use in improving the bedside diagnosis and management of patients with heart failure.
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Affiliation(s)
- Sanjiv J Shah
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, CA, USA
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Marcus FI, Sorrell V, Zanetti J, Bosnos M, Baweja G, Perlick D, Ott P, Indik J, He DS, Gear K. Accelerometer-derived time intervals during various pacing modes in patients with biventricular pacemakers: comparison with normals. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 30:1476-81. [PMID: 18070301 DOI: 10.1111/j.1540-8159.2007.00894.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Changes due to biventricular pacing have been documented by shortening of QRS duration and echocardiography. Compared to normal ventricular activation, the presence of left bundle branch block (LBBB) results in a significant change in cardiac cycle time intervals. Some of these have been used to quantify the underlying cardiac dyssynchrony, assess the effects of biventricular pacing, and guide programming of ventricular pacing devices. This study evaluates a simple noninvasive method using accelerometers attached to the skin to measure cardiac time intervals in biventricularly paced patients. METHODS Ten patients with biventricular pacemakers previously implanted for congestive heart failure were paced in the AAI mode, then in atrioventricular (AV) sequential mode from the right and left ventricles followed by biventricular pacing. Simultaneous recordings were obtained by 2D, Doppler echocardiography as well as by accelerometers. Similar recordings were obtained from 10 gender, aged matched, normal controls during sinus rhythm. RESULTS Compared to normals, heart failure patients paced in AAI mode had prolonged isovolumetric contraction time (IVCT), shorter ventricular ejection time (LVET), and prolonged isovolumetric relaxation (IVRT). With biventricular pacing the IVCT decreased, but the LVET and IVRT did not change significantly. There was excellent correlation between the echo and accelerometer-measured intervals. CONCLUSIONS Shortening of the IVCT measured by an accelerometer is a consistent time interval change due to biventricular pacing that probably reflects more rapid acceleration of left ventricular ejection. The accelerometer may be useful to assess immediate efficacy of biventricular pacing during device implantation and optimize programmable time intervals such as AV and interventricular (VV) delays.
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Affiliation(s)
- Frank I Marcus
- University Medical Center, Sarver Heart Center, Tucson, AZ 85724, USA.
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Delgado RM, Radovancevic B. Symptomatic Relief: Left Ventricular Assist Devices Versus Resynchronization Therapy. Heart Fail Clin 2007; 3:259-65. [PMID: 17723934 DOI: 10.1016/j.hfc.2007.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In patients who have end-stage heart failure, medical therapy is of limited use, and heart transplantation is frequently not an option because of the shortage of donor hearts. Two new treatment options, left ventricular assist devices (LVADs) and implantable cardiac resynchronization therapy (CRT) devices, can improve survival and quality of life in patients who have heart failure. Both types of devices are easy to implant. However, LVADs carry the risk of infection and mechanical failure, and CRT is ineffective in a substantial proportion of patients who have heart failure. Therefore, methods must be devised to identify patients who have heart failure who are likely to benefit from these devices. Data suggest that early LVAD implantation, before end-stage heart failure develops, is critical to slowing or reversing disease progression. Similarly, in indicated patients who have less advanced disease, CRT may be particularly beneficial.
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Affiliation(s)
- Reynolds M Delgado
- The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77225-0345, USA.
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Shah SJ, Michaels AD. Hemodynamic Correlates of the Third Heart Sound and Systolic Time Intervals. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1527-5299.2006.05773.x-i1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sanjiv J. Shah
- From the Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA;1 and the Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT2
| | - Andrew D. Michaels
- From the Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA;1 and the Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT2
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Delgado RM, Palanichamy N, Radovancevic R, Vrtovec B, Vrtotec B, Radovancevic B. Brain Natriuretic Peptide Levels and Response to Cardiac Resynchronization Therapy in Heart Failure Patients. ACTA ACUST UNITED AC 2006; 12:250-3. [PMID: 17033272 DOI: 10.1111/j.1527-5299.2006.05469.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors used brain natriuretic peptide (BNP) as a reliable marker to identify nonresponders to cardiac resynchronization therapy (CRT) in patients with advanced heart failure. The study included 70 patients with left ventricular dysfunction (mean ejection fraction, 21+/-4%) and left bundle branch block (QRS duration, 164+/-25 milliseconds) treated with CRT. The authors reviewed data on New York Heart Association functional class, baseline ejection fraction, sodium, creatinine, QRS duration, and BNP levels 3 months before and after CRT therapy. The authors compared results of 42 patients who survived (973+/-192 days) after CRT implantation (responders) to those of 28 patients (nonresponders) who either expired (n=21) or underwent heart transplantation (n=5) or left ventricular assist device implantation (n=2) after an average of 371+/-220 days. Mean BNP levels after 3 months of CRT decreased in responders from 758+/-611 pg/mL to 479+/-451 pg/mL (P=.044), while in nonresponders there was increase in BNP levels from 1191+/-466 pg/mL to 1611+/-1583; P=.046. A rise in BNP levels was associated with poor response (death or need for transplantation or left ventricular assist device and impaired long-term outcome), which makes it a good predictor to identify such patients.
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Affiliation(s)
- Reynolds M Delgado
- Center for Cardiac Support, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, TX 77225-0345, USA
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Herweg B, Ilercil A, Madramootoo C, Krishnan S, Rinde-Hoffman D, Weston M, Curtis AB, Barold SS. Latency During Left Ventricular Pacing From the Lateral Cardiac Veins: A Cause of Ineffectual Biventricular Pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:574-81. [PMID: 16784422 DOI: 10.1111/j.1540-8159.2006.00404.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report three patients with cardiomyopathy and pronounced stimulus to QRS latency during left ventricular (LV) pacing from an epicardial cardiac vein. Delayed LV activation during simultaneous biventricular pacing produced an electrocardiographic pattern dominated by right ventricular stimulation. Hemodynamic parameters improved immediately after advancing LV stimulation (in one patient) or pacing the LV only (in two patients) coupled with dramatic improvement of heart failure symptoms.
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Affiliation(s)
- Bengt Herweg
- Arrhythmia Service and Division of Cardiology, Tampa General Hospital and University of South Florida, Tampa, Florida 33606, USA.
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García Calabozo R, Martínez Ferrer J, Sancho-Tello de Carranza MJ. Temas de actualidad en estimulación cardíaca 2005. Rev Esp Cardiol (Engl Ed) 2006; 59 Suppl 1:66-77. [PMID: 16540022 DOI: 10.1157/13084450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Currently, three areas of active development in cardiac pacing are of particular interest to clinical cardiologists. Biventricular pacing is now considered a type-I indication for adjuvant treatment in advanced and refractory heart failure. Consequently, some changes in everyday clinical practice will be seen when patients with end-stage heart failure start to receive resynchronization therapy. Secondly, the Cardiac Pacing Working Group of the Spanish Society of Cardiology has developed a national consensus document on sleep apnea and cardiac rhythm abnormalities. It appears that a novel way of tackling the current growing epidemic could be to use permanent cardiac pacing in an attempt to modify the cardiac rhythm alterations, mainly bradyarrhythmias, related to sleep apnea. Finally, promising developments are taking place in systems designed to reduce the unwanted right ventricular stimulation sometimes observed with antibradycardia pacing modalities. These new systems are expected to minimize significantly the well-known deleterious hemodynamic effects sometimes seen in our patients.
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