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Văcărescu C, Cozma D, Crișan S, Gaiță D, Anutoni DD, Margan MM, Faur-Grigori AA, Roteliuc R, Luca SA, Lazăr MA, Pătru O, Cirin L, Baneu P, Luca CT. Left Atrium Reverse Remodeling in Fusion CRT Pacing: Implications in Cardiac Resynchronization Response and Atrial Fibrillation Incidence. J Clin Med 2024; 13:4814. [PMID: 39200955 PMCID: PMC11355325 DOI: 10.3390/jcm13164814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
Background: When compared to biventricular pacing, fusion CRT pacing was linked to a decreased incidence of atrial fibrillation (AF). There is a gap in the knowledge regarding exclusive fusion CRT without interference with RV pacing, and all the current data are based on populations of patients with intermittent fusion pacing. Purpose: To assess left atrium remodeling and AF incidence in a real-life population of permanent fusion CRT-P. Methods: Retrospective data were analyzed from a cohort of patients with exclusive fusion CRT-P. Device interrogation, exercise testing, transthoracic echocardiography (TE), and customized medication optimization were all part of the six-monthly individual follow-up. Results: Study population: 73 patients (38 males) with non-ischemic dilated cardiomyopathy aged 63.7 ± 9.3 y.o. Baseline characteristic: QRS 159.8 ± 18.2 ms; EF 27.9 ± 5.1%; mitral regurgitation was severe in 38% of patients, moderate in 47% of patients, and mild in 15% of patients; 43% had type III diastolic dysfunction (DD), 49% had type II DD, 8% had type I DD. Average follow-up was 6.4 years ± 27 months: 93% of patients were responders (including 31% super-responders); EF increased to 40.4 ± 8.5%; mitral regurgitation decreased in 69% of patients; diastolic profile improved in 64% of patients. Paroxysmal and persistent AF incidence was 11%, with only 2% of patients developing permanent AF. Regarding LA volume, statistically significant LA reverse remodeling was observed. Conclusions: Exclusive fusion CRT-P was associated with important LA reverse remodeling and a low incidence of AF.
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Affiliation(s)
- Cristina Văcărescu
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (S.C.); (D.G.); (S.-A.L.); (M.-A.L.); (P.B.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (D.-D.A.); (A.-A.F.-G.); (R.R.)
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Dragoș Cozma
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (S.C.); (D.G.); (S.-A.L.); (M.-A.L.); (P.B.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (D.-D.A.); (A.-A.F.-G.); (R.R.)
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Simina Crișan
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (S.C.); (D.G.); (S.-A.L.); (M.-A.L.); (P.B.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (D.-D.A.); (A.-A.F.-G.); (R.R.)
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Dan Gaiță
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (S.C.); (D.G.); (S.-A.L.); (M.-A.L.); (P.B.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (D.-D.A.); (A.-A.F.-G.); (R.R.)
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Debora-Delia Anutoni
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (D.-D.A.); (A.-A.F.-G.); (R.R.)
| | - Mădălin-Marius Margan
- Department of Functional Sciences, Discipline of Public Health, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | | | - Romina Roteliuc
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (D.-D.A.); (A.-A.F.-G.); (R.R.)
| | - Silvia-Ana Luca
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (S.C.); (D.G.); (S.-A.L.); (M.-A.L.); (P.B.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (D.-D.A.); (A.-A.F.-G.); (R.R.)
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.P.); (L.C.)
| | - Mihai-Andrei Lazăr
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (S.C.); (D.G.); (S.-A.L.); (M.-A.L.); (P.B.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (D.-D.A.); (A.-A.F.-G.); (R.R.)
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Oana Pătru
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.P.); (L.C.)
| | - Liviu Cirin
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.P.); (L.C.)
| | - Petru Baneu
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (S.C.); (D.G.); (S.-A.L.); (M.-A.L.); (P.B.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (D.-D.A.); (A.-A.F.-G.); (R.R.)
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.P.); (L.C.)
| | - Constantin-Tudor Luca
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (S.C.); (D.G.); (S.-A.L.); (M.-A.L.); (P.B.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (D.-D.A.); (A.-A.F.-G.); (R.R.)
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
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2
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Gold MR, Zhou J, Higuera L, Lanctin DP, Chung ES. Association Between the Use of an Adaptive Cardiac Resynchronization Therapy Algorithm and Health Care Use and Cost. J Card Fail 2024:S1071-9164(24)00225-2. [PMID: 38977056 DOI: 10.1016/j.cardfail.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/20/2024] [Accepted: 06/04/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To assess the association between the use of adaptive pacing on clinical and economic outcomes of cardiac resynchronization therapy (CRT) recipients in a real-world analysis. BACKGROUND The adaptivCRT (aCRT) algorithm was shown in prior subgroup analyses of prospective trials to achieve clinical benefits, but a large prospective trial showed nonsignificant changes in the endpoint of mortality or hospitalizations due to heart failure. METHODS CRT-implanted patients from the Optum Clinformatics database with ≥ 90 days of follow-up were included. Remote monitoring data were used to classify patients based on CRT setting-adaptive biventricular and left ventricular pacing (aCRT) vs standard biventricular pacing (Standard CRT). Inverse probability of treatment weighting was used to adjust for baseline differences between groups. Mortality, 30-day readmissions, health care use, and payer and patients' costs were evaluated post-implantation. RESULTS This study included 2412 aCRT and 1638 Standard CRT patients (mean follow-up: 2.4 ± 1.4 years), with balanced baseline characteristics after adjustment. The aCRT group was associated with lower all-cause mortality rates (adjusted hazard ratio = 0.88 [95% confidence interval (CI):0.80, 0.96]), fewer all-cause 30-day readmissions (adjusted incidence rate ratio = 0.87 [CI:0.81, 0.94]), and fewer all-cause and HF-related inpatient, outpatient and emergency department visits. The aCRT cohort was also associated with lower all-cause outpatient payer-paid amounts and lower all-cause and HF-related inpatient and emergency department patient-paid amounts. CONCLUSIONS In this retrospective analysis of a large real-world cohort, the use of an adaptive CRT algorithm was associated with lower mortality rates, reduced health care resource use and lower payer and patient costs.
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3
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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 for 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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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 286] [Impact Index Per Article: 286.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
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5
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 PMCID: PMC11104284 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 95] [Impact Index Per Article: 95.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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6
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Liu X, Liu K, Cha YM. Right ventricular lead position can be critical in determining clinical response to cardiac resynchronization therapy-A case of successful cardiac resynchronization response conferred by relocating the right ventricular pacing lead. HeartRhythm Case Rep 2023; 9:764-767. [PMID: 38047200 PMCID: PMC10691941 DOI: 10.1016/j.hrcr.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Xiaoke Liu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Health System, La Crosse, Wisconsin
| | - Kyle Liu
- University of Michigan, Ann Arbor, Michigan
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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7
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Knijnik L, Wang B, Cardoso R, Shanafelt C, Lloyd MS. Clinical outcomes of automatic algorithms in cardiac resynchronization therapy: Systematic review and meta-analysis. Heart Rhythm O2 2023; 4:618-624. [PMID: 37936674 PMCID: PMC10626183 DOI: 10.1016/j.hroo.2023.09.001] [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] [Indexed: 11/09/2023] Open
Abstract
Background Algorithms to automatically adjust atrioventricular (AV) and interventricular (VV) intervals in cardiac resynchronization therapy (CRT) devices are common, but their clinical efficacy is unknown. Objective The purpose of this study was to evaluate automatic CRT algorithms in patients with heart failure for the reduction of mortality, heart failure hospitalizations, and clinical improvement. Methods We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) in patients with CRT using automatic algorithms that change AV and VV intervals dynamically without manual input, on a beat-to-beat basis. We performed a subgroup analysis including intracardiac electrogram-based (EGM) algorithms and contractility-based algorithms. Results Nine RCTs with 8531 participants were included, of whom 4275 (50.1%) were randomized to automatic algorithm. Seven of the 9 trials used EGM-based algorithms, and 2 used contractility sensors. There was no difference in all-cause mortality (10.3% vs 11.3%; odds ratio [OR] 0.90; 95% confidence interval [CI] 0.71-1.03; P = .13; I2 = 0%) or heart failure hospitalizations (15.0% vs 16.1%; OR 0.924; 95% CI 0.81-1.04; P = .194; I2 = 0%) between the automatic algorithm group and the control group. Study-defined clinical improvement was also not significantly different between groups (66.6% vs 63.3%; risk ratio 1.01; 95% CI 0.95-1.06; P = .82; I2 = 50%). In the contractility-based subgroup, there was a trend toward greater clinical improvement with the use of the automatic algorithm (75% vs 68.3%; OR 1.45; 95% CI 0.97-2.18; P = .07; I2 = 40%), which did not reach statistical significance. The overall risk of bias was low. Conclusion Automatic algorithms that change AV or VV intervals did not improve mortality, heart failure hospitalizations, or cardiovascular symptoms in patients with heart failure and CRT.
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Affiliation(s)
- Leonardo Knijnik
- Emory University Adult Congenital Heart Center, Atlanta, Georgia
| | - Bo Wang
- Emory University Adult Congenital Heart Center, Atlanta, Georgia
| | - Rhanderson Cardoso
- Heart and Vascular Center, Brigham and Women’s Hospital, Boston Massachusetts
| | - Colby Shanafelt
- Emory University Adult Congenital Heart Center, Atlanta, Georgia
| | - Michael S. Lloyd
- Emory University Adult Congenital Heart Center, Atlanta, Georgia
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8
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Wilkoff BL, Filippatos G, Leclercq C, Gold MR, Hersi AS, Kusano K, Mullens W, Felker GM, Kantipudi C, El-Chami MF, Essebag V, Pierre B, Philippon F, Perez-Gil F, Chung ES, Sotomonte J, Tung S, Singh B, Bozorgnia B, Goel S, Ebert HH, Varma N, Quan KJ, Salerno F, Gerritse B, van Wel J, Schaber DE, Fagan DH, Birnie D. Adaptive versus conventional cardiac resynchronisation therapy in patients with heart failure (AdaptResponse): a global, prospective, randomised controlled trial. Lancet 2023; 402:1147-1157. [PMID: 37634520 DOI: 10.1016/s0140-6736(23)00912-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Continuous automatic optimisation of cardiac resynchronisation therapy (CRT), stimulating only the left ventricle to fuse with intrinsic right bundle conduction (synchronised left ventricular stimulation), might offer better outcomes than conventional CRT in patients with heart failure, left bundle branch block, and normal atrioventricular conduction. This study aimed to compare clinical outcomes of adaptive CRT versus conventional CRT in patients with heart failure with intact atrioventricular conduction and left bundle branch block. METHODS This global, prospective, randomised controlled trial was done in 227 hospitals in 27 countries across Asia, Australia, Europe, and North America. Eligible patients were aged 18 years or older with class 2-4 heart failure, an ejection fraction of 35% or less, left bundle branch block with QRS duration of 140 ms or more (male patients) or 130 ms or more (female patients), and a baseline PR interval 200 ms or less. Patients were randomly assigned (1:1) via block permutation to adaptive CRT (an algorithm providing synchronised left ventricular stimulation) or conventional biventricular CRT using a device programmer. All patients received device programming but were masked until procedures were completed. Site staff were not masked to group assignment. The primary outcome was a composite of all-cause death or intervention for heart failure decompensation and was assessed in the intention-to-treat population. Safety events were collected and reported in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT02205359, and is closed to accrual. FINDINGS Between Aug 5, 2014, and Jan 31, 2019, of 3797 patients enrolled, 3617 (95·3%) were randomly assigned (1810 to adaptive CRT and 1807 to conventional CRT). The futility boundary was crossed at the third interim analysis on June 23, 2022, when the decision was made to stop the trial early. 1568 (43·4%) of 3617 patients were female and 2049 (56·6%) were male. Median follow-up was 59·0 months (IQR 45-72). A primary outcome event occurred in 430 of 1810 patients (Kaplan-Meier occurrence rate 23·5% [95% CI 21·3-25·5] at 60 months) in the adaptive CRT group and in 470 of 1807 patients (25·7% [23·5-27·8] at 60 months) in the conventional CRT group (hazard ratio 0·89, 95% CI 0·78-1·01; p=0·077). System-related adverse events were reported in 452 (25·0%) of 1810 patients in the adaptive CRT group and 440 (24·3%) of 1807 patients in the conventional CRT group. INTERPRETATION Compared with conventional CRT, adaptive CRT did not significantly reduce the incidence of all-cause death or intervention for heart failure decompensation in the included population of patients with heart failure, left bundle branch block, and intact AV conduction. Death and heart failure decompensation rates were low with both CRT therapies, suggesting a greater response to CRT occurred in this population than in patients in previous trials. FUNDING Medtronic.
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Affiliation(s)
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.
| | | | - Michael R Gold
- Medical University of South Carolina, Charleston, SC, USA
| | - Ahmad S Hersi
- King Saud University, Faculty of Medicine, Riyadh, Saudi Arabia
| | - Kengo Kusano
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Hasselt University, Hasselt, Belgium
| | | | | | | | - Vidal Essebag
- McGill University Health Centre, Montreal, QC, Canada; Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Bertrand Pierre
- Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, Tours, France
| | - Francois Philippon
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | | | - Eugene S Chung
- The Lindner Research Center at The Christ Hospital, Cincinnati, OH, USA
| | - Juan Sotomonte
- Cardiovascular Center of Puerto Rico and the Caribbean, San Juan, Puerto Rico
| | - Stanley Tung
- St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; Royal Columbian Hospital, New Westminster, BC, Canada
| | - Balbir Singh
- Medanta-The Medicity Hospital, Gurugram, Haryana, India
| | | | - Satish Goel
- First Coast Cardiovascular Institute, Jacksonville, FL, USA
| | | | | | - Kara J Quan
- Harrington Heart and Vascular Institute, University Hospitals of Cleveland, Cleveland, OH, USA
| | | | - Bart Gerritse
- Medtronic Bakken Research Center, Maastricht, Netherlands
| | | | | | | | - David Birnie
- University of Ottawa Heart Institute, Ottawa, ON, Canada
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Statuto G, Carecci A, Lazzeri M, Bertelli M, Ziacchi M, Biffi M. Can we correct dyssynchrony by pacing the right side? The case for right ventricular-synchronized cardiac resynchronization therapy. HeartRhythm Case Rep 2023; 9:634-638. [PMID: 37746565 PMCID: PMC10511925 DOI: 10.1016/j.hrcr.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Affiliation(s)
- Giovanni Statuto
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandro Carecci
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Mirco Lazzeri
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michele Bertelli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Matteo Ziacchi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mauro Biffi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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10
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Marcantoni L, Pastore G, Biffi M, Zanon F. The weakest point of cardiac resynchronization therapy: new technologies facing old terminology. Front Cardiovasc Med 2023; 10:1236369. [PMID: 37636299 PMCID: PMC10450245 DOI: 10.3389/fcvm.2023.1236369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Patients with symptomatic heart failure (HF) and left bundle branch block (LBBB) are currently treated with biventricular pacing (BiV) which has a Class IA recommendation. Given the possibility to re-establish the inter and intra-ventricular synchrony, BiV is commonly referred to as cardiac resynchronization therapy (CRT). This wording is widely utilized and over time the terms BiV and CRT have become interchangeable. Conduction system pacing (CSP) is emerging as a valid therapeutic opportunity to obtain CRT restoring the native conduction via the Purkinje network. Therefore the acronym CRT is no longer synonymous with BiV only but could also refer to CSP. A terminology update is needed to include the resource of CSP to ensure better communication among all the stakeholders involved in managing recipients of cardiac devices and should be a fundamental step in advancing the quality of patient care. Making use of the NBG code to describe the implantable cardiac device would ease such terminology update, since only the first three positions of the five letters NBG code are commonly utilized, while the last two are rarely used.
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Affiliation(s)
- Lina Marcantoni
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Gianni Pastore
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Mauro Biffi
- Istituto di Cardiologia, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
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11
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Waddingham PH, Mangual JO, Orini M, Badie N, Muthumala A, Sporton S, McSpadden LC, Lambiase PD, Chow AWC. Electrocardiographic imaging demonstrates electrical synchrony improvement by dynamic atrioventricular delays in patients with left bundle branch block and preserved atrioventricular conduction. Europace 2023; 25:536-545. [PMID: 36480445 PMCID: PMC9935053 DOI: 10.1093/europace/euac224] [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: 08/16/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022] Open
Abstract
AIMS Cardiac resynchronization therapy programmed to dynamically fuse pacing with intrinsic conduction using atrioventricular (AV) timing algorithms (e.g. SyncAV) has shown promise; however, mechanistic data are lacking. This study assessed the impact of SyncAV on electrical dyssynchrony across various pacing modalities using non-invasive epicardial electrocardiographic imaging (ECGi). METHODS AND RESULTS Twenty-five patients with left bundle-branch block (median QRS duration (QRSd) 162.7 ms) and intact AV conduction (PR interval 174.0 ms) were prospectively enrolled. ECGi was performed acutely during biventricular pacing with fixed nominal AV delays (BiV) and using SyncAV (optimized for the narrowest QRSd) during: BiV + SyncAV, LV-only single-site (LVSS + SyncAV), MultiPoint pacing (MPP + SyncAV), and LV-only MPP (LVMPP + SyncAV). Dyssynchrony was quantified via ECGi (LV activation time, LVAT; RV activation time, RVAT; LV electrical dispersion index, LVEDi; ventricular electrical uncoupling index, VEU; and biventricular total activation time, VVtat). Intrinsic conduction LVAT (124 ms) was significantly reduced by BiV pacing (109 ms) (P = 0.001) and further reduced by LVSS + SyncAV (103 ms), BiV + SyncAV (103 ms), LVMPP + SyncAV (95 ms), and MPP + SyncAV (90 ms). Intrinsic RVAT (93 ms), VVtat (130 ms), LVEDi (36 ms), VEU (50 ms), and QRSd (163 ms) were reduced by SyncAV across all pacing modes. More patients exhibited minimal LVAT, VVtat, LVEDi, and QRSd with MPP + SyncAV than any other modality. CONCLUSION Dynamic AV delay programming targeting fusion with intrinsic conduction significantly reduced dyssynchrony, as quantified by ECGi and QRSd for all evaluated pacing modes. MPP + SyncAV achieved the greatest synchrony overall but not for all patients, highlighting the value of pacing mode individualization during fusion optimization.
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Affiliation(s)
- Peter H Waddingham
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.,William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London EC1M 6BQ, UK
| | | | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Amal Muthumala
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | | | - Pier D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.,Institute of Cardiovascular Science, University College London, London, UK
| | - Anthony W C Chow
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.,William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London EC1M 6BQ, UK
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12
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Gold MR, Rickard J, Daubert JC, Cerkvenik J, Linde C. Association of left ventricular remodeling with cardiac resynchronization therapy outcomes. Heart Rhythm 2023; 20:173-180. [PMID: 36442825 DOI: 10.1016/j.hrthm.2022.11.016] [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: 07/02/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) response stratified by left ventricular (LV) remodeling revealed differing mortality profiles for distinct patient cohorts. Measuring functional end points, as well as mortality, may better assess CRT efficacy and inform patient management. However, the association between LV remodeling and functional outcomes after CRT is not well understood. OBJECTIVE The purpose of this study was to evaluate long-term CRT outcomes by extent of LV remodeling. METHODS REsynchronization reVErses Remodeling in Systolic Left vEntricular dysfunction (ClinicalTrials.gov identifier NCT00271154) was a prospective, double-blind, randomized trial of CRT. Subjects were classified on the basis of LV end-systolic volume (LVESV) change from baseline to 6 months post-CRT: worsened (increase), stabilized (0%-≤15% reduction), responder (>15%-<30% reduction), and super-responder (≥30% reduction). Subjects were evaluated annually for 5 years. RESULTS The analyses included 353 subjects randomized to CRT-ON arm. All-cause mortality was higher in the worsened group than in the other 3 response groups (29.8% vs 8.0%; P < .0001), with no difference in survival among those groups (P = .87). A significant interaction between the LVESV group and time was observed for health status and quality of life (P = .02 for both). The interaction was not significant for 6-minute hall walk (P = .79); however, super-responders had increased walk distance compared with the other 3 response groups (P = .03). CONCLUSION Preventing further increase in LVESV with CRT was associated with reduced mortality, whereas functional measure improvement was associated with LV remodeling magnitude. These results support the consideration of functional and mortality end points to assess CRT efficacy and provide further evidence that the dichotomous "responder and nonresponder" classification should be modified.
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Affiliation(s)
- Michael R Gold
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
| | - John Rickard
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - J Claude Daubert
- Faculty of Medicine, University of Rennes 1, CIC IT, INSERM 642, Rennes, France
| | | | - Cecilia Linde
- Department of Medicine, Cardiology Unit, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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13
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Chung ES, Rickard J, Lu X, DerSarkissian M, Zichlin ML, Cheung HC, Swartz N, Greatsinger A, Duh MS. Real-world clinical burden among patients with and without heart failure worsening after cardiac resynchronization therapy. Curr Med Res Opin 2022; 38:1489-1498. [PMID: 35727103 DOI: 10.1080/03007995.2022.2092374] [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] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cardiac resynchronization therapy (CRT) can improve cardiac function in patients with heart failure (HF); however, in some patients, HF worsens despite CRT. This study characterized the long-term clinical burden of patients with and without HF worsening (HFW) within 6 months post CRT implantation. METHODS A claims database (2007-2018) was used to identify two cohorts of adults: those with HFW within 180 days post-CRT and those with no HFW (NHFW). The evaluated clinical outcomes were cardiovascular events/complications, HF-related interventions, hospice enrollment, and all-cause mortality. Inverse probability of treatment weighting (IPTW) was used to adjust for confounders; adjusted comparisons were assessed using weighted Cox proportional hazard ratios (HRs). RESULTS Among the 12,753 adults analyzed (HFW: N = 4,785; NHFW: N = 7,968), the mean age was 72 years and the mean duration of follow-up was approximately 2 years. The clinical burden was greater for HFW than for NHFW in terms of all-cause mortality (19.7% vs. 12.1%) and occurrence of atrial fibrillation (57.4% vs. 51.2%). In the IPTW-adjusted Cox proportional hazard analyses, patients with HFW had a 54% higher average hazard of experiencing all-cause mortality compared to NHFW (adjusted average HR = 1.54, 95% confidence interval [CI]: 1.41-1.70; p < .001). Of the clinical events experienced by ≥5% of patients, the greatest differences in average hazard were for HF decompensation (adjusted average HR = 1.83, 95% CI: 1.60-2.09) and HF decompensation or death (HR = 1.63, 95%CI: 1.50-1.77). CONCLUSION Patients with early HFW post-CRT experienced a significantly higher clinical burden than those without HFW. Vigilance for signs of worsening HF in the first 6 months post-CRT is warranted.
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Affiliation(s)
- Eugene S Chung
- The Lindner Clinical Research Center at The Christ Hospital, Cincinnati, OH, USA
| | | | - Xiaoxiao Lu
- Medtronic Global CRHF Headquarters, Mounds View, MN, USA
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14
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Lehmann HI, Tsao L, Singh JP. Treatment of cardiac resynchronization therapy non-responders: current approaches and new frontiers. Expert Rev Med Devices 2022; 19:539-547. [PMID: 35997539 DOI: 10.1080/17434440.2022.2117031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) has developed into a very effective technology for patients with decreased systolic function and has substantially improved patients' clinical course. However, non-responsiveness to CRT, described as lack of reverse cardiac chamber remodeling, leading to lack to improve symptoms, heart failure hospitalizations or mortality, is common, rather unpredictable, and not fully understood. AREAS COVERED This article aims to discuss key factors that are impacting CRT response; from patient selection to LV lead position, to structured follow-up in CRT clinics. Secondly, common causes and interventions for CRT non-responsiveness are discussed. Next, insight is given into technologies representing new and feasible interventions as well as pacing strategies in this group of patients that remain challenging to treat. Finally, an outlook is given into future scientific development. EXPERT OPINION Despite the progress that has been made, CRT non-response remains a significant and complex problem. Patient management in interdisciplinary teams including heart failure, imaging, and cardiac arrhythmia experts appears critical as complexity is increasing and CRT non-response often is a multifactorial problem. This will allow optimization of medical therapy, the use of new integrated sensor technologies and telemedicine to ultimately optimize outcomes for all patients in need of CRT.
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Affiliation(s)
- H Immo Lehmann
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lana Tsao
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jagmeet P Singh
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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15
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Graham J, Iverson A, Monteiro J, Weiner K, Southall K, Schiller K, Gupta M, Simard EP. Applying computable phenotypes within a common data model to identify heart failure patients for an implantable cardiac device registry. IJC HEART & VASCULATURE 2022; 39:100974. [PMID: 35242997 PMCID: PMC8861122 DOI: 10.1016/j.ijcha.2022.100974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/18/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Jove Graham
- Center for Pharmacy Innovation and Outcomes, Geisinger Clinic, Danville, PA, USA
- Corresponding author at: 100 N Academy Ave, MC 44-01, Danville, PA 17822-2402, USA.
| | - Andy Iverson
- Global Clinical Research and Analytics Medtronic, Inc., Minneapolis, MN, USA
| | - Joao Monteiro
- Global Clinical Research and Analytics Medtronic, Inc., Minneapolis, MN, USA
| | - Katherine Weiner
- Global Clinical Research and Analytics Medtronic, Inc., Minneapolis, MN, USA
| | - Kara Southall
- Global Clinical Research and Analytics Medtronic, Inc., Minneapolis, MN, USA
| | - Katherine Schiller
- Global Clinical Research and Analytics Medtronic, Inc., Minneapolis, MN, USA
| | - Mudit Gupta
- Phenomic Analytics and Clinical Data Core, Geisinger Clinic, Danville, PA, USA
| | - Edgar P. Simard
- Global Clinical Research and Analytics Medtronic, Inc., Minneapolis, MN, USA
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16
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Murata Y, Ishibashi K, Yamagata K, Izumi C, Noguchi T, Kusano K. Impact of atrial septal pacing in left ventricular–only pacing in patients with a first-degree atrioventricular block: A case series. HeartRhythm Case Rep 2022; 8:187-190. [PMID: 35492843 PMCID: PMC9039549 DOI: 10.1016/j.hrcr.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Kohei Ishibashi
- Address reprints and correspondence: Dr Kohei Ishibashi, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan.
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17
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Waddingham PH, Mangual J, Orini M, Badie N, McSpadden L, Lambiase PD, Chow AW. Noninvasive electrocardiographic imaging of dynamic atrioventricular delay programming in a patient with left bundle branch block. HeartRhythm Case Rep 2021; 7:849-853. [PMID: 34987974 PMCID: PMC8695252 DOI: 10.1016/j.hrcr.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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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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19
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Haq KT, Rogovoy NM, Thomas JA, Hamilton C, Lutz KJ, Wirth A, Bender AB, German DM, Przybylowicz R, van Dam P, Dewland TA, Dalouk K, Stecker E, Nazer B, Jessel PM, MacMurdy KS, Zarraga IGE, Beitinjaneh B, Henrikson CA, Raitt M, Fuss C, Ferencik M, Tereshchenko LG. Adaptive Cardiac Resynchronization Therapy Effect on Electrical Dyssynchrony (aCRT-ELSYNC): A randomized controlled trial. Heart Rhythm O2 2021; 2:374-381. [PMID: 34430943 PMCID: PMC8369305 DOI: 10.1016/j.hroo.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Adaptive cardiac resynchronization therapy (aCRT) is known to have clinical benefits over conventional CRT, but the mechanisms are unclear. OBJECTIVE Compare effects of aCRT and conventional CRT on electrical dyssynchrony. METHODS A prospective, double-blind, 1:1 parallel-group assignment randomized controlled trial in patients receiving CRT for routine clinical indications. Participants underwent cardiac computed tomography and 128-electrode body surface mapping. The primary outcome was change in electrical dyssynchrony measured on the epicardial surface using noninvasive electrocardiographic imaging before and 6 months post-CRT. Ventricular electrical uncoupling (VEU) was calculated as the difference between the mean left ventricular (LV) and right ventricular (RV) activation times. An electrical dyssynchrony index (EDI) was computed as the standard deviation of local epicardial activation times. RESULTS We randomized 27 participants (aged 64 ± 12 years; 34% female; 53% ischemic cardiomyopathy; LV ejection fraction 28% ± 8%; QRS duration 155 ± 21 ms; typical left bundle branch block [LBBB] in 13%) to conventional CRT (n = 15) vs aCRT (n = 12). In atypical LBBB (n = 11; 41%) with S waves in V5-V6, conduction block occurred in the anterior RV, as opposed to the interventricular groove in strict LBBB. As compared to baseline, VEU reduced post-CRT in the aCRT (median reduction 18.9 [interquartile range 4.3-29.2 ms; P = .034]), but not in the conventional CRT (21.4 [-30.0 to 49.9 ms; P = .525]) group. There were no differences in the degree of change in VEU and EDI indices between treatment groups. CONCLUSION The effect of aCRT and conventional CRT on electrical dyssynchrony is largely similar, but only aCRT harmoniously reduced interventricular dyssynchrony by reducing RV uncoupling.
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Affiliation(s)
- Kazi T. Haq
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Nichole M. Rogovoy
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Jason A. Thomas
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- University of Washington, Seattle, Washington
| | - Christopher Hamilton
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Katherine J. Lutz
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Ashley Wirth
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Aron B. Bender
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- University of California Los Angeles, Los Angeles, California
| | - David M. German
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Ryle Przybylowicz
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Thomas A. Dewland
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- University of California San Francisco, San Francisco, California
| | - Khidir Dalouk
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Eric Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Peter M. Jessel
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Karen S. MacMurdy
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Ignatius Gerardo E. Zarraga
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Bassel Beitinjaneh
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Charles A. Henrikson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Merritt Raitt
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Cristina Fuss
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
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20
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O'Donnell D, Manyam H, Pappone C, Park SJ, Leclercq C, Lunati M, Lercher P, Rordorf R, Landolina M, Badie N, McSpadden LC, Ryu K, Mangual JO, Singh JP, Varma N, Niazi IK. Ventricular activation patterns during intrinsic conduction and right ventricular pacing in cardiac resynchronization therapy patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1663-1670. [PMID: 34319603 DOI: 10.1111/pace.14329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/10/2021] [Accepted: 07/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) involves stimulation of both right ventricle (RV) and left ventricle (LV). LV pacing from the sites of delayed electrical activation improves CRT response. The RV-LV conduction is typically measured in intrinsic rhythm. The differences in RV-LV conduction patterns and timing between intrinsic rhythm and during paced RV activation, these differences are not fully understood. METHODS Enrolled patients were implanted with a de novo CRT device and quadripolar LV lead, with lead implant locations at the implanting physician's discretion. QRS duration and conduction delay between the RV lead and each of the four LV electrodes (D1, M2, M3, and P4) were measured during intrinsic conduction and RV pacing. RESULTS Conduction measurements were collected from 275 patients across 14 international centers (68 ± 13 years of age, 73% male, 45% ischemic, 158 ± 22 ms QRS duration). Mean RV-LV conduction time was shorter during intrinsic conduction versus RV pacing by 59.6 ms (106.5 ± 36.5 versus 166.1 ± 32.1 ms, p < 0.001). The intra-LV activation delay between the latest and earliest activating LV electrode was also shorter during intrinsic conduction versus RV pacing by 6.6 ms (20.6 ± 13.1 vs. 27.2 ± 21.2 ms, p < 0.001). Intrinsic conduction and RV pacing resulted in a different activation order in 72.7% of patients, and the same LV activation order in 27.3%. CONCLUSIONS Differences in RV-LV conduction time, intra-LV conduction time, and activation pattern were observed between intrinsic conduction and RV pacing. These findings highlight the importance of evaluating intrinsic versus paced ventricular activation to guide LV pacing site selection in CRT patients.
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Affiliation(s)
- David O'Donnell
- Cardiology, GenesisCare, Wellington Parade, Melbourne, Australia
| | - Harish Manyam
- Department of Cardiology, Erlanger Hospital University of Tennessee, Chattanooga, Tennessee, USA
| | - Carlo Pappone
- Department of Arrhythmology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - Seung-Jung Park
- Samsung Medical Center, Sungkyunkwan School of Medicine, Seoul, Korea
| | | | - Maurizio Lunati
- Cardiac Department, Niguarda Ca' Granda, Granda Hospital, Milan, Italy
| | - Peter Lercher
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Roberto Rordorf
- Coronay Care Unit, Department of Cardiology, Fondazione Policlinico San Matteo, Pavia, Italy
| | - Maurizio Landolina
- Coronay Care Unit, Department of Cardiology, Fondazione Policlinico San Matteo, Pavia, Italy.,Cardiology Department, Ospedale Maggiore di Crema, Crema, Italy
| | | | | | | | | | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Imran K Niazi
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA
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21
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Rodriguez JBC. Beyond Left Ventricular Ejection Fraction Improvement in the Optimization of Cardiac Resynchronization Therapy. Angiology 2021; 73:293-295. [PMID: 33977766 DOI: 10.1177/00033197211015551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jose B Cruz Rodriguez
- Division of Cardiovascular Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
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22
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Varma N, Hu Y, Connolly AT, Thibault B, Singh B, Mont L, Nabutovsky Y, Zareba W. Gain in real-world cardiac resynchronization therapy efficacy with SyncAV dynamic optimization: Heart failure hospitalizations and costs. Heart Rhythm 2021; 18:1577-1585. [PMID: 33965608 DOI: 10.1016/j.hrthm.2021.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND SyncAV, a device-based cardiac resynchronization therapy (CRT) algorithm, promotes electrical optimization by dynamically adjusting atrioventricular intervals. OBJECTIVE The purpose of this study was to evaluate the impact of SyncAV on heart failure hospitalizations (HFHs) and related costs in a real-world CRT cohort. METHODS Patients with SyncAV-capable CRT devices followed by remote monitoring and enrolled in Medicare fee-for-service for at least 1 year preimplant and up to 2 years postimplant were studied. Patients with SyncAV OFF were 4:1 matched to those with SyncAV ON on preimplant HFH rate, demographics, comorbidities, disease etiology, and left bundle branch block. HFHs were determined from the primary diagnosis of inpatient hospitalizations, and the cost for each event was the sum of Medicare, supplemental insurance, and patient payment. RESULTS After 4:1 propensity score matching, 3630 patients were studied (mean age 75 ± 8 years; 1386 [38%] female), including 726 (25%) patients with SyncAV ON. The pre-CRT HFH rate was 0.338 HFH events per patient-year. Overall, CRT diminished the HFH rate to 0.204 events per patient-year (P < .001). SyncAV elicited a larger reduction in HFH rate (SyncAV ON: hazard ratio [HR] 0.52; 95% confidence interval [CI] 0.41-0.66; P < .001 and SyncAV OFF: HR 0.68; 95% CI 0.59-0.77; P < .001). After 2 years, the HFH rate was lower in the SyncAV ON group than in the SyncAV OFF group (0.143 HFHs per patient-year vs 0.193 HFHs per patient-year; HR 0.70; 95% CI 0.55-0.89; P = .003) and fewer HFHs were followed by 30-day HFH readmissions (4.41% vs 7.68%; P = .003) and 30-day all-cause hospital readmissions (7.04% vs 10.01%; P = .010). The total 2-year HFH-associated costs per patient were lower with SyncAV ON (difference $1135; 90% CI $93-$2109; P = .038). CONCLUSION This large, real-world, propensity score-matched study demonstrates that SyncAV CRT is associated with significantly reduced HFHs and associated costs, incremental to standard CRT.
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Affiliation(s)
- Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | | | | | | | - Balbir Singh
- Cardiology Department, Max Healthcare, New Delhi, India
| | - Lluis Mont
- Secció Arrítmies. Institut Clínic Cardiovascular Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Wojciech Zareba
- Cardiovascular Division, University of Rochester, Rochester, New York
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Dilaveris P, Antoniou CK, Chrysohoou C, Xydis P, Konstantinou K, Manolakou P, Kordalis A, Gatzoulis K, Tsioufis C. Comparative Trial of the Effects of Left Ventricular and Biventricular Pacing on Indices of Cardiac Function and Clinical Course of Patients With Heart Failure: Rationale and Design of the READAPT Randomized Trial. Angiology 2021; 72:961-970. [PMID: 33938290 DOI: 10.1177/00033197211012520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Nonresponse to cardiac resynchronization therapy (CRT) has been related with right ventricular dysfunction. Ventriculoarterial coupling (VAC) assesses energy efficiency of the failing heart and stroke work maximization for a given contractility, for both systemic and pulmonary circulations. Preferential left ventricular pacing (pLVP) can overcome iatrogenic right ventricular dysfunction by achieving left ventricle resynchronization and by allowing for intrinsic activation of the right side, with ramifications extending beyond cardiac output and atrial fibrillation occurrence. In the present article, we detail the design of a single-center randomized clinical trial to evaluate the effects of a pLVP algorithm. More specifically, following randomization of 220 CRT-eligible patients to standard biventricular pacing and pLVP, their clinical course will be followed for 12 months, through echocardiography to study indices of systolic and diastolic function of ventricles, left and right side VAC to evaluate efficiency, and cardiopulmonary exercise test to objectively document improvements in functional status, as well as a self-reported quality of life questionnaire. Device programming will be based on echocardiography-evaluated maximization of stroke volume and subsequent interventricular and atrioventricular delay adjustments delegated to the device. Findings of this trial may provide evidence for alternative programming of the devices, linking pLVP to improved clinical outcomes.
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Affiliation(s)
| | | | - Christina Chrysohoou
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Panagiotis Xydis
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | | | - Panagiota Manolakou
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Athanasios Kordalis
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | | | - Costas Tsioufis
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
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24
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Gierula J, Paton MF, Witte KK. Advances in cardiac resynchronization and implantable cardioverter/defibrillator therapy: Medtronic Cobalt and Crome. Future Cardiol 2021; 17:609-618. [PMID: 33635121 DOI: 10.2217/fca-2020-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiovascular implantable electronic devices have revolutionized the management of heart failure with reduced ejection fraction. New device generations tend to be launched every few years, with incremental improvements in performance and safety and with an expectation that these will improve patient management and outcomes while remaining cost-effective. As a result, today's cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator devices are quite different from the pioneering but often bulky devices of the late 20th century. This review discusses new and improved features developed to target specific needs in managing heart failure patients, some of which are especially pertinent to the current worldwide healthcare situation, with focus on the latest generation of CRTs with defibrillator (CRT-Ds) and implantable cardioverter defibrillators from Medtronic.
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Affiliation(s)
- John Gierula
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - Maria F Paton
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
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25
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Gold MR, Rickard J, Daubert JC, Zimmerman P, Linde C. Redefining the Classifications of Response to Cardiac Resynchronization Therapy: Results From the REVERSE Study. JACC Clin Electrophysiol 2021; 7:871-880. [PMID: 33640347 DOI: 10.1016/j.jacep.2020.11.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This study sought to assess the impact of a more detailed classification of response on survival. BACKGROUND Cardiac resynchronization therapy (CRT) improves functional status and outcomes in selected populations with heart failure (HF). However, approximately 30% of patients do not improve with CRT by various metrics, and they are traditionally classified as nonresponders. METHODS REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) was a randomized trial of CRT among patients with mild HF. Patients were classified as Improved, Stabilized, or Worsened using prespecified criteria based on the clinical composite score (CCS) and change in left ventricular end-systolic volume index (LVESVi). All-cause mortality across CRT ON subgroups at 5 years was compared. RESULTS Of the 406 subjects surviving 1 year, 5-year survival differed between CCS subgroups (p = 0.03), with increased mortality in the Worsened response group. Of the 353 subjects with adequate echocardiograms, survival differed significantly between response groups (p < 0.001), also due to increased mortality in the Worsened group. When combining CCS and LVESVi results, the lowest survival was observed among subjects who worsened for both measures, whereas the highest survival occurred in subjects who did not worsen by either endpoint. Multivariate analysis showed that LVESVi worsening with CRT at 6 months, baseline LVESVi, and gender were independent predictors of survival. CONCLUSIONS For both CCS and reverse remodeling, patients who worsen with CRT have a high mortality, although remodeling was the more important endpoint. Patients who stabilize early with CRT have a much better prognosis than previously recognized, suggesting that the current convention of nonresponder classification should be modified. (REVERSE [Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction]; NCT00271154).
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Affiliation(s)
- Michael R Gold
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - John Rickard
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland Ohio, USA
| | - J Claude Daubert
- Département de Cardiologie, University of Rennes 1, CIC IT, INSERM 642, Rennes, France
| | - Patrick Zimmerman
- Cardiac Rhythm Management, Medtronic Inc., Minneapolis, Minnesota, USA
| | - Cecilia Linde
- Department of Medicine, Cardiology Unit, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
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26
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Karki R, Lloyd J, Mulpuru SK, Asirvatham SJ, DeSimone CV. Ventricular asystole in the presence of a biventricular device. J Cardiovasc Electrophysiol 2020; 31:3031-3035. [PMID: 32786037 DOI: 10.1111/jce.14715] [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: 06/16/2020] [Accepted: 08/01/2020] [Indexed: 11/27/2022]
Abstract
In pacemaker-dependent patients with a newly implanted cardiac device, acute lead dislodgement constitutes one of the most common causes of loss of capture and ventricular asystole. In a biventricular system, it would be expected that such a potentially catastrophic event would be prevented with back-up right ventricular pacing unless both leads dislodge.
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Affiliation(s)
- Roshan Karki
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - James Lloyd
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Siva K Mulpuru
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Department of Clinical Anatomy, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher V DeSimone
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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27
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Singh JP, Cha YM, Lunati M, Chung ES, Li S, Smeets P, O'Donnell D. Real-world behavior of CRT pacing using the AdaptivCRT algorithm on patient outcomes: Effect on mortality and atrial fibrillation incidence. J Cardiovasc Electrophysiol 2020; 31:825-833. [PMID: 32009263 PMCID: PMC7187461 DOI: 10.1111/jce.14376] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 12/18/2019] [Accepted: 01/15/2020] [Indexed: 01/14/2023]
Abstract
Background The AdaptivCRT (aCRT) algorithm continuously adjusts cardiac resynchronization therapy (CRT) according to intrinsic atrioventricular conduction, providing synchronized left ventricular pacing in patients with normal PR interval and adaptive BiV pacing in patients with prolonged PR interval. Previous analyses demonstrated an association between aCRT and clinical benefit. We evaluated the incidence of patient mortality and atrial fibrillation (AF) with aCRT compared with standard CRT in a real‐world population. Methods and Results Patients enrolled in the Medtronic Personalized CRT Registry and implanted with a CRT from 2013‐2018 were divided into aCRT ON or standard CRT groups based upon device‐stored data. A Frailty survival model was used to evaluate the potential survival benefit of aCRT, accounting for patient heterogeneity and center variability. Daily AF burden and first device‐detected AF episodes of various durations were recorded by the device during follow‐up. A total of 1814 CRT patients with no reported long‐standing AF history at implant were included. Mean follow‐up time was 26.1 ± 16.5 months and 1162 patients (64.1%) had aCRT ON. Patient survival probability at 36 months was 88.3% for aCRT ON and 83.7% for standard CRT (covariate‐adjusted hazard ratio [HR] = 0.71, 95% CI: 0.53‐0.96, P = .028). Mean AF burden during follow‐up was consistently lower in aCRT ON patients compared with standard CRT. At 36 months, the probability of AF was lower in patients with aCRT ON, regardless of which AF definition threshold was applied (6 minutes‐30 days, all P < .001). Conclusion Use of the AdaptivCRT algorithm was associated with improved patient survival and lower incidence of AF in a real‐world, prospective, nonrandomized registry.
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Affiliation(s)
- Jagmeet P Singh
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Maurizio Lunati
- Department of Cardiology/Cardiac-Thoracic-Vascular Surgery, Ospedale Niguarda, Niguarda, Italy
| | - Eugene S Chung
- The Lindner Clinical Research Center, The Heart and Vascular Center at the Christ Hospital, Cincinnati, Ohio
| | - Shelby Li
- Medtronic, Plc, Mounds View, Minnesota
| | - Pascal Smeets
- Medtronic Bakken Research Center, Maastricht, Netherlands
| | - David O'Donnell
- Department of Electrophysiology, GenesisCare, Heidelberg, Victoria, Australia
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