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Butter C, Auricchio A, Stellbrink C, Fleck E, Ding J, Yu Y, Huvelle E, Spinelli J. Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation 2001; 104:3026-9. [PMID: 11748094 DOI: 10.1161/hc5001.102229] [Citation(s) in RCA: 437] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves systolic function in heart failure patients with ventricular conduction delay by stimulating the left ventricle (LV) or both ventricles (biventricular, BV). Optimal LV site selection is of major clinical interest for CRT device implantation; however, the dependence of hemodynamics on LV stimulation site has not been established. Thus, the objective of this study was to compare the hemodynamic response to CRT for 2 LV coronary vein sites: the free wall and anterior wall. Methods and Results- A total of 30 patients (mean NYHA class, 2.7; mean QRS interval, 152 ms; mean PR interval, 194 ms) enrolled in the PATH-CHF-II trial were studied. CRT was administered with LV and BV stimulation in VDD mode at 4 AV delays. LV stimulation was at the lateral free wall or anterior wall, whereas right ventricular stimulation was fixed near the apex. LV+dP/dt(max) and aortic pulse pressure changes from baseline during CRT were compared for LV sites. Free wall sites with LV and BV stimulation yielded significantly larger LV+dP/dt(max) (14% versus 6%, P<0.001 for LV; 12% versus 5%, P<0.001 for BV) and pulse pressure (8% versus 4%, P<0.001 for LV; 9% versus 5%, P<0.001 for BV) compared with anterior sites. In one third of patients, CRT at free wall sites increased LV+dP/dt(max), whereas it decreased at anterior sites over most AV delays. CONCLUSION CRT with LV free wall stimulation produced significantly better LV systolic performance compared with anterior stimulation. Further studies are warranted to prove the clinical superiority of the LV free wall as a site for long-term CRT.
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Affiliation(s)
- C Butter
- German Heart Institute and Charité, Campus Virchow Klinikum, Berlin, Germany
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Butter C, Auricchio A, Stellbrink C, Schlegl M, Fleck E, Hörsch W, Huvelle E, Ding J, Kramer A. Should stimulation site be tailored in the individual heart failure patient? Am J Cardiol 2000; 86:144K-151K. [PMID: 11084115 DOI: 10.1016/s0002-9149(00)01385-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Right ventricular pacing at various sites and shortened atrioventricular (AV) delay has failed to demonstrate a convincing short-term and long-term improvement of left ventricular function. Left-ventricular-based stimulation offers a new therapeutic option for patients with symptomatic congestive heart failure and conduction disturbances, especially of left bundle-branch block configuration. Left ventricular mechanical improvement seems mainly dependent on the pacing site, in addition to optimizing the AV delay. Predominantly retrospective data suggest that pacing the posterolateral free wall results in the greatest hemodynamic improvement. Based on the evaluation of different pacing sites in 2 patients, we noted that site is of major importance for maximal improvement of left ventricular function, and pacing at a suboptimal site can even deteriorate left ventricular contractility. Moreover, lead technology has advanced rapidly and different areas of the left ventricle can now be reached transvenously for acute and chronic placement. Therefore, ongoing trials will help to identify the optimal pacing site and might indicate whether invasive testing will be required in the future.
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Affiliation(s)
- C Butter
- Charité, Campus Virchow, Humboldt-University and German Heart Institute, Berlin, Germany
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Breithardt OA, Stellbrink C, Franke A, Auricchio A, Huvelle E, Sack S, Bakker P, Hanrath P. Echocardiographic evidence of hemodynamic and clinical improvement in patients paced for heart failure. Am J Cardiol 2000; 86:133K-137K. [PMID: 11084113 DOI: 10.1016/s0002-9149(00)01193-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dilated cardiomyopathy is frequently associated with electrical conduction disturbances. Development of left bundle-branch block with discoordinated ventricular contraction pattern further contributes to impaired hemodynamic performance. Biventricular pacing has evolved as a new treatment option for patients with dilated cardiomyopathy and conduction disturbances. The "electrical" approach aims to normalize the disturbed contraction pattern, thereby improving hemodynamic function by simultaneous stimulation at different ventricular sites. Acute hemodynamic improvement with biventricular pacing has been demonstrated in patients with depressed left ventricular function and delayed intraventricular conduction. Due to the variations in optimal pacing site and atrioventricular delay, individual optimization to achieve optimal hemodynamic benefit is necessary. Echocardiography has the potential to provide hemodynamic data by Doppler techniques and combine these with geometric information about ventricular volumes, ejection fraction, and contraction patterns. This article focuses on the use of echocardiographic techniques for noninvasive optimization in cardiac pacing and presents preliminary experience from the initial trials on multisite pacing in heart failure.
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Affiliation(s)
- O A Breithardt
- Department of Cardiology, RWTH University of Technology, Aachen, Germany
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Yu Y, Auricchio A, Ding J, Kramer A, Huvelle E, Potty P, Spinelli J. Is resynchronization between left and right ventricles responsible for improving hemodynamic function of heart failure patients with LBBB? Eur J Heart Fail 2000. [DOI: 10.1016/s1388-9842(00)80383-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Y. Yu
- CRM, Guidant Corporation; St. Paul United States
| | - A. Auricchio
- Department of Cardiology; University Hospital; Magdeburg Germany
| | - J. Ding
- Mail Stop E207, Guidant Corporation; St. Paul United States
| | - A. Kramer
- Mail Stop E207, Guidant Corporation; St. Paul United States
| | - E. Huvelle
- Mail Stop E207, Guidant Corporation; St. Paul United States
| | - P. Potty
- Mail Stop E207, Guidant Corporation; St. Paul United States
| | - J. Spinelli
- Mail Stop E207, Guidant Corporation; St. Paul United States
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Auricchio A, Carlson G, Kadhiresan V, Huvelle E, Spinelli J, Michel U. Prognosis of heart failure patients with ventricular resynchronization therapy based on autonomic function assessment. Eur J Heart Fail 2000. [DOI: 10.1016/s1388-9842(00)80131-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- A. Auricchio
- Department of Cardiology; University Hospital; Magdeburg Germany
| | - G. Carlson
- CHF Research, Guidant Corporation; St. Paul MN United States
| | - V. Kadhiresan
- CHF Research, Guidant Corporation; St. Paul MN United States
| | - E. Huvelle
- CHF Research, Guidant Corporation; Brussels Belgium
| | - J. Spinelli
- CHF Research, Guidant Corporation; St. Paul MN United States
| | - U. Michel
- CHF Research, Guidant Corporation; Zaventem Belgium
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Auricchio A, Sack S, Bakker P, Kloss M, Kirkels H, Potty P, Salo R, Huvelle E, Pochet T. Chronic evaluation of long-term pacing resynchronization for congestive heart failure, relation with acute hemodynamic improvement. Eur J Heart Fail 2000. [DOI: 10.1016/s1388-9842(00)80381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - S. Sack
- University Hospital; Essen Germany
| | - P. Bakker
- University Hospital; Utrecht Netherlands
| | - M. Kloss
- University Hospital; Magdeburg Germany
| | - H. Kirkels
- University Hospital; Utrecht Netherlands
| | - P. Potty
- Guidant, CRM Research; Brussels Belgium
| | - R. Salo
- Guidant, CRM Research; St-Paul MN United States
| | | | - T. Pochet
- Guidant, CRM Research; Brussels Belgium
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Sack S, Auricchio A, Kadhiresan V, Salo R, Huvelle E, Michel U, Spinelli J. Long term improvement with ventricular resynchronization therapy in heart failure patients: Does etiology of heart failure matter? Eur J Heart Fail 2000. [DOI: 10.1016/s1388-9842(00)80255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- S. Sack
- Dept. of Cardiology University-GHS Essen; Essen Germany
| | - A. Auricchio
- Department of Cardiology; University Hospital; Magdeburg Germany
| | - V. Kadhiresan
- CHF Research, Mail Stop E207, Guidant Corporation; St. Paul United States
| | - R. Salo
- CHF Research, Mail Stop E207, Guidant Corporation; St. Paul United States
| | - E. Huvelle
- CHF Research Group, Guidant Europe NV/SA; Brussels Belgium
| | - U. Michel
- CHF Research Group, Guidant Europe NV/SA; Brussels Belgium
| | - J. Spinelli
- CHF Research, Mail Stop E207, Guidant Corporation; St. Paul United States
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Yu Y, Auricchio A, Ding J, Kramer A, Hoersch W, Huvelle E, Spinelli J. Identification of patients suitable for ventricular resynchronization therapy based on normalized LV-RV pressure loop area. Eur J Heart Fail 2000. [DOI: 10.1016/s1388-9842(00)80384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Y. Yu
- CRM, Guidant Corporation St. Paul; United States
| | - A. Auricchio
- Department of Cardiology; University Hospital Magdeburg; Germany
| | - J. Ding
- Mail Stop E207, Guidant Corporation; St. Paul United States
| | - A. Kramer
- Mail Stop E207, Guidant Corporation; St. Paul United States
| | - W. Hoersch
- Mail Stop E207, Guidant Corporation; St. Paul United States
| | - E. Huvelle
- Mail Stop E207, Guidant Corporation; St. Paul United States
| | - J. Spinelli
- Mail Stop E207, Guidant Corporation; St. Paul United States
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Fenelon G, Huvelle E, Brugada P. Initial clinical experience with a new small sized third-generation implantable cardioverter defibrillator: results of a multicenter study. European Ventak Mini Investigator Group. Pacing Clin Electrophysiol 1997; 20:2967-74. [PMID: 9455759 DOI: 10.1111/j.1540-8159.1997.tb05468.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study reports the acute clinical experience with the new CPI VENTAK MINI: a small sized (68 cc), implantable cardioverter defibrillator (ICD) with 33 J stored energy. Implantation of the device was attempted in 113 patients (90 men, mean age 57 +/- 16 years, 64 with coronary artery disease, mean left ventricular ejection fraction 41%) with ventricular tachycardia or ventricular fibrillation (VF). All 113 patients (100%) were ultimately implanted, 12% of them for ICD replacement. Transvenous lead implantation was accomplished in all 104 patients (100%) receiving new leads, 95% of them with a single lead configuration. The safety criteria for implantation (2 consecutive VF conversions at 15 J or 3 at 20 J, in both cases without failures to convert) were demonstrated in all but 7 patients (6%). In 6 of these, safety criteria were not fully assessed while in the last patient defibrillation efficacy was not determined. Of the 104 patients with new leads, 90% underwent pectoral implantation. Of the 9 patients (9%) abdominally implanted, only 4 (4%) (3 children) were judged small sized for pectoral implant. At predischarge testing, reliable VF detection and conversion were noted in 96 of 97 patients tested. There was no perioperative mortality. At a 3.6 +/- 1.3 months follow-up, 34% of the patients had a spontaneous arrhythmic event, and 24% of the patients received shocks. Clinically inappropriate therapies occurred in 8% of the episodes in which any kind of therapy was delivered. This study demonstrates the short-term clinical efficacy and safety of the new device, and that pectoral implantation can be performed in the large majority of patients.
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Affiliation(s)
- G Fenelon
- Cardiovascular Research and Teaching Institute Aalst, Cardiovascular Center, O.L.V. Hospital, Belgium
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Affiliation(s)
- H Klein
- Department of Cardiology, University Hospital, Magdeburg, Germany
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Huvelle E, Geubelle F, Simar L, Mélon J. [Direct methods of measuring ciliary beats]. Rev Med Liege 1987; 42:140-55. [PMID: 3550996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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