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Francisco-Pascual J, Adeliño R, Quesada A, Sainz Godoy I, Exposito V, Ferrando J, Fernadez Armenta J, Cabanas P, Pérez-Rodon J, Santos-Ortega A, Villuendas R, Trucco E, Benito B, Jordan-Marchite P, Rodríguez-Palomares JF, Ferreira-González I, Rivas-Gándara N. Cardiac Resynchronization Therapy with Triple Fusion Using the SyncAV Dynamic Algorithm Compared to Conventionally Optimized Biventricular Pacing: Results from the Multicentric, Randomized, Doble-blinded CRUSTY Trial. Heart Rhythm 2024:S1547-5271(24)02696-1. [PMID: 38880204 DOI: 10.1016/j.hrthm.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 06/01/2024] [Accepted: 06/08/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Jaume Francisco-Pascual
- Arrhythmia Unit. Cardiology Department. Hospital Universitari Vall d'Hebron. Vall d'Hebron Institut de Recerca (VHIR). Vall d'Hebron Barcelona Hospital Campus. Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina. Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBER-CV). Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain.
| | - Raquel Adeliño
- Arrhythmia Unit. Cardiology Department. Hospital Universitari Vall d'Hebron. Vall d'Hebron Institut de Recerca (VHIR). Vall d'Hebron Barcelona Hospital Campus. Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina. Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBER-CV). Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain; Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Germans Tries i Pujol. Carretera de Canyet, s/n, 08916 Badalona, Barcelona, España
| | - Aurelio Quesada
- Hospital General Universitario de Valencia. Av. de les Tres Creus, 2, 46014 València, Valencia, España
| | - Iñigo Sainz Godoy
- Hospital de Cruces. Cruces Plaza, s/n, 48903 Barakaldo, Bizkaia, España
| | - Victor Exposito
- Unidad de Arritmias, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Jose Ferrando
- Hospital Universitario Dr. Peset. Av. de Gaspar Aguilar, 90, 46017 València, Valencia, España
| | | | - Pilar Cabanas
- Unidad de Arritmias. Servicio de Cardiologia. Hospital Álvaro Cunqueiro. Estrada de Clara Campoamor, 341, 36312 Vigo, Pontevedra, España
| | - Jordi Pérez-Rodon
- Arrhythmia Unit. Cardiology Department. Hospital Universitari Vall d'Hebron. Vall d'Hebron Institut de Recerca (VHIR). Vall d'Hebron Barcelona Hospital Campus. Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina. Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBER-CV). Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Alba Santos-Ortega
- Arrhythmia Unit. Cardiology Department. Hospital Universitari Vall d'Hebron. Vall d'Hebron Institut de Recerca (VHIR). Vall d'Hebron Barcelona Hospital Campus. Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina. Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBER-CV). Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Roger Villuendas
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Germans Tries i Pujol. Carretera de Canyet, s/n, 08916 Badalona, Barcelona, España
| | - Emilce Trucco
- Hospital Universitario Puerta del Mar. Av. Ana de Viya, 21, 11009 Cádiz, España
| | - Begoña Benito
- Arrhythmia Unit. Cardiology Department. Hospital Universitari Vall d'Hebron. Vall d'Hebron Institut de Recerca (VHIR). Vall d'Hebron Barcelona Hospital Campus. Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina. Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBER-CV). Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Pablo Jordan-Marchite
- Arrhythmia Unit. Cardiology Department. Hospital Universitari Vall d'Hebron. Vall d'Hebron Institut de Recerca (VHIR). Vall d'Hebron Barcelona Hospital Campus. Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jose Fernando Rodríguez-Palomares
- Cardiology Department. Hospital Universitari Vall d'Hebron. Vall d'Hebron Institut de Recerca (VHIR). Vall d'Hebron Barcelona Hospital Campus. Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina. Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBER-CV). Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Ignacio Ferreira-González
- Cardiology Department. Hospital Universitari Vall d'Hebron. Vall d'Hebron Institut de Recerca (VHIR). Vall d'Hebron Barcelona Hospital Campus. Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina. Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; CIBER de Epidemiología y Salud Pública (CIBER-ESP). Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Nuria Rivas-Gándara
- Arrhythmia Unit. Cardiology Department. Hospital Universitari Vall d'Hebron. Vall d'Hebron Institut de Recerca (VHIR). Vall d'Hebron Barcelona Hospital Campus. Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina. Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBER-CV). Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, 28029 Madrid, Spain
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Gerra L, Bonini N, Mei DA, Imberti JF, Vitolo M, Bucci T, Boriani G, Lip GYH. Cardiac resynchronization therapy (CRT) nonresponders in the contemporary era: A state-of-the-art review. Heart Rhythm 2024:S1547-5271(24)02670-5. [PMID: 38848860 DOI: 10.1016/j.hrthm.2024.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024]
Abstract
In the 2000s, cardiac resynchronization therapy (CRT) became a revolutionary treatment of heart failure with reduced left ventricular ejection fraction (HFrEF) and wide QRS. However, about one-third of CRT recipients do not show a favorable response. This review of the current literature aims to better define the concept of CRT response/nonresponse. The diagnosis of CRT nonresponder should be viewed as a continuum, and it cannot rely solely on a single parameter. Moreover, baseline features of some patients might predict an unfavorable response. A strong collaboration between heart failure specialists and electrophysiologists is key to overcoming this challenge with multiple strategies. In the contemporary era, new pacing modalities, such as His-bundle pacing and left bundle branch area pacing, represent a promising alternative to CRT. Observational studies have demonstrated their potential; however, several limitations should be addressed. Large randomized controlled trials are needed to prove their efficacy in HFrEF with electromechanical dyssynchrony.
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Affiliation(s)
- Luigi Gerra
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bonini
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Davide Antonio Mei
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Jacopo Francesco Imberti
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Bucci
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of General and Specialized Surgery, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Boriani
- Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Spitaler P, Pfeifer BE, Mayr A, Bachler R, Bilgeri V, Adukauskaite A, Bauer A, Stühlinger M, Barbieri F, Dichtl W. Visualization of the SyncAV ® Algorithm for CRT Optimization by Non-invasive Imaging of Cardiac Electrophysiology: NICE-CRT Trial. J Clin Med 2023; 12:4510. [PMID: 37445543 DOI: 10.3390/jcm12134510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Periodic repetitive AV interval optimization using a device-based algorithm in cardiac resynchronization therapy (CRT) devices may improve clinical outcomes. There is an unmet need to successfully transform its application into clinical routine. (2) Methods: Non-invasive imaging of cardiac electrophysiology was performed in different device programming settings of the SyncAV® algorithm in 14 heart failure patients with left bundle branch block and a PR interval ≤ 250 milliseconds to determine the shortest ventricular activation time. (3) Results: the best offset time (to be manually programmed) permitting automatic dynamic adjustment of the paced atrioventricular interval after every 256 heart beats was found to be 30 and 50 milliseconds, decreasing mean native QRS duration from 181.6 ± 23.9 milliseconds to 130.7 ± 10.0 and 130.1 ± 10.5 milliseconds, respectively (p = 0.01); this was followed by an offset of 40 milliseconds (decreasing QRS duration to 130.1 ± 12.2 milliseconds; p = 0.08). (4) Conclusions: The herein presented NICE-CRT study supports the current recommendation to program an offset of 50 milliseconds as default in patients with left bundle branch block and preserved atrioventricular conduction after implantation of a CRT device capable of SyncAV® optimization. Alternatively, offset programming of 30 milliseconds may also be applied as default programming. In patients with no or poor CRT response, additional efforts should be spent to individualize best offset programming with electrocardiographic optimization techniques.
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Affiliation(s)
- Philipp Spitaler
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Bernhard Erich Pfeifer
- Institute of Clinical Epidemiology, Tirol Kliniken, 6020 Innsbruck, Austria
- Institute of Medical Informatics, UMIT TIROL, Eduart Wallnöfer Zentrum, 6600 Hall in Tirol, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria
| | | | - Valentin Bilgeri
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Agne Adukauskaite
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Markus Stühlinger
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Fabian Barbieri
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Wolfgang Dichtl
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Sami A, Mustafa B, Butt HA, Ashraf Z, Ullah A, Babar F, Asad M, Awais M, Zaidi SMJ, Fakhar T, Mehmoodi A, Adnan N, Malik J. Echocardiography- versus intracardiac electrocardiogram-based optimization of cardiac resynchronization therapy: A systematic review. Ann Noninvasive Electrocardiol 2023; 28:e13040. [PMID: 36606676 PMCID: PMC10023891 DOI: 10.1111/anec.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE This systematic review aimed to evaluate the performance of echocardiography-based programming in comparison with the intracardiac electrocardiogram (IEGM)-based method for the optimization of cardiac resynchronization therapy (CRT). METHODS A literature review was conducted using digital databases to systematically identify the studies reporting CRT optimization through echocardiography compared with IEGM. Detailed patient-level study characteristics including the type of study, sample size, therapy, the New York Heart Classification (NYHA) status, lead placement, and other parameters were abstracted. Finally, postprogramming outcomes were extracted for each article. RESULTS In a total of 11 studies, 919 patients were recruited for the final analysis. Overall, 692 (75.29%) were males. The mean duration of the QRS complex in our study population ranged from 145.2 ± 21.8 ms to 183 ± 19.9 ms. There was an equal improvement in the NYHA class between the two methods while the left ventricular ejection fraction (LVEF) demonstrated an improvement by IEGM. Many studies supported IEGM to increase the 6-minute walk test and left ventricular outflow tract velocity time interval (LVOT VTI) when compared to echocardiography. The mean time for echocardiography-based optimization was 60.15 min while that of IEGM-based optimization was 6.65 min. CONCLUSION IEGM is an alternative method for CRT optimization in improving the NYHA class, LVEF, and LVOT VTI, and is less time-consuming when compared to the echocardiography-based methods.
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Affiliation(s)
- Abdul Sami
- Department of CardiologyDHQ Teaching HospitalKohatPakistan
| | - Bilal Mustafa
- Department of CardiologyAkbar Niazi Teaching HospitalIslamabadPakistan
| | | | - Zainab Ashraf
- Department of MedicineCMH Lahore Medical CollegeLahorePakistan
| | - Asif Ullah
- Department of CardiologyKhyber Medical University Institute of Medical SciencesKohatPakistan
| | | | - Muhammad Asad
- Department of CardiologyBenazir Bhutto HospitalRawalpindiPakistan
| | - Muhammad Awais
- Department of ElectrophysiologyArmed Forces Institute of CardiologyRawalpindiPakistan
| | | | - Tehniat Fakhar
- Department of MedicineShifa Tameer e Millat UniversityIslamabadPakistan
| | - Amin Mehmoodi
- Department of MedicineIbn e Seena HospitalKabulAfghanistan
| | - Nawal Adnan
- Department of MedicineJinnah Sindh Medical UniversityKarachiPakistan
| | - Jahanzeb Malik
- Department of ElectrophysiologyArmed Forces Institute of CardiologyRawalpindiPakistan
- Cardiovascular Analytics GroupHong KongChina
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Impact of long-term optimizing atrioventricular delay using device-based algorithms on cardiac resynchronization therapy. Heart Vessels 2023; 38:216-227. [PMID: 36173447 PMCID: PMC9816250 DOI: 10.1007/s00380-022-02162-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/18/2022] [Indexed: 01/10/2023]
Abstract
Sub-optimal atrioventricular delay (AVD) is one of the main causes of non-responder for cardiac resynchronization therapy (CRT). Recently, device-based algorithms (DBAs) that provide optimal AVD based on intracardiac electrograms, have been developed. However, their long-term effectiveness is still unknown. This study aims to investigate the effect of optimizing AVD using DBAs over a long period, on the prognosis of patients undergoing CRT. A total of 118 patients who underwent CRT at our hospital between April 2008 and March 2018, were retrospectively reviewed; 61 of them with optimizing AVD using DBAs were classified into the treated group (group 1), and the remaining 57 were classified into the control group (group 2). The median follow-up period was 46.0 months. The responder and survival rate in group 1 were significantly better than those in group 2 (group 1 vs. group 2: responder rate = 64% vs. 46%, p = 0.046; survival rate: 85.2% vs. 64.9%, p = 0.02). Moreover, investigating only the non-responder population showed that group 1 had an improved survival rate compared to group 2 (group 1 vs. group 2 = 72.7% vs. 45.1%, p = 0.02). Optimizing AVD using DBAs was a significant contributor to the improved survival rate in CRT non-responders in multivariate analysis (HR 3.6, p = 0.01). In conclusion, the long-term optimizing AVD using DBAs improved the survival rate in CRT and the prognosis of CRT non-responders, as well.
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Ikeda Y, Kato R. Clinical implication of device-based algorithm that optimize atrioventricular delay during cardiac resynchronization therapy: author’s reply. Heart Vessels 2022; 38:998-999. [DOI: 10.1007/s00380-022-02205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 11/28/2022]
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Hua J, Kong Q, Chen Q. Alternative pacing strategies for optimal cardiac resynchronization therapy. Front Cardiovasc Med 2022; 9:923394. [PMID: 36237907 PMCID: PMC9551024 DOI: 10.3389/fcvm.2022.923394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/06/2022] [Indexed: 12/02/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) via biventricular pacing (BVP) improves morbidity, mortality, and quality of life, especially in subsets of patients with impaired cardiac function and wide QRS. However, the rate of unsuccessful or complicated left ventricular (LV) lead placement through coronary sinus is 5–7%, and the rate of “CRT non-response” is approximately 30%. These reasons have pushed physicians and engineers to collaborate to overcome the challenges of LV lead implantation. Thus, various alternatives to BVP have been proposed to improve CRT effectiveness. His bundle pacing (HBP) has been increasingly used by activating the His–Purkinje system but is constrained by challenging implantation, low success rates, high and often unstable thresholds, and low perception. Therefore, the concept of pacing a specialized conduction system distal to the His bundle to bypass the block region was proposed. Multiple clinical studies have demonstrated that left bundle branch area pacing (LBBAP) has comparable electrical resynchronization with HBP but is superior in terms of simpler operation, higher success rates, lower and stable capture thresholds, and higher perception. Despite their well-demonstrated effectiveness, the transvenous lead-related complications remain major limitations. Recently, leadless LV pacing has been developed and demonstrated effective for these challenging patient cohorts. This article focuses on the current state and latest progress in HBP, LBBAP, and leadless LV pacing as alternatives for failed or non-responsive conventional CRT as well as their limits and prospects.
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8
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Sedláček K, Polášek R, Jansová H, Grieco D, Kučera P, Kautzner J, Francis DP, Wichterle D. Inadvertent QRS prolongation by an optimization device-based algorithm in patients with cardiac resynchronization therapy. PLoS One 2022; 17:e0275276. [PMID: 36155997 PMCID: PMC9512171 DOI: 10.1371/journal.pone.0275276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 09/13/2022] [Indexed: 11/22/2022] Open
Abstract
Background Device-based algorithms offer the potential for automated optimization of cardiac resynchronization therapy (CRT), but the process for accepting them into clinical use is currently still ad-hoc, rather than based on pre-clinical and clinical testing of specific features of validity. We investigated how the QuickOpt-guided VV delay (VVD) programming performs against the clinical and engineering heuristic of QRS complex shortening by CRT. Methods A prospective, 2-center study enrolled 37 consecutive patients with CRT. QRS complex duration (QRSd) was assessed during intrinsic atrioventricular conduction, synchronous biventricular pacing, and biventricular pacing with QuickOpt-proposed VVD. The measurements were done manually by electronic calipers in signal-averaged and magnified 12-lead QRS complexes. Results Native QRSd was 174 ± 22 ms. Biventricular pacing with empiric AVD and synchronous VVD resulted in QRSd 156 ± 20 ms, a significant narrowing from the baseline QRSd by 17 ± 27 ms, P = 0.0003. In 36 of 37 patients, the QuickOpt algorithm recommended left ventricular preexcitation with VVD of 42 ± 18 ms (median 40 ms; interquartile range 30–55 ms, P <0.00001). QRSd in biventricular pacing with QuickOpt-based VVD was significantly longer compared with synchronous biventricular pacing (168 ± 25 ms vs. 156 ± 20 ms; difference 12 ± 11ms; P <0.00001). This prolongation correlated with the absolute VVD value (R = 0.66, P <0.00001). Conclusions QuickOpt algorithm systematically favours a left-preexcitation VVD which translates into a significant prolongation of the QRSd compared to synchronous biventricular pacing. There is no reason to believe that a manipulation that systematically widens QRSd should be considered to optimize physiology. Device-based CRT optimization algorithms should undergo systematic mechanistic pre-clinical evaluation in various scenarios before they are tested in large clinical studies.
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Affiliation(s)
- Kamil Sedláček
- 1 Department of Internal Medicine–Cardiology and Angiology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic
- * E-mail:
| | - Rostislav Polášek
- Cardiology Department, Liberec Regional Hospital, Liberec, Czech Republic
| | - Helena Jansová
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Domenico Grieco
- Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Rome, Italy
| | - Pavel Kučera
- Cardiology Department, Liberec Regional Hospital, Liberec, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Darrel P. Francis
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- 2 Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Effect Evaluation of Cardiac Resynchronization Therapy in Elderly Patients with Heart Failure by Ultrasound Image under QuickOpt Algorithm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8680446. [PMID: 35712000 PMCID: PMC9197669 DOI: 10.1155/2022/8680446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 12/29/2022]
Abstract
This research was aimed at analyzing the application value of echocardiography and QuickOpt algorithm in optimizing parameters of cardiac resynchronization therapy (CRT) in elderly patients with heart failure. 50 elderly patients who were diagnosed with chronic heart failure and underwent CRT were chosen as the research objects. According to the different optimization methods, the patients were divided into the echocardiography group and QuickOpt algorithm group, 25 cases in each group. The general data, optimized intervals, corresponding maximum aortic velocity time integrals (aVTIs), cardiac ultrasound indicators, and ventricular arrhythmia episodes of the patients in the two groups were analyzed. The results showed that there was no significant difference in the optimized sensed atrioventricular (SAV), paced atrioventricular (PAV), and ventricle to ventricle (VV) intervals and the corresponding aVTIs obtained by echocardiography and QuickOpt (P > 0.05). The consistency analysis revealed that the aVTIs in the SAV, PAV, and VV intervals presented a good consistency (P < 0.01), which were obtained by the echocardiography and QuickOpt functional optimization; the concordance correlation coefficient (CCC) in them was 96.16%, 98.03%, and 95.48%, respectively. The left ventricular ejection fraction (LVEF) showed an increasing trend over time in both groups, while the left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), and morphological right ventricle (MRV) showed the downward trends over time, and the differences between two groups were not significant (P > 0.05). For the premature ventricular contraction (PVC) of ventricular arrhythmia episodes, there was no significant difference between the two groups in log (PVCs) and log (PVC runs) (P > 0.05). It was also found that both echocardiography and QuickOpt algorithm could improve the cardiac function of patients with heart failure significantly and reduce ventricular arrhythmia episodes and ventricular remodeling via optimized CRT; there was no difference in the improvement effect of the two optimization methods. However, echocardiography was inferior to QuickOpt algorithm in terms of time-consuming optimization in the intervals. This provided a reference for the clinical diagnosis and treatment of elderly patients with heart failure.
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Wang Z, Li P, Zhang B, Huang J, Chen S, Cai Z, Qin Y, Fan J, Tang W, Qin Y, Li R, Zhao X. Improvement of LV Reverse Remodeling Using Dynamic Programming of Fusion-Optimized Atrioventricular Intervals in Cardiac Resynchronization Therapy. Front Cardiovasc Med 2021; 8:700424. [PMID: 34490369 PMCID: PMC8417774 DOI: 10.3389/fcvm.2021.700424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/20/2021] [Indexed: 12/04/2022] Open
Abstract
Background: The patient-tailored SyncAV algorithm shortens the QRS duration (QRSd) beyond what conventional biventricular (BiV) pacing can. However, evidence of the ability of SyncAV to improve the cardiac resynchronization therapy (CRT) response is lacking. The aim of this study was to evaluate the impact of CRT enhanced by SyncAV on echocardiographic and clinical responses. Methods and Results: Consecutive heart failure (HF) patients from three centers treated with a quadripolar CRT system (Abbott) were enrolled. The total of 122 patients were divided into BiV+SyncAV (n = 68) and BiV groups (n = 54) according to whether they underwent CRT with or without SyncAV. Electrocardiographic, echocardiographic, and clinical data were assessed at baseline and during follow-up. Echocardiographic response to CRT was defined as a ≥15% decrease in left ventricular end-systolic volume (LVESV), and clinical response was defined as a NYHA class reduction of ≥1. At the 6-month follow-up, the baseline QRSd and LVESV decreased more significantly in the BiV+SyncAV than in the BiV group (QRSd −36.25 ± 16.33 vs. −22.72 ± 18.75 ms, P < 0.001; LVESV −54.19 ± 38.87 vs. −25.37 ± 36.48 ml, P < 0.001). Compared to the BiV group, more patients in the BiV+SyncAV group were classified as echocardiographic (82.35 vs. 64.81%; P = 0.036) and clinical responders (83.82 vs. 66.67%; P = 0.033). During follow-up, no deaths due to HF deterioration or severe procedure related complications occurred. Conclusion: Compared to BiV pacing, BiV combined with SyncAV leads to a more significant reduction in QRSd and improves LV remodeling and long-term outcomes in HF patients treated with CRT.
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Affiliation(s)
- Zhongkai Wang
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Pan Li
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bili Zhang
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jingjuan Huang
- Department of Cardiology, Shanghai Chest hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shaoping Chen
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhuhong Cai
- Department of Ultrasound, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yingyi Qin
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Jihai Fan
- Department of Cardiology, 455th Hospital of Nanjing Military Command, Shanghai, China
| | - Wendong Tang
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yongwen Qin
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xianxian Zhao
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
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11
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Waddingham PH, Lambiase P, Muthumala A, Rowland E, Chow AW. Fusion Pacing with Biventricular, Left Ventricular-only and Multipoint Pacing in Cardiac Resynchronisation Therapy: Latest Evidence and Strategies for Use. Arrhythm Electrophysiol Rev 2021; 10:91-100. [PMID: 34401181 PMCID: PMC8335856 DOI: 10.15420/aer.2020.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 12/11/2022] Open
Abstract
Despite advances in the field of cardiac resynchronisation therapy (CRT), response rates and durability of therapy remain relatively static. Optimising device timing intervals may be the most common modifiable factor influencing CRT efficacy after implantation. This review addresses the concept of fusion pacing as a method for improving patient outcomes with CRT. Fusion pacing describes the delivery of CRT pacing with a programming strategy to preserve intrinsic atrioventricular (AV) conduction and ventricular activation via the right bundle branch. Several methods have been assessed to achieve fusion pacing. QRS complex duration (QRSd) shortening with CRT is associated with improved clinical response. Dynamic algorithm-based optimisation targeting narrowest QRSd in patients with intact AV conduction has shown promise in people with heart failure with left bundle branch block. Individualised dynamic programming achieving fusion may achieve the greatest magnitude of electrical synchrony, measured by QRSd narrowing.
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Affiliation(s)
- Peter H Waddingham
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Pier Lambiase
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,UCL Institute of Cardiovascular Science University College London, London, UK
| | - Amal Muthumala
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Edward Rowland
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anthony Wc Chow
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
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12
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AlTurki A, Lima PY, Vidal A, Toscani B, Diaz S, Garcia D, Montemezzo M, Al-Dossari A, Bernier ML, Hadjis T, Joza J, Essebag V. Fusion pacing in patients with right bundle branch block who undergo cardiac resynchronization therapy. J Electrocardiol 2020; 64:66-71. [PMID: 33348136 DOI: 10.1016/j.jelectrocard.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Patients with right bundle branch block (RBBB) are less likely to respond to cardiac resynchronization therapy (CRT). We aimed to assess whether patients with RBBB respond to CRT with biventricular fusion pacing. METHODS Consecutive patients with RBBB at a single tertiary care center, who were implanted with a CRT device capable of biventricular fusion pacing using SyncAV programming, were assessed and compared to a historical cohort of CRT patients with RBBB. QRSd was measured and compared during intrinsic conduction, nominal CRT pacing and manual electrocardiogram-based optimized SyncAV programming. Left ventricular ejection fraction (LVEF) was also compared before and 6 months after CRT. RESULTS We included 8 consecutive patients with RBBB (group 1) who were able to undergo SyncAV programming and 16 patients with RBBB (group 2) from a historical cohort. In group 1, compared to mean intrinsic conduction QRSd (155 ± 13 ms), mean nominally-paced QRSd was 156 ± 15 ms (ΔQRSd 1.3 ± 11.6; p = 0.77) and SyncAV-optimized paced QRSd was 135 ± 14 ms (ΔQRSd -20.0 ± 20.4; p = 0.03 and ΔQRSd -21.3 ± 16.3; p = 0.008; compared to intrinsic conduction and nominal pacing respectively). In group 2, mean QRSd with nominal pacing was 160 ± 24 ms (ΔQRSd 3.8 ± 33.4; p = 0.66 compared to intrinsic conduction). In group 1, baseline LVEF was 22.1 ± 11.5 and after 6 months of follow-up was 27.8 ± 8.6 (p = 0.047). In group 2, the baseline LVEF was 27.2 ± 10.6 and after 6 months of follow-up was 25.0 ± 10.0 (p = 0.45). CONCLUSIONS CRT programed to allow biventricular fusion pacing significantly improved electrical synchrony and LVEF in patients with RBBB. Larger studies are required to confirm these findings.
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Affiliation(s)
- Ahmed AlTurki
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Pedro Y Lima
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Alejandro Vidal
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Bruno Toscani
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Sergio Diaz
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Daniel Garcia
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | | | - Alaa Al-Dossari
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Martin L Bernier
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Tomy Hadjis
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, Montreal, Canada.
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13
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Wang Z, Wu Y, Zhang J. Cardiac resynchronization therapy in heart failure patients: tough road but clear future. Heart Fail Rev 2020; 26:735-745. [PMID: 33098491 DOI: 10.1007/s10741-020-10040-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 01/14/2023]
Abstract
Cardiac resynchronization therapy (CRT) based on biventricular pacing (BVP) is an invaluable intervention currently used in heart failure (HF) patients. The therapy involves electromechanical dyssynchrony, which can not only improve heart function and quality of life but also reduce hospitalization and mortality rates. However, approximately 30% to 40% of patients remain unresponsive to conventional BVP in clinical practice. In the recent years, extensive research has been employed to find a more physiological approach to cardiac resynchronization. The His-Purkinje system pacing (HPSP) including His bundle pacing (HBP) and left bundle branch area pacing (LBBaP) may potentially be the future of CRT. These technologies present various advantages including offering an almost real physiological pacing, less complicated procedures, and economic feasibility. Additionally, other methods, such as isolated left-ventricular pacing and multipoint pacing, may in the future be important but non-mainstream alternatives to CRT because currently, there is no strong evidence to support their effectiveness. This article reviews the current situation and latest progress in CRT, explores the existing technology, and highlights future prospects in the development of CRT.
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Affiliation(s)
- Ziyu Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Junmeng Zhang
- Department of Cardiology, Heart Center, the First Hospital of Tsinghua University, No. 6 Jiuxianqiao 1st Street, Chaoyang District, Beijing, 100016, China.
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14
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Kella DK, Kantipudi C, Stambler BS. LV only pacing-mediated electrical storm with cardiac resynchronization therapy managed by simultaneous biventricular pacing. J Cardiovasc Electrophysiol 2020; 31:2539-2543. [PMID: 32720729 DOI: 10.1111/jce.14697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/12/2020] [Accepted: 07/18/2020] [Indexed: 11/29/2022]
Abstract
Ventricular arrhythmia (VA) is a rare complication of cardiac resynchronization therapy (CRT). Little is known about ventricular proarrhythmia related to the pacing vector of CRT. This case report describes the elimination of ventricular arrythmia using biventricular pacing in a patient with VT-storm related to LV only pacing as part of the AdaptivCRT algorithm (Medtronic Inc). Simultaneous biventricular pacing was effective in eliminating polymorphic ventricular tachycardia. Changing the pacing vector is a noninvasive treatment strategy that should be considered to manage VA due to CRT.
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Affiliation(s)
- Danesh K Kella
- Clinical Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Charan Kantipudi
- Clinical Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Bruce S Stambler
- Clinical Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
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