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Mulpuru SK, Cha YM, Asirvatham SJ. Synchronous ventricular pacing with direct capture of the atrioventricular conduction system: Functional anatomy, terminology, and challenges. Heart Rhythm 2016; 13:2237-2246. [DOI: 10.1016/j.hrthm.2016.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Indexed: 10/21/2022]
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Grupper A, Killu AM, Friedman PA, Abu Sham'a R, Buber J, Kuperstein R, Rozen G, Asirvatham SJ, Espinosa RE, Luria D, Webster TL, Brooke KL, Hodge DO, Wiste HJ, Cha YM, Glikson M. Effects of tricuspid valve regurgitation on outcome in patients with cardiac resynchronization therapy. Am J Cardiol 2015; 115:783-9. [PMID: 25638518 DOI: 10.1016/j.amjcard.2014.12.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/13/2014] [Accepted: 12/13/2014] [Indexed: 11/29/2022]
Abstract
Cardiac resynchronization therapy (CRT) has a symptomatic and survival benefit for patients with heart failure (HF), but the percentage of nonresponders remains relatively high. The aims of this study were to assess the clinical significance of baseline tricuspid regurgitation (TR) or worsening TR after implantation of a CRT device on the response to therapy. This is a multicenter retrospective analysis of prospectively collected databases that includes 689 consecutive patients who underwent implantation of CRT. The patients were divided into groups according to baseline TR grade and according to worsening TR within 15 months after device implantation. Outcome was assessed by clinical and echocardiographic response within 15 months and by estimated survival for a median interquartile range follow-up time of 3.3 years (1.6, 4.6). TR worsening after CRT implantation was documented in 104 patients (15%). These patients had worse clinical and echocardiographic response to CRT, but worsening of TR was not a significant predictor of mortality (p = 0.17). According to baseline echocardiogram, 620 patients (90%) had some degree of TR before CRT implant. Baseline TR was an independent predictor of worse survival (p <0.001), although these patients had significantly better clinical and echocardiographic response compared with patients without TR. In conclusion, worsening of TR after CRT implantation is a predictor of worse clinical and echocardiographic response but was not significantly associated with increased mortality. Baseline TR is associated with reduced survival despite better clinical and echocardiographic response after CRT implantation.
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Affiliation(s)
- Avishay Grupper
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Ammar M Killu
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Raed Abu Sham'a
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Jonathan Buber
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Rafael Kuperstein
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Guy Rozen
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Raul E Espinosa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David Luria
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Tracy L Webster
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kelly L Brooke
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David O Hodge
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Heather J Wiste
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Michael Glikson
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
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Madhavan M, Friedman PA. Leadless endocardial left ventricular resynchronization: is it ready for prime time? Europace 2014; 16:623-5. [DOI: 10.1093/europace/euu075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Imaging evaluation of implantation site of permanent direct His bundle pacing lead. Heart Rhythm 2014; 11:529-30. [DOI: 10.1016/j.hrthm.2013.01.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Indexed: 11/20/2022]
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Konecny T, DeSimone CV, Friedman PA, Bruce C, Asirvatham SJ. Synchronous intra-myocardial ventricular pacing without crossing the tricuspid valve or entering the coronary sinus. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 14:137-8. [PMID: 23773495 DOI: 10.1016/j.carrev.2013.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 03/26/2013] [Indexed: 10/26/2022]
Abstract
Ventricular pacing is most commonly performed at the right ventricular (RV) apex. This is not without risk as placement requires crossing the tricuspid valve (TV) and may cause valvular dysfunction and dyssynchronous activation of the ventricles. The fact that the tricuspid valve lies more apically than the mitral valve allows for the possibility of pacing the ventricles from the right atrium (RA) via the "atrio-ventricular septum" without crossing the TV or entering the coronary sinus (CS). In order to mitigate far field activation inherent to current pacing technology, we constructed a novel lead in which the cathode and anode are both intra-myocardial. We demonstrate safety and efficacy of this novel lead for ventricular pacing at the atrio-ventricular septum in canines, including improved synchronous activation of both ventricles, improved differentiation in ventricular versus atrial sensing, while providing reliable ventricular capture, opening novel and a potentially safer alternative to human cardiac resynchronization therapy.
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Affiliation(s)
- Tomas Konecny
- Department of Medicine, Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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McLeod CJ, Asirvatham SJ, Warnes CA, Ammash NM. Device therapy for arrhythmia management in adults with congenital heart disease. Expert Rev Med Devices 2014; 7:519-27. [DOI: 10.1586/erd.10.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Correa de Sa DD, Hardin NJ, Crespo EM, Nicholas KB, Lustgarten DL. Autopsy Analysis of the Implantation Site of a Permanent Selective Direct His Bundle Pacing Lead. Circ Arrhythm Electrophysiol 2012; 5:244-6. [DOI: 10.1161/circep.111.968834] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel D. Correa de Sa
- From the Department of Medicine (D.D.C., D.L.L.) and Department of Pathology and Laboratory Medicine (N.J.H., K.B.N.), University of Vermont, College of Medicine, Burlington, VT; Fletcher Allen Health Care, Burlington, VT (D.D.C., N.J.H., K.B.N., D.L.L.); Department of Cardiology, Hartford Hospital, Hartford, CT (E.M.C.); and Cardiovascular Research Institute, Burlington, VT (D.L.L.)
| | - Nicholas J. Hardin
- From the Department of Medicine (D.D.C., D.L.L.) and Department of Pathology and Laboratory Medicine (N.J.H., K.B.N.), University of Vermont, College of Medicine, Burlington, VT; Fletcher Allen Health Care, Burlington, VT (D.D.C., N.J.H., K.B.N., D.L.L.); Department of Cardiology, Hartford Hospital, Hartford, CT (E.M.C.); and Cardiovascular Research Institute, Burlington, VT (D.L.L.)
| | - Eric M. Crespo
- From the Department of Medicine (D.D.C., D.L.L.) and Department of Pathology and Laboratory Medicine (N.J.H., K.B.N.), University of Vermont, College of Medicine, Burlington, VT; Fletcher Allen Health Care, Burlington, VT (D.D.C., N.J.H., K.B.N., D.L.L.); Department of Cardiology, Hartford Hospital, Hartford, CT (E.M.C.); and Cardiovascular Research Institute, Burlington, VT (D.L.L.)
| | - Karolyn B. Nicholas
- From the Department of Medicine (D.D.C., D.L.L.) and Department of Pathology and Laboratory Medicine (N.J.H., K.B.N.), University of Vermont, College of Medicine, Burlington, VT; Fletcher Allen Health Care, Burlington, VT (D.D.C., N.J.H., K.B.N., D.L.L.); Department of Cardiology, Hartford Hospital, Hartford, CT (E.M.C.); and Cardiovascular Research Institute, Burlington, VT (D.L.L.)
| | - Daniel L. Lustgarten
- From the Department of Medicine (D.D.C., D.L.L.) and Department of Pathology and Laboratory Medicine (N.J.H., K.B.N.), University of Vermont, College of Medicine, Burlington, VT; Fletcher Allen Health Care, Burlington, VT (D.D.C., N.J.H., K.B.N., D.L.L.); Department of Cardiology, Hartford Hospital, Hartford, CT (E.M.C.); and Cardiovascular Research Institute, Burlington, VT (D.L.L.)
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McLEOD CHRISTOPHERJ, AMMASH NASERM, ASIRVATHAM SAMUELJ. Intercommissural Lead Placement into a Right Ventricular Coronary Sinus-Utility of Intracardiac Echo Guidance. Pacing Clin Electrophysiol 2011; 34:e30-2. [DOI: 10.1111/j.1540-8159.2010.02748.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rehwinkel AE, Müller JG, Vanburen PC, Lustgarten DL. Ventricular resynchronization by implementation of direct his bundle pacing in a patient with congenital complete AV block and newly diagnosed cardiomyopathy. J Cardiovasc Electrophysiol 2010; 22:818-21. [PMID: 21134028 DOI: 10.1111/j.1540-8167.2010.01969.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Congenital complete atrioventricular block (CCAVB) is usually due to failure of AV nodal conduction with preservation of the His Purkinje system, typically present at birth. While most patients with CCAVB ultimately require pacemaker therapy to restore physiologic heart rates, recent studies have suggested that chronic right ventricular (RV) pacing in patients with CCAVB can have detrimental effects on cardiac structure and function, and may account for a 7-10% incidence of congestive heart failure in these patients. Since the His Purkinje system is preserved in CCAVB, this patient population could be uniquely well served by direct His bundle pacing (DHBP) which would be expected to restore physiologic activation of both ventricles. We present a case of a young woman who presented with RV pacing-induced cardiomyopathy who responded dramatically to DHBP.
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Affiliation(s)
- Alia E Rehwinkel
- Department of Medicine, University of Vermont School of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA
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Kapa S, Bruce CJ, Friedman PA, Asirvatham SJ. Advances in Cardiac Pacing: Beyond the Transvenous Right Ventricular Apical Lead. Cardiovasc Ther 2010; 28:369-79. [PMID: 20553288 DOI: 10.1111/j.1755-5922.2010.00157.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Suraj Kapa
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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LACHMAN NIRUSHA, SYED FAISALF, HABIB AMMAR, KAPA SURAJ, BISCO SUSANE, VENKATACHALAM KL, ASIRVATHAM SAMUELJ. Correlative Anatomy for the Electrophysiologist, Part I: The Pericardial Space, Oblique Sinus, Transverse Sinus. J Cardiovasc Electrophysiol 2010; 21:1421-6. [DOI: 10.1111/j.1540-8167.2010.01872.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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To the Editor:. J Cardiovasc Electrophysiol 2010. [DOI: 10.1111/j.1540-8167.2010.01725.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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To the Editor:. J Cardiovasc Electrophysiol 2010; 21:E76; author reply E77. [DOI: 10.1111/j.1540-8167.2010.01724.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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