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Ziacchi M, Anselmino M, Palmisano P, Casella M, Pelargonio G, Russo V, D'Onofrio A, Massaro G, Vilotta M, Lauretti M, Themistoclakis S, Boriani G, De Ponti R. Selection of candidates for cardiac resynchronization therapy and implantation management: an Italian survey promoted by the Italian Association of Arrhythmology and Cardiac Pacing. J Cardiovasc Med (Hagerstown) 2024; 25:601-608. [PMID: 38949147 DOI: 10.2459/jcm.0000000000001650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) represents an effective heart failure treatment, associated with reduction in mortality and heart failure hospitalizations. This Italian survey aimed to address relevant CRT issues. METHODS An online survey was administered to AIAC members. RESULTS One hundred and five electrophysiologists participated, with a median of 40 (23-70) CRT implantations/year (33% in high-volume centres). Forty-five percent of respondents (especially working in high-volume centres) reported an increase in CRT implantations in the last 2 years, in 16% a decrease, and in 38% CRT remained stable. Seventy-five percent of respondents implanted CRT only in patients with European Heart Rhythm Association (EHRA) class I indications. All operators collected ECG and echocardiography before implantation. Eighty-five percent of respondents selected coronary sinus target vein empirically, whereas 10% used mechanical and/or electrical delay techniques. Physicians working in high-volume centres reported a lower failure rate compared with others (16 vs. 34%; P = 0.03). If the coronary sinus lead could not be positioned in the target branch, 80% placed it in another vein, whereas 16% opted for a surgical approach or for conduction system pacing (CSP). Eighty percent accomplished CRT optimization in all patients, 17% only in nonresponders. Regarding anticoagulation, high agreement with EHRA guidelines emerged. CONCLUSION CRT represents a valid therapeutic option in heart failure treatment. Nowadays, CRT implantations remain stable and are mainly performed in patients with class I indications. ECG remains the preferred tool for patient selection, whereas imaging is increasingly used to determine the left pacing target area. In most patients, the left ventricular lead can be successfully positioned in the target vein, but in some cases, the result can be unsatisfactory; however, the decision to explore alternative resynchronization approaches is rarely pursued.
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Affiliation(s)
- Matteo Ziacchi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Dipartimento Cardio-toraco-vascolare, Bologna
| | - Matteo Anselmino
- Cardiology Division, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Turin
| | | | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital 'Azienda Ospedaliero-Universitaria delle Marche'
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona
| | - Gemma Pelargonio
- Institute of Cardiology, Catholic University of Sacred Heart
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Vincenzo Russo
- Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli
| | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples
| | - Giulia Massaro
- Institute of Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna
| | - Manola Vilotta
- Department of Medicine and Surgery, University of Insubria
- Cardiology Unit, Ospedale di Circolo, ASST Settelaghi, Varese
| | | | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria
- Cardiology Unit, Ospedale di Circolo, ASST Settelaghi, Varese
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Strocchi M, Wijesuriya N, Mehta V, de Vere F, Rinaldi CA, Niederer SA. Computational Modelling Enabling In Silico Trials for Cardiac Physiologic Pacing. J Cardiovasc Transl Res 2024; 17:685-694. [PMID: 37870689 PMCID: PMC11219462 DOI: 10.1007/s12265-023-10453-y] [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: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
Conduction system pacing (CSP) has the potential to achieve physiological-paced activation by pacing the ventricular conduction system. Before CSP is adopted in standard clinical practice, large, randomised, and multi-centre trials are required to investigate CSP safety and efficacy compared to standard biventricular pacing (BVP). Furthermore, there are unanswered questions about pacing thresholds required to achieve optimal pacing delivery while preventing device battery draining, and about which patient groups are more likely to benefit from CSP rather than BVP. In silico studies have been increasingly used to investigate mechanisms underlying changes in cardiac function in response to pathologies and treatment. In the context of CSP, they have been used to improve our understanding of conduction system capture to optimise CSP delivery and battery life, and noninvasively compare different pacing methods on different patient groups. In this review, we discuss the in silico studies published to date investigating different aspects of CSP delivery.
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Affiliation(s)
- Marina Strocchi
- National Heart and Lung Institute, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK.
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Felicity de Vere
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Steven A Niederer
- National Heart and Lung Institute, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- The Alan Turing Institute, London, UK
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3
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Ramdat Misier NL, Moore JP, Nguyen HH, Lloyd MS, Dubin AM, Mah DY, Czosek RJ, Khairy P, Chang PM, Nielsen JC, Aydin A, Pilcher TA, O'Leary ET, Shivkumar K, de Groot NMS. Long-Term Outcomes of Cardiac Resynchronization Therapy in Patients With Repaired Tetralogy of Fallot: A Multicenter Study. Circ Arrhythm Electrophysiol 2024; 17:e012363. [PMID: 38344811 DOI: 10.1161/circep.123.012363] [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: 08/01/2023] [Accepted: 01/17/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND A growing number of patients with tetralogy of Fallot develop left ventricular systolic dysfunction and heart failure, in addition to right ventricular dysfunction. Although cardiac resynchronization therapy (CRT) is an established treatment option, the effect of CRT in this population is still not well defined. This study aimed to investigate the early and late efficacy, survival, and safety of CRT in patients with tetralogy of Fallot. METHODS Data were analyzed from an observational, retrospective, multicenter cohort, initiated jointly by the Pediatric and Congenital Electrophysiology Society and the International Society of Adult Congenital Heart Disease. Twelve centers contributed baseline and longitudinal data, including vital status, left ventricular ejection fraction (LVEF), QRS duration, and NYHA functional class. Outcomes were analyzed at early (3 months), intermediate (1 year), and late follow-up (≥2 years) after CRT implantation. RESULTS A total of 44 patients (40.3±19.2 years) with tetralogy of Fallot and CRT were enrolled. Twenty-nine (65.9%) patients had right ventricular pacing before CRT upgrade. The left ventricular ejection fraction improved from 32% [24%-44%] at baseline to 42% [32%-50%] at early follow-up (P<0.001) and remained improved from baseline thereafter (P≤0.002). The QRS duration decreased from 180 [160-205] ms at baseline to 152 [133-182] ms at early follow-up (P<0.001) and remained decreased at intermediate and late follow-up (P≤0.001). Patients with upgraded CRT had consistent improvement in left ventricular ejection fraction and QRS duration at each time point (P≤0.004). Patients had a significantly improved New York Heart Association functional class after CRT implantation at each time point compared with baseline (P≤0.002). The transplant-free survival rates at 3, 5, and 8 years after CRT implantation were 85%, 79%, and 73%. CONCLUSIONS In patients with tetralogy of Fallot treated with CRT consistent improvement in QRS duration, left ventricular ejection fraction, New York Heart Association functional class, and reasonable long-term survival were observed. The findings from this multicenter study support the consideration of CRT in this unique population.
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Affiliation(s)
- Nawin L Ramdat Misier
- Department of Cardiology, Erasmus Medical Center, Rotterdam , The Netherlands (N.L.R.M., N.M.S.d.G.)
| | - Jeremy P Moore
- Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.S.)
| | - Hoang H Nguyen
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (H.H.N.)
| | - Michael S Lloyd
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (M.S.L.)
| | - Anne M Dubin
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto CA (A.M.D.)
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston MA (D.Y.M., E.T.O.)
| | - Richard J Czosek
- Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati OH (R.J.C.)
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal Quebec, Canada (P.K.)
| | - Philip M Chang
- Congenital Heart Center, University of Florida Health, Gainesville, FL (P.M.C.)
| | - Jens C Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus Denmark (J.C.N.)
- Department of Cardiology, Aarhus University Hospital, Aarhus Denmark (J.C.N.)
| | - Alper Aydin
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario Canada (A.A.)
| | - Thomas A Pilcher
- Division of Pediatric Cardiology, Department of Internal Medicine, University of Utah, Salt Lake City UT (T.A.P.)
| | - Edward T O'Leary
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston MA (D.Y.M., E.T.O.)
| | - Kalyanam Shivkumar
- Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.S.)
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam , The Netherlands (N.L.R.M., N.M.S.d.G.)
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Zhang W, He L, Zhang J, Fu G, Sheng X, Pan Y, Zeng G, Li Z, Huang J, Lu H, Shi T, Zhou X, Stadler R, Demmer W, Li R. Electrical Synchrony Optimization for Left Bundle Branch Area Pacing in Patients With Bradycardia and Heart Failure. Am J Cardiol 2023; 203:436-443. [PMID: 37540902 DOI: 10.1016/j.amjcard.2023.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 08/06/2023]
Abstract
Left bundle branch area pacing (LBBAP) has emerged as a promising physiological pacing modality. This study was designed to investigate the acute impact of the atrioventricular delay (AVD) on cardiac electrical characteristics and identify an optimal range of AVDs for LBBAP to achieve electrical atrioventricular and interventricular synchrony. Patients indicated for ventricular or biventricular pacing were studied during routine follow-ups at least 3 months after LBBAP implantation. Patients were excluded if they had a complete AV block or persistent atrial fibrillation. AVD was programed from 40 to 240 ms or until intrinsic conduction occurred. Optimal AVD was determined by the electrocardiography criteria, including QRS duration, reduced R-wave in lead V1, reduced notching or slurring in lateral leads, and more desirable precordial QRS transition. A total of 38 patients (age 68.7 ± 10.3 years; 16 male (42%); 18 dual-chamber pacemakers and 20 cardiac resynchronization therapy devices; average follow-up period 15.1 ± 10.2 months) were included. The fusion of LBBAP and intrinsic right ventricular conduction occurred in 21 patients with corresponding optimal AVD determined. A great proportion (∼85%) of the optimal AVDs ranged from 50% to 80% of the observed atrium-to-left bundle branch-sensing (A-LBBS) intervals. The linear correlation between the optimal AVD and corresponding A-LBBS interval (optimal AVD = 0.84 × [A-LBSs interval] - 36 ms) produced R = 0.86 and p <0.0001. In conclusion, AVD selection during LBBAP greatly impacted the ventricular electrical characteristics and the optimal AVD was linearly correlated with the corresponding A-LBBS interval.
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Affiliation(s)
- Weiwei Zhang
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lang He
- Department of Cardiology, Greentown Hospital, Hangzhou, China
| | - Jiefang Zhang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guosheng Fu
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xia Sheng
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiwen Pan
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guang Zeng
- Department of Cardiology, Greentown Hospital, Hangzhou, China
| | - Zhidi Li
- Department of Cardiology, Greentown Hospital, Hangzhou, China
| | - Jingjuan Huang
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongyang Lu
- Cardiac Rhythm Management, Medtronic Technology Center, Medtronic (Shanghai) Ltd., Shanghai, China
| | - Tianyi Shi
- Cardiac Rhythm Management, Medtronic Technology Center, Medtronic (Shanghai) Ltd., Shanghai, China
| | - Xiaohong Zhou
- Cardiac Rhythm Management, Medtronic plc., Mounds View, Minnesota
| | - Robert Stadler
- Cardiac Rhythm Management, Medtronic plc., Mounds View, Minnesota
| | - Wade Demmer
- Cardiac Rhythm Management, Medtronic plc., Mounds View, Minnesota
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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5
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Strocchi M, Gillette K, Neic A, Elliott MK, Wijesuriya N, Mehta V, Vigmond EJ, Plank G, Rinaldi CA, Niederer SA. Comparison between conduction system pacing and cardiac resynchronization therapy in right bundle branch block patients. Front Physiol 2022; 13:1011566. [PMID: 36213223 PMCID: PMC9532840 DOI: 10.3389/fphys.2022.1011566] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022] Open
Abstract
A significant number of right bundle branch block (RBBB) patients receive cardiac resynchronization therapy (CRT), despite lack of evidence for benefit in this patient group. His bundle (HBP) and left bundle pacing (LBP) are novel CRT delivery methods, but their effect on RBBB remains understudied. We aim to compare pacing-induced electrical synchrony during conventional CRT, HBP, and LBP in RBBB patients with different conduction disturbances, and to investigate whether alternative ways of delivering LBP improve response to pacing. We simulated ventricular activation on twenty-four four-chamber heart geometries each including a His-Purkinje system with proximal right bundle branch block (RBBB). We simulated RBBB combined with left anterior and posterior fascicular blocks (LAFB and LPFB). Additionally, RBBB was simulated in the presence of slow conduction velocity (CV) in the myocardium, left ventricular (LV) or right ventricular (RV) His-Purkinje system, and whole His-Purkinje system. Electrical synchrony was measured by the shortest interval to activate 90% of the ventricles (BIVAT-90). Compared to baseline, HBP significantly improved activation times for RBBB alone (BIVAT-90: 66.9 ± 5.5 ms vs. 42.6 ± 3.8 ms, p < 0.01), with LAFB (69.5 ± 5.0 ms vs. 58.1 ± 6.2 ms, p < 0.01), with LPFB (81.8 ± 6.6 ms vs. 62.9 ± 6.2 ms, p < 0.01), with slow myocardial CV (119.4 ± 11.4 ms vs. 97.2 ± 10.0 ms, p < 0.01) or slow CV in the whole His-Purkinje system (102.3 ± 7.0 ms vs. 75.5 ± 5.2 ms, p < 0.01). LBP was only effective in RBBB cases if combined with anodal capture of the RV septum myocardium (BIVAT-90: 66.9 ± 5.5 ms vs. 48.2 ± 5.2 ms, p < 0.01). CRT significantly reduced activation times in RBBB in the presence of severely slow RV His-Purkinje CV (95.1 ± 7.9 ms vs. 84.3 ± 9.3 ms, p < 0.01) and LPFB (81.8 ± 6.6 ms vs. CRT: 72.9 ± 8.6 ms, p < 0.01). Both CRT and HBP were ineffective with severely slow CV in the LV His-Purkinje system. HBP is effective in RBBB patients with otherwise healthy myocardium and Purkinje system, while CRT and LBP are ineffective. Response to LBP improves when LBP is combined with RV septum anodal capture. CRT is better than HBP only in patients with severely slow CV in the RV His-Purkinje system, while CV slowing of the whole His-Purkinje system and the myocardium favor HBP over CRT.
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Affiliation(s)
- Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Karli Gillette
- BioTechMed-Graz, Graz, Austria
- Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | | | - Mark K. Elliott
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Gernot Plank
- BioTechMed-Graz, Graz, Austria
- Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
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Gasparini M, Biffi M, Landolina M, Cattafi G, Rordorf R, Botto GL, Battista Forleo G, Morani G, Santini L, Dello Russo A, Rossillo A, Meloni S, Grammatico A, Vitolo M, Boriani G. The Interplay of PR Interval and AV Pacing Delays Used for Cardiac Resynchronization Therapy in Heart Failure Patients: Association with Clinical Response in a Retrospective Analysis of a Large Observational Study. J Pers Med 2022; 12:1512. [PMID: 36143297 PMCID: PMC9501597 DOI: 10.3390/jpm12091512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF) patients with prolonged QRS and impaired left ventricular (LV) systolic function. We aim to evaluate how the baseline PR interval is associated with outcomes (all-cause death or HF hospitalizations) and LV reverse remodeling (>15% relative reduction in LV end-systolic volume). Methods. Among 2224 patients with CRT defibrillators, 1718 (77.2%) had a device programmed at out-of-the-box settings (sensed AV delay: 100 ms and paced AV delay: 130 ms). Results. In this cohort of 1718 patients (78.7% men, mean age 66 years, 71.6% in NYHA class III/IV, LVEF = 27 ± 6%), echocardiographic assessment at 6-month follow-up showed that LV reverse remodeling was not constant as a function of the PR interval; in detail, it occurred in 56.4% of all patients but was more frequent (76.6%) in patients with a PR interval of 160 ms. In a median follow-up of 20 months, the endpoint of death or HF hospitalizations occurred in 304/1718 (17.7%) patients; in the multivariable regression analysis it was significantly less frequent when the PR interval was between 150 and 170 ms (hazard ratio = 0.79, 95% confidence interval (CI): 0.63−0.99, p = 0.046). The same PR range was associated with higher probability of CRT response (odds ratio = 2.51, 95% CI: 1.41−4.47, p = 0.002). Conclusions. In a large population of CRT patients, with fixed AV pacing delays, specific PR intervals are associated with significant benefits in terms of LV reverse remodeling and lower morbidity. These observational data suggest the importance of optimizing pacing programming as a function of the PR interval to maximize CRT response and patient outcome.
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Affiliation(s)
- Maurizio Gasparini
- Electrophysiology and Pacing Unit, Humanitas Clinical and Research Hospital, IRCCS, 20089 Rozzano, Italy
| | - Mauro Biffi
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy
| | | | | | - Roberto Rordorf
- Cardiology Department, Policlinico San Matteo Pavia Fondazione, IRCCS, 27100 Pavia, Italy
| | | | | | - Giovanni Morani
- Cardiology Department, Ospedale Civile Maggiore, 37126 Verona, Italy
| | - Luca Santini
- Cardiology Department, Ospedale G.B. Grassi, 00122 Rome, Italy
| | | | - Antonio Rossillo
- Cardiology Department, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Sarah Meloni
- Medtronic Core Clinical Solutions, 00165 Rome, Italy
| | - Andrea Grammatico
- Medtronic Core Clinical Solutions, 00165 Rome, Italy
- Abbott EMEA Medical Affairs, 1931 Brussels, Belgium
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Modena University Hospital, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Modena University Hospital, University of Modena and Reggio Emilia, 41125 Modena, Italy
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7
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Affiliation(s)
- Daniel Keene
- Department of Cardiology, Imperial College London, London, UK
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8
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Tailoring cardiac resynchronisation therapy to non-left bundle branch block: Successful cardiac resynchronisation for right bundle branch block with left posterior fascicular block without implantation of a left ventricular lead. Indian Pacing Electrophysiol J 2022; 22:207-211. [PMID: 35427783 PMCID: PMC9264020 DOI: 10.1016/j.ipej.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/20/2022] [Accepted: 04/10/2022] [Indexed: 12/04/2022] Open
Abstract
Despite advances, cardiac resynchronisation therapy (CRT) remains fundamentally orientated to the dyssynchrony of left bundle branch block (LBBB), in which septo-lateral electrical and mechanical delays predominate. For non-LBBB patients response rates to conventional CRT are lower and mortality and rehospitalisation rates are not reduced. Despite this, alternative approaches which tailor CRT to the differing dyssynchrony patterns of non-LBBB have yet to be developed. In the specific non-LBBB subgroup of right bundle branch block (RBBB) with left posterior fascicular block (LPFB), ventricular conduction via the left anterior fascicle results in a unique early lateral, and late septal depolarisation, or lateral to septal left ventricular (LV) delay, an electrical sequence which is followed mechanically. This latero-septal delay is somewhat the reverse of LBBB and was overcome by fusing right ventricular (RV) septal pacing with intrinsic conduction via the left anterior fascicle, achieving successful resynchronisation without implantation of a left ventricular lead. A stable fusion pattern was achieved via the ‘Negative AV Hysteresis with Search’ algorithm (Abbott, St Paul, Minnesota). Improvement in all standard CRT response indices was achieved at 3 months: QRS duration was reduced from 153 to 106 ms, ejection fraction increased from 14 to 32%, and LV end-systolic and end-diastolic diameters reduced by 19% and 12.5% respectively. NYHA class improved from III-IV to class II. Cardiac resynchronisation for RBBB with LPFB can be successfully achieved with a standard pacemaker or defibrillator without left ventricular lead implantation by fusing RV septal-only pacing with intrinsic conduction.
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Abstract
Cardiac resynchronization therapy (CRT) is a good treatment for heart failure accompanied by ventricular conduction abnormalities. Current ECG criteria in international guidelines seem to be suboptimal to select heart failure patients for CRT. The criteria QRS duration and left bundle branch block (LBBB) QRS morphology insufficiently detect left ventricular activation delay, which is required for benefit from CRT. Additionally, there are various definitions for LBBB, in which each one has a different association with CRT benefit and is prone to subjective interpretation. Recent studies have shown that the objectively measured vectorcardiographic QRS area identifies left ventricular activation delay with higher accuracy than any of the current ECG criteria. Indeed, various studies have consistently shown that a high QRS area prior to CRT predicts both echocardiographic and clinical improvement after CRT. The beneficial relation of QRS area with CRT-outcome was largely independent from QRS morphology, QRS duration, and patient characteristics known to affect CRT-outcome including ischemic etiology and sex. On top of QRS area prior to CRT, the reduction in QRS area after CRT further improves benefit. QRS area is easily obtainable from a standard 12-lead ECG though it currently requires off-line analysis. Clinical applicability will be significantly improved when QRS area is automatically determined by ECG equipment.
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Jacquemart E, Combes N, Duthoit G, Bessière F, Ladouceur M, Iserin L, Laredo M, Bredy C, Maltret A, Di Filippo S, Hascoët S, Pasquié JL, Marijon E, Waldmann V. Cardiac resynchronization therapy in patients with congenital heart disease and systemic right ventricle. Heart Rhythm 2021; 19:658-666. [PMID: 34863963 DOI: 10.1016/j.hrthm.2021.11.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although patients with systemic right ventricle (SRV) represent a significant proportion of patients with congenital heart disease (CHD) implanted with cardiac resynchronization therapy (CRT), there are limited and conflicting data in this specific patient group. OBJECTIVE We aimed to analyze outcomes of patients with SRV implanted with a CRT device. METHODS Data were analyzed from an observational, retrospective, multicenter cohort study including all patients with CHD implanted with a CRT device from 6 French centers from 2004 to 2020. Response to CRT was defined as an increase in systemic ventricular ejection fraction of ≥10% and/or an improvement in New York Heart Association functional class by at least 1 grade. RESULTS A total of 85 patients with CHD were enrolled (mean age 39.8 ± 20.0 years; 55 [64.7%] males; 25 defibrillators [29.4%]), including 31 patients with SRV (36.5%) (mean age 43.9 ± 19.8 years; 16 [51.6%] males). The mean change in QRS duration after implantation was similar as compared with patients with systemic left ventricle (-46 ± 26 ms vs -35 ± 32 ms; P = .16). During a mean follow-up of 5.1 ± 3.5 years, late complications included 2 lead dysfunctions (6.5%), 3 CRT-related infections (9.7%), and 1 inappropriate implantable cardioverter-defibrillator shock (3.2%). The proportion of CRT responders at 6, 12, and 24 months were 82.6%, 80.0%, and 77.8% in patients with SRV vs 66.7%, 64.3%, and 69.6% in patients with systemic left ventricle (P = NS). CONCLUSION In this multicenter cohort, one-third of patients with CHD implanted with a CRT device had SRV. CRT in patients with SRV was associated with a high rate of responders, comparable to that of patients with systemic left ventricle.
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Affiliation(s)
| | - Nicolas Combes
- Department of Pediatric Cardiology and Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France; Pasteur Clinic, Toulouse, France
| | | | | | - Magalie Ladouceur
- Université de Paris, PARCC, INSERM, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | - Laurence Iserin
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | - Mikael Laredo
- La Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Alice Maltret
- Department of Pediatric Cardiology and Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France
| | | | - Sébastien Hascoët
- Department of Pediatric Cardiology and Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France
| | | | - Eloi Marijon
- Université de Paris, PARCC, INSERM, Paris, France; Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France
| | - Victor Waldmann
- Université de Paris, PARCC, INSERM, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France.
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11
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Xiao PL, Cai C, Zhang P, Han J, Mulpuru SK, Deshmukh AJ, Yin YH, Cha YM. Better CRT Response in Patients Who Underwent Atrioventricular Node Ablation or Upgrade From Pacemaker: A Nomogram to Predict CRT Response. Front Cardiovasc Med 2021; 8:760195. [PMID: 34790708 PMCID: PMC8591090 DOI: 10.3389/fcvm.2021.760195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Response rates for cardiac resynchronization therapy (CRT) in patients without intrinsic left bundle-branch block (LBBB) morphology are poor. Objective: We sought to develop a nomogram model to predict response to CRT in patients without intrinsic LBBB. Methods: We searched electronic health records for patients without intrinsic LBBB who underwent CRT at Mayo Clinic. Logistic regression and Cox proportional hazards regression analysis were performed for the odds of response to CRT and risk of death, respectively. Results were used to develop the nomogram model. Results: 761 patients without intrinsic LBBB were identified. Six months after CRT, 47.8% of patients demonstrated improvement of left ventricular ejection fraction by more than 5%. The 1-, 3-, and 5-year survival rates were 95.9, 82.4, and 66.70%, respectively. Patients with CRT upgrade from pacemaker [odds ratio (OR), 1.67 (95% CI, 1.05–2.66)] or atrioventricular node (AVN) ablation [OR, 1.69 (95% CI, 1.09–2.64)] had a greater odds of CRT response than those patients who had new implant, or who did not undergo AVN ablation. Patients with right bundle-branch block had a low response rate (39.2%). Patients undergoing AVN ablation had a lower mortality rate than those without ablation [hazard ratio, 0.65 (95% CI, 0.46–0.91)]. Eight clinical variables were automatically selected to build a nomogram model and predict CRT response. The model had an area under the receiver operating characteristic curve of 0.71 (95% CI, 0.63–0.78). Conclusions: Among patients without intrinsic LBBB undergoing CRT, upgrade from pacemaker and AVN ablation were favorable factors in achieving CRT response and better long-term outcomes.
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Affiliation(s)
- Pei-Lin Xiao
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cheng Cai
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pei Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jie Han
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Yue-Hui Yin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
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12
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Patient Selection for Biventricular Cardiac Resynchronization Therapy, His Bundle Pacing, and Left Bundle Branch Pacing. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00684-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Mele D, Trevisan F, Fiorencis A, Smarrazzo V, Bertini M, Ferrari R. Current Role of Echocardiography in Cardiac Resynchronization Therapy: from Cardiac Mechanics to Flow Dynamics Analysis. Curr Heart Fail Rep 2021; 17:384-396. [PMID: 32979151 DOI: 10.1007/s11897-020-00484-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to summarily explain what LV synchrony, coordination, myocardial work, and flow dynamics are, trying to clarify their advantages and limitations in the treatment of heart failure patients undergoing or with implanted cardiac resynchronization therapy (CRT). RECENT FINDINGS CRT is an established treatment for patients with heart failure and left ventricular systolic dysfunction. In the current guidelines, CRT implant indications rely only on electrical dyssynchrony, but in the last years, many aspects of cardiac mechanics (including contractile synchrony, coordination, propagation, and myocardial work) and flow dynamics have been studied using echocardiographic techniques to better characterize patients undergoing or with implanted CRT. However, the concepts, limits, and potential applications of all these echocardiographic evaluations are unclear to most clinicians. The use of left ventricular dyssynchrony and discoordination indices may help to identify those significant mechanical alterations whose correction may increase the probability of a favorable CRT response. Assessment of myocardial work and intracardiac flow dynamics may overcome some limitations of the conventional evaluation of cardiac mechanics but more investigations are needed before extensive clinical application.
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Affiliation(s)
- Donato Mele
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy.
| | - Filippo Trevisan
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - Andrea Fiorencis
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - Vittorio Smarrazzo
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - Matteo Bertini
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - Roberto Ferrari
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
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14
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Lin J, Chen K, Dai Y, Sun Q, Li Y, Jiang Y, Zhou Y, Chen R, Jin Y, Yan L, Zhou X, Cheng A, Zhang X, Gold MR, Zhang S. Bilateral Bundle Branch Area Pacing to Achieve Physiological Conduction System Activation. Circ Arrhythm Electrophysiol 2020; 13:e008267. [DOI: 10.1161/circep.119.008267] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Left bundle branch pacing (LBBP) is a technique for conduction system pacing, but it often results in right bundle branch block morphology on the ECG. This study was designed to assess simultaneous pacing of the left and right bundle branch areas to achieve more synchronous ventricular activation.
Methods:
In symptomatic bradycardia patients, the distal electrode of a bipolar pacing lead was placed at the left bundle branch area via a transventricular-septal approach. This was used to pace the left bundle branch area, while the ring electrode was used to pace the right bundle branch area. Bilateral bundle branch area pacing (BBBP) was achieved by stimulating the cathode and anode in various pacing configurations. QRS duration, delayed right ventricular activation time, left ventricular activation time, and interventricular conduction delay were measured. Pacing stability and short-term safety were assessed at 3-month follow-up.
Results:
BBBP was successfully performed in 22 of 36 patients. Compared with LBBP, BBBP resulted in greater shortening of QRS duration (109.3±7.1 versus 118.4±5.7 ms,
P
<0.001). LBBP resulted in a paced right bundle branch block configuration, with a delayed right ventricular activation time of 115.0±7.5 ms and interventricular conduction delay of 34.0±8.8 ms. BBBP fully resolved the right bundle branch block morphology in 18 patients. In the remaining 4 patients, BBBP partially corrected the right bundle branch block with delayed right ventricular activation time decreasing from 120.5±4.7 ms during LBBP to 106.1±4.2 ms during BBBP (
P
=0.005).
Conclusions:
LBBP results in a relatively narrow QRS complex but with an interventricular activation delay. BBBP can diminish the delayed right ventricular activation, producing more physiological ventricular activation.
Graphic Abstract:
A
graphic abstract
is available for this article.
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Affiliation(s)
- Jinxuan Lin
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuqiu Li
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yong Jiang
- State Key Laboratory of Cardiovascular Disease, Department of Echocardiography (Y. Jiang), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yu’an Zhou
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ruohan Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuanhao Jin
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lirong Yan
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaohong Zhou
- Medtronic Inc, Cardiac Rhythm Heart Failure Division, Minneapolis, MN (X. Zhou, A.C.)
| | - Alan Cheng
- Medtronic Inc, Cardiac Rhythm Heart Failure Division, Minneapolis, MN (X. Zhou, A.C.)
| | - Xue Zhang
- Medtronic (Shanghai) Ltd, Shanghai, China (X. Zhang)
| | - Michael R. Gold
- Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.)
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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15
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Cardiac Resynchronization Defibrillator Therapy for Nonspecific Intraventricular Conduction Delay Versus Right Bundle Branch Block. J Am Coll Cardiol 2020; 73:3082-3099. [PMID: 31221257 DOI: 10.1016/j.jacc.2019.04.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/17/2019] [Accepted: 04/02/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The benefits of cardiac resynchronization therapy (CRT) in patients with non-left bundle branch block (LBBB) conduction abnormality have not been fully explored. OBJECTIVES This study sought to evaluate clinical outcomes among Medicare-aged patients with nonspecific intraventricular conduction delay (NICD) versus right bundle branch block (RBBB) in patients eligible for implantation with a CRT with defibrillator (CRT-D). METHODS Using the National Cardiovascular Data Registry implantable cardioverter-defibrillator (ICD) registry data between 2010 and 2013, the authors compared outcomes in CRT-eligible patients implanted with CRT-D versus ICD-only therapy among patients with NICD and RBBB. Also, among all CRT-D-implanted patients, the authors compared outcomes in those with NICD versus RBBB. Survival curves and multivariable adjusted hazard ratios (HRs) were used to assess outcomes including hospitalization and death. RESULTS In 11,505 non-LBBB CRT-eligible patients, after multivariable adjustment, among patients with RBBB, CRT-D was not associated with better outcomes, compared with ICD alone, regardless of QRS duration. Among patients with NICD and a QRS ≥150 ms, CRT-D was associated with decreased mortality at 3 years compared with ICD alone (HR: 0.602; 95% confidence interval [CI]: 0.416 to 0.871; p = 0.0071). Among 5,954 CRT-D-implanted patients, after multivariable adjustment NICD compared with RBBB was associated with lower mortality at 3 years in those with a QRS duration of ≥150 ms (HR: 0.757; 95% CI: 0.625 to 0.917; p = 0.0044). CONCLUSIONS Among non-LBBB CRT-D-eligible patients, CRT-D implantation was associated with better outcomes compared with ICD alone specifically in NICD patients with a QRS duration of ≥150 ms. Careful patient selection should be considered for CRT-D implantation in patients with non-LBBB conduction.
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16
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Salden OA, Vernooy K, van Stipdonk AM, Cramer MJ, Prinzen FW, Meine M. Strategies to Improve Selection of Patients Without Typical Left Bundle Branch Block for Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2020; 6:129-142. [DOI: 10.1016/j.jacep.2019.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
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17
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Henin M, Ragy H, Mannion J, David S, Refila B, Boles U. Indications of Cardiac Resynchronization in Non-Left Bundle Branch Block: Clinical Review of Available Evidence. Cardiol Res 2020; 11:1-8. [PMID: 32095190 PMCID: PMC7011924 DOI: 10.14740/cr989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 12/28/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) benefits have been firmly established in patients with heart failure and reduced left ventricular ejection fraction (HFrEF), who remain in New York Heart Association (NYHA) functional classes II and III, despite optimal medical therapy, and have a wide QRS complex. An important and consistent finding in published systematic reviews and in subgroup analyses is that the benefits of CRT are maximum for patients with a broader QRS durations, typically described as QRS duration > 150 ms, and for patients with a typical left bundle branch block (LBBB) QRS morphology. It remains uncertain whether patients with non-LBBB QRS complex morphology clearly benefit from CRT or only modestly respond.
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Affiliation(s)
- Maged Henin
- University Hospital Waterford, Waterford, Ireland
| | - Hany Ragy
- National Heart Institute, Cairo, Egypt
| | | | - Santhosh David
- Cardiology Department, Letterkenny University Hospital, Donegal, Ireland
| | - Beshoy Refila
- Cardiology Department, Heart and Vascular Center, Mater Private Hospital, Dublin 7, Ireland
| | - Usama Boles
- Cardiology Department, Heart and Vascular Center, Mater Private Hospital, Dublin 7, Ireland
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18
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Shah BR, DerSarkissian M, Tsintzos SI, Xiao Y, May D, Lu X, Kinrich D, Davis E, Lefebvre P, Duh MS, Dasta JF. Adherence to heart failure management medications following cardiac resynchronization therapy. Curr Med Res Opin 2020; 36:199-207. [PMID: 31535559 DOI: 10.1080/03007995.2019.1670474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The purpose of this study is to assess the real-world impact of cardiac resynchronization therapy (CRT) on adherence to heart failure (HF) medications.Methods: MarketScan administrative health care claims data from 2008 to 2014 among patients with HF were used. The date of first CRT implantation served as the index date. Adherence to guideline-directed medical therapy (GDMT) classes were compared during pre- and post-index periods using proportion of days covered (PDC). Comparisons between the two periods were made using the Wilcoxon sign-rank test for continuous PDC and McNemar's test for dichotomized PDC.Results: Increases in medication adherence were observed for major classes of HF GDMT medications. Specifically, adherence to angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), beta blockers (BB), and furosemide increased by 22, 24, 32, and 28% (all p < .001), respectively, in the 12 months pre to 12 months post-CRT. Large increases between the pre- and post-CRT period were also observed when considering adherence as dichotomized PDC ≥0.80 in the 12 months pre- versus post-CRT.Conclusion: Adherence to HF medications significantly improved among HF patients post-CRT implantation. Further research is needed to better understand the underlying determinants of this effect, including whether the effect is attributable to factors such as enhanced patient monitoring and improved access to high-quality specialized HF care among patients receiving CRT.
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Affiliation(s)
- Bimal R Shah
- Duke University School of Medicine, Durham, NC, USA
- Livongo, Mountain View, CA, USA
| | | | | | | | - Damian May
- Medtronic Global CRHF Headquarters, Mounds View, MN, USA
| | - Xiaoxiao Lu
- Medtronic Global CRHF Headquarters, Mounds View, MN, USA
| | | | | | | | - Mei S Duh
- Analysis Group, Inc., Boston, MA, USA
| | - Joseph F Dasta
- College of Pharmacy, University of Texas, Austin, TX, USA
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19
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Jurak P, Curila K, Leinveber P, Prinzen FW, Viscor I, Plesinger F, Smisek R, Prochazkova R, Osmancik P, Halamek J, Matejkova M, Lipoldova J, Novak M, Panovsky R, Andrla P, Vondra V, Stros P, Vesela J, Herman D. Novel ultra‐high‐frequency electrocardiogram tool for the description of the ventricular depolarization pattern before and during cardiac resynchronization. J Cardiovasc Electrophysiol 2019; 31:300-307. [DOI: 10.1111/jce.14299] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Pavel Jurak
- Institute of Scientific InstrumentsThe Czech Academy of SciencesBrno Czech Republic
| | - Karol Curila
- Department of Cardiology, Cardiocenter, Third Faculty of MedicineCharles University, University Hospital Kralovske VinohradyPrague Czech Republic
| | - Pavel Leinveber
- International Clinical Research CenterSt Anneʼs University HospitalBrno Czech Republic
- First Department of Internal Medicine‐CardioangiologyFaculty of Medicine of Masaryk University, St Anneʼs University HospitalBrno Czech Republic
| | - Frits W. Prinzen
- Department of Physiology, Cardiovascular Research Institute MaastrichtMaastricht UniversityMaastricht The Netherlands
| | - Ivo Viscor
- Institute of Scientific InstrumentsThe Czech Academy of SciencesBrno Czech Republic
| | - Filip Plesinger
- Institute of Scientific InstrumentsThe Czech Academy of SciencesBrno Czech Republic
| | - Radovan Smisek
- Institute of Scientific InstrumentsThe Czech Academy of SciencesBrno Czech Republic
- Department of Biomedical Engineering, The Faculty of Electrical Engineering and CommunicationBrno University of TechnologyBrno Czech Republic
| | - Radka Prochazkova
- Department of Cardiology, Cardiocenter, Third Faculty of MedicineCharles University, University Hospital Kralovske VinohradyPrague Czech Republic
| | - Pavel Osmancik
- Department of Cardiology, Cardiocenter, Third Faculty of MedicineCharles University, University Hospital Kralovske VinohradyPrague Czech Republic
| | - Josef Halamek
- Institute of Scientific InstrumentsThe Czech Academy of SciencesBrno Czech Republic
| | - Magdalena Matejkova
- International Clinical Research CenterSt Anneʼs University HospitalBrno Czech Republic
| | - Jolana Lipoldova
- International Clinical Research CenterSt Anneʼs University HospitalBrno Czech Republic
- First Department of Internal Medicine‐CardioangiologyFaculty of Medicine of Masaryk University, St Anneʼs University HospitalBrno Czech Republic
| | - Miroslav Novak
- International Clinical Research CenterSt Anneʼs University HospitalBrno Czech Republic
- First Department of Internal Medicine‐CardioangiologyFaculty of Medicine of Masaryk University, St Anneʼs University HospitalBrno Czech Republic
| | - Roman Panovsky
- International Clinical Research CenterSt Anneʼs University HospitalBrno Czech Republic
- First Department of Internal Medicine‐CardioangiologyFaculty of Medicine of Masaryk University, St Anneʼs University HospitalBrno Czech Republic
| | - Petr Andrla
- Institute of Scientific InstrumentsThe Czech Academy of SciencesBrno Czech Republic
| | - Vlastimil Vondra
- Institute of Scientific InstrumentsThe Czech Academy of SciencesBrno Czech Republic
| | - Petr Stros
- Department of Cardiology, Cardiocenter, Third Faculty of MedicineCharles University, University Hospital Kralovske VinohradyPrague Czech Republic
| | - Jana Vesela
- Department of Cardiology, Cardiocenter, Third Faculty of MedicineCharles University, University Hospital Kralovske VinohradyPrague Czech Republic
| | - Dalibor Herman
- Department of Cardiology, Cardiocenter, Third Faculty of MedicineCharles University, University Hospital Kralovske VinohradyPrague Czech Republic
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20
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Huntgeburth M, Germund I, Geerdink LM, Sreeram N, Udink Ten Cate FEA. Emerging clinical applications of strain imaging and three-dimensional echocardiography for the assessment of ventricular function in adult congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S326-S345. [PMID: 31737540 DOI: 10.21037/cdt.2018.11.08] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Management of congenital heart disease (CHD) in adults (ACHD) remains an ongoing challenge due to the presence of residual hemodynamic lesions and development of ventricular dysfunction in a large number of patients. Echocardiographic imaging plays a central role in clinical decision-making and selection of patients who will benefit most from catheter interventions or cardiac surgery.. Recent advances in both strain imaging and three-dimensional (3D)-echocardiography have significantly contributed to a greater understanding of the complex pathophysiological mechanisms involved in CHD. The aim of this paper is to provide an overview of emerging clinical applications of speckle-tracking imaging and 3D-echocardiography in ACHD with focus on functional assessment, ventriculo-ventricular interdependency, mechanisms of electromechanical delay, and twist abnormalities in adults with tetralogy of Fallot (TOF), a systemic RV after atrial switch repair or in double discordance ventricles, and in those with a Fontan circulation.
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Affiliation(s)
- Michael Huntgeburth
- Center for Grown-ups with congenital heart disease (GUCH), Clinic III for Internal Medicine, Department of Cardiology, Heart Center, University Hospital of Cologne, Germany
| | - Ingo Germund
- Department of Pediatric Cardiology, Heart Center, University Hospital of Cologne, Germany
| | - Lianne M Geerdink
- Academic Center for Congenital Heart Disease (ACAHA), Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen.,Division of Pediatric Cardiology, Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, Heart Center, University Hospital of Cologne, Germany
| | - Floris E A Udink Ten Cate
- Academic Center for Congenital Heart Disease (ACAHA), Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen.,Division of Pediatric Cardiology, Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
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21
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AlHabeeb W, Al-Ayoubi F, AlGhalayini K, Al Ghofaili F, Al Hebaishi Y, Al-Jazairi A, Al-Mallah MH, AlMasood A, Al Qaseer M, Al-Saif S, Chaudhary A, Elasfar A, Tash A, Arafa M, Hassan W. Saudi Heart Association (SHA) guidelines for the management of heart failure. J Saudi Heart Assoc 2019; 31:204-253. [PMID: 31371908 PMCID: PMC6660461 DOI: 10.1016/j.jsha.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/31/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is the leading cause of morbidity and mortality worldwide and negatively impacts quality of life, healthcare costs, and longevity. Although data on HF in the Arab population are scarce, recently developed regional registries are a step forward to evaluating the quality of current patient care and providing an overview of the clinical picture. Despite the burden of HF in Saudi Arabia, there are currently no standardized protocols or guidelines for the management of patients with acute or chronic heart failure. Therefore, the Heart Failure Expert Committee, comprising 13 local specialists representing both public and private sectors, has developed guidelines to address the needs and challenges for the diagnosis and treatment of HF in Saudi Arabia. The ultimate aim of these guidelines is to assist healthcare professionals in delivering optimal care and standardized clinical practice across Saudi Arabia.
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Affiliation(s)
- Waleed AlHabeeb
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
- Corresponding author at: Cardiac Sciences Department, King Saud University, P.O. Box 7805, Riyadh 11472, Saudi Arabia.
| | - Fakhr Al-Ayoubi
- King Fahad Cardiac Center, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
| | - Kamal AlGhalayini
- King Abdulaziz University Hospital, Jeddah, Saudi ArabiaSaudi Arabia
| | - Fahad Al Ghofaili
- King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi ArabiaSaudi Arabia
| | | | - Abdulrazaq Al-Jazairi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaSaudi Arabia
| | - Mouaz H. Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi ArabiaSaudi Arabia
| | - Ali AlMasood
- Riyadh Care Hospital, Riyadh, Saudi ArabiaSaudi Arabia
| | - Maryam Al Qaseer
- King Fahad Specialist Hospital, Dammam, Saudi ArabiaSaudi Arabia
| | - Shukri Al-Saif
- Saud Al-Babtain Cardiac Center, Dammam, Saudi ArabiaSaudi Arabia
| | - Ammar Chaudhary
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi ArabiaSaudi Arabia
| | - Abdelfatah Elasfar
- Madina Cardiac Center, AlMadina AlMonaoarah, Saudi ArabiaSaudi Arabia
- Cardiology Department, Tanta University, EgyptEgypt
| | - Adel Tash
- Ministry of Health, Riyadh, Saudi ArabiaSaudi Arabia
| | - Mohamed Arafa
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
| | - Walid Hassan
- International Medical Center, Jeddah, Saudi ArabiaSaudi Arabia
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22
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Halamek J, Leinveber P, Viscor I, Smisek R, Plesinger F, Vondra V, Lipoldova J, Matejkova M, Jurak P. The relationship between ECG predictors of cardiac resynchronization therapy benefit. PLoS One 2019; 14:e0217097. [PMID: 31150418 PMCID: PMC6544221 DOI: 10.1371/journal.pone.0217097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/04/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) is an effective treatment that reduces mortality and improves cardiac function in patients with left bundle branch block (LBBB). However, about 30% of patients passing the current criteria do not benefit or benefit only a little from CRT. Three predictors of benefit based on different ECG properties were compared: 1) "strict" left bundle branch block classification (SLBBB); 2) QRS area; 3) ventricular electrical delay (VED) which defines the septal-lateral conduction delay. These predictors have never been analyzed concurrently. We analyzed the relationship between them on a subset of 602 records from the MADIT-CRT trial. METHODS & RESULTS SLBBB classification was performed by two experts; QRS area and VED were computed fully automatically. High-frequency QRS (HFQRS) maps were used to inspect conduction abnormalities. The correlation between SLBBB and other predictors was R = 0.613, 0.523 and 0.390 for VED, QRS area in Z lead, and QRS duration, respectively. Scatter plots were used to pick up disagreement between the predictors. The majority of SLBBB subjects- 295 of 330 (89%)-are supposed to respond positively to CRT according to the VED and QRS area, though 93 of 272 (34%) non-SLBBB should also benefit from CRT according to the VED and QRS area. CONCLUSION SLBBB classification is limited by the proper setting of cut-off values. In addition, it is too "strict" and excludes patients that may benefit from CRT therapy. QRS area and VED are clearly defined parameters. They may be used to optimize biventricular stimulation. Detailed analysis of conduction irregularities with CRT optimization should be based on HFQRS maps.
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Affiliation(s)
- Josef Halamek
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Pavel Leinveber
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
| | - Ivo Viscor
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Radovan Smisek
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Filip Plesinger
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Vlastimil Vondra
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Jolana Lipoldova
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
| | - Magdalena Matejkova
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
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23
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Das A, Chatterjee S. Feasibility of RA-LV pacing in patients with symptomatic left bundle branch block: a pilot study. Heart Vessels 2019; 34:1552-1558. [PMID: 30963301 DOI: 10.1007/s00380-019-01390-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
Abstract
Several studies have reported the adverse effects of right ventricular apical pacing. Permanent His bundle pacing is proved to be the most physiological. But it can be technically difficult sometimes. One recent large multicenter randomized trial showed that pacing from left ventricular apex or mid-lateral wall has the greatest potential to prevent pacing-induced reduction of cardiac pump function (by maintaining left ventricular mechanical synchrony) and, therefore, can be considered as physiological site. In our study, we have wanted to see the outcome of left ventricular pacing through coronary sinus branch with active fixation bipolar lead as a routine pacing technique in patients with symptomatic left bundle branch block. In our study we have recruited 27 patients for left ventricular pacing through coronary sinus branch (as done in cardiac resynchronization therapy) with active fixation bipolar lead and 33 patients for right ventricular apical pacing (control) and compared left ventricular pacing with right ventricular apical pacing in patients with history of syncope with left bundle branch block in baseline electrocardiography who presented with atrio-ventricular block or prolonged HV interval (≥ 70 ms) on electrophysiology study in term of procedure and fluoroscopy time and short-term lead performance and left ventricular function. The results of our study showed that left ventricular pacing through a tributary of coronary sinus is associated with shortened QRS duration (21.10 ± 3.92 ms) and better LV function (higher left ventricular ejection fraction 64.00 ± 3.03 vs. 59.73 ± 6.73 and lower left ventricular diastolic internal diameter 4.58 ± 0.32 vs. 5.23 ± 0.40 cm) in comparison to right ventricular apical pacing. However, the total procedure time and fluoroscopy time was significantly higher (73.75 ± 11.02 vs. 63.32 ± 6.06 min and 7.08 ± 1.48 vs. 5.02 ± 1.39 min, respectively) in left ventricular pacing group. The results of this study indicate that transvenous left ventricular epicardial pacing may be an option for physiological pacing in patients with symptomatic left bundle branch block.
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Affiliation(s)
- Asit Das
- Department of Cardiology, IPGME&R and SSKM Hospital, Flat-B1, GB-43, Narayantala (west), DB Nagar, Kolkata, West Bengal, 700059, India.
| | - Suman Chatterjee
- Department of Cardiology, IPGME&R and SSKM Hospital, Flat-B1, GB-43, Narayantala (west), DB Nagar, Kolkata, West Bengal, 700059, India
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24
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Abstract
The treatment of individual patients in cardiology practice increasingly relies on advanced imaging, genetic screening and devices. As the amount of imaging and other diagnostic data increases, paralleled by the greater capacity to personalize treatment, the difficulty of using the full array of measurements of a patient to determine an optimal treatment seems also to be paradoxically increasing. Computational models are progressively addressing this issue by providing a common framework for integrating multiple data sets from individual patients. These models, which are based on physiology and physics rather than on population statistics, enable computational simulations to reveal diagnostic information that would have otherwise remained concealed and to predict treatment outcomes for individual patients. The inherent need for patient-specific models in cardiology is clear and is driving the rapid development of tools and techniques for creating personalized methods to guide pharmaceutical therapy, deployment of devices and surgical interventions.
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Affiliation(s)
- Steven A Niederer
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France
| | - Natalia A Trayanova
- Department of Biomedical Engineering and the Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
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25
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Right ventricularly paced right bundle-type pattern on ECG: Does this preclude upgrading to biventricular pacing? HeartRhythm Case Rep 2018; 4:298-300. [PMID: 30023275 PMCID: PMC6050427 DOI: 10.1016/j.hrcr.2018.03.010] [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: 11/22/2022] Open
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26
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Plesinger F, Jurak P, Halamek J, Nejedly P, Leinveber P, Viscor I, Vondra V, McNitt S, Polonsky B, Moss AJ, Zareba W, Couderc JP. Ventricular Electrical Delay Measured From Body Surface ECGs Is Associated With Cardiac Resynchronization Therapy Response in Left Bundle Branch Block Patients From the MADIT-CRT Trial (Multicenter Automatic Defibrillator Implantation-Cardiac Resynchronization Therapy). Circ Arrhythm Electrophysiol 2018; 11:e005719. [PMID: 29700054 DOI: 10.1161/circep.117.005719] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/28/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although cardiac resynchronization therapy (CRT) is beneficial in heart failure patients with left bundle branch block, 30% of these patients do not respond to the therapy. Identifying these patients before implantation of the device is one of the current challenges in clinical cardiology. METHODS We verified the diagnostic contribution and an optimized computerized approach to measuring ventricular electrical activation delay (VED) from body surface 12-lead ECGs. We applied the method to ECGs acquired before implantation (baseline) in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation-Cardiac Resynchronization Therapy). VED values were dichotomized using its quartiles, and we tested the association of VED values with the MADIT-CRT primary end point of heart failure or death. Multivariate Cox proportional models were used to estimate the risk of study end points. In addition, the association between VED values and hemodynamic changes after CRT-D implantation was examined using 1-year follow-up echocardiograms. RESULTS Our results showed that left bundle branch block patients with baseline VED <31.2 ms had a 35% risk of MADIT-CRT end points, whereas patients with VED ≥31.2 ms had a 14% risk (P<0.001). The hazard ratio for predicting primary end points in patients with low VED was 2.34 (95% confidence interval, 1.53-3.57; P<0.001). Higher VED values were also associated with beneficial hemodynamic changes. These strong VED associations were not found in the right bundle branch block and intraventricular conduction delay cohorts of the MADIT-CRT trial. CONCLUSIONS Left bundle branch block patients with a high baseline VED value benefited most from CRT, whereas left bundle branch block patients with low VED did not show CRT benefits.
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Affiliation(s)
- Filip Plesinger
- The Czech Academy of Sciences, Institute of Scientific Instruments, Department of Medical Signals, Brno, (F.P., P.J., J.H., P.N., I.V., V.V.).
| | - Pavel Jurak
- The Czech Academy of Sciences, Institute of Scientific Instruments, Department of Medical Signals, Brno, (F.P., P.J., J.H., P.N., I.V., V.V.)
| | - Josef Halamek
- The Czech Academy of Sciences, Institute of Scientific Instruments, Department of Medical Signals, Brno, (F.P., P.J., J.H., P.N., I.V., V.V.)
| | - Petr Nejedly
- The Czech Academy of Sciences, Institute of Scientific Instruments, Department of Medical Signals, Brno, (F.P., P.J., J.H., P.N., I.V., V.V.)
| | - Pavel Leinveber
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (P.L.)
| | - Ivo Viscor
- The Czech Academy of Sciences, Institute of Scientific Instruments, Department of Medical Signals, Brno, (F.P., P.J., J.H., P.N., I.V., V.V.)
| | - Vlastimil Vondra
- The Czech Academy of Sciences, Institute of Scientific Instruments, Department of Medical Signals, Brno, (F.P., P.J., J.H., P.N., I.V., V.V.)
| | - Scott McNitt
- Heart Research Follow-up Program, University of Rochester Medical Center, NY (S.M., B.P., A.J.M., W.Z., J.-P.C.)
| | - Bronislava Polonsky
- Heart Research Follow-up Program, University of Rochester Medical Center, NY (S.M., B.P., A.J.M., W.Z., J.-P.C.)
| | - Arthur J Moss
- Heart Research Follow-up Program, University of Rochester Medical Center, NY (S.M., B.P., A.J.M., W.Z., J.-P.C.)
| | - Wojciech Zareba
- Heart Research Follow-up Program, University of Rochester Medical Center, NY (S.M., B.P., A.J.M., W.Z., J.-P.C.)
| | - Jean-Philippe Couderc
- Heart Research Follow-up Program, University of Rochester Medical Center, NY (S.M., B.P., A.J.M., W.Z., J.-P.C.)
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27
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Huntjens PR, Ploux S, Strik M, Walmsley J, Ritter P, Haissaguerre M, Prinzen FW, Delhaas T, Lumens J, Bordachar P. Electrical Substrates Driving Response to Cardiac Resynchronization Therapy. Circ Arrhythm Electrophysiol 2018; 11:e005647. [DOI: 10.1161/circep.117.005647] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/22/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Peter R. Huntjens
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Sylvain Ploux
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Marc Strik
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - John Walmsley
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Philippe Ritter
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Michel Haissaguerre
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Frits W. Prinzen
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Tammo Delhaas
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Joost Lumens
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Pierre Bordachar
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
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28
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Poposka L, Boskov V, Risteski D, Taleski J, Janusevski F, Srbinovska E, Georgievska-Ismail L. Electrocardiographic Parameters as Predictors of Response to Cardiac Resynchronization Therapy. Open Access Maced J Med Sci 2018. [PMID: 29531592 PMCID: PMC5839436 DOI: 10.3889/oamjms.2018.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION: Although strict selection criteria are used to select patients for cardiac resynchronisation therapy, up to 30% of patients do not have a positive clinical response. PATIENTS: A total of 102 consecutive patients who had biventricular pacemaker/defibrillator (CRT-P or CRT-D) implanted were enrolled in this prospective observational study. RESULTS: During the average follow-up period of 24.3 months 5 patients died and 17 (16.7%) patients were hospitalised with the symptoms of heart failure; 75 (73.5%) patients were responders based on the previously defined criteria. Responders in the group of LBBB patients kept the significant difference in a computed variable (S1 + R6) - (S6 + R1) and R6/S6 ratio. Responders in non-LBBB patients kept the significant difference only in the height of R waves in V6. The R6/S6 ratio tended to be higher, but it did not reach a statistical significance. CONCLUSION: None of the tested ECG parameters stands out as an independent predictor of response to cardiac resynchronisation therapy, but some of them were different in responder-compared to the non-responder group. The amplitude of R wave in V6, higher R/S ratio in V6 and higher computed variable (S1 + R6) - (S6 + R1) may predict the likelihood of response to CRT therapy in both LBBB-patients and non-LBBB patients.
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Affiliation(s)
- Lidija Poposka
- University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Vladimir Boskov
- University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Dejan Risteski
- University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Jane Taleski
- University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Filip Janusevski
- University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Elizabeta Srbinovska
- University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Ljubica Georgievska-Ismail
- University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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29
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Auricchio A, Prinzen FW. Enhancing Response in the Cardiac Resynchronization Therapy Patient. JACC Clin Electrophysiol 2017; 3:1203-1219. [DOI: 10.1016/j.jacep.2017.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/02/2017] [Accepted: 08/10/2017] [Indexed: 12/17/2022]
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30
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Malhotra S, Jain D. Detection of interventricular dyssynchrony: An evolution of the phase analysis technique. J Nucl Cardiol 2017; 24:1687-1689. [PMID: 27282162 DOI: 10.1007/s12350-016-0550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Saurabh Malhotra
- Division of Cardiovascular Medicine, Jacob School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Clinical and Translation Research Center, Suite 7030, Buffalo, NY, 14221, USA.
| | - Diwakar Jain
- Section of Cardiovascular Medicine, New York Medical College, Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY, USA
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31
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Janoušek J, Kovanda J, Ložek M, Tomek V, Vojtovič P, Gebauer R, Kubuš P, Krejčíř M, Lumens J, Delhaas T, Prinzen F. Pulmonary Right Ventricular Resynchronization in Congenital Heart Disease. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006424. [DOI: 10.1161/circimaging.117.006424] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 08/22/2017] [Indexed: 02/04/2023]
Abstract
Background—
Electromechanical discoordination may contribute to long-term pulmonary right ventricular (RV) dysfunction in patients after surgery for congenital heart disease. We sought to evaluate changes in RV function after temporary RV cardiac resynchronization therapy.
Methods and Results—
Twenty-five patients aged median 12.0 years after repair of tetralogy of Fallot and similar lesions were studied echocardiographically (n=23) and by cardiac catheterization (n=5) after primary repair (n=4) or after surgical RV revalvulation for significant pulmonary regurgitation (n=21). Temporary RV cardiac resynchronization therapy was applied in the presence of complete right bundle branch block by atrial-synchronized RV free wall pacing in complete fusion with spontaneous ventricular depolarization using temporary electrodes. The q-RV interval at the RV free wall pacing site (mean 77.2% of baseline QRS duration) confirmed pacing from a late activated RV area. RV cardiac resynchronization therapy carried significant decrease in QRS duration (
P
<0.001) along with elimination of the right bundle branch block QRS morphology, increase in RV filling time (
P
=0.002), pulmonary artery velocity time integral (
P
=0.006), and RV maximum +dP/dt (
P
<0.001), and decrease in RV index of myocardial performance (
P
=0.006). RV mechanical synchrony improved: septal-to-lateral RV mechanical delay decreased (
P
<0.001) and signs of RV dyssynchrony pattern were significantly abolished. RV systolic stretch fraction reflecting the ratio of myocardial stretching and contraction during systole diminished (
P
=0.001).
Conclusions—
In patients with congenital heart disease and right bundle branch block, RV cardiac resynchronization therapy carried multiple positive effects on RV mechanics, synchrony, and contraction efficiency.
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Affiliation(s)
- Jan Janoušek
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Jan Kovanda
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Miroslav Ložek
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Viktor Tomek
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Pavel Vojtovič
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Roman Gebauer
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Peter Kubuš
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Miroslav Krejčíř
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Joost Lumens
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Tammo Delhaas
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Frits Prinzen
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
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Bilateral bundle branch block, an old concept revisited in the light of cardiac resynchronization therapy. Heart Rhythm 2016; 13:2297-2298. [PMID: 27544745 DOI: 10.1016/j.hrthm.2016.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Indexed: 11/23/2022]
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Cannon JA, Collier TJ, Shen L, Swedberg K, Krum H, Van Veldhuisen DJ, Vincent J, Pocock SJ, Pitt B, Zannad F, McMurray JJV. Clinical outcomes according to QRS duration and morphology in the Eplerenone in Mild Patients: Hospitalization and SurvIval Study in Heart Failure (EMPHASIS-HF). Eur J Heart Fail 2016; 17:707-16. [PMID: 26139584 DOI: 10.1002/ejhf.303] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/02/2015] [Accepted: 05/07/2015] [Indexed: 11/07/2022] Open
Abstract
AIMS We examined the relationship between different degrees of QRS prolongation and different QRS morphologies and clinical outcomes in patients with heart failure, reduced ejection fraction (HF-REF), and mild symptoms in the Eplerenone in Mild Patients Hospitalization and SurvIval Study in Heart Failure trial (EMPHASIS-HF). We also evaluated the effect of eplerenone in these patients according to QRS duration/morphology. METHODS AND RESULTS Patients were categorized as: QRS duration (ms) (i) <120 (n = 1375); (ii) 120-149 (n = 517); and (iii) ≥150 (n = 383), and QRS morphology (i) normal (n = 1252); (ii) left bundle branch block (BBB) (n = 608); and (iii) right BBB/intraventricular conduction defect (IVCD) (n = 415). The outcomes examined were the composite of cardiovascular death or heart failure hospitalization and all-cause mortality. Both abnormal QRS duration and QRS morphology were associated with higher risk, e.g. the rates of the composite outcome were: 10.2, 17.6, and 15.5 per 100 patient-years in the <120, 120-149, and ≥150 ms groups, respectively. Eplerenone reduced the risk of the primary outcome and mortality, compared with placebo, consistently across the QRS duration/morphology subgroups. CONCLUSION We found that even moderate prolongation of QRS duration and right BBB/IVCD were associated with a high risk of adverse outcomes in HF-REF. Eplerenone was similarly effective, irrespective of QRS duration/morphology.
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Affiliation(s)
- Jane A Cannon
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | - Li Shen
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | | | - Faiez Zannad
- Nancy Université, Nancy, France Inserm, Université de Lorraine and CHU de Nancy, Nancy, France
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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Walmsley J, Huntjens PR, Prinzen FW, Delhaas T, Lumens J. Septal flash and septal rebound stretch have different underlying mechanisms. Am J Physiol Heart Circ Physiol 2016; 310:H394-403. [DOI: 10.1152/ajpheart.00639.2015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/16/2015] [Indexed: 11/22/2022]
Abstract
Abnormal left-right motion of the interventricular septum in early systole, known as septal flash (SF), is frequently observed in patients with left bundle branch block (LBBB). Transseptal pressure gradient and early active septal contraction have been proposed as explanations for SF. Similarities in timing (early systole) and location (septum) suggest that SF may be related to septal systolic rebound stretch (SRSsept). We aimed to clarify the mechanisms generating SF and SRSsept. The CircAdapt computer model was used to isolate the effects of timing of activation of the left ventricular free wall (LVFW), right ventricular free wall (RVFW), and septum on SF and SRSsept. LVFW and septal activation times were varied by ±80 ms relative to RVFW activation time. M-mode-derived wall motions and septal strains were computed and used to quantify SF and SRSsept, respectively. SF depended on early activation of the RVFW relative to the LVFW. SF and SRSsept occurred in LBBB-like simulations and against a rising transseptal pressure gradient. When the septum was activated before both LVFW and RVFW, no SF occurred despite the presence of SRSsept. Computer simulations therefore indicate that SF and SRSsept have different underlying mechanisms, even though both can occur in LBBB. The mechanism of leftward motion during SF is early RVFW contraction pulling on and straightening the septum when unopposed by the LVFW. SRSsept is caused by late LVFW contraction following early contraction of the septum. Changes in transseptal pressure gradient are not the main cause of SF in LBBB.
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Affiliation(s)
- John Walmsley
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; and
| | - Peter R. Huntjens
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; and
- L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Université de Bordeaux, Pessac, France
| | - Frits W. Prinzen
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; and
| | - Tammo Delhaas
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; and
| | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; and
- L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Université de Bordeaux, Pessac, France
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Irie T, Kaneko Y, Kurosawa K, Nakajima T, Kurabayashi M. Standard cardiac resynchronization therapy with a second right ventricular lead for severe right ventricular heart failure in 2 patients with repaired tetralogy of Fallot. HeartRhythm Case Rep 2016; 2:76-79. [PMID: 28491638 PMCID: PMC5412653 DOI: 10.1016/j.hrcr.2015.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cleland JGF, Freemantle N. QRS morphology as a predictor of the response to cardiac resynchronisation therapy: fact or fashion? Heart 2015; 101:1441-3. [PMID: 26187602 DOI: 10.1136/heartjnl-2015-307553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- John G F Cleland
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK
| | - Nick Freemantle
- Institute of Epidemiology & Health, University College, London, UK
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Does surgically induced right bundle branch block really effect ventricular function in children after ventricular septal defect closure? Pediatr Cardiol 2015; 36:481-8. [PMID: 25293427 DOI: 10.1007/s00246-014-1037-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/27/2014] [Indexed: 10/24/2022]
Abstract
In this prospective study, we aimed to assess left and right ventricular function in terms of the presence of right bundle branch block (RBBB) in the cases with repaired ventricular septal defect (VSD). Fifty-three patients who had VSD surgery at least 1-year preceding admission and 52 healthy controls were enrolled into the study. All the participants underwent electrocardiographic and echocardiographic examination. The cases with RBBB were determined. The conventional and tissue Doppler echocardiographic measurements of the patients with and without RBBB were compared with each other and healthy controls. Twenty-eight of VSD repair groups were male and 25 were female. Control group consisted of 30 males and 22 females. The mean age of the study and control groups was 7.5 ± 5.0 and 6.9 ± 4.3 years, respectively. RBBB was detected in 20 of 53 (37.7 %) operated patients. The only significant difference between the cases with and without RBBB was decreased right ventricular fractional area change (%) in the former group (33 ± 7 vs. 39 ± 5 p < 0.05). When compared to controls, operated group had statistically lower [corrected] tricuspid annular plane systolic excursion (p < 0.05), lower systolic, early diastolic, and late diastolic myocardial velocities, higher left and right ventricular myocardial performance indices, irrespective of the presence of RBBB. The ratios of mitral or tricuspid inflow to left or right ventricular myocardial in early diastolic velocities measured from lateral annular levels were increased in operated group (all p values <0.05). In conclusion, RBBB in the cases with surgical VSD repair might be associated with right ventricular dysfunction. Biventricular systolic and diastolic dysfunction may develop following VSD repair irrespective of the presence of RBBB. Tissue Doppler-derived myocardial performance indices are useful in detection of those subclinical dysfunctions.
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Affiliation(s)
- Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Hitoshi Horigome
- Department of Child Health, Faculty of Medicine, University of Tsukuba
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