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Beyer SE, Imnadze G, Sommer P. [New pacing strategies for heart failure]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:778-786. [PMID: 38967707 DOI: 10.1007/s00108-024-01747-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
In patients with a reduced left ventricular (LV) systolic function (ejection fraction < 35%) and a left bundle branch block with a QRS duration > 130 ms, cardiac resynchronization therapy (CRT) can contribute to an improvement in the quality of life and a reduction in mortality. The resynchronization is mostly achieved by pacing via an epicardial LV lead in the coronary sinus; however, this approach is often limited by the patient's venous anatomy and an increase in the stimulation threshold over time. In addition, up to 30% of patients do not respond to the intervention. New treatment approaches involve direct stimulation of the conduction system by pacing of the bundle of His or left bundle branch. This enables a more physiological propagation of the stimulus. Pacing of the left bundle branch is achieved by advancing the lead into the right ventricle and screwing it deep into the interventricular septum. Due to the relatively large target area of the left bundle branch the success rate is very high (currently > 90%). Observational studies have shown a greater reduction in the QRS duration, a more pronounced improvement in systolic function and a lower hospitalization rate for heart failure associated with conduction system pacing compared to CRT using a coronary sinus lead. These findings have been confirmed in small randomized trials. Therefore, the use of left bundle branch pacing should be considered not only as a bail out in the case of failed resynchronization using coronary sinus lead placement but increasingly also as an initial pacing strategy. The results of the first large randomized trials are expected to be released in late 2024.
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Affiliation(s)
- Sebastian E Beyer
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - Guram Imnadze
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland.
- Herz- und Diabeteszentrum NRW, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland.
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Jacobs M, Bodin A, Spiesser P, Babuty D, Clementy N, Bisson A. Single-center experience of efficacy and safety of atrioventricular node ablation after left bundle branch area pacing for the management of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01847-2. [PMID: 38913133 DOI: 10.1007/s10840-024-01847-2] [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: 03/17/2024] [Accepted: 05/30/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Atrioventricular node ablation (AVNA) with permanent pacing is an effective treatment of symptomatic atrial fibrillation (AF). Left bundle branch area pacing (LBBAP) prevents cardiac dyssynchrony associated with right ventricular pacing and could prevent worsening of heart failure (HF). METHODS In this retrospective monocentric study, all patients who received AVNA procedure with LBBAP were consecutively included. AVNA procedure data, electrical and echocardiographic parameters at 6 months, and clinical outcomes at 1 year were studied and compared to a matched cohort of patients who received AVNA procedure with conventional pacing between 2010 and 2023. RESULTS Seventy-five AVNA procedures associated with LBBAP were studied. AVNA in this context was feasible, with a success rate of 98.7% at first ablation, and safe without any complications. There was no threshold rise at follow-up. At 1 year, 6 (8%) patients were hospitalized for HF and 2 (2.7%) were deceased. Patients had a significant improvement in NYHA class and left ventricular ejection fraction (LVEF) (P ≤ 0.0001). When compared to a matched cohort of patients with AVNA and conventional pacing, AVNA data and pacing complications rates were similar. Patients with LBBAP had a better improvement of LVEF (+5.27 ± 9.62% vs. -0.48 ± 14%, P = 0.01), and a lower 1-year rate of composite outcome of hospitalization for HF or death (HR 0.39, 95% CI: 0.16-0.95, P = 0.037), significant on survival analysis (log-rank P-value = 0.03). CONCLUSION AVNA with LBBAP in patients with symptomatic AF is feasible, safe, and efficient. Hospitalization for HF or death rate was significantly lower and LVEF improvement was greater.
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Affiliation(s)
- Mathieu Jacobs
- University Hospital of Tours, Avenue de la république, Chambray-Les-Tours, 37170, France.
| | - Alexandre Bodin
- University Hospital of Tours, Avenue de la république, Chambray-Les-Tours, 37170, France
| | - Pascal Spiesser
- University Hospital of Orleans, 14 Avenue de l'Hopital, Orleans, 45100, France
| | - Dominique Babuty
- University Hospital of Tours, Avenue de la république, Chambray-Les-Tours, 37170, France
| | - Nicolas Clementy
- Clinic du Millenaire, 220 Boulevard Penelope, Montpellier, 34000, France
| | - Arnaud Bisson
- University Hospital of Tours, Avenue de la république, Chambray-Les-Tours, 37170, France
- University Hospital of Orleans, 14 Avenue de l'Hopital, Orleans, 45100, France
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Martinez JG, De Sousa J, Dompnier A, Martins-Oliveira M, Israel CW, Teijeira E, Rubin JM, Sebag F, Martino M, Michel Y, Marques P. Efficacy and safety of novel left ventricular pacing leads: 1-year analysis of the NAVIGATOR trial. Open Heart 2024; 11:e002517. [PMID: 38316493 PMCID: PMC10860098 DOI: 10.1136/openhrt-2023-002517] [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: 10/13/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVES Assess safety and performance of novel quadripolar preshaped left ventricular (LV) leads: NAVIGO 4LV 2D ('S shaped') and NAVIGO 4LV ARC ('U shaped'). METHODS Patients indicated for cardiac resynchronisation therapy were enrolled in a multicentre, prospective, controlled study (NAVIGATOR, NCT03279484). Patients were implanted with either a NAVIGO 4LV 2D or ARC lead, and assessed at 10 weeks, 6, 12 and 24 months post-implant. Co-primary safety and performance endpoints were assessed at 10 weeks. Safety endpoint was the patients' rate free from lead-related complications. Performance endpoint was the rate of patients with successful lead performance, defined as LV pacing threshold ≤2.5 V at 0.5 ms on at least one pacing vector, and the absence of phrenic nerve stimulation at the final programmed configuration. Lead-related complications and electrical parameters were monitored throughout study. RESULTS A NAVIGO 4LV lead was successfully implanted in 211 out of 217 patients (97.2%). The safety endpoint was met, with 100% and 96.1% of patients free from complications for NAVIGO 4LV 2D and ARC, respectively. The performance endpoint was met with 98.1% and 98.9% of patients with a successful lead performance for NAVIGO 4LV 2D and ARC, respectively. Over 12 months, the global complication-free rate for both leads was 97.1% (95% CI: 93.71% to 98.70%), with a mean pacing capture threshold of 1.23 V±0.73 V and a mean impedance of 951 Ω±300.1 Ω. CONCLUSION A high implantation success rate and low complication rate was reported for the novel NAVIGO 4LV 2D and ARC leads, along with successful performance up to 12 months.
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Affiliation(s)
- Juan Gabriel Martinez
- Hospital General Universitario Dr.Balmis. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | | | | | | | | | | | | | | | | | - Yann Michel
- Microport CRM, Clamart, Île-de-France, France
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Diaz JC, Duque M, Aristizabal J, Marin J, Niño C, Bastidas O, Ruiz LM, Matos CD, Hoyos C, Hincapie D, Velasco A, Romero JE. The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2023; 12:e29. [PMID: 38173800 PMCID: PMC10762674 DOI: 10.15420/aer.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/04/2023] [Indexed: 01/05/2024] Open
Abstract
Cardiac resynchronisation therapy (CRT) reduces the risk of heart failure-related hospitalisations and all-cause mortality, as well as improving quality of life and functional status in patients with persistent heart failure symptoms despite optimal medical treatment and left bundle branch block. CRT has traditionally been delivered by implanting a lead through the coronary sinus to capture the left ventricular epicardium; however, this approach is associated with significant drawbacks, including a high rate of procedural failure, phrenic nerve stimulation, high pacing thresholds and lead dislodgement. Moreover, a significant proportion of patients fail to derive any significant benefit. Left bundle branch area pacing (LBBAP) has recently emerged as a suitable alternative to traditional CRT. By stimulating the cardiac conduction system physiologically, LBBAP can result in a more homogeneous left ventricular contraction and relaxation, thus having the potential to improve outcomes compared with conventional CRT strategies. In this article, the evidence supporting the use of LBBAP in patients with heart failure is reviewed.
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Affiliation(s)
- Juan Carlos Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical SchoolMedellin, Colombia
| | - Mauricio Duque
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical SchoolMedellin, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las AmericasMedellin, Colombia
| | - Jorge Marin
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las AmericasMedellin, Colombia
| | - Cesar Niño
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobón UribeMedellin, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobón UribeMedellin, Colombia
| | | | - Carlos D Matos
- Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, US
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, US
| | - Daniela Hincapie
- Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, US
| | - Alejandro Velasco
- Electrophysiology Section, University of Texas Health Sciences CentreSan Antonio, TX, US
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, US
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Koneru JN, Ellenbogen KA. First Among Equals?: Is Left Bundle Branch Pacing Superior to Biventricular Pacing for Heart Failure? JACC Clin Electrophysiol 2023; 9:1582-1584. [PMID: 37227341 DOI: 10.1016/j.jacep.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
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Diaz JC, Sauer WH, Duque M, Koplan BA, Braunstein ED, Marín JE, Aristizabal J, Niño CD, Bastidas O, Martinez JM, Hoyos C, Matos CD, Lopez-Cabanillas N, Steiger NA, Kapur S, Tadros TM, Martin DT, Zei PC, Tedrow UB, Romero JE. Left Bundle Branch Area Pacing Versus Biventricular Pacing as Initial Strategy for Cardiac Resynchronization. JACC Clin Electrophysiol 2023; 9:1568-1581. [PMID: 37212761 DOI: 10.1016/j.jacep.2023.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) for cardiac resynchronization therapy (CRT) is an alternative to biventricular pacing (BiVp). OBJECTIVES The purpose of this study was to compare the outcomes between LBBAP and BiVp as an initial implant strategy for CRT. METHODS In this prospective multicenter, observational, nonrandomized study, first-time CRT implant recipients with LBBAP or BiVp were included. The primary efficacy outcome was a composite of heart failure (HF)-related hospitalization and all-cause mortality. The primary safety outcomes were acute and long-term complications. Secondary outcomes included postprocedural New York Heart Association functional class and electrocardiographic and echocardiographic parameters. RESULTS A total of 371 patients (median follow-up of 340 days [IQR: 206-477 days]) were included. The primary efficacy outcome occurred in 24.2% in the LBBAP vs 42.4% in the BiVp (HR: 0.621 [95% CI: 0.415-0.93]; P = 0.021) group, driven by a reduction in HF-related hospitalizations (22.6% vs 39.5%; HR: 0.607 [95% CI: 0.397-0.927]; P = 0.021) without significant difference in all-cause mortality (5.5% vs 11.9%; P = 0.19) or differences in long-term complications (LBBAP: 9.4% vs BiVp: 15.2%; P = 0.146). LBBAP resulted in shorter procedural (95 minutes [IQR: 65-120 minutes] vs 129 minutes [IQR: 103-162 minutes]; P < 0.001) and fluoroscopy times (12 minutes [IQR: 7.4-21.1 minutes] vs 21.7 minutes [IQR: 14.3-30 minutes]; P < 0.001), shorter QRS duration (123.7 ± 18 milliseconds vs 149.3 ± 29.1 milliseconds; P < 0.001), and higher postprocedural left ventricular ejection fraction (34.1% ± 12.5% vs 31.4% ± 10.8%; P = 0.041). CONCLUSIONS LBBAP as an initial CRT strategy resulted in a lower risk of HF-related hospitalizations compared to BiVp. A reduction in procedural and fluoroscopy times, shorter paced QRS duration, and improvements in left ventricular ejection fraction compared with BiVp were observed.
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Affiliation(s)
- Juan Carlos Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - William H Sauer
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mauricio Duque
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Bruce A Koplan
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric D Braunstein
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Jorge Eduardo Marín
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Las Americas Cardiovascular Institute, Medellin, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Las Americas Cardiovascular Institute, Medellin, Colombia
| | - Cesar Daniel Niño
- Cardiac Arrhythmia and Electrophysiology Service, Clinica SOMER, Rionegro, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Juan Manuel Martinez
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Las Americas Cardiovascular Institute, Medellin, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas M Tadros
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David T Martin
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Alvarez CK, Zweibel S, Stangle A, Panza G, May T, Marieb M. Anesthetic Considerations in the Electrophysiology Laboratory: A Comprehensive Review. J Cardiothorac Vasc Anesth 2023; 37:96-111. [PMID: 36357307 DOI: 10.1053/j.jvca.2022.10.013] [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: 06/11/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Catheter ablation procedures for arrhythmias or implantation and/or extraction of cardiac pacemakers can present many clinical challenges. It is imperative that there is clear communication and understanding between the anesthesiologist and electrophysiologist during the perioperative period regarding the mode of ventilation, hemodynamic considerations, and various procedural complications. This article provides a comprehensive narrative review of the anesthetic techniques and considerations for catheter ablation procedures, ventilatory modes using techniques such as high-frequency jet ventilation, and strategies such as esophageal deviation and luminal temperature monitoring to decrease the risk of esophageal injury during catheter ablation. Various hemodynamic considerations, such as the intraprocedural triaging of cardiac tamponade and fluid administration during catheter ablation, also are discussed. Finally, this review briefly highlights the early research findings on pulse-field ablation, a new and evolving ablation modality.
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Affiliation(s)
- Chikezie K Alvarez
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; University of Connecticut, Farmington, CT.
| | - Steven Zweibel
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT
| | - Alexander Stangle
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; University of Connecticut, Farmington, CT
| | - Gregory Panza
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; University of Connecticut, Farmington, CT
| | - Thomas May
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT
| | - Mark Marieb
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; Griffin Hospital, Derby, CT
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De Innocentiis C, Astore P, Buonpane A, Santamaria AP, Patragnoni F, Santamaria M. Case report: An unusual case of phrenic nerve stimulation in a patient with single chamber implantable cardioverter defibrillator. Front Cardiovasc Med 2023; 10:1088697. [PMID: 36910536 PMCID: PMC9995897 DOI: 10.3389/fcvm.2023.1088697] [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: 11/03/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Background Phrenic nerve stimulation is a well-recognized complication related to cardiac implantable electronic devices, in particular with left ventricular coronary sinus pacing leads for cardiac resynchronization therapy. Case presentation We report an unusual case of symptomatic phrenic nerve stimulation due to inadvertent placement of a right ventricular defibrillation lead in coronary sinus posterior branch in a patient with heart failure with reduced ejection fraction with a recently implanted single-chamber cardioverter defibrillator. Discussion Phrenic nerve stimulation is a relatively common complication of left ventricular pacing. Inadvertent placement of a right ventricular lead in a coronary sinus branch is a rare but possible cause of phrenic nerve stimulation. Careful evaluation of intraprocedural fluoroscopic and electrocardiographic appearance of pacing and defibrillation leads during implantation may prevent inadvertent placement of a right ventricular lead in the coronary sinus.
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Affiliation(s)
- Carlo De Innocentiis
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Campobasso, CB, Italy
| | - Pasquale Astore
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Campobasso, CB, Italy
| | - Angela Buonpane
- Agostino Gemelli IRCCS University Hospital Foundation, Rome, Italy
| | | | | | - Matteo Santamaria
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Campobasso, CB, Italy
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 140] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 893] [Impact Index Per Article: 297.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Dewidar O, Birnie D, Podinic I, Welch V, Wells GA. Sex differences in CRT device implantation rates, efficacy, and complications following implantation: protocol for a systematic review and meta-analysis of cohort studies. Syst Rev 2021; 10:210. [PMID: 34301313 PMCID: PMC8305491 DOI: 10.1186/s13643-021-01746-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION There is abundant evidence for sex differences in the diagnosis, implantation, and outcomes for cardiac resynchronization therapy (CRT) devices. Controversial data suggesting women are less likely to receive the device regardless of the greater benefit. The aim of this review is to assess sex differences in the implantation rate, clinical effectiveness, and safety of patients receiving CRT devices. METHODS We will conduct a systematic literature search of MEDLINE, Embase, and Web of Science to identify cohort studies that meet our eligibility criteria. Title and full text screening will be conducted in duplicate independently. Eligible studies report clinical effectiveness or safety of patients receiving CRT device while providing sex-disaggregated data. Implantation rate will be extracted from the baseline characteristics tables of the studies. The effectiveness outcomes include the following: all-cause death, hospitalization, peak oxygen consumption (pVO2), quality of life (QoL), 6-min walk test, NYHA class reduction, LVEF, and heart failure hospitalization. The complication outcomes include the following: contrast-induced nephropathy, pneumothorax, pocket-related hematoma, pericardial tamponade, phrenic nerve stimulation, device infection, death, pulmonary edema, electrical storm, cardiogenic shock, and hypotension requiring resuscitation. Description of included studies will be reported in detail and outcomes will be meta-analyzed and presented using forest plots when feasible. Risk of bias will be assessed using the Newcastle-Ottawa Scale (NOS) by two review authors independently. GRADE approach will be used to assess the certainty of evidence. DISCUSSION The aim of this review is to determine the presence of differences in CRT implantation between women and men as well as differences in clinical effectiveness and safety of CRT after device implantation. Results from this systematic review will provide important insights into sex differences in CRT devices that could contribute to the development of sex-specific recommendations and inform policy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020204804.
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Affiliation(s)
- Omar Dewidar
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada. .,Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada.
| | - David Birnie
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Ontario, K1Y 4W7, Canada
| | - Irina Podinic
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Vivian Welch
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.,Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.,Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Ontario, K1Y 4W7, Canada
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Koerber SM, Field ME, Cobb DB, Gregoski MJ, Sturdivant JL, Gold MR. Electrical delays in quadripolar leads with cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2021; 32:2498-2503. [PMID: 34245479 DOI: 10.1111/jce.15156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pacing at sites of late intraventricular activation (QLV) or long interventricular conduction (right ventricle [RV]-left ventricular [LV]) have been associated with improved cardiac resynchronization therapy (CRT) outcomes. Quadripolar leads improve CRT outcomes by allowing for electrical repositioning to optimize pacing sites. However, little is known regarding the effect of such repositioning on electrical delay. OBJECTIVE Determine the relationship between different electrical bipoles from a quadripolar lead and measures of electrical delay. METHODS Forty-six patients underwent CRT with a quadripolar lead. The RV-LV and QLV intervals were measured for both the proximal and distal bipoles and the difference (Δ) between bipoles for each measure were calculated. Multivariate analyses were performed to identify predictors of electrical delays. RESULTS This was a typical CRT population with a mean age of 65 years and ejection fraction of 27%, with left bundle branch block (LBBB) present in 70%. The regression model for ΔQLV was significant (p = .05), with both gender (p = .008) and LBBB status (p = .020) significant predictors. The overall regression model for ΔRV-LV was not significant. ΔQLV and ΔRV-LV were significant among LBBB patients. Among non-LBBB, only ΔRV-LV was significant (mean: 7.2 ms, p = .006). ΔRV-LV versus ΔQLV were strongly correlated in LBBB (R2 = .92) but not non-LBBB (R2 = .06). CONCLUSION In LBBB, ΔRV-LV and ΔQLV are closely correlated suggesting that the proximal bipole and thus basal LV pacing sites should be selected when feasible. Greater variation in activation pattern is present in non-LBBB, so pacing sites should be individualized.
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Affiliation(s)
- Scott M Koerber
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael E Field
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Daniel B Cobb
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mathew J Gregoski
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John L Sturdivant
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
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15
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Left ventricle pacing challenges in cardiac resynchronization therapy systems. Indian Pacing Electrophysiol J 2021; 21:232-240. [PMID: 33862228 PMCID: PMC8263312 DOI: 10.1016/j.ipej.2021.04.001] [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] [Received: 01/23/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 11/20/2022] Open
Abstract
Left ventricle (LV) pacing can be considered peculiar due to its different lead/tissue interface (epicardial pacing) and the small vein wedging lead locations with less reliable lead stability. The current technologies available for LV capture automatic confirmation adopt the evoked response (ER), as well as "LV pace to right ventricular (RV) sense" algorithms. The occurrence of anodal RV capture is today completely solved by the use of bipolar LV leads, while intriguing data are recently published regarding the unintentional LV anodal capture beside the cathodal one, which may enlarge the front wave of cardiac resynchronization therapy (CRT) delivery. The LV threshold behavior over time leading to ineffective CRT issues (subthreshold stimulation or concealed loss of capture), the extracardiac capture with phrenic nerve stimulation (PNS), the flexible electronic cathode reprogramming and the inadequate CRT delivery related to inadequate AV and VV pace timing (and its management by LV "dromotropic pace-conditioning") are discussed. Moreover, recently, His bundle pacing (HBP) and left bundle branch pacing (LBBP) have shown growing interest to prevent pacing-induced cardiomyopathy as well as for direct intentional CRT. The purpose of the present review is to explore these new challenges regarding LV pacing starting from old concepts.
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16
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Dalex M, Malezieux A, Parent T, Zekry D, Serratrice C. Phrenic nerve stimulation, a rare complication of pacemaker: A case report. Medicine (Baltimore) 2021; 100:e25060. [PMID: 33725981 PMCID: PMC7982205 DOI: 10.1097/md.0000000000025060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The phrenic nerve stimulation (PNS) is a rare complication after pacemaker setting. We report a case report that describes this complication and how it can be resolved. PATIENT CONCERNS An 88-year-old man presented himself to the emergency geriatric unit with intermittent painless abdominal contraction due to phrenic nerve stimulation. He has a history of transcatheter aortic valve implantation with cardiac resynchronization therapy pacemaker due to persistent left bundle branch block. DIAGNOSES All the usual causes for abdominal spasms were eliminated and the possibility of a link with the pacemaker was considered. The phrenic nerve stimulation is a rare complication of a pacemaker implantation. It can be clinically nonrelevant but challenging to diagnose for those not familiar with cardiac devices technology. INTERVENTIONS Initial setting was an axis of stimulation between distal left ventricular (LV) and right ventricular. It was changed to LV and D1-M2. OUTCOMES This noninvasive procedure managed to eradicate the involuntary abdominal spasms. LESSONS PNS could be challenging to diagnose for those not familiar with cardiac devices technology but easy to manage with noninvasive methods.
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Affiliation(s)
| | | | | | - Dina Zekry
- Division of Internal Medicine for the Aged
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Serratrice
- Division of Internal Medicine for the Aged
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
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17
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Affiliation(s)
- Hai-Long Dai
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Clinical Medicine Center for Cardiovascular Disease of Yunnan Province, Department of Cardiology, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xue-Feng Guang
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Clinical Medicine Center for Cardiovascular Disease of Yunnan Province, Department of Cardiology, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei-Hua Zhang
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Clinical Medicine Center for Cardiovascular Disease of Yunnan Province, Department of Cardiology, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, China
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18
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Sekihara T, Miyazaki S, Ishida T, Nagao M, Kakehashi S, Mukai M, Aoyama D, Nodera M, Eguchi T, Hasegawa K, Uzui H, Tada H. Phrenic nerve stimulation during right ventricular outflow tract pacing: A rare but possible complication. J Cardiovasc Electrophysiol 2020; 31:3330-3333. [DOI: 10.1111/jce.14760] [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: 08/14/2020] [Revised: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Takayuki Sekihara
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Tomokazu Ishida
- Department of Radiography, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Moeko Nagao
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Shota Kakehashi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Tomoya Eguchi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan
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19
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Siroky GP, Gold A, Tang D, Alam A, Simon M, Huang M, Kostis WJ. Left Pericardiophrenic Vein Pacing for Tachy-Brady Syndrome Due to an Obstructing Cardiac Angiosarcoma. JACC Case Rep 2020; 2:1771-1775. [PMID: 34317054 PMCID: PMC8312131 DOI: 10.1016/j.jaccas.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
We describe a case of a permanent pacemaker lead placement via the left pericardiophrenic vein for the treatment of tachy-brady syndrome due to a primary cardiac angiosarcoma. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Gregory P. Siroky
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Address for correspondence: Dr. Gregory P. Siroky, Mount Sinai Morningside Hospital, 1111 Amsterdam Avenue, New York, New York 10025.
| | - Alex Gold
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Delphine Tang
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Amit Alam
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Mitchell Simon
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michael Huang
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - William J. Kostis
- Department of Medicine, Division of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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20
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Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy Using Left Bundle Branch Pacing. JACC Clin Electrophysiol 2020; 6:849-858. [DOI: 10.1016/j.jacep.2020.04.011] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/23/2022]
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21
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Juliá J, López-Gil M, Fontenla A, Lozano Á, Villagraz L, Salguero R, Arribas F. Super-response to cardiac resynchronization therapy may predict late phrenic nerve stimulation. Europace 2019; 20:1498-1505. [PMID: 29182757 DOI: 10.1093/europace/eux311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 09/10/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Changes in the anatomical relationship between left phrenic nerve and coronary veins may occur due to the reverse remodelling observed in super-responders to cardiac resynchronization therapy (CRT) and might be the underlying mechanism in patients developing late-onset phrenic nerve stimulation (PNS) without evidence of lead dislodgement (LD). In this study, we sought to evaluate the role of super-response (SR) to CRT as a potential predictor of late-onset PNS. Methods and results Consecutive patients implanted with a left ventricular (LV) lead in a single centre were retrospectively analysed. Phrenic nerve stimulation was classified as 'early' when it occurred within 3 months of implantation and 'late' for occurrences thereafter. 'Late' PNS was considered related to LD (LD-PNS) when LV threshold differed by > 1 V or impedance >250 Ω from baseline values or in case of radiological displacement. Cases not meeting the former criteria were classified as 'non-LD-PNS'. Super-response was defined as a decrease ≥30% of the left ventricluar end-systolic volume at 1-year echocardiography. At 32 ± 7 months follow-up, PNS occurred in 20 of 139 patients. Late non-LD-PNS incidence was significantly higher in the SR group (8/61; 13.1%) when compared with the non-SR (1/78; 1.3%) (P = 0.010). Super-response remained the only predictor of non-LD-PNS at multivariate analysis (odds ratio: 11.62, 95% confidence interval 1.41-95.68, P = 0.023). Conclusion Incidence of late non-LD-PNS is higher among SR to CRT, suggesting a potential role of the changes in the anatomical relationship between left phrenic nerve and coronary veins.
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Affiliation(s)
- Justo Juliá
- Cardiac Electrophysiology Unit, Department of Cardiology, Hospital Doce de Octubre, Avenida de Córdoba, s/n, Madrid, Spain
| | - María López-Gil
- Cardiac Electrophysiology Unit, Department of Cardiology, Hospital Doce de Octubre, Avenida de Córdoba, s/n, Madrid, Spain
| | - Adolfo Fontenla
- Cardiac Electrophysiology Unit, Department of Cardiology, Hospital Doce de Octubre, Avenida de Córdoba, s/n, Madrid, Spain
| | - Álvaro Lozano
- Cardiac Electrophysiology Unit, Department of Cardiology, Hospital Doce de Octubre, Avenida de Córdoba, s/n, Madrid, Spain
| | - Lola Villagraz
- Cardiac Electrophysiology Unit, Department of Cardiology, Hospital Doce de Octubre, Avenida de Córdoba, s/n, Madrid, Spain
| | - Rafael Salguero
- Cardiac Electrophysiology Unit, Department of Cardiology, Hospital Doce de Octubre, Avenida de Córdoba, s/n, Madrid, Spain
| | - Fernando Arribas
- Cardiac Electrophysiology Unit, Department of Cardiology, Hospital Doce de Octubre, Avenida de Córdoba, s/n, Madrid, Spain
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22
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Sieniewicz BJ, Gould J, Porter B, Sidhu BS, Teall T, Webb J, Carr-White G, Rinaldi CA. Understanding non-response to cardiac resynchronisation therapy: common problems and potential solutions. Heart Fail Rev 2019; 24:41-54. [PMID: 30143910 PMCID: PMC6313376 DOI: 10.1007/s10741-018-9734-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Heart failure is a complex clinical syndrome associated with a significant morbidity and mortality burden. Reductions in left ventricular (LV) function trigger adaptive mechanisms, leading to structural changes within the LV and the potential development of dyssynchronous ventricular activation. This is the substrate targeted during cardiac resynchronisation therapy (CRT); however, around 30-50% of patients do not experience benefit from this treatment. Non-response occurs as a result of pre-implant, peri-implant and post implant factors but the technical constraints of traditional, transvenous epicardial CRT mean they can be challenging to overcome. In an effort to improve response, novel alternative methods of CRT delivery have been developed and of these endocardial pacing, where the LV is stimulated from inside the LV cavity, appears the most promising.
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Affiliation(s)
- Benjamin J Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK.
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Baldeep S Sidhu
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Thomas Teall
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Jessica Webb
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Gerarld Carr-White
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Christopher A Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
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23
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Performance and clinical comparison between left ventricular quadripolar and bipolar leads in cardiac resynchronization therapy: Observational research. Indian Heart J 2018; 70:864-871. [PMID: 30580858 PMCID: PMC6306340 DOI: 10.1016/j.ihj.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 03/08/2018] [Accepted: 05/06/2018] [Indexed: 12/03/2022] Open
Abstract
Aim To evaluate Attain Performa (Medtronic, Dublin, Ireland) quadripolar lead performance in clinical practice and, secondarily, to compare its long term clinical outcomes vs bipolar leads for left ventricular (LV) pacing. Methods and results We retrospectively analyzed clinical, procedural and follow-up data of 215 patients implanted with a quadripolar lead. One hundred and twenty one patients implanted with bipolar lead were selected to compare long-term clinical outcomes. The quadripolar lead was implanted in the target vein in 196 patients (91%) without acute dislodgements. In 50% of patients the chosen final pacing configuration at implant would not have been available with bipolar leads. A dedicated quadripolar pacing vector was chosen more frequently when the LV tip location was apical than otherwise (65.6% vs 42.7%, p = 0.003). After a median follow-up of 14 months, the LV pacing threshold was less than 2.5 V at 0.4 ms in 98 patients (90%) with a safety margin between phrenic nerve and LV pacing threshold >3 V in 97 patients (89%). We observed a slight trend toward a lower risk of heart failure worsening and a lower incidence of ventricular arrhythmias and pulmonary congestion in patients implanted with quadripolar leads compared with the control group. Conclusion Quadripolar leads improve the management of phrenic nerve stimulation at no trade-off with pacing threshold and lead stability. Quadripolar leads seems to be associated with a lower incidence of VT/VF and pulmonary congestion, when compared with bipolar leads, but further investigations are necessary to confirm that this positive effect is associated with better LV reverse remodeling.
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24
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de la Concha Castañeda JF, García Guerrero JJ, Merchán Cuenda M, Doblado Calatrava M. Abolition of diaphragmatic stimulation and restoration of left ventricular pacing by nonsurgical withdrawal of the left ventricular lead: Report of two cases. HeartRhythm Case Rep 2018; 4:102-104. [PMID: 29707484 PMCID: PMC5918181 DOI: 10.1016/j.hrcr.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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25
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von Bary C, Laski V, Fricke H, Linhardt F, Reithmann C, Fiek M. Impact of intraoperative mechanical ventilation on left ventricular lead function in cardiac resynchronization therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:578-582. [PMID: 29577341 DOI: 10.1111/pace.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/04/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intraoperative controlled mechanical ventilation (CMV) changes the intrathoracic geometry and may impact postoperative left ventricular (LV) lead function after CRT implantation. This multicenter study investigates the effect of intraoperative ventilation setting (spontaneous breathing [SB] vs CMV) on postoperative LV lead function taking into account patients' body mass index (BMI). METHODS CRT implantation was performed at two centers during SB in 92 and during CMV in 73 patients. Follow-up was carried out after 3 ± 5 and 36 ± 53 days. Functional lead parameters (FLP; pacing threshold and impedance), postoperative adverse events (A; phrenic nerve stimulation [PNS] and lead malfunction), and patients' BMI were assessed. Delta values of FLP between baseline and follow-up visits were analyzed applying an analysis of covariance model to detect subclinical alterations in LV lead function. RESULTS AE occurred in a total of 36 (21%) patients. PNS was observed in 26 (15%) patients and LV lead repositioning due to malfunction was necessary in 10 (6%) patients. Both AE and FLP delta values between baseline and follow-up were not associated with intraoperative ventilation settings nor the patients' BMI. CONCLUSIONS This study demonstrates that there is no impact of the intraoperative ventilation setting (SB vs CMV) on postoperative FLP or the occurrence of AE. This is also the case taking into account the BMI. With respect to these findings both approaches-sedation only or general anaesthesia including CMV-can be safely implemented during CRT implantation.
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Affiliation(s)
- Christian von Bary
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Viktoria Laski
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Hannes Fricke
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Florian Linhardt
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Christopher Reithmann
- Medizinische Klinik I, Helios Klinikum München West, Lehrkrankenhaus der Ludwig-Maximilans-Universität München, München, Germany
| | - Michael Fiek
- Medizinische Klinik I, Helios Klinikum München West, Lehrkrankenhaus der Ludwig-Maximilans-Universität München, München, Germany
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26
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Okamura H. Up-to-date cardiac resynchronization therapy. J Gen Fam Med 2017; 18:195-199. [PMID: 29264026 PMCID: PMC5689416 DOI: 10.1002/jgf2.24] [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: 01/12/2016] [Accepted: 04/19/2016] [Indexed: 11/10/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) has been first reported more than 10 years ago as a therapy for patients with severe chronic heart failure. The efficacy of CRT has been proven in many studies that it improves not only quality of life but also the prognosis of the patients. Its indication has been expanded for patients with mild heart failure. On the other hand, some patients cannot receive enough benefit through CRT. The position of the left ventricular lead is limited due to the anatomy of coronary sinus branches, pacing threshold of the myocardium, phrenic nerve stimulation, and so on. Also, the right selection of the candidates for CRT is critical to receive the most benefit of this therapy. The target of this review article is to describe the efficacy and the indication of CRT, which can be of any help to enroll more patients with heart failure who are likely to get benefits through CRT.
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Affiliation(s)
- Hideo Okamura
- National Cerebral and Cardiovascular Center; Osaka Japan
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27
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Malagù M, Marcantoni L, Scalone A, Toselli T, Pratola C, Bertini M. A migrant left ventricular lead. J Cardiovasc Med (Hagerstown) 2017; 18:782-783. [DOI: 10.2459/jcm.0b013e3283654ca4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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28
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Sardu C, Barbieri M, Santamaria M, Giordano V, Sacra C, Paolisso P, Spirito A, Marfella R, Paolisso G, Rizzo MR. Multipolar pacing by cardiac resynchronization therapy with a defibrillators treatment in type 2 diabetes mellitus failing heart patients: impact on responders rate, and clinical outcomes. Cardiovasc Diabetol 2017; 16:75. [PMID: 28599667 PMCID: PMC5466779 DOI: 10.1186/s12933-017-0554-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/23/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a multi factorial disease, affecting clinical outcomes in failing heart patients treated by cardiac resynchronization therapy with a defibrillator (CRT-d). METHODS One hundred and ninety-five T2DM patients received a CRT-d treatment. Randomly the study population received a CRT-d via multipolar left ventricle (LV) lead pacing (n 99, multipolar group), vs a CRT-d via bipolar LV pacing (n 96, bipolar group). These patients were followed by clinical, and instrumental assessment, and telemetric device control at follow up. In this study we evaluated, in a population of failing heart T2DM patients, cardiac deaths, all cause deaths, arrhythmic events, CRT-d responders rate, hospitalizations for HF worsening, phrenic nerve stimulation (PNS), and LV catheter dislodgment events (and re-intervention for LV catheter re-positioning), comparing multipolar CRT-d vs bipolar CRT-d group of patients at follow up. RESULTS At follow up there was a statistical significant difference about atrial arrhythmic events [7 (7%) vs 16 (16.7%), p value 0.019], hospitalizations for HF worsening [15 (15.2% vs 24 (25%), p value 0.046], LV catheter dislodgments [1 (1%) vs 9 (9.4%), p value 0018], PNS [5 (5%) vs 18 (18.7%), p value 0.007], and LV re-positioning [1 (1%) vs 9 (9.4%), p value 0.018], comparing multipolar CRT-d vs bipolar CRT-d group of patients. Multipolar pacing was an independent predictor of all these events. CONCLUSIONS CRT-d pacing via multipolar LV lead vs bipolar LV lead may reduce arrhythmic burden, hospitalization rate, PNS, LV catheters dislodgments, and re-interventions in T2DM failing heart patients. Clinical trial number NCT03095196.
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Affiliation(s)
- Celestino Sardu
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy. .,Cardiovascular and Arrhythmias Department, John Paul II Research and Care Foundation, Campobasso, Italy. .,Cardiovascular Department, Inselspital of Bern University, Bern, Switzerland.
| | - Michelangela Barbieri
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Matteo Santamaria
- Cardiovascular and Arrhythmias Department, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Valerio Giordano
- Cardiovascular and Arrhythmias Department, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Cosimo Sacra
- Cardiovascular and Arrhythmias Department, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Pasquale Paolisso
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Alessandro Spirito
- Cardiovascular Department, Inselspital of Bern University, Bern, Switzerland
| | - Raffaele Marfella
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Giuseppe Paolisso
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Maria Rosaria Rizzo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
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Molina-Martín de Nicolás J, López-Gil M, Fontenla A, Salguero R, Díaz-Antón B, Arribas F. Estimulación frénica de aparición tardía en paciente superrespondedor a la terapia de resincronización. ¿El precio del éxito? Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Molina-Martín de Nicolás J, López-Gil M, Fontenla A, Salguero R, Díaz-Antón B, Arribas F. Late Phrenic Nerve Stimulation in a Super-responder to Cardiac Resynchronization Therapy. The Toll of Success? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:868-870. [PMID: 27425122 DOI: 10.1016/j.rec.2016.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/07/2016] [Indexed: 06/06/2023]
Affiliation(s)
| | - María López-Gil
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Adolfo Fontenla
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rafael Salguero
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Belén Díaz-Antón
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Arribas
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
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Turagam MK, Afzal MR, Iskander S, Madhu-Reddy, Biase LD, Natale A, Lakkireddy D. A Meta-Analysis Of Quadripolar Versus Bipolar Left Ventricular Leads On Post-Procedural Outcomes. J Atr Fibrillation 2016; 9:1472. [PMID: 27909543 DOI: 10.4022/jafib.1472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 08/19/2016] [Accepted: 08/24/2016] [Indexed: 11/10/2022]
Abstract
Objective: We aimed to perform a meta-analysis from eligible studies to analyze the true impact of QL when compared with BL with regard to post-procedural outcomes including lead deactivation, revision or replacement. Background: Many observational and retrospective studies showed that quadripolar left ventricular leads (QL) are associated with better outcomes and fewer complications when compared with bipolar leads (BL). Methods: We performed a comprehensive literature search through June 30, 2015 using: quadripolar, bipolar, left ventricular lead and CRT in Pubmed, Ebsco and google scholar databases. Results: The analysis included 8 studies comparing QL and BL implantation. Post-procedural outcomes such as lead deactivation, revision or replacement were used as primary outcome and assessed with Mantel-Haenszel risk ratio (RR). Secondary outcomes included total fluoroscopy/procedure time, occurrence of phrenic nerve stimulation (PNS) and all-cause mortality on follow up. Follow-up duration for the studies ranged from 3 to 60 months. Compared with BL, the use of QL is associated with 52 % reduction (relative risk 0.48; 95% CI: 0.36-0.64, p=0.00001) in the risk of deactivation, revision or replacement of the LV lead. QL had significantly lower fluoroscopy/procedure time, PNS and all-cause mortality when compared with BL. Conclusion:Our meta-analysis shows that QL implantation was associated with decreased risk of LV lead deactivation, revision or replacement when compared with BL.
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Affiliation(s)
- Mohit K Turagam
- Division of Cardiovascular Medicine, University of Missouri Hospital and Clinics, Columbia, MO
| | - Muhammad R Afzal
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Sandia Iskander
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Madhu-Reddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
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Mafi-Rad M, Luermans JGLM, Blaauw Y, Janssen M, Crijns HJ, Prinzen FW, Vernooy K. Feasibility and Acute Hemodynamic Effect of Left Ventricular Septal Pacing by Transvenous Approach Through the Interventricular Septum. Circ Arrhythm Electrophysiol 2016; 9:e003344. [PMID: 26888445 DOI: 10.1161/circep.115.003344] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular septal (LVS) pacing reduces ventricular dyssynchrony and improves cardiac function relative to right ventricular apex (RVA) pacing in animals. We aimed to establish permanent placement of an LVS pacing lead in patients using a transvenous approach through the interventricular septum. METHODS AND RESULTS Ten patients with sinus node dysfunction scheduled for dual-chamber pacemaker implantation were prospectively enrolled. A custom pacing lead with extended helix was introduced via the left subclavian vein and, after positioning against the right ventricular septum (RVS) using a preshaped guiding catheter, driven through the interventricular septum to the LVS. The acute hemodynamic effect of RVA, RVS, and LVS pacing was evaluated by invasive LVdP/dtmax measurements. The lead was successfully delivered to the LVS in all patients. Procedure time and fluoroscopy time shortened with experience. QRS duration was shorter during LVS pacing (144 ± 20 ms) than during RVA (172 ± 33 ms; P = 0.02 versus LVS) and RVS pacing (165 ± 17 ms; P = 0.004 versus LVS). RVA and RVS pacing reduced LVdP/dtmax compared with baseline atrial pacing (-7.1 ± 4.1% and -6.9 ± 4.3%, respectively), whereas LVS pacing maintained LVdP/dtmax at baseline level (1.0 ± 4.3%; P = 0.001 versus RVA and RVS). R-wave amplitude and pacing threshold were 12.2 ± 6.7 mV and 0.5 ± 0.2 V at implant and remained stable during 6-month follow-up without lead-related complications. CONCLUSIONS Permanent placement of an LVS pacing lead by transvenous approach through the interventricular septum is feasible in patients. LVS pacing preserves acute left ventricular pump function. This new pacing method could serve as an alternative and hemodynamically preferable approach for antibradycardia pacing.
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Affiliation(s)
- Masih Mafi-Rad
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.)
| | - Justin G L M Luermans
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.)
| | - Yuri Blaauw
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.)
| | - Michel Janssen
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.)
| | - Harry J Crijns
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.)
| | - Frits W Prinzen
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.)
| | - Kevin Vernooy
- From the Department of Cardiology, Maastricht University Medical Center, The Netherlands (M.M.-R., J.G.L.M.L., Y.B., M.J., H.J.C., K.V.); and Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, The Netherlands (F.W.P.).
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Ziacchi M, Diemberger I, Biffi M, Martignani C, Bertini M, Rocchi G, Biagini E, Graziosi M, Mazzotti A, Rapezzi C, Boriani G. Predictors of nonsimultaneous interventricular delay at cardiac resynchronization therapy optimization. J Cardiovasc Med (Hagerstown) 2016; 17:299-305. [DOI: 10.2459/jcm.0000000000000196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Boriani G, Connors S, Kalarus Z, Lemke B, Mullens W, Osca Asensi J, Raatikainen P, Gazzola C, Farazi TG, Leclercq C. Cardiac Resynchronization Therapy With a Quadripolar Electrode Lead Decreases Complications at 6 Months. JACC Clin Electrophysiol 2016; 2:212-220. [DOI: 10.1016/j.jacep.2015.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/14/2015] [Accepted: 10/08/2015] [Indexed: 11/29/2022]
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Abstract
Cardiac resynchronisation therapy (CRT) is an important therapy for patients with heart failure with a reduced ejection fraction and interventricular conduction delay. Large trials have established the role of CRT in reducing heart failure hospitalisations and improving symptoms, left ventricular (LV) function and mortality. Guidelines from major medical societies are consistent in support of CRT for patients with New York Health Association (NYHA) class II, III and ambulatory class IV heart failure, reduced LV ejection fraction and QRS prolongation, particularly left bundle branch block. The current challenge facing practitioners is to maximise the rate of patients who respond to CRT and the magnitude of that response. Current areas of interest for achieving these goals include tailoring patient selection, individualising LV lead placement and application of new technologies and techniques for CRT delivery.
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Affiliation(s)
- Geoffrey F Lewis
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, US
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, US
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Capucci A, Luzi M, Cipolletta L, Molini S. Health economic concerns on cardiac rhythm management devices longevity and how to overcome them. Expert Rev Med Devices 2016; 13:297-303. [PMID: 26778415 DOI: 10.1586/17434440.2016.1142871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The number of device implantations is in constant increase due to the ageing population, extended indications to implant for preventing sudden cardiac death and treating heart failure. An increase in the number of implants is directly related to a higher number of device replacements and that is one of the most important risk factors for device infection. Therefore, all the above mentioned factors contribute to an increase in the cost for health care system. Currently, several methods help to prolong device battery longevity and consequently reduce the costs, such as: a new battery, drug eluting leads, high impedance leads, algorithm to minimize unnecessary pacing, capture management and correct programming to avoid inappropriate and unnecessary shock in Implantable Cardioverter Defibrillators and Cardiac Resynchronization Therapy devices. Furthermore remote monitoring is very promising to reduce health system costs related to devices.
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Affiliation(s)
| | - Mario Luzi
- a Cardiology Clinic , Marche Polytechnic University , Ancona , Italy
| | - Laura Cipolletta
- a Cardiology Clinic , Marche Polytechnic University , Ancona , Italy
| | - Silvano Molini
- a Cardiology Clinic , Marche Polytechnic University , Ancona , Italy
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Ziacchi M, Saporito D, Zardini M, Luzi M, Quartieri F, Morgagni G, De Maria E, Bertini M, Carinci V, Boriani G, Biffi M. Left Ventricular Reverse Remodeling Elicited by a Quadripolar Lead: Results from the Multicenter Per4mer Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:250-60. [PMID: 26643691 DOI: 10.1111/pace.12792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/07/2015] [Accepted: 12/01/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND To understand the impact of a quadripolar left ventricular (LV) lead on reverse remodeling and phrenic nerve stimulation (PNS) in congestive heart failure patients treated by cardiac resynchronization therapy at 8-month follow-up (FU). METHODS One hundred and fifty-eight patients received an LV Medtronic Performa lead (Medtronic Inc., Minneapolis, MN, USA) and were reevaluated at FU by echocardiography and measurement of electrical parameters. RESULTS A targeted LV lead placement was achieved in 140 (89%) patients. Super responders and responders were 76 (50%) and 26 (18%), respectively, at FU; seven (4%) died and 13 (8%) were hospitalized for any cause. Nonischemic etiology was the only independent predictor of reverse remodeling. The configurations available only with the Performa leads reduced PNS occurrence at 8 V@0.4 ms from 43 (27%) to 14 (9%) of patients at implantation, and from 44 (28%) to 19 (12%) at last FU, compared to configurations available with bipolar leads. Patients with detectable PNS had >10/16 pacing configurations with a PNS safety margin >2 V both at implantation and at FU. During FU 16 (10%) patients had an adverse event possibly related to the lead or to modification of the underlying heart disease but 99% of these events were fixed by reprogramming of the pacing vector. CONCLUSIONS Performa Lead enables an increased capability to achieve a targeted lead positioning in the broad clinical scenario of large- and small-volume implanting centers, with a relevant impact on the occurrence of reverse remodeling compared to literature data. The enhanced management of PNS resulted in a dislodgement rate of only 1%.
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Affiliation(s)
- Matteo Ziacchi
- Institute of Cardiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Marco Zardini
- Division of Cardiology, University Hospital, Parma, Italy
| | - Mario Luzi
- Cardiovascular Department, Ospedali Riuniti, Ancona, Italy
| | - Fabio Quartieri
- Division of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | - Elia De Maria
- Division of Cardiology, Ramazzini Hospital, Carpi, Italy
| | | | | | - Giuseppe Boriani
- Institute of Cardiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Biffi
- Institute of Cardiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Huntsinger ME, Rabara R, Peralta I, Doshi RN. Current Technology to Maximize Cardiac Resynchronization Therapy Benefit for Patients With Symptomatic Heart Failure. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The incidence of heart failure (HF) continues to increase, affecting millions of people in the United States each year. Cardiac resynchronization therapy (CRT) has been used and studied for patients with symptomatic HF for more than 20 years. The purpose of this article is to review technologies and developments to help maximize CRT for patients with symptomatic HF. Although most interventions to optimize CRT are physician directed, nurses also have an important role in the care and education of patients with symptomatic HF and can affect clinical outcomes. Therefore, nurses’ understanding of CRT and measures to maximize this lifesaving therapy is critical in HF management.
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Affiliation(s)
- Mary Eng Huntsinger
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Roselou Rabara
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Irene Peralta
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Rahul N. Doshi
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
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Syed FF, DeSimone CV, Ebrille E, Gaba P, Ladewig DJ, Mikell SB, Suddendorf SH, Gilles EJ, Danielsen AJ, Lukášová M, Wolf J, Leinveber P, Novák M, Stárek Z, Kara T, Bruce CJ, Friedman PA, Asirvatham SJ. Percutaneous Epicardial Pacing using a Novel Insulated Multi-electrode Lead. JACC Clin Electrophysiol 2015; 1:273-283. [PMID: 27547832 DOI: 10.1016/j.jacep.2015.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Epicardial cardiac resynchronization therapy (CRT) permits unrestricted electrode positioning. However, this requires surgical placement of device leads and the risk of unwanted phrenic nerve stimulation. We hypothesized that shielded electrodes can capture myocardium without extracardiac stimulation. METHODS In 6 dog and 5 swine experiments, we used a percutaneous approach to access the epicardial surface of the heart, and deploy novel leads housing multiple electrodes with selective insulation. Bipolar pacing thresholds at prespecified sites were tested compare electrode threshold data both facing towards and away from the epicardial surface. RESULTS In 151 paired electrode recordings (70 in 6 dogs; 81 in 5 swine), thresholds facing myocardium were lower than facing away (median [IQR] mA: dogs 0.9 [0.4-1.6] vs 4.6 [2.1 to >10], p<0.0001; swine 0.5 [0.2-1] vs 2.5 [0.5-6.8], p<0.0001). Myocardial capture was feasible without extracardiac stimulation at all tested sites, with mean ± SE threshold margin 3.6±0.7 mA at sites of high output extracardiac stimulation (p=0.004). CONCLUSION Selective electrode insulation confers directional pacing to a multielectrode epicardial pacing lead. This device has the potential for a novel percutaneous epicardial resynchronization therapy that permits placement at an optimal pacing site, irrespective of the anatomy of the coronary veins or phrenic nerves.
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Affiliation(s)
- Faisal F Syed
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Christopher V DeSimone
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Elisa Ebrille
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | - Markéta Lukášová
- ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic
| | - Jiří Wolf
- ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic
| | - Pavel Leinveber
- ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic
| | - Miroslav Novák
- ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic
| | - Zdeněk Stárek
- ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic
| | - Tomas Kara
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN; ICRC - Department of Cardiovascular Diseases, St Anne's University Hospital, Brno, Czech Republic
| | - Charles J Bruce
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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Colquitt JL, Mendes D, Clegg AJ, Harris P, Cooper K, Picot J, Bryant J. Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure: systematic review and economic evaluation. Health Technol Assess 2015; 18:1-560. [PMID: 25169727 DOI: 10.3310/hta18560] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This assessment updates and expands on two previous technology assessments that evaluated implantable cardioverter defibrillators (ICDs) for arrhythmias and cardiac resynchronisation therapy (CRT) for heart failure (HF). OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of ICDs in addition to optimal pharmacological therapy (OPT) for people at increased risk of sudden cardiac death (SCD) as a result of ventricular arrhythmias despite receiving OPT; to assess CRT with or without a defibrillator (CRT-D or CRT-P) in addition to OPT for people with HF as a result of left ventricular systolic dysfunction (LVSD) and cardiac dyssynchrony despite receiving OPT; and to assess CRT-D in addition to OPT for people with both conditions. DATA SOURCES Electronic resources including MEDLINE, EMBASE and The Cochrane Library were searched from inception to November 2012. Additional studies were sought from reference lists, clinical experts and manufacturers' submissions to the National Institute for Health and Care Excellence. REVIEW METHODS Inclusion criteria were applied by two reviewers independently. Data extraction and quality assessment were undertaken by one reviewer and checked by a second. Data were synthesised through narrative review and meta-analyses. For the three populations above, randomised controlled trials (RCTs) comparing (1) ICD with standard therapy, (2) CRT-P or CRT-D with each other or with OPT and (3) CRT-D with OPT, CRT-P or ICD were eligible. Outcomes included mortality, adverse events and quality of life. A previously developed Markov model was adapted to estimate the cost-effectiveness of OPT, ICDs, CRT-P and CRT-D in the three populations by simulating disease progression calculated at 4-weekly cycles over a lifetime horizon. RESULTS A total of 4556 references were identified, of which 26 RCTs were included in the review: 13 compared ICD with medical therapy, four compared CRT-P/CRT-D with OPT and nine compared CRT-D with ICD. ICDs reduced all-cause mortality in people at increased risk of SCD, defined in trials as those with previous ventricular arrhythmias/cardiac arrest, myocardial infarction (MI) > 3 weeks previously, non-ischaemic cardiomyopathy (depending on data included) or ischaemic/non-ischaemic HF and left ventricular ejection fraction ≤ 35%. There was no benefit in people scheduled for coronary artery bypass graft. A reduction in SCD but not all-cause mortality was found in people with recent MI. Incremental cost-effectiveness ratios (ICERs) ranged from £14,231 per quality-adjusted life-year (QALY) to £29,756 per QALY for the scenarios modelled. CRT-P and CRT-D reduced mortality and HF hospitalisations, and improved other outcomes, in people with HF as a result of LVSD and cardiac dyssynchrony when compared with OPT. The rate of SCD was lower with CRT-D than with CRT-P but other outcomes were similar. CRT-P and CRT-D compared with OPT produced ICERs of £27,584 per QALY and £27,899 per QALY respectively. The ICER for CRT-D compared with CRT-P was £28,420 per QALY. In people with both conditions, CRT-D reduced the risk of all-cause mortality and HF hospitalisation, and improved other outcomes, compared with ICDs. Complications were more common with CRT-D. Initial management with OPT alone was most cost-effective (ICER £2824 per QALY compared with ICD) when health-related quality of life was kept constant over time. Costs and QALYs for CRT-D and CRT-P were similar. The ICER for CRT-D compared with ICD was £27,195 per QALY and that for CRT-D compared with OPT was £35,193 per QALY. LIMITATIONS Limitations of the model include the structural assumptions made about disease progression and treatment provision, the extrapolation of trial survival estimates over time and the assumptions made around parameter values when evidence was not available for specific patient groups. CONCLUSIONS In people at risk of SCD as a result of ventricular arrhythmias and in those with HF as a result of LVSD and cardiac dyssynchrony, the interventions modelled produced ICERs of < £30,000 per QALY gained. In people with both conditions, the ICER for CRT-D compared with ICD, but not CRT-D compared with OPT, was < £30,000 per QALY, and the costs and QALYs for CRT-D and CRT-P were similar. A RCT comparing CRT-D and CRT-P in people with HF as a result of LVSD and cardiac dyssynchrony is required, for both those with and those without an ICD indication. A RCT is also needed into the benefits of ICD in non-ischaemic cardiomyopathy in the absence of dyssynchrony. STUDY REGISTRATION This study is registered as PROSPERO number CRD42012002062. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Jill L Colquitt
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Diana Mendes
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Andrew J Clegg
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Petra Harris
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Keith Cooper
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Joanna Picot
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Jackie Bryant
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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Behar JM, Bostock J, Zhu Li AP, Chin HMS, Jubb S, Lent E, Gamble J, Foley PWX, Betts TR, Rinaldi CA, Herring N. Cardiac Resynchronization Therapy Delivered Via a Multipolar Left Ventricular Lead is Associated with Reduced Mortality and Elimination of Phrenic Nerve Stimulation: Long-Term Follow-Up from a Multicenter Registry. J Cardiovasc Electrophysiol 2015; 26:540-6. [PMID: 25631303 PMCID: PMC4864396 DOI: 10.1111/jce.12625] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 12/24/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) using quadripolar left ventricular (LV) leads provides more pacing vectors compared to bipolar leads. This may avoid phrenic nerve stimulation (PNS) and allow optimal lead placement to maximize biventricular pacing. However, a long-term improvement in patient outcome has yet to be demonstrated. METHODS A total of 721 consecutive patients with conventional CRTD criteria implanted with quadripolar (n = 357) or bipolar (n = 364) LV leads were enrolled into a registry at 3 UK centers. Lead performance and mortality was analyzed over a 5-year period. RESULTS Patients receiving a quadripolar lead were of similar age and sex to those receiving a bipolar lead, although a lower proportion had ischemic heart disease (62.6% vs. 54.1%, P = 0.02). Both groups had similar rates of procedural success, although lead threshold, impedance, and procedural radiation dose were significantly lower in those receiving a quadripolar lead. PNS was more common in those with quadripolar leads (16.0% vs. 11.6%, P = 0.08), but was eliminated by switching pacing vector in all cases compared with 60% in the bipolar group (P < 0.001). Furthermore, LV lead displacement (1.7% vs. 4.6%, P = 0.03) and repositioning (2.0% vs. 5.2%, P = 0.03) occurred significantly less often in those with a quadripolar lead. All-cause mortality was also significantly lower in the quadripolar compared to bipolar lead group in univariate and multivariate analysis (13.2% vs. 22.5%, P < 0.001). CONCLUSIONS In a large, multicenter experience, the use of quadripolar LV leads for CRT was associated with elimination of PNS and lower overall mortality. This has important implications for LV pacing lead choice.
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Affiliation(s)
- Jonathan M Behar
- Department of Imaging Sciences and Bioengineering, BHF Centre of Research Excellence, The Rayne Institute, London, UK
- Department of Cardiology, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Julian Bostock
- Department of Imaging Sciences and Bioengineering, BHF Centre of Research Excellence, The Rayne Institute, London, UK
- Department of Cardiology, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Adrian Po Zhu Li
- Department of Cardiology, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Hui Men Selina Chin
- Department of Cardiology, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Stephen Jubb
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK
| | - Edward Lent
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK
| | - James Gamble
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK
| | - Paul W X Foley
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK
- Great Western Hospital, Swindon, UK
| | - Tim R Betts
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK
| | - Christopher Aldo Rinaldi
- Department of Imaging Sciences and Bioengineering, BHF Centre of Research Excellence, The Rayne Institute, London, UK
- Department of Cardiology, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Neil Herring
- Department of Cardiology, Guy's and St Thomas's NHS Foundation Trust, London, UK
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK
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VAN GELDER BERRYM, BRACKE FRANKA. Acute Hemodynamic Effects of Single- and Dual-Site Left Ventricular Pacing Employing a Dual Cathodal Coronary Sinus Lead. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:558-64. [DOI: 10.1111/pace.12606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/28/2014] [Accepted: 01/28/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | - FRANK A. BRACKE
- Department of Cardiology; Catharina Hospital; Eindhoven the Netherlands
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Improved implant and postoperative lead performance in CRT-D patients implanted with a quadripolar left ventricular lead. A 6-month follow-up analysis from a multicenter prospective comparative study. J Interv Card Electrophysiol 2014; 42:59-66. [DOI: 10.1007/s10840-014-9956-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
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OSCA JOAQUÍN, ALONSO PAU, CANO ÓSCAR, SÁNCHEZ JUANMIGUEL, TEJADA DAVID, ANDRÉS ANA, SANCHO TELLO MARÍAJOSÉ, OLAGÜE JOSÉ. The Use of Quadripolar Left Ventricular Leads Improves the Hemodynamic Response to Cardiac Resynchronization Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:326-33. [DOI: 10.1111/pace.12545] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/09/2014] [Accepted: 10/19/2014] [Indexed: 11/29/2022]
Affiliation(s)
- JOAQUÍN OSCA
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - PAU ALONSO
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - ÓSCAR CANO
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - JUAN MIGUEL SÁNCHEZ
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - DAVID TEJADA
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - ANA ANDRÉS
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - MARÍA JOSÉ SANCHO TELLO
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - JOSÉ OLAGÜE
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
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Corbisiero R, Muller D. Profile of St. Jude Medical's Allure Quadra quadripolar pacemaker system for cardiac resynchronization therapy. Expert Rev Med Devices 2014; 12:41-8. [PMID: 25418543 DOI: 10.1586/17434440.2015.984686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Congestive heart failure is a major public health epidemic and economic burden in the USA and worldwide. Cardiac resynchronization therapy is an effective therapy for treating congestive heart failure in conjunction with pharmacologic therapy. The average congestive heart failure admission costs approximately US$ 8 billion annually. Current cardiac resynchronization therapy pacemaker systems from various manufacturers deliver therapy-utilizing bipolar leads including the left ventricle, with electrode spacing ranging from 8 to 22 mm. The Quartet LV™ lead model 1458Q (St. Jude Medical Sylmar, CA) is a quadripolar lead with a 4.0 Fr. tip electrode and three 4.7 Fr. ring electrodes located 20, 30 and 47 mm from the tip. The Quartet lead and Allure Quadra TM allows 14 pacing configurations, providing benefits, including reductions in phrenic nerve stimulation, reduced pacing thresholds, improved battery longevity and potential reductions, in non-responders to cardiac resynchronization therapy. In addition, there is cost benefit data from utilizing quadripolar technology compared with traditional bipolar cardiac resynchronization therapy.
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Forleo GB, Di Biase L, Bharmi R, Dalal N, Panattoni G, Pollastrelli A, Tesauro M, Santini L, Natale A, Romeo F. Hospitalization rates and associated cost analysis of cardiac resynchronization therapy with an implantable defibrillator and quadripolar vs. bipolar left ventricular leads: a comparative effectiveness study. Europace 2014; 17:101-7. [PMID: 25371428 PMCID: PMC4280828 DOI: 10.1093/europace/euu290] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aims This study compares, from a prospective, observational, non-randomized registry, the post-implant hospitalization rates and associated healthcare resource utilization of cardiac resynchronization therapy-defibrillator (CRT-D) patients with quadripolar (QUAD) vs. bipolar (BIP) left ventricular (LV) leads. Methods and results Between January 2009 and December 2012, 193 consecutive patients receiving de novo CRT-D implants with either a QUAD (n = 116) or a BIP (n = 77) LV lead were enrolled at implant and followed until July 2013 at a single-centre, university hospital. Post-implant hospitalizations related to heart failure (HF) or LV lead surgical revision and associated payer costs were identified using ICD-9-CM diagnosis and procedure codes. Italian national reimbursement rates were determined. Propensity scores were estimated using a logistic regression model based upon 11 pre-implant baseline characteristics and were used to derive a 1 : 1 matched cohort of QUAD (n = 77) and BIP (n = 77) patients. Hospitalization rates for the two groups were compared using negative binomial regression and associated payer costs were compared using non-parametric bootstrapping (×10 000) and one-sided hypothesis test. Hospitalization rates of the QUAD group [0.15/ patient (pt)-year] were lower than those of the BIP group (0.32/ pt-year); the incidence rate ratio was 0.46, P = 0.04. The hospitalization costs for the QUAD group (434 ± 128 €/pt-year) were lower than those for the BIP group (1136 ± 362 €/pt-year). The average difference was 718 €/pt-year, P = 0.016. Conclusions In this comparative effectiveness assessment of well-matched groups of CRT-D patients with quadripolar and bipolar LV leads, QUAD patients experienced a lower rate of hospitalizations for HF and LV lead surgical revision, and a lower cost burden. This has important implications for LV pacing lead choice.
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Affiliation(s)
- Giovanni B Forleo
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
| | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, USA Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, USA Department of Cardiology, University of Foggia, Foggia, Italy
| | | | | | - Germana Panattoni
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
| | | | - Manfredi Tesauro
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
| | - Luca Santini
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, USA
| | - Francesco Romeo
- Department of Cardiology, University of Rome 'Tor Vergata', Viale Oxford, 81, Rome 00133, Italy
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Seifert M, Schau T, Schoepp M, Arya A, Neuss M, Butter C. MitraClip in CRT non-responders with severe mitral regurgitation. Int J Cardiol 2014; 177:79-85. [DOI: 10.1016/j.ijcard.2014.09.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/16/2014] [Indexed: 12/30/2022]
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48
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Rinaldi CA, Burri H, Thibault B, Curnis A, Rao A, Gras D, Sperzel J, Singh JP, Biffi M, Bordachar P, Leclercq C. A review of multisite pacing to achieve cardiac resynchronization therapy. Europace 2014; 17:7-17. [DOI: 10.1093/europace/euu197] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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49
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Mafi Rad M, Blaauw Y, Dinh T, Pison L, Crijns HJ, Prinzen FW, Vernooy K. Left ventricular lead placement in the latest activated region guided by coronary venous electroanatomic mapping. Europace 2014; 17:84-93. [DOI: 10.1093/europace/euu221] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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50
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Huang JL, Lin YJ, Hung YW, Hsieh YC, Cheng CM, Wang KY. Preventing phrenic nerve stimulation by a patch insulation in an intact swine heart model. PLoS One 2014; 9:e102608. [PMID: 25033271 PMCID: PMC4102517 DOI: 10.1371/journal.pone.0102608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/04/2014] [Indexed: 12/04/2022] Open
Abstract
Introduction Phrenic nerve stimulation (PNS) could be prevented by a silastic patch over the epicardial lead. We studied the effects in preventing PNS by placing a silastic patch directly over an epicardial lead or placing a graft around the phrenic nerve (PN). Methods and Results Fourteen Lanyu swine were enrolled. A bipolar lead was placed epicardially on the left ventricle (LV) inferior to the PN. An implantable cardioverter-defibrillator (ICD) lead was placed into the right ventricle (RV). The maximal influential distance (MID) was measured under 3 pacing configurations to express the influential electrical field on the PN. The threshold of the LV and PN were evaluated epicardially. Then, PTFE patches of different sizes (10×10 mm, 20×20 mm and 30×30 mm) were placed between the LV lead and PN to study the rise in PN threshold in 7 swine. On the other hand, the PN were surrounded by a PTFE graft of different lengths (10 mm, 20 mm, and 30 mm) in the remaining 7 swine. LV-bipolar pacing showed the shortest MID when compared to the other 2 unipolar pacing configurations at pacing voltage of 10 V. The patch was most effective in preventing PNS during LV-bipolar pacing. PNS was prevented under all circumstances with a larger PTFE patch (30×30 mm) or long graft (30 mm). Conclusions PNS was avoided by placing a PTFE patch over the LV lead or a graft around the PN despite pacing configurations. Hence if PNS persisted during CRT implantation, a PTFE patch on the LV lead or a graft around the PN could be considered.
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Affiliation(s)
- Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- * E-mail:
| | - Yenn-Jiang Lin
- Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Wen Hung
- Department of Education and Research, Taichung Veterans General Hospital, Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Ming Cheng
- Division of Cardiology, Department of Medicine, Feng Yuan Hospital of the Ministry of Health and Welfare, Executive Yuan, Taichung City, Taiwan (R.O.C)
| | - Kuo-Yang Wang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
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