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Papageorgiou N, Sohrabi C, Bakogiannis C, Tsarouchas A, Kukendrarajah K, Matiti L, Srinivasan NT, Ahsan S, Sporton S, Schilling RJ, Hunter RJ, Muthumala A, Creta A, Chow AW, Providencia R. Blood groups and Rhesus status as potential predictors of outcomes in patients with cardiac resynchronisation therapy. Sci Rep 2024; 14:8371. [PMID: 38600217 PMCID: PMC11006901 DOI: 10.1038/s41598-024-58747-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 04/02/2024] [Indexed: 04/12/2024] Open
Abstract
Cardiac resynchronisation therapy (CRT) improves prognosis in patients with heart failure (HF) however the role of ABO blood groups and Rhesus factor are poorly understood. We hypothesise that blood groups may influence clinical and survival outcomes in HF patients undergoing CRT. A total of 499 patients with HF who fulfilled the criteria for CRT implantation were included. Primary outcome of all-cause mortality and/or heart transplant/left ventricular assist device was assessed over a median follow-up of 4.6 years (IQR 2.3-7.5). Online repositories were searched to provide biological context to the identified associations. Patients were divided into blood (O, A, B, and AB) and Rhesus factor (Rh-positive and Rh-negative) groups. Mean patient age was 66.4 ± 12.8 years with a left ventricular ejection fraction of 29 ± 11%. There were no baseline differences in age, gender, and cardioprotective medication. In a Cox proportional hazard multivariate model, only Rh-negative blood group was associated with a significant survival benefit (HR 0.68 [0.47-0.98], p = 0.040). No association was observed for the ABO blood group (HR 0.97 [0.76-1.23], p = 0.778). No significant interaction was observed with prevention, disease aetiology, and presence of defibrillator. Rhesus-related genes were associated with erythrocyte and platelet function, and cholesterol and glycated haemoglobin levels. Four drugs under development targeting RHD were identified (Rozrolimupab, Roledumab, Atorolimumab, and Morolimumab). Rhesus blood type was associated with better survival in HF patients with CRT. Further research into Rhesus-associated pathways and related drugs, namely whether there is a cardiac signal, is required.
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Affiliation(s)
- Nikolaos Papageorgiou
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Catrin Sohrabi
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, UK
| | | | | | - Kishore Kukendrarajah
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Luso Matiti
- Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Essex, UK
| | - Neil T Srinivasan
- Department of Cardiac Electrophysiology, Essex Cardiothoracic Centre, Basildon, UK
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - Syed Ahsan
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, UK
| | - Simon Sporton
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, UK
| | - Richard J Schilling
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, UK
| | - Ross J Hunter
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, UK
| | - Amal Muthumala
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, UK
| | - Antonio Creta
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, UK
| | - Anthony W Chow
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, UK
| | - Rui Providencia
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, UK.
- Institute of Cardiovascular Science, University College London, London, UK.
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2
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Roccisano L, Voskoboinik A, Mariani J, Marwick TH, Patel HC. Cardiac Resynchronisation Therapy: How Medicare Criteria Might Inadvertently Promote Disparate Healthcare. Heart Lung Circ 2024; 33:e10-e11. [PMID: 38453294 DOI: 10.1016/j.hlc.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Laura Roccisano
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia.
| | - Aleksandr Voskoboinik
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Justin Mariani
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Central Clinical School, Monash University, Melbourne, Vic, Australia
| | | | - Hitesh C Patel
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
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Ahmed MA, Gercek M, Sommer P, Rudolph V, Dumitrescu D, Faber L, Fox H. Echocardiographic mechanical dyssynchrony predicts long-term mortality in patients with cardiac resynchronisation therapy. Int J Cardiovasc Imaging 2024; 40:35-43. [PMID: 37819382 PMCID: PMC10774169 DOI: 10.1007/s10554-023-02972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
Cardiac resynchronisation therapy (CRT) is an established treatment for patients with symptomatic heart failure with reduced left ventricular ejection fraction (LVEF ≤ 35%; HFrEF) and conduction disturbances (QRS duration ≥ 130 ms). The presence of mechanical dyssynchrony (MD) on echocardiography has been hypothesised to be of predictive value in determining indication for CRT. This study investigated the impact of MD (apical rocking [AR] and septal flash [SF]) on long-term survival in CRT recipients. HFrEF patients (n = 425; mean age 63.0 ± 10.6 years, 72.3% male, 60.7% non-ischaemic aetiology) with a guideline-derived indication for CRT underwent device implantation. MD markers were determined at baseline and after a mean follow-up of 11.5 ± 8.0 months; long-term survival was also determined. AR and/or SF were present in 307 (72.2%) participants at baseline. During post-CRT follow-up, AR and/or SF disappeared in 256 (83.4%) patients. Overall mean survival was 95.9 ± 52.9 months, longer in women than in men (109.1 ± 52.4 vs. 90.9 ± 52.4 months; p < 0.001) and in younger (< 60 years) versus older patients (110.6 ± 53.7 vs. 88.6 ± 51.1 months; p < 0.001). Patients with versus without MD markers at baseline generally survived for longer (106.2 ± 52.0 vs. 68.9 ± 45.4 months; p < 0.001), and survival was best in patients with resolved versus persisting MD (111.6 ± 51.2 vs. 79.7 ± 47.6 months p < 0.001). Age and MD at baseline were strong predictors of long-term survival in HFrEF patients undergoing CRT on multivariate analysis. Novel echocardiography MD parameters in HFrEF CRT recipients predicted long-term mediated better outcome, and survival improved further when AR and/or SF disappear after CRT implantation.
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Affiliation(s)
- Mohamed Abdelbaset Ahmed
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Muhammed Gercek
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Daniel Dumitrescu
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Lothar Faber
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany.
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany.
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Tuohinen S, Aro A, Karvonen J. Trans-oesophageal echocardiography-guided implantation of a cardiac resynchronization therapy pacemaker and successful ablation of the atrioventricular node after TriClip: case report. Eur Heart J Case Rep 2023; 7:ytad494. [PMID: 37954565 PMCID: PMC10639096 DOI: 10.1093/ehjcr/ytad494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/16/2023] [Accepted: 10/05/2023] [Indexed: 11/14/2023]
Abstract
Background Edge-to-edge intervention is the most common trans-catheter procedure performed for isolated severe tricuspid regurgitation in high-surgical-risk patients. However, it creates an obstacle for future right ventricular (RV) procedures such as implantation of cardiac implantable electronic devices (CIEDs). Reports of the management of CIED implantation after tricuspid edge-to-edge therapy are scarce. Case summary A 76-year-old woman suffered from severe tricuspid regurgitation with New York Heart Association three symptoms despite optimal medical therapy. After a thorough evaluation, the heart team recommended the TriClip procedure as the treatment of choice. However, 12 months after a successful TriClip procedure, rapid atrial fibrillation needed to be addressed with CIED implantation and atrioventricular (AV) node ablation. Pre-procedural planning included the intended posterior location of the CIED to avoid interference with the implanted clip and future AV node ablation. With an additional left ventricular lead positioned anteriorly to the RV lead, the posterior position of the RV lead was secured. Under peri-procedural trans-oesophageal echocardiography (TEE), the planned procedures were performed successfully. Discussion A blind manoeuvring of the RV lead may damage the edge-to-edge tricuspid device. In addition, friction due to an overly close contract between the RV lead and the edge-to-edge device may damage the RV lead. A successful and safe CIED implantation and atrioventricular node ablation can be performed after tricuspid edge-to-edge therapy with careful planning and its precise execution under TEE surveillance.
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Affiliation(s)
- Suvi Tuohinen
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, PO Box 340, PL 52, Haartmaninkatu 4, Helsinki 00029, Finland
| | - Aapo Aro
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, PO Box 340, PL 52, Haartmaninkatu 4, Helsinki 00029, Finland
| | - Jarkko Karvonen
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, PO Box 340, PL 52, Haartmaninkatu 4, Helsinki 00029, Finland
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Wenzelburger FWG, Schumacher B. [Legal aspects of telemedicine in cardiology in Germany]. Herzschrittmacherther Elektrophysiol 2023; 34:193-197. [PMID: 37434022 DOI: 10.1007/s00399-023-00949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/06/2023] [Indexed: 07/13/2023]
Abstract
Since 2016, quarterly telemedical remote monitoring of patients with an implanted defibrillator or cardiac resynchronization therapy (CRT) system is part of the Einheitlichen Bewertungsmaßstab (EBM, physician's fee schedule) and is the first telemedical service to be reimbursed in German cardiology. Many publications like the TIM-HF2 or the InTime trial have shown a significant benefit for different endpoints in patients with advanced heart failure. Therefore, the German Society of Cardiology (DGK) has published different recommendations that emphasize an obvious indication of telemedical care with daily control of implantable cardioverter-defibrillator (ICD) information, parameters like blood pressure and weight, and telemedical counselling of patients with heart failure with reduced ejection fraction. This recommendation is also part of the guidelines of the European Society of Cardiology (ESC) published in 2021. It has a level IIb for patients with heart failure. In December 2020 the "Gemeinsame Bundesausschuss" (G-BA) decided to accept telemonitoring as a diagnostic tool and treatment option for patients with heart failure. This service of physicians became part of the EBM and ever since may be offered to patients. This development is accompanied with many questions regarding a physician's accountability, protection of data privacy, and also regarding the structures given by the G‑BA and the "Kassenärztlichen Vereinigungen" (KV). Thus, this paper tries to give an overview of these topics. It will also provide a critical discussion of these structures and their legal foundation because there are many constraints that need to be taken into consideration as a cardiologist. These constraints may ultimately hinder the expansion of this service to patients in Germany.
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Affiliation(s)
- F W G Wenzelburger
- Medizinische Klinik II, Westpfalzklinikum Kaiserslautern, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland.
| | - B Schumacher
- Medizinische Klinik II, Westpfalzklinikum Kaiserslautern, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland
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6
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Ezzeddine FM, Leon IG, Cha YM. Cardiac Resynchronisation with Conduction System Pacing. Arrhythm Electrophysiol Rev 2023; 12:e22. [PMID: 37654672 PMCID: PMC10466271 DOI: 10.15420/aer.2023.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/12/2023] [Indexed: 09/02/2023] Open
Abstract
To date, biventricular pacing (BiVP) has been the standard pacing modality for cardiac resynchronisation therapy. However, it is non-physiological, with the activation spreading between the left ventricular epicardium and right ventricular endocardium. Up to one-third of patients with heart failure who are eligible for cardiac resynchronisation therapy do not derive benefit from BiVP. Conduction system pacing (CSP), which includes His bundle pacing and left bundle branch area pacing, has emerged as an alternative to BiVP for cardiac resynchronisation. There is mounting evidence supporting the benefits of CSP in achieving synchronous ventricular activation and repolarisation. The aim of this review is to summarise the current options and outcomes of CSP when used for cardiac resynchronisation in patients with heart failure.
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Affiliation(s)
| | - Isaac G Leon
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, US
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, US
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7
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Rademakers LM, van den Broek JLPM, Bracke FA. Left bundle branch pacing as an alternative to biventricular pacing for cardiac resynchronisation therapy. Neth Heart J 2023; 31:140-149. [PMID: 35920989 PMCID: PMC10033770 DOI: 10.1007/s12471-022-01712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to biventricular pacing (BVP) for the delivery of cardiac resynchronisation therapy (CRT). This study assessed the feasibility and outcomes of LBBP in comparison to BVP. METHODS LBBP was attempted in 40 consecutive patients as the first-line method for delivering CRT. To evaluate LBBP versus BVP, 40 patients with identical inclusion criteria who received BVP were compared with the LBBP group. Acute success rate, complications, functional and echocardiographic outcomes as well as hospitalisation for heart failure and all-cause mortality 6 months after implantation were evaluated. RESULTS LBBP was successfully performed in 31 (78%) patients and resulted in significant QRS narrowing (from 166 ± 16 to 123 ± 18 ms, p < 0.001), improvement in left ventricular ejection fraction (LVEF; from 28 ± 8 to 43 ± 12%, p < 0.001) and New York Heart Association functional class (from 2.8 ± 0.5 to 1.6 ± 0.6, p < 0.001) at 6 months. No LBBP-related complications occurred. Compared to BVP, LBBP resulted in a greater reduction in QRS duration (44 ± 17 vs 15 ± 26 ms, p < 0.001) with comparable absolute improvement in LVEF (15.2 ± 11.7 vs 9.6 ± 12.1%, p = 0.088). Hospitalisation for heart failure and all-cause mortality were similar in the two groups. CONCLUSIONS LBBP is feasible and was safe in 78% of patients with favourable electrical resynchronisation and functional improvement and may serve as an alternative to BVP.
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Affiliation(s)
- L M Rademakers
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
| | | | - F A Bracke
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
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Theuns DA, Verstraelen TE, van der Lingen ACJ, Delnoy PP, Allaart CP, van Erven L, Maass AH, Vernooy K, Wilde AAM, Boersma E, Meeder JG. Implantable defibrillator therapy and mortality in patients with non-ischaemic dilated cardiomyopathy : An updated meta-analysis and effect on Dutch clinical practice by the Task Force of the Dutch Society of Cardiology. Neth Heart J 2023; 31:89-99. [PMID: 36066840 PMCID: PMC9950314 DOI: 10.1007/s12471-022-01718-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Primary prophylactic implantable cardioverter-defibrillators (ICDs) in patients with non-ischaemic cardiomyopathy (NICMP) remains controversial. This study sought to assess the benefit of ICD therapy with or without cardiac resynchronisation therapy (CRT) in patients with NICMP. In addition, data were compared with real-world clinical data to perform a risk/benefit analysis. METHODS Relevant randomised clinical trials (RCTs) published in meta-analyses since DANISH, and in PubMed, EMBASE and Cochrane databases from 2016 to 2020 were identified. The benefit of ICD therapy stratified by CRT use was assessed using random effects meta-analysis techniques. RESULTS Six RCTs were included in the meta-analysis. Among patients without CRT, ICD use was associated with a 24% reduction in mortality (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.62-0.93; P = 0.008). In contrast, among patients with CRT, a CRT-defibrillator was not associated with reduced mortality (HR: 0.74, 95% CI 0.47-1.16; P = 0.19). For ICD therapy without CRT, absolute risk reduction at 3‑years follow-up was 3.7% yielding a number needed to treat of 27. CONCLUSION ICD use significantly improved survival among patients with NICMP who are not eligible for CRT. Considering CRT, the addition of defibrillator therapy was not significantly associated with mortality benefit compared with CRT pacemaker.
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Affiliation(s)
- D. A. Theuns
- grid.5645.2000000040459992XDepartment of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - T. E. Verstraelen
- grid.5650.60000000404654431Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - A. C. J. van der Lingen
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - P. P. Delnoy
- grid.452600.50000 0001 0547 5927Isala klinieken, Zwolle, The Netherlands
| | - C. P. Allaart
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - L. van Erven
- grid.10419.3d0000000089452978LUMC, Leiden, The Netherlands
| | - A. H. Maass
- grid.4494.d0000 0000 9558 4598UMCG, Groningen, The Netherlands
| | - K. Vernooy
- grid.412966.e0000 0004 0480 1382Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - A. A. M. Wilde
- grid.5650.60000000404654431Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - E. Boersma
- grid.5645.2000000040459992XDepartment of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - J. G. Meeder
- grid.416856.80000 0004 0477 5022VieCuri, Venlo, The Netherlands
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Wood-Kurland HK, Phelps M, Thune JJ, Philbert B, Larroudé CE, Schou M, Hansen ML, Gislason GH, Bang CN. Impact of Nationwide COVID-19 Lockdowns on the Implantation Rate of Cardiac Implantable Electronic Devices. Heart Lung Circ 2023; 32:364-372. [PMID: 36513581 PMCID: PMC9741195 DOI: 10.1016/j.hlc.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/05/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
AIM The COVID-19 pandemic resulted in a significant decrease in the number of hospital admissions for severe emergent cardiovascular diseases during lockdowns worldwide. This study aimed to determine the impact of both the first and the second Danish nationwide lockdown on the implantation rate of cardiac implantable electronic devices (CIEDs). METHODS We retrospectively analysed the number of CIED implantations performed in Denmark and stratified them into 3-week intervals. RESULTS The total number of de novo CIED implantations decreased during the first lockdown by 15.5% and during the second by 5.1%. Comparing each 3-week interval using rate ratios, a significant decrease in the daily rates of the total number of de novo and replacement CIEDs (0.82, 95% CI [0.70, 0.96]), de novo CIEDs only (0.82, 95% CI [0.69, 0.98]), and non-acute pacemaker implantations (0.80, 95% CI [0.63, 0.99]) was observed during the first interval of the first lockdown. During the second lockdown (third interval), a significant decrease was seen in the daily rates of de novo CIEDs (0.73, 95% CI [0.55, 0.97]), and of pacemakers in total during both the second (0.78, 95% CI [0.62, 0.97]) and the third (0.60, 95% CI [0.42, 0.85]) intervals. Additionally, the daily rates of acute pacemaker implantation decreased during the second interval (0.47, 95% CI [0.27, 0.79]) and of non-acute implantation during the third interval (0.57, 95% CI [0.38, 0.84]). A significant increase was observed in the number of replacement procedures during the first interval of the second lockdown (1.70, 95% CI [1.04, 2.85]). CONCLUSIONS Our study found only modest changes in CIED implantations in Denmark during two national lockdowns.
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Affiliation(s)
- Hannah K Wood-Kurland
- Department of Cardiology, Bispebjerg & Frederiksberg Hospitals, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - Jens Jakob Thune
- Department of Cardiology, Bispebjerg & Frederiksberg Hospitals, Copenhagen, Denmark
| | - Berit Philbert
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
| | | | - Gunnar H Gislason
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark; Danish Heart Foundation, Copenhagen, Denmark
| | - Casper N Bang
- Department of Cardiology, Bispebjerg & Frederiksberg Hospitals, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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10
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Puyol-Antón E, Sidhu BS, Gould J, Porter B, Elliott MK, Mehta V, Rinaldi CA, King AP. A multimodal deep learning model for cardiac resynchronisation therapy response prediction. Med Image Anal 2022; 79:102465. [PMID: 35487111 DOI: 10.1016/j.media.2022.102465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/03/2022] [Accepted: 04/15/2022] [Indexed: 01/03/2023]
Abstract
We present a novel multimodal deep learning framework for cardiac resynchronisation therapy (CRT) response prediction from 2D echocardiography and cardiac magnetic resonance (CMR) data. The proposed method first uses the 'nnU-Net' segmentation model to extract segmentations of the heart over the full cardiac cycle from the two modalities. Next, a multimodal deep learning classifier is used for CRT response prediction, which combines the latent spaces of the segmentation models of the two modalities. At test time, this framework can be used with 2D echocardiography data only, whilst taking advantage of the implicit relationship between CMR and echocardiography features learnt from the model. We evaluate our pipeline on a cohort of 50 CRT patients for whom paired echocardiography/CMR data were available, and results show that the proposed multimodal classifier results in a statistically significant improvement in accuracy compared to the baseline approach that uses only 2D echocardiography data. The combination of multimodal data enables CRT response to be predicted with 77.38% accuracy (83.33% sensitivity and 71.43% specificity), which is comparable with the current state-of-the-art in machine learning-based CRT response prediction. Our work represents the first multimodal deep learning approach for CRT response prediction.
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Affiliation(s)
- Esther Puyol-Antón
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK.
| | - Baldeep S Sidhu
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Justin Gould
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Bradley Porter
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Mark K Elliott
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Andrew P King
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK
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Calle S, Timmermans F, De Pooter J. Defining left bundle branch block according to the new 2021 European Society of Cardiology criteria. Neth Heart J 2022; 30:495-498. [PMID: 35503400 PMCID: PMC9613831 DOI: 10.1007/s12471-022-01697-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/29/2022] Open
Abstract
Correctly diagnosing left bundle branch block (LBBB) is fundamental, as LBBB occurs frequently in heart failure and may trigger a vicious cycle of progressive left ventricular dysfunction. Moreover, a correct diagnosis of LBBB is pivotal to guide cardiac resynchronisation therapy. Since the LBBB diagnostic criteria were recently updated by the European Society of Cardiology (ESC), we assessed their diagnostic accuracy compared with the previous ESC 2013 definition. We further discuss the complexity of defining LBBB within the context of recent insights into the electromechanical pathophysiology of LBBB.
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Affiliation(s)
- S Calle
- Department of Cardiology, 8-K12, University Hospital Ghent, Ghent, Belgium.
| | - F Timmermans
- Department of Cardiology, 8-K12, University Hospital Ghent, Ghent, Belgium
| | - J De Pooter
- Department of Cardiology, 8-K12, University Hospital Ghent, Ghent, Belgium
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12
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Heckman LIB, Luermans JGLM, Jastrzębski M, Weijs B, Van Stipdonk AMW, Westra S, den Uijl D, Linz D, Mafi-Rad M, Prinzen FW, Vernooy K. A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics. Neth Heart J 2022. [PMID: 35380414 DOI: 10.1007/s12471-022-01679-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Left bundle branch area pacing (LBBAP) has recently been introduced as a physiological pacing technique with synchronous left ventricular activation. It was our aim to evaluate the feasibility and learning curve of the technique, as well as the electrical characteristics of LBBAP. Methods and results LBBAP was attempted in 80 consecutive patients and electrocardiographic characteristics were evaluated during intrinsic rhythm, right ventricular septum pacing (RVSP) and LBBAP. Permanent lead implantation was successful in 77 of 80 patients (96%). LBBAP lead implantation time and fluoroscopy time shortened significantly from 33 ± 16 and 21 ± 13 min to 17 ± 5 and 12 ± 7 min, respectively, from the first 20 to the last 20 patients. Left bundle branch (LBB) capture was achieved in 54 of 80 patients (68%). In 36 of 45 patients (80%) with intact atrioventricular conduction and narrow QRS, an LBB potential (LBBpot) was present with an LBBpot to onset of QRS interval of 22 ± 6 ms. QRS duration increased significantly more during RVSP (141 ± 20 ms) than during LBBAP (125 ± 19 ms), compared to 130 ± 30 ms without pacing. An even clearer difference was observed for QRS area, which increased significantly more during RVSP (from 32 ± 16 µVs to 73 ± 20 µVs) than during LBBAP (41 ± 15 µVs). QRS area was significantly smaller in patients with LBB capture compared to patients without LBB capture (43 ± 18 µVs vs 54 ± 21 µVs, respectively). In patients with LBB capture (n = 54), the interval from the pacing stimulus to R‑wave peak time in lead V6 was significantly shorter than in patients without LBB capture (75 ± 14 vs 88 ± 9 ms, respectively). Conclusion LBBAP is a safe and feasible technique, with a clear learning curve that seems to flatten after 40–60 implantations. LBB capture is achieved in two-thirds of patients. Compared to RVSP, LBBAP largely maintains ventricular electrical synchrony at a level close to intrinsic (narrow QRS) rhythm. Supplementary Information The online version of this article (10.1007/s12471-022-01679-7) contains supplementary material, which is available to authorized users.
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13
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Azraai M, D'Souza D, Nadurata V. Current Clinical Practice in Patients With Cardiac Implantable Electronic Devices (CIED) Undergoing Radiotherapy (RT). Heart Lung Circ 2021; 31:327-340. [PMID: 34844904 DOI: 10.1016/j.hlc.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
Patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy (RT) are more common due to ageing of the population. With newer CIEDs implementing the complementary metal-oxide semiconductor (CMOS) technology which allows the miniaturisation of CIED, it is also more susceptible to RT. Effects of RT on CIED ranges from device interference, device operational/memory errors of permanent damage. These malfunctions can cause life threatening clinical effects. Cumulative dose is not the only component of RT that causes CIED malfunction, as neutron use and dose rate effect also affects CIEDs. The management of this patient cohort in clinical practice is inconsistent due to lack of a consistent guideline from manufacturers and physician specialty societies. Our review will focus on the current clinical practice and the recent updated guidelines of managing patients with CIED undergoing RT. We aim to simplify the evidence and provide a simple and easy to use guide based on the recent guidelines.
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Affiliation(s)
- Meor Azraai
- Department of Cardiology, Bendigo Health, Bendigo, Vic, Australia.
| | - Daniel D'Souza
- Department of Cardiology, Bendigo Health, Bendigo, Vic, Australia
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14
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Rademakers LM, van den Broek JLPM, Op 't Hof M, Bracke FA. Initial experience, feasibility and safety of permanent left bundle branch pacing: results from a prospective single-centre study. Neth Heart J 2021. [PMID: 34837151 DOI: 10.1007/s12471-021-01648-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Left bundle branch (LBB) pacing is a novel pacing technique which may serve as an alternative to both right ventricular pacing for symptomatic bradycardia and cardiac resynchronisation therapy (CRT). A substantial amount of data is reported by relatively few, highly experienced centres. This study describes the first experience of LBB pacing in a high-volume device centre. Methods Success rates (i.e. the ability to achieve LBB pacing), electrophysiological parameters and complications at implant and up to 6 months of follow-up were prospectively assessed in 100 consecutive patients referred for various pacing indications. Results The mean age was 71 ± 11 years and 65% were male. Primary pacing indication was atrioventricular (AV) block in 40%, CRT in 42%, and sinus node dysfunction or refractory atrial fibrillation prior to AV node ablation in 9% each. Baseline left ventricular ejection fraction was < 50% in 57% of patients, mean baseline QRS duration 145 ± 34 ms. Overall LBB pacing was successful in 83 of 100 (83%) patients but tended to be lower in patients with CRT pacing indication (69%, p = ns). Mean left ventricular activation time (LVAT) during LBB pacing was 81 ms and paced QRS duration was 120 ± 19 ms. LBB capture threshold and R‑wave sense at implant was 0.74 ± 0.4 mV at 0.4 ms and 11.9 ± 5.9 V and remained stable at 6‑month follow-up. No complications occurred during implant or follow-up. Conclusion LBB pacing for bradycardia pacing and resynchronisation therapy can be easily adopted by experienced implanters, with favourable success rates and safety profile.
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15
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Stassen J, Scherrenberg M, Dilling-Boer D, Vijgen J, Koopman P, Schurmans J, Herbots L, Verwerft J, Schroyens M, Timmermans P. Comparison of de novo versus upgrade cardiac resynchronisation therapy on clinical effect and long-term outcome. Acta Cardiol 2021; 76:993-1000. [PMID: 33432875 DOI: 10.1080/00015385.2020.1867387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The benefit of de novo cardiac resynchronisation therapy (CRT) implantation in selected patients with heart failure is well known. The number of upgrade procedures is increasing but data on clinical response and outcome are less well documented as compared to de novo implantation. OBJECTIVES To investigate the efficacy and outcome of CRT upgrade procedures in patients with existing cardiac implantable electronic devices (CIEDs). METHODS Baseline characteristics, change in New York Heart Association (NYHA) functional class, echocardiographic parameters, life-threatening ventricular tachyarrhythmias, all-cause mortality and mode of death were evaluated in CRT patients with the comparison between de novo and upgrade CRT procedures. RESULTS About 410 patients (CRT upgrade/de novo CRT, n = 97/313) were followed for 63.5 ± 38.1 months. Upgrade patients were older (75.5 ± 8.1 vs 69.9 ± 10.7 years; p < 0.001), had more often an ischaemic cause of heart failure (58.8% vs 45.4%; p = 0.021), a higher NYHA functional class (p = 0.004) and a higher comorbidity burden. Improvement in left ventricular ejection fraction (LVEF) was higher in the de novo CRT group (8.4 ± 9.9 vs 11.0 ± 10.3%; p = 0.035). Clinical response was similar between both groups (60.5 vs 62.5%; p = 0.793), as was mortality at 1 year (8.2 vs 5.8%; p = 0.351) and at last follow-up (33.0 vs 28.8%; p = 0.447). The proportion of cardiovascular related deaths was similar between both groups (46.9% vs 38.9%; p = 0.531). CONCLUSIONS Patients with CRT upgrade procedures have similar symptomatic improvements, as well as 1 year and long-term outcome as compared to patients with de novo CRT implantation.
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Affiliation(s)
- Jan Stassen
- Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium
| | - Martijn Scherrenberg
- Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt – Hasselt University, Agoralaan, Belgium
| | | | - Johan Vijgen
- Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium
| | | | | | | | - Jan Verwerft
- Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium
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16
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Sus I, Suteu C, Dobreanu D. Cardiac resynchronisation therapy in a pace-dependent infant with tetralogy of Fallot. Cardiol Young 2021; 32:1-4. [PMID: 34641991 DOI: 10.1017/s1047951121004169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We present the case of a 5-month-old infant with tetralogy of Fallot and congenital atrio-ventricular block that developed severe left ventricular dysfunction during apical left ventricular pacing, in which cardiac resynchronisation therapy was used as an emergency procedure due to persistent low cardiac output syndrome.
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Affiliation(s)
- Ioana Sus
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tirgu Mures, Romania
- University of Medicine, Pharmacy, Science and Technology "G. E. Palade" of Tirgu Mures, Tirgu Mures, Romania
| | - Carmen Suteu
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tirgu Mures, Romania
- University of Medicine, Pharmacy, Science and Technology "G. E. Palade" of Tirgu Mures, Tirgu Mures, Romania
| | - Dan Dobreanu
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tirgu Mures, Romania
- University of Medicine, Pharmacy, Science and Technology "G. E. Palade" of Tirgu Mures, Tirgu Mures, Romania
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17
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Waddingham PH, Lambiase P, Muthumala A, Rowland E, Chow AW. Fusion Pacing with Biventricular, Left Ventricular-only and Multipoint Pacing in Cardiac Resynchronisation Therapy: Latest Evidence and Strategies for Use. Arrhythm Electrophysiol Rev 2021; 10:91-100. [PMID: 34401181 PMCID: PMC8335856 DOI: 10.15420/aer.2020.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 12/11/2022] Open
Abstract
Despite advances in the field of cardiac resynchronisation therapy (CRT), response rates and durability of therapy remain relatively static. Optimising device timing intervals may be the most common modifiable factor influencing CRT efficacy after implantation. This review addresses the concept of fusion pacing as a method for improving patient outcomes with CRT. Fusion pacing describes the delivery of CRT pacing with a programming strategy to preserve intrinsic atrioventricular (AV) conduction and ventricular activation via the right bundle branch. Several methods have been assessed to achieve fusion pacing. QRS complex duration (QRSd) shortening with CRT is associated with improved clinical response. Dynamic algorithm-based optimisation targeting narrowest QRSd in patients with intact AV conduction has shown promise in people with heart failure with left bundle branch block. Individualised dynamic programming achieving fusion may achieve the greatest magnitude of electrical synchrony, measured by QRSd narrowing.
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Affiliation(s)
- Peter H Waddingham
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Pier Lambiase
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,UCL Institute of Cardiovascular Science University College London, London, UK
| | - Amal Muthumala
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Edward Rowland
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anthony Wc Chow
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
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18
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Appadurai V, D'Elia N, Mew T, Tomlinson S, Chan J, Hamilton-Craig C, Scalia GM. Global longitudinal strain as a prognostic marker in cardiac resynchronisation therapy: A systematic review. Int J Cardiol Heart Vasc 2021; 35:100849. [PMID: 34386575 PMCID: PMC8342974 DOI: 10.1016/j.ijcha.2021.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/07/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022]
Abstract
Left ventricular global longitudinal strain (LV GLS) is a sensitive parameter that correlates with myocardial scar burden and fibrosis with potential value in CRT candidates. First systematic review evaluating the existing evidence for the prognostic value of LV GLS in patients undergoing CRT implantation. Despite significantly abnormal baseline GLS at CRT implantation, there is still a significant association between incrementally worse LV GLS at CRT implantation and prognostic outcomes on long-term follow-up.
Purpose Cardiac resynchronisation therapy (CRT) has proven mortality benefits for heart failure patients with moderate to severe systolic left ventricular dysfunction and evidence of a left bundle branch block. Determining responders to this therapy can be difficult due to the presence of myocardial fibrosis and scar. Left ventricular global longitudinal strain (LV GLS) is a robust and sensitive measure of myocardial function and fibrosis that has significant prognostic value for a plethora of cardiac pathologies. Our aim was to perform a systematic review of the value of LV GLS for predicting outcomes in patients undergoing CRT. Methods A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) protocol for reporting on systematic reviews and meta-analyses. An electronic search of all English, adult publications in EMBASE, MEDLINE/PubMed and the Cochrane Database of Systematic reviews was undertaken. Results The search yielded, 9 studies that included 3,981 patients with symptomatic heart failure, undergoing CRT implantation with LV GLS utilised as a predictor of all-cause mortality, cardiovascular death, rehospitalisation, LVAD implantation/ heart transplantation or left ventricular reverse remodelling. Significant heterogeneity was observed in study outcome measures, included populations, LV-GLS cut-offs and follow-up definitions, resulting in the inability to reliably conduct a meta-analyses. Overall, pre-CRT LV GLS was found to be a predictor of outcome post CRT insertion. Conclusions In conclusion, all studies implied that incrementally abnormal baseline LV GLS pre-CRT implantation was associated with a long term poorer outcome.
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Affiliation(s)
- Vinesh Appadurai
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.,School of Medicine, The University of Queensland, St Lucia, Australia
| | - Nicholas D'Elia
- The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Thomas Mew
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.,School of Medicine, The University of Queensland, St Lucia, Australia
| | - Stephen Tomlinson
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.,School of Medicine, The University of Queensland, St Lucia, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - Christian Hamilton-Craig
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.,School of Medicine, The University of Queensland, St Lucia, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - Gregory M Scalia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.,School of Medicine, The University of Queensland, St Lucia, Australia
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19
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Sidhu BS, Gould J, Elliott MK, Mehta V, Niederer S, Rinaldi CA. Leadless Left Ventricular Endocardial Pacing and Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2021; 10:45-50. [PMID: 33936743 PMCID: PMC8076968 DOI: 10.15420/aer.2020.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/31/2020] [Indexed: 12/02/2022] Open
Abstract
Cardiac resynchronisation therapy is an important intervention to reduce mortality and morbidity, but even in carefully selected patients approximately 30% fail to improve. This has led to alternative pacing approaches to improve patient outcomes. Left ventricular (LV) endocardial pacing allows pacing at site-specific locations that enable the operator to avoid myocardial scar and target areas of latest activation. Left bundle branch area pacing (LBBAP) provides a more physiological activation pattern and may allow effective cardiac resynchronisation. This article discusses LV endocardial pacing in detail, including the indications, techniques and outcomes. It discusses LBBAP, its potential benefits over His bundle pacing and procedural outcomes. Finally, it concludes with the future role of endocardial pacing and LBBAP in heart failure patients.
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Affiliation(s)
- Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' Hospital, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' Hospital, London, UK
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' Hospital, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' Hospital, London, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' Hospital, London, UK
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20
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Dębska-Kozłowska A, Warchoł I, Książczyk M, Lubiński A. The Significance of Renal Function in Response to Cardiac Resynchronisation Therapy - A Piece of a Much Larger Puzzle. Curr Vasc Pharmacol 2021; 19:403-410. [PMID: 32286948 DOI: 10.2174/1570161118666200414103432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although cardiac resynchronisation therapy (CRT) is an important player in the treatment of patients with heart failure (HF), the proportion of CRT patients with no improvement in either echocardiographic or clinical parameters remains consistently high and accounts for about 30% despite meeting CRT implantation criteria. Furthermore, in patients suffering from HF, renal dysfunction accounts for as many as 30-60%. Accordingly, CRT may improve renal function inducing a systemic haemodynamic benefit leading to increased renal blood flow. OBJECTIVES The aim of the present study was to evaluate the importance of renal function in response to resynchronisation therapy during a 12-month follow-up period. MATERIALS AND METHODS The study consisted of 46 HF patients qualified for implantation of cardiac resynchronisation therapy defibrillator (CRT-D). A CRT responder is defined as a person without chronic HF exacerbations during observation whose physical efficiency has improved owing to the New York Heart Association (NYHA) class improvement ≥1. RESULTS A statistically significant difference was noted between responders and non-responders regarding creatinine level at the 3rd month (p=0.04) and, particularly, at the 12th month (p=0.02) of follow-up (100±23 vs 139±78 μmol/l). Moreover, there was a remarkable difference between both study groups with regard to GFR CKD-EPI (glomerular filtration rate (GFR) assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula) at the 6th (p=0.03) and 12th month (p=0.01) of follow-up. The reference values for initial creatinine concentrations (101 μmol/l) as well as GFR CKDEPI (63 ml/min/1.73m2) were empirically evaluated to predict favourable therapeutic CRT response. CONCLUSION Predictive value of GFR CKD-EPI and creatinine concentration for a positive response to CRT was found relevant.
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Affiliation(s)
- Agnieszka Dębska-Kozłowska
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Lodz, Poland
| | - Izabela Warchoł
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Lodz, Poland
| | - Marcin Książczyk
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Lodz, Poland
| | - Andrzej Lubiński
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Lodz, Poland
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21
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Tan L, Ganesananthan S, Huzaien H, Elsayed H, Shah N, Shah P, Yousef Z. Upgrading to cardiac resynchronisation therapy: Concordance of real-world experience with clinical guidelines. Int J Cardiol Heart Vasc 2021; 33:100746. [PMID: 33748400 PMCID: PMC7957085 DOI: 10.1016/j.ijcha.2021.100746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/04/2021] [Accepted: 02/21/2021] [Indexed: 11/19/2022]
Abstract
Objective Revision to cardiac resynchronisation therapy (CRT) in patients with existing pacemakers with worsening heart failure (HF) can improve symptoms and cardiac function. We identify factors that predict improvement in left ventricular ejection fraction (LVEF) within a year of CRT revision. Methods We performed a retrospective study of 146 consecutive patients (16% female, mean age 73 ± 11 years, mean LVEF 27 ± 8%) undergoing revision to CRT (January 2012 to May 2018) in a single tertiary centre. LVEF was measured pre-revision and 3, 6 and 12 months post-upgrade. Results At 6 months, 68% of patients demonstrated improvement in LVEF (mean ΔLVEF + 6.7% ± 9.6). Compared to patients in atrial fibrillation (AF), patients with sinus rhythm had a greater improvement in LVEF at 6 months (sinus 8.4 ± 10.3% vs. AF 4.2 ± 8.0%, p = 0.02). Compared to ischaemic cardiomyopathy (ICM), patients with non-ischaemic cardiomyopathy (NICM) had a greater improvement in LVEF at 6 months (NICM 8.4 ± 9.8% vs ICM 4.8 ± 9.2%, p = 0.05). Patients with RV pacing ≥40% at baseline had a greater improvement in LVEF at 6 months (≥40% RV pacing 9.3 ± 10.2 vs. < 40% RV pacing 4.0 ± 7.4%, p = 0.01). All improvements were sustained over 12 months post-revision. There was no significant difference between genders, years between initial implant and revision, or previous device type. Conclusions Our real-world experience supports current guidelines on CRT revision. NICM, ≥40% RV pacing and sinus rhythm are the main predictors of improvement in LVEF in patients who underwent CRT revision.
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Affiliation(s)
- Laura Tan
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | | | - Hani Huzaien
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Hossam Elsayed
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Nisar Shah
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Parin Shah
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
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22
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Barbieri F, Adukauskaite A, Senoner T, Rubatscher A, Schgör W, Stühlinger M, Pfeifer BE, Bauer A, Hintringer F, Dichtl W. Supplemental dataset on the influence of cardiac resynchronisation therapy in pacing-induced cardiomyopathy and concomitant central sleep Apnea. Data Brief 2020; 33:106461. [PMID: 33294502 PMCID: PMC7689044 DOI: 10.1016/j.dib.2020.106461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022] Open
Abstract
This article contains supplemental data to the publication “Central Sleep Apnea and Pacing-Induced Cardiomyopathy” [1], which was the most recent publication of the “UPGRADE” study. It provides in-depth analysis of the effects of cardiac resynchronisation therapy (CRT) in patients suffering from pacing-induced cardiomyopathy (PICM) on cardiac remodeling as well as functional cardiac parameters in comparison to continuous right ventricular pacing (RVP). Furthermore, it also covers additional data on several sleep parameters, which were not presented in the main article including the index for obstructive sleep apnea (OSA), the index for mixed sleep apnea and the oxygen saturation measurements during polysomnography. Further, Kaplan-Meier curves are presented for major adverse cardiac events (MACE) and overall mortality by severity of sleep apnea. Generally, the “UGRADE” study was a single-center prospective double-blinded randomized controlled trial lasting from 2014 to 2020. The methodology included a cross-over design giving the possibility to detect differences while CRT was activated and while continuous RVP was applied. The presented data should aid clinicians in daily practice as upgrading to CRT is not limited to improvement in cardiac parameters, but also modifies sleep apnea in patients with PICM, a generally sparsely studied entity of heart failure.
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Affiliation(s)
- Fabian Barbieri
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Agne Adukauskaite
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Senoner
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Andrea Rubatscher
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Wilfried Schgör
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Stühlinger
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Erich Pfeifer
- Institute of Clinical Epidemiology, Tirol Kliniken, Innsbruck, Austria.,Institute of Medical Informatics, UMIT TIROL, Eduart Wallnöfer Zentrum, Hall in Tirol, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Florian Hintringer
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Dichtl
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
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Grebmer C, Friedrich L, Semmler V, Kottmaier M, Bourier F, Brkic A, Blazek P, Weigand S, Connor MO, Deisenhofer I, Hessling G, Kolb C, Lennerz C. Cardiac resynchronisation therapy in patients with left bundle branch block with residual conduction. Indian Pacing Electrophysiol J 2020; 21:14-17. [PMID: 33212244 PMCID: PMC7854372 DOI: 10.1016/j.ipej.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/30/2022] Open
Abstract
Aim To evaluate whether left bundle branch block with residual conduction (rLBBB) is associated with worse outcomes after cardiac resynchronisation therapy (CRT). Methods All consecutive CRT implants at our institution between 2006 and 2013 were identified from our local device registry. Pre- and post-implant patient specific data were extracted from clinical records. Results A total of 690 CRT implants were identified during the study period. Prior to CRT, 52.2% of patients had true left bundle branch block (LBBB), 19.1% a pacing-induced LBBB (pLBBB), 11.2% a rLBBB, 0.8% a right bundle branch block (RBBB), and 16.5% had a nonspecific intraventricular conduction delay (IVCD) electrocardiogram pattern. Mean age at implant was 67.5 years (standard deviation [SD] = 10.6), mean left ventricular ejection fraction (LV EF) was 25.7% (SD = 7.9%), and mean QRS duration was 158.4 ms (SD = 32 ms). After CRT, QRS duration was significantly reduced in the LBBB (p < 0.001), pLBBB (p < 0.001), rLBBB (p < 0.001), RBBB (p = 0.04), and IVCD groups (p = 0.03). LV EF significantly improved in the LBBB (p < 0.001), rLBBB (p = 0.002), and pLBBB (p < 0.001) groups, but the RBBB and IVCD groups showed no improvement. There was no significant difference in mortality between the LBBB and rLBBB groups. LV EF post-CRT, chronic kidney disease, hyperkalaemia, hypernatremia, and age at implant were significant predictors of mortality. Conclusion CRT in patients with rLBBB results in improved LV EF and similar mortality rates to CRT patients with complete LBBB. Predictors of mortality post-CRT include post-CRT LV EF, presence of CKD, hyperkalaemia, hypernatremia, and older age at implant.
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Affiliation(s)
- Christian Grebmer
- Deutsches Herzzentrum München, Klinik für Herz- uns Kreislauferkrankungen, Klinik an der Technischen Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Lena Friedrich
- Deutsches Herzzentrum München, Klinik für Herz- uns Kreislauferkrankungen, Klinik an der Technischen Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Verena Semmler
- Deutsches Herzzentrum München, Klinik für Herz- uns Kreislauferkrankungen, Klinik an der Technischen Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Marc Kottmaier
- Deutsches Herzzentrum München, Klinik für Herz- uns Kreislauferkrankungen, Klinik an der Technischen Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Felix Bourier
- Deutsches Herzzentrum München, Klinik für Herz- uns Kreislauferkrankungen, Klinik an der Technischen Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Amir Brkic
- Deutsches Herzzentrum München, Klinik für Herz- uns Kreislauferkrankungen, Klinik an der Technischen Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Patrick Blazek
- Deutsches Herzzentrum München, Klinik für Herz- uns Kreislauferkrankungen, Klinik an der Technischen Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Severin Weigand
- Deutsches Herzzentrum München, Klinik für Herz- uns Kreislauferkrankungen, Klinik an der Technischen Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Matthew O' Connor
- Wellington Hospital, Department of Cardiology, Wellington, New Zealand
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz- uns Kreislauferkrankungen, Klinik an der Technischen Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Gabriele Hessling
- Deutsches Herzzentrum München, Klinik für Herz- uns Kreislauferkrankungen, Klinik an der Technischen Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- uns Kreislauferkrankungen, Klinik an der Technischen Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Carsten Lennerz
- Deutsches Herzzentrum München, Klinik für Herz- uns Kreislauferkrankungen, Klinik an der Technischen Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Geller JC, Wöhrle A, Busch M, Elsässer A, Kleemann T, Birkenhauer F, Bramlage P, Veltmann C; ReduceIT Investigators. Reduction of inappropriate implantable cardioverter-defibrillator therapies using enhanced supraventricular tachycardia discriminators: the ReduceIT study. J Interv Card Electrophysiol 2021; 61:339-48. [PMID: 32661865 DOI: 10.1007/s10840-020-00816-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Inappropriate implantable cardioverter-defibrillator (ICD) shocks are associated with greater healthcare resource utilization, poorer quality-of-life, and higher mortality. We aimed to investigate the performance of enhanced supraventricular tachycardia (SVT) discrimination algorithms (morphology discrimination, rate stability, and sudden or chamber onset) for reducing inappropriate ICD therapies in patients with ICD/cardiac resynchronization therapy devices. METHODS This prospective, non-randomized, multicenter study (ReduceIT) study took place at 56 sites across Germany and Estonia. Adults at risk of sudden cardiac death undergoing St. Jude Medical™ ICD or CRT-D implantation were included. The primary endpoint was freedom from inappropriate ICD shock at 12 months and was analyzed in the intention to treat (ITT) and per-protocol population. RESULTS Overall, 733 patients (65.9 ± 11.4 years) were included, of which 40.9% and 59.1% received a single- and dual-chamber detection device, respectively. During follow-up (median 11.9 [0-21.6] months), 96.3% of patients experienced no inappropriate therapy (ITT). The sensitivity, specificity, and accuracy for VT/VF were 91.9%, 95.5%, and 94.7%, respectively. In the per-protocol population (n = 620), the proportion of patients free from inappropriate shock at 12 months was 98.4% (n = 610; 95% CI 97.1-99.2%) and exceeded the expected value of 93% (p < 0.0001) which was derived from the rates in the SPICE, ATPonFastVT, and DECREASE studies. A total of 44 patients (6.0%) died during follow-up, 19 deaths were cardiac-related which is consistent with a meta-analysis of EMPIRIC, MADIT-RIT, ADVANCE III, and PROVIDE. Serious device and procedure-related adverse effects occurred in 9.8% of patients. CONCLUSIONS In ICD/CRT-D devices with advanced SVT discriminators, device programming according to clinical setting and detection chamber significantly reduces the rate of inappropriate ICD shocks without compromising patient safety. The algorithms and settings described herein have particular clinical importance and their employment may be of benefit to ICD recipients.
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Abstract
Left bundle branch block (LBBB) is associated with improved outcome after cardiac resynchronisation therapy (CRT). One historical presumption of LBBB has been that the underlying pathophysiology involved diffuse disease throughout the distal conduction system. The ability to normalize wide QRS patterns with His bundle pacing (HBP) has called this notion into question. The determination of LBBB pattern is conventionally made by assessment of surface 12-lead ECGs and can include patients with and without conduction block, as assessed by invasive electrophysiology study (EPS). During a novel extension of the classical EPS to involve left-sided recordings, we found that conduction block associated with the LBBB pattern is most often proximal, usually within the left-sided His fibres, and these patients are the most likely to demonstrate QRS correction with HBP for resynchronisation. Patients with intact Purkinje activation and intraventricular conduction delay are less likely to benefit from HBP. Future EPS are required to determine the impact of newer approaches to conduction system pacing, including intraseptal or left ventricular septal pacing. Left-sided EPS has the potential to refine patient selection in CRT trials and may be used to physiologically phenotype distinct conduction patterns beyond LBBB pattern.
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Affiliation(s)
- Roderick Tung
- Center for Arrhythmia Care, Pritzker School of Medicine, University of Chicago, Chicago, IL, US
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Pritzker School of Medicine, University of Chicago, Chicago, IL, US
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Pilecky D, Fischer R, Wiesinger T, Gröbner M, Vamos M, Elsner D. Anterior wall ST-elevation myocardial infarction in biventricular paced rhythm. Herzschrittmacherther Elektrophysiol 2020; 31:228-231. [PMID: 32361770 DOI: 10.1007/s00399-020-00682-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
There is a lack of evidence on electrocardiographic criteria for ST-elevation myocardial infarction (STEMI) in patients with biventricular paced rhythm. In all previous case reports of STEMI in biventricular paced rhythm, concordant ST-elevations and/or discordant ST-elevations >5 mm were present. This report describes the case of a patient with anterior STEMI and discordant ST-elevations of less than 5 mm during biventricular stimulation with epicardial left ventricular lead and highlights the importance of comparing the electrocardiogram to previous recordings when STEMI is suspected.
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Affiliation(s)
- David Pilecky
- Department of Internal Medicine III, Klinikum Passau, Innstraße 76, 94032, Passau, Germany.
| | - Robert Fischer
- Department of Internal Medicine III, Klinikum Passau, Innstraße 76, 94032, Passau, Germany
| | - Tanja Wiesinger
- Department of Internal Medicine III, Klinikum Passau, Innstraße 76, 94032, Passau, Germany
| | - Michael Gröbner
- Department of Internal Medicine III, Klinikum Passau, Innstraße 76, 94032, Passau, Germany
| | - Mate Vamos
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Dietmar Elsner
- Department of Internal Medicine III, Klinikum Passau, Innstraße 76, 94032, Passau, Germany
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Gathier WA, Salden OAE, van Ginkel DJ, van Everdingen WM, Mohamed Hoesein FAA, Cramer MJM, Doevendans PA, Meine M, Chamuleau SAJ, van Slochteren FJ. Feasibility and potential benefit of pre-procedural CMR imaging in patients with ischaemic cardiomyopathy undergoing cardiac resynchronisation therapy. Neth Heart J 2020; 28:89-95. [PMID: 31953775 DOI: 10.1007/s12471-019-01360-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim To determine the feasibility and potential benefit of a full cardiac magnetic resonance (CMR) work-up for assessing the location of scarred myocardium and the region of latest contraction (LCR) in patients with ischaemic cardiomyopathy (ICM) undergoing cardiac resynchronisation therapy (CRT). Methods In 30 patients, scar identification and contraction timing analysis was retrospectively performed on CMR images. Fluoroscopic left ventricular (LV) lead positions were scored with respect to scar location, and when placed outside scar, with respect to the LCR. The association between the lead position with respect to scar, the LCR and echocardiographic LV end-systolic volume (LVESV) reduction was subsequently evaluated. Results The CMR work-up was feasible in all but one patient, in whom image quality was poor. Scar and contraction timing data were succesfully displayed on 36-segment cardiac bullseye plots. Patients with leads placed outside scar had larger LVESV reduction (−21 ± 21%, n = 19) compared to patients with leads within scar (1 ± 25%, n = 11), yet total scar burden was higher in the latter group. There was a trend towards larger LVESV reduction in patients with leads in the scar-free LCR, compared to leads situated in scar-free segments but not in the LCR (−34 ± 14% vs −15 ± 21%, p = 0.06). Conclusions The degree of reverse remodelling was larger in patients with leads situated in a scar-free LCR. In patients with leads situated within scar there was a neutral effect on reverse remodelling, which can be caused both by higher scar burden or lead position. These findings demonstrate the feasibility of a CMR work-up and potential benefit in ICM patients undergoing CRT.
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Crespo C, Linhart M, Acosta J, Soto-Iglesias D, Martínez M, Jáuregui B, Mira Á, Restovic G, Sagarra J, Auricchio A, Fahn B, Boltyenkov A, Lasalvia L, Sampietro-Colom L, Berruezo A. Optimisation of cardiac resynchronisation therapy device selection guided by cardiac magnetic resonance imaging: Cost-effectiveness analysis. Eur J Prev Cardiol 2019; 27:622-632. [PMID: 31487998 DOI: 10.1177/2047487319873149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND A recent study showed that the presence and characteristics of myocardial scar could independently predict appropriate implantable cardioverter-defibrillator therapies and the risk of sudden cardiac death in patients receiving a de novo cardiac resynchronisation device. DESIGN The aim was to evaluate the cost-effectiveness of cardiac magnetic resonance imaging-based algorithms versus clinical practice in the decision-making process for the implantation of a cardiac resynchronisation device pacemaker versus cardiac resynchronisation device implantable cardioverter-defibrillator device in heart failure patients with indication for cardiac resynchronisation therapy. METHODS An incidental Markov model was developed to simulate the lifetime progression of a heart failure patient cohort. Key health variables included in the model were New York Heart Association functional class, hospitalisations, sudden cardiac death and total mortality. The analysis was done from the healthcare system perspective. Costs (€2017), survival and quality-adjusted life years were assessed. RESULTS At 5-year follow-up, algorithm I reduced mortality by 39% in patients with a cardiac resynchronisation device pacemaker who were underprotected due to misclassification by clinical protocol. This approach had the highest quality-adjusted life years (algorithm I 3.257 quality-adjusted life years; algorithm II 3.196 quality-adjusted life years; clinical protocol 3.167 quality-adjusted life years) and the lowest lifetime costs per patient (€20,960, €22,319 and €28,447, respectively). Algorithm I would improve results for three subgroups: non-ischaemic, New York Heart Association class III-IV and ≥65 years old. Furthermore, implementing this approach could generate an estimated €702 million in health system savings annually in European Society of Cardiology countries. CONCLUSION The application of cardiac magnetic resonance imaging-based algorithms could improve survival and quality-adjusted life years at a lower cost than current clinical practice (dominant strategy) used for assigning cardiac resynchronisation device pacemakers and cardiac resynchronisation device implantable cardioverter-defibrillators to heart failure patients.
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Affiliation(s)
- Carlos Crespo
- GM Statistics Department, Universitat de Barcelona, Spain.,Axentiva Solutions, Tacoronte, Spain
| | - Markus Linhart
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Juan Acosta
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - David Soto-Iglesias
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Mikel Martínez
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Beatriz Jáuregui
- Cardiology Department, Heart Institute, Teknon Medical Center, Spain
| | - Áurea Mira
- Center for Biomedical Diagnosis (CDB), Hospital Clinic, Spain.,Department of Biomedicine, University of Barcelona, Spain
| | | | - Joan Sagarra
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Switzerland
| | | | | | | | | | - Antonio Berruezo
- Cardiology Department, Heart Institute, Teknon Medical Center, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Spain
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Abstract
OBJECTIVES To compare the contemporary practice of CRT implantation in Scandinavia and Europe. DESIGN We used data from The European CRT Survey II to highlight similarities and differences in the practice of CRT implantation between Europe (EUR) and Scandinavia (SCAND) and between the Scandinavian countries Denmark, Norway and Sweden. Implant data from the national pacemaker registries were used to calculate coverage. RESULTS The coverage was 24% in SCAND and 11% in EUR. SCAND patients were more often referred from another centre and follow-up was less often to be performed at the operating centre. Telemonitoring was more commonly used. More patients had AV-block or pacemaker dependency/expected high RV pacing percentage as indication for CRT. A CRT-P was more commonly used, and ischaemic aetiology was slightly less common. Echocardiography was more often used to determine LVEF, as well as occlusive venography and placing the RV lead first. In DK implanters tended to choose a septal RV position. Quadripolar leads were more often and a test shock less often used. The paced QRS duration was slightly longer and the narrowing of QRS with CRT more limited. Procedure times and preoperative LVEF were similar. CONCLUSIONS In Scandinavia AV-conduction disturbance and/or a ventricular pacing indication was a more common indication for CRT, suggesting adaptation of the most recent guidelines ahead of their publication. A test shock was almost never performed, in agreement with recent scientific evidence. CRT-P was more often used, the procedures seem more centralized and quadripolar leads were preferred.
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Affiliation(s)
- Torkel Steen
- a Centre for Pacemakers and ICDs , Oslo University Hospital Ullevaal , Oslo , Norway
| | - Elena Sciaraffia
- b Institution of Medical Sciences, Department of Cardiology , Uppsala University Hospital , Uppsala , Sweden
| | - Camilla Normand
- c Cardiology Department , Stavanger University Hospital , Stavanger , Norway.,d Institute of Internal Medicine , University of Bergen , Bergen , Norway
| | - Nigussie Bogale
- c Cardiology Department , Stavanger University Hospital , Stavanger , Norway
| | - Kenneth Dickstein
- c Cardiology Department , Stavanger University Hospital , Stavanger , Norway.,d Institute of Internal Medicine , University of Bergen , Bergen , Norway
| | - Cecilia Linde
- e Heart and Vascular Theme, Karolinska University Hospital , Stockholm, and Karolinska Institutet , Stockholm , Sweden
| | - Berit T Philbert
- f Department of Cardiology, The Heart Centre, Rigshospitalet , University of Copenhagen , Copenhagen , Denmark
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Biffi M, Defaye P, Jaïs P, Ruffa F, Leclercq C, Gras D, Yang Z, Gerritse B, Ziacchi M, Morgan JM. Benefits of left ventricular endocardial pacing comparing failed implants and prior non-responders to conventional cardiac resynchronization therapy: A subanalysis from the ALSYNC study. Int J Cardiol 2018; 259:88-93. [PMID: 29579617 DOI: 10.1016/j.ijcard.2018.01.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 12/21/2017] [Accepted: 01/08/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cardiac resynchronisation therapy (CRT) is limited by a substantial proportion of non-responders. Left ventricular endocardial pacing (LVEP) may offer enhanced possibility to deliver CRT in patients with a failed attempt at implantation and to improve clinical status of CRT non-responders. METHODS The ALternate Site Cardiac ResYNChronisation (ALSYNC) study was a prospective, multi-centre cohort study that included 118 CRT patients with a successfully implanted endocardial left ventricular (LV) lead, including 90 failed coronary sinus (CS) implants and 28 prior non-responders who had worsened or unchanged heart failure status after at least 6 months of optimal conventional CRT therapy. RESULTS Patients were followed for 19 ± 9 months. At baseline, prior non-responders were sicker as evidenced by a larger LV end-diastolic diameter (70 ± 12 vs 65 ± 9 mm, p = .03) and a trend towards larger LV end-systolic volume index (LVESVi, 95 ± 51 vs 74 ± 39 ml/m2, p = .07), and were more frequently anti-coagulated (96% vs 72%, p = .008) despite similar history of atrial fibrillation (54% vs 51%, p = .83). At 6 months, LVEP significantly improved LV ejection fraction (2.3 ± 7.5 and 8.6 ± 10.0%), New York Heart Association Class (0.4 ± 0.9 and 0.7 ± 0.8), LVESVi (9 ± 16 and 18 ± 43 ml/m2), and six-minute walk test (56 ± 73 and 54 ± 92 m) in prior non-responders and failed CS implants, relative to baseline (all p < .05), respectively. LVESVi reduction ≥15% was seen in 47% of the prior non-responder patients and 57% of failed CS patients. CONCLUSION These data suggest that a sizable proportion of CRT non-responders can improve by LVEP, though to a lesser extent than failed CS implants. Clinical trial registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01277783.
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Affiliation(s)
- Mauro Biffi
- Policlinico S Orsola-Malpighi University Hospital, Bologna, Italy.
| | | | - Pierre Jaïs
- CHU Bordeaux - Bordeaux University, Bordeaux, France
| | | | | | - Daniel Gras
- Le Confluent Nouvelle Clinique Nantaises, Nantes, France
| | | | - Bart Gerritse
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - Matteo Ziacchi
- Policlinico S Orsola-Malpighi University Hospital, Bologna, Italy
| | - John M Morgan
- University Hospital Southampton, Southampton, United Kingdom
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Kuznetsov VA, Soldatova AM, Kasprzak JD, Krinochkin DV, Melnikov NN. Echocardiographic markers of dyssynchrony as predictors of super-response to cardiac resynchronisation therapy - a pilot study. Cardiovasc Ultrasound 2018; 16:24. [PMID: 30285762 PMCID: PMC6167795 DOI: 10.1186/s12947-018-0140-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/21/2018] [Indexed: 01/05/2023] Open
Abstract
Background Some patients with congestive heart failure have greater improvement of cardiac remodelling after cardiac resynchronisation therapy (CRT) and they are identified as super-responders (SRs). It remains unclear if echocardiographic markers of dyssynchrony could accuratelly predict super-response to CRT. The aim of this study is to evaluate potential echocardiographic predictors associated with super-response to CRT. Methods Fifthy nine CRT patients (mean age 52.9 ± 9.0 years, 88% men) with congestive heart failure (54% ischaemic and 46% non-ischaemic aetiology) II-IV NYHA functional class were enrolled. To assess mechanical dyssynchrony we evaluated interventricular mechanical delay, the maximum delay between peak systolic velocities of the septal and posterior walls of left ventricle, duration of left ventricular pre-ejection period (LVPEP), left ventricular and interventricular dyssynchrony by tissue Doppler imaging and systolic dyssynchrony index by 3D echocardiography. After six months the patients were assessed for response and classified as SRs (reduction in left ventricular end-systolic volume (LVESV) ≥30%, n = 20) and non-SRs (reduction in LVESV < 30%, n = 39) and baseline data were analyzed to identify the predictors. Results Both groups demonstrated significant improvement in NYHA functional class, increase in left ventricular ejection fraction and reduction in LVESV. All parameters of mechanical dyssynchrony at baseline were significantly higher in SR group. Multiple logistic regression analysis showed that LVPEP (HR 1.031; 95% CI 1.007–1.055; p = 0.011) was an independent predictor for CRT super-response. In ROC curve analysis LVPEP with a cut-off value of 147 ms demonstrated 73.7% sensitivity and 75% specificity (AUC = 0.753; p = 0.002) for the prediction of super-response to CRT. Conclusion Greater mechanical dyssynchrony is associated with super-response to CRT in patients with congestive heart failure. It is probable that an LVPEP > 147 ms can be used as independent predictor of super-response.
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Affiliation(s)
- V A Kuznetsov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia, Melnikaite st. 111, Tyumen, 625026, Russia
| | - A M Soldatova
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia, Melnikaite st. 111, Tyumen, 625026, Russia.
| | - J D Kasprzak
- Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Kniaziewicza 1/5, 91-347, Lodz, Poland
| | - D V Krinochkin
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia, Melnikaite st. 111, Tyumen, 625026, Russia
| | - N N Melnikov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia, Melnikaite st. 111, Tyumen, 625026, Russia
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Nguyên UC, Cluitmans MJM, Luermans JGLM, Strik M, de Vos CB, Kietselaer BLJH, Wildberger JE, Prinzen FW, Mihl C, Vernooy K. Visualisation of coronary venous anatomy by computed tomography angiography prior to cardiac resynchronisation therapy implantation. Neth Heart J 2018; 26:433-44. [PMID: 30030750 DOI: 10.1007/s12471-018-1132-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The purpose of this study was to illustrate the additive value of computed tomography angiography (CTA) for visualisation of the coronary venous anatomy prior to cardiac resynchronisation therapy (CRT) implantation. METHODS Eighteen patients planned for CRT implantation were prospectively included. A specific CTA protocol designed for visualisation of the coronary veins was carried out on a third-generation dual-source CT platform. Coronary veins were semi-automatically segmented to construct a 3D model. CTA-derived coronary venous anatomy was compared with intra-procedural fluoroscopic angiography (FA) in right and left anterior oblique views. RESULTS Coronary venous CTA was successfully performed in all 18 patients. CRT implantation and FA were performed in 15 patients. A total of 62 veins were visualised; the number of veins per patient was 3.8 (range: 2-5). Eighty-five per cent (53/62) of the veins were visualised on both CTA and FA, while 10% (6/62) were visualised on CTA only, and 5% (3/62) on FA only. Twenty-two veins were present on the lateral or inferolateral wall; of these, 95% (21/22) were visualised by CTA. A left-sided implantation was performed in 13 patients, while a right-sided implantation was performed in the remaining 2 patients because of a persistent left-sided superior vena cava with no left innominate vein on CTA. CONCLUSION Imaging of the coronary veins by CTA using a designated protocol is technically feasible and facilitates the CRT implantation approach, potentially improving the outcome.
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Claridge S, Briceno N, Chen Z, De Silva K, Modi B, Jackson T, Behar JM, Niederer S, Rinaldi CA, Perera D. Changes in contractility determine coronary haemodynamics in dyssynchronous left ventricular heart failure, not vice versa. Int J Cardiol Heart Vasc 2018; 19:8-13. [PMID: 29946557 PMCID: PMC6016072 DOI: 10.1016/j.ijcha.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/07/2018] [Accepted: 03/11/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Biventricular pacing has been shown to increase both cardiac contractility and coronary flow acutely but the causal relationship is unclear. We hypothesised that changes in coronary flow are secondary to changes in cardiac contractility. We sought to examine this relationship by modulating coronary flow and cardiac contractility. METHODS Contractility and lusitropy were altered by varying the location of pacing in 8 patients. Coronary autoregulation was transiently disabled with intracoronary adenosine. Simultaneous coronary flow velocity, coronary pressure and left ventricular pressure data were measured in the different pacing settings with and without hyperaemia and wave intensity analysis performed. RESULTS Multisite pacing was effective at altering left ventricular contractility and lusitropy (pos. dp/dtmax -13% to +10% and neg. dp/dtmax -15% to +17% compared to baseline). Intracoronary adenosine decreased microvascular resistance (362.5 mm Hg/s/m to 156.7 mm Hg/s/m, p < 0.001) and increased LAD flow velocity (22 cm/s vs 45 cm/s, p < 0.001) but did not acutely change contractility or lusitropy. The magnitude of the dominant accelerating wave, the Backward Expansion Wave, was proportional to the degree of contractility as well as lusitropy (r = 0.47, p < 0.01 and r = -0.50, p < 0.01). Perfusion efficiency (the proportion of accelerating waves) increased at hyperaemia (76% rest vs 81% hyperaemia, p = 0.04). Perfusion efficiency correlated with contractility and lusitropy at rest (r = 0.43 & -0.50 respectively, p = 0.01) and hyperaemia (r = 0.59 & -0.6, p < 0.01). CONCLUSIONS Acutely increasing coronary flow with adenosine in patients with systolic heart failure does not increase contractility. Changes in coronary flow with biventricular pacing are likely to be a consequence of enhanced cardiac contractility from resynchronization and not vice versa.
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Affiliation(s)
- Simon Claridge
- Department of Imaging Sciences, King's College, London, United Kingdom
| | - Natalia Briceno
- NIHR Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Zhong Chen
- Department of Imaging Sciences, King's College, London, United Kingdom
| | - Kalpa De Silva
- NIHR Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Bhavik Modi
- NIHR Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Tom Jackson
- Department of Imaging Sciences, King's College, London, United Kingdom
| | - Jonathan M. Behar
- Department of Imaging Sciences, King's College, London, United Kingdom
| | - Steven Niederer
- Department of Imaging Sciences, King's College, London, United Kingdom
| | | | - Divaka Perera
- NIHR Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
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Abstract
Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure (HF) patients with an electrical substrate pathology causing ventricular dyssynchrony. However 40-50% of patients do not respond to treatment. Cardiac modeling of the electrophysiology, electromechanics, and hemodynamics of the heart has been used to study mechanisms behind HF pathology and CRT response. Recently, multi-scale dyssynchronous HF models have been used to study optimal device settings and optimal lead locations, investigate the underlying cardiac pathophysiology, as well as investigate emerging technologies proposed to treat cardiac dyssynchrony. However the breadth of patient and experimental data required to create and parameterize these models and the computational resources required currently limits the use of these models to small patient numbers. In the future, once these technical challenges are overcome, biophysically based models of the heart have the potential to become a clinical tool to aid in the diagnosis and treatment of HF.
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Affiliation(s)
- Angela W C Lee
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | | | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Kerekanič M, Hudák M, Mišíková S, Komanová E, Bohó A, Kyselovič J, Stančák B. The prognostic value of high sensitive cardiac troponin I in patients receiving cardiac resynchronisation therapy. Acta Cardiol 2018; 73:141-146. [PMID: 29025373 DOI: 10.1080/00015385.2017.1351248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiac troponin I (cTnI) is a valuable prognostic biomarker in patients with chronic heart failure (CHF). However, the prognostic importance of cTnI in patients who received cardiac resynchronisation therapy (CRT) remains unknown. The aim of this prospective study was to determine the prognostic value of high-sensitive cTnI (hs-cTnI) in CHF patients receiving CRT. METHODS We performed measurements of baseline hs-cTnI levels in CRT patients with ischaemic as well as nonischaemic aetiology of CHF, and we investigated their possible association with response to CRT and survival of patients. RESULTS Ninety consecutive CRT patients (mean age 64 ± 9 years, 71 men) were included. According to the best cut-off value of hs-cTnI level to predict CRT response and all cause mortality, patients were divided into group 1 (hs-cTnI level ≥6.5 ng/l, n = 46) and group 2 (hs-cTnI level <6.5 ng/l, n = 44). During the follow-up period (1155 ± 406 days), 47% of patients were CRT responders (30% in group 1 and 64% in group 2, p = .002) and 31% of patients died from any cause (48% in group 1 and 14% in group 2, p = .001). Regression analysis showed that hs-cTnI level <6.5 ng/l was an independent predictor of CRT response (OR 3.49, p = .019) and that hs-cTnI level ≥6.5 ng/l was an independent predictor of all cause mortality (HR 3.01, p = .021). CONCLUSION The hs-cTnI can be an useful biomarker with prognostic value in patients receiving CRT.
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Affiliation(s)
- Michal Kerekanič
- Cardiology Clinic, Arrhythmology department, East Slovak Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Marek Hudák
- Cardiology Clinic, Arrhythmology department, East Slovak Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Silvia Mišíková
- Cardiology Clinic, Arrhythmology department, East Slovak Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
| | - Erika Komanová
- Cardiology Clinic, Arrhythmology department, East Slovak Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
| | - Alexander Bohó
- Cardiology Clinic, Arrhythmology department, East Slovak Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
| | - Ján Kyselovič
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Branislav Stančák
- Cardiology Clinic, Arrhythmology department, East Slovak Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
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36
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Panayiotou M, Housden RJ, Ishak A, Brost A, Rinaldi CA, Sieniewicz B, Behar JM, Kurzendorfer T, Rhode KS. LV function validation of computer-assisted interventional system for cardiac resyncronisation therapy. Int J Comput Assist Radiol Surg 2018; 13:777-786. [PMID: 29603064 PMCID: PMC5974009 DOI: 10.1007/s11548-018-1748-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/21/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Cardiac resynchronisation therapy (CRT) is an established treatment for symptomatic patients with heart failure, a prolonged QRS duration, and impaired left ventricular (LV) function; however, non-response rates remain high. Recently proposed computer-assisted interventional platforms for CRT provide new routes to improving outcomes. Interventional systems must process information in an accurate, fast and highly automated way that is easy for the interventional cardiologists to use. In this paper, an interventional CRT platform is validated against two offline diagnostic tools to demonstrate that accurate information processing is possible in the time critical interventional setting. METHODS The study consisted of 3 healthy volunteers and 16 patients with heart failure and conventional criteria for CRT. Data analysis included the calculation of end-diastolic volume, end-systolic volume, stroke volume and ejection fraction; computation of global volume over the cardiac cycle as well as time to maximal contraction expressed as a percentage of the total cardiac cycle. RESULTS The results showed excellent correlation ([Formula: see text] values of [Formula: see text] and Pearson correlation coefficient of [Formula: see text]) with comparable offline diagnostic tools. CONCLUSION Results confirm that our interventional system has good accuracy in everyday clinical practice and can be of clinical utility in identification of CRT responders and LV function assessment.
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Affiliation(s)
- Maria Panayiotou
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
| | - R James Housden
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Athanasius Ishak
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | | | - Christopher A Rinaldi
- Department of Cardiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Benjamin Sieniewicz
- Department of Cardiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Jonathan M Behar
- Department of Cardiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Kawal S Rhode
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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37
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Dickstein K, Normand C, Auricchio A, Bogale N, Cleland JG, Gitt AK, Stellbrink C, Anker SD, Filippatos G, Gasparini M, Hindricks G, Blomström Lundqvist C, Ponikowski P, Ruschitzka F, Botto GL, Bulava A, Duray G, Israel C, Leclercq C, Margitfalvi P, Cano Ó, Plummer C, Sarigul NU, Sterlinski M, Linde C. CRT Survey II: a European Society of Cardiology survey of cardiac resynchronisation therapy in 11 088 patients-who is doing what to whom and how? Eur J Heart Fail 2018; 20:1039-1051. [PMID: 29457358 DOI: 10.1002/ejhf.1142] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/22/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in appropriately selected patients with heart failure and is strongly recommended for such patients by guidelines. A European Society of Cardiology (ESC) CRT survey conducted in 2008-2009 showed considerable variation in guideline adherence and large individual, national and regional differences in patient selection, implantation practice and follow-up. Accordingly, two ESC associations, the European Heart Rhythm Association and the Heart Failure Association, designed a second prospective survey to describe contemporary clinical practice regarding CRT. METHODS AND RESULTS A survey of the clinical practice of CRT-P and CRT-D implantation was conducted from October 2015 to December 2016 in 42 ESC member countries. Implanting centres provided information about their hospital and CRT service and were asked to complete a web-based case report form collecting information on patient characteristics, investigations, implantation procedures and complications during the index hospitalisation. The 11 088 patients enrolled represented 11% of the total number of expected implantations in participating countries during the survey period; 32% of patients were aged ≥75 years, 28% of procedures were upgrades from a permanent pacemaker or implantable cardioverter-defibrillator and 30% were CRT-P rather than CRT-D. Most patients (88%) had a QRS duration ≥130 ms, 73% had left bundle branch block and 26% were in atrial fibrillation at the time of implantation. Large geographical variations in clinical practice were observed. CONCLUSION CRT Survey II provides a valuable source of information on contemporary clinical practice with respect to CRT implantation in a large sample of ESC member states. The survey permits assessment of guideline adherence and demonstrates variations in patient selection, management, implantation procedure and follow-up strategy.
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Affiliation(s)
- Kenneth Dickstein
- Cardiology Division, Stavanger University Hospital, Stavanger, Norway.,Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Camilla Normand
- Cardiology Division, Stavanger University Hospital, Stavanger, Norway.,Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Nigussie Bogale
- Cardiology Division, Stavanger University Hospital, Stavanger, Norway
| | - John G Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow and National Heart & Lung Institute, Imperial College London, UK
| | - Anselm K Gitt
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.,Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.,University of Cyprus, School of Medicine, Cyprus
| | | | - Stefan D Anker
- Division of Cardiology and Metabolism; Department of Cardiology (CVK); Berlin-Brandenburg Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Athens University Hospital Attikon, Athens, Greece
| | | | - Gerhard Hindricks
- Department of Cardiac Surgery, HELIOS Heart Center Leipzig, Leipzig, Germany
| | | | - Piotr Ponikowski
- Department of Heart Diseases, Medical University Wroclaw, Wroclaw, Poland
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Alan Bulava
- Department of Cardiology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic.,Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic.,Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Gabor Duray
- Clinical Electrophysiology, Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Carsten Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany
| | | | - Peter Margitfalvi
- The National Institute of Cardiovascular Diseases, Bratislava, Slovak Republic
| | - Óscar Cano
- Unidad de Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Chris Plummer
- Department of Cardiology, Freeman Hospital, Freeman Rd, Newcastle upon Tyne, UK
| | - Nedim Umutay Sarigul
- Department of Cardiology, Medicalpark Goztepe Hospital, Istanbul, Turkey.,Kardio Bremen, Bremen, Germany
| | | | - Cecilia Linde
- Heart and Vessels Theme, Karolinska University Hospital, Stockholm, and Karolinska Institutet, Stockholm, Sweden
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38
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Lima da Silva G, de Sousa J, Marques P. Utilisation of the snare technique for left ventricular lead placement in a patient with persistent left superior vena cava. Rev Port Cardiol 2018; 37:201.e1-201.e3. [PMID: 29398393 DOI: 10.1016/j.repc.2017.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/06/2017] [Indexed: 10/17/2022] Open
Abstract
Persistence of the left superior vena cava occurs in about 0.3-0.7% of the general population. It is of particular importance in patients who need cardiac resynchronisation therapy. We present a unique case in which a snare system and tunnelling tool were used to place the left ventricular lead in a patient with persistence of the left superior vena cava.
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Affiliation(s)
- Gustavo Lima da Silva
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal.
| | - João de Sousa
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
| | - Pedro Marques
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
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39
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Katritsis DG, Auricchio A. Do We Need an Implantable Cardioverter-defibrillator for Primary Prevention in Cardiac Resynchronisation Therapy Patients? Arrhythm Electrophysiol Rev 2018; 7:157-158. [PMID: 30416727 DOI: 10.15420/aer.2018.7.3.eo1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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40
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Sinclair M, Peressutti D, Puyol-Antón E, Bai W, Rivolo S, Webb J, Claridge S, Jackson T, Nordsletten D, Hadjicharalambous M, Kerfoot E, Rinaldi CA, Rueckert D, King AP. Myocardial strain computed at multiple spatial scales from tagged magnetic resonance imaging: Estimating cardiac biomarkers for CRT patients. Med Image Anal 2018; 43:169-85. [PMID: 29112879 DOI: 10.1016/j.media.2017.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 08/11/2017] [Accepted: 10/11/2017] [Indexed: 12/24/2022]
Abstract
Abnormal cardiac motion can indicate different forms of disease, which can manifest at different spatial scales in the myocardium. Many studies have sought to characterise particular motion abnormalities associated with specific diseases, and to utilise motion information to improve diagnoses. However, the importance of spatial scale in the analysis of cardiac deformation has not been extensively investigated. We build on recent work on the analysis of myocardial strains at different spatial scales using a cardiac motion atlas to find the optimal scales for estimating different cardiac biomarkers. We apply a multi-scale strain analysis to a 43 patient cohort of cardiac resynchronisation therapy (CRT) patients using tagged magnetic resonance imaging data for (1) predicting response to CRT, (2) identifying septal flash, (3) estimating QRS duration, and (4) identifying the presence of ischaemia. A repeated, stratified cross-validation is used to demonstrate the importance of spatial scale in our analysis, revealing different optimal spatial scales for the estimation of different biomarkers.
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41
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Kanawati J, Sy RW. Contemporary Review of Left Bundle Branch Block in the Failing Heart - Pathogenesis, Prognosis, and Therapy. Heart Lung Circ 2017; 27:291-300. [PMID: 29097067 DOI: 10.1016/j.hlc.2017.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/13/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
Cardiac resynchronisation therapy (CRT) is a cornerstone in the contemporary management of heart failure. The most effective way of predicting response to this therapy remains electrocardiographic (ECG) criteria of electromechanical dyssynchrony. The left bundle branch block (LBBB) pattern is currently the most robust ECG criterion in predicting improvement in symptoms and reduction in mortality. However, recent studies using three-dimensional (3D) mapping and cardiac magnetic resonance imaging (CMR) have demonstrated heterogeneous left ventricular activation patterns in patients with LBBB. This has led to intense debate on the activation pattern of "true LBBB" and resulted in the proposal of stricter criteria for defining LBBB. This review will focus on the definitions and implications of LBBB in the CRT era. At a minimum, the use of stricter ECG criteria appears warranted, and adjunctive pre-implant imaging or mapping may further identify patient-specific electrophysiological patterns that determine response to CRT.
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Affiliation(s)
- Juliana Kanawati
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Raymond W Sy
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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42
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Wengenmayer T, Reinöhl J, Steinfurt J, Mittag A, Bode C, Biermann J. Implantation of CARILLON ® Mitral Contour System with transvenous left ventricular lead in place. Clin Res Cardiol 2017; 106:796-801. [PMID: 28477282 DOI: 10.1007/s00392-017-1121-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/26/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac resynchronisation therapy (CRT) is an established treatment option for chronic heart failure patients with left bundle branch block. Although a concomitant functional mitral regurgitation is often reduced by CRT, many patients need additional mitral valve repair. Placing a CARILLON® Mitral Contour System (CMCS) over a transvenous CRT lead is currently not recommended, since both of them are implanted in the coronary sinus (CS). The aim of this study was to investigate the feasibility of sequential implantation of a transvenous LV lead followed by CMCS implantation, and to assess LV lead performance and possibility of extraction. METHODS AND RESULTS Standard transvenous LV leads were implanted in the CS of five female sheep. After establishing regular anatomical position with stable electrical parameters of the LV lead, a CMCS was additionally implanted in the CS. After an observation period of 100 days, lead performance and positions of lead and CMCS were studied. Sequential implantation of the two components was feasible in sheep. After 100 days, all leads showed regular measurements of impedance, threshold, and sensing. There was no migration of either the LV lead or the CMCS. In all cases, the LV lead could be completely extracted without migration of the CMCS. There were no acute or long-term complications. CONCLUSIONS In an animal model of healthy adult sheep, implantation of CMCS with a transvenous LV lead already in place was feasible and without major problems with either the CMCS or the LV lead. Electrical performance of the LV leads was excellent. All LV leads could be extracted without migration of the CMCS.
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Affiliation(s)
- T Wengenmayer
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - J Reinöhl
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - J Steinfurt
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - A Mittag
- IMTR, Institute of Medical Technology and Research, Rottmersleben, Germany
| | - C Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - J Biermann
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Abstract
Cardiac resynchronisation therapy (CRT) is a standard treatment for patients with heart failure; however, the low response rate significantly reduces its cost-effectiveness. A favourable CRT response primarily depends on whether implanters can identify the optimal left ventricular (LV) lead position and accurately place the lead at the recommended site. Myocardial imaging techniques, including echocardiography, cardiac magnetic resonance imaging and nuclear imaging, have been used to assess LV myocardial viability and mechanical dyssynchrony, and deduce the optimal LV lead position. The optimal position, presented as a segment of the myocardial wall, is then overlaid with images of the coronary veins from fluoroscopy to aid navigation of the LV lead to the target venous site. Once validated by large clinical trials, these image-guided techniques for CRT lead placement may have an impact on current clinical practice.
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Affiliation(s)
- Haipeng Tang
- School of Computing, University of Southern Mississippi, Long Beach, MS, USA
| | - Shaojie Tang
- School of Automation, Xi'an University of Posts and Telecommunications, Xi'an, Shaanxi, China
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, USA
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44
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Cerit L. Age of cardiac resynchronisation therapy; cardiac resynchronisation therapy in elderly. J Geriatr Cardiol 2016; 13:940. [PMID: 28133475 DOI: 10.11909/j.issn.1671-5411.2016.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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45
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Peressutti D, Sinclair M, Bai W, Jackson T, Ruijsink J, Nordsletten D, Asner L, Hadjicharalambous M, Rinaldi CA, Rueckert D, King AP. A framework for combining a motion atlas with non-motion information to learn clinically useful biomarkers: Application to cardiac resynchronisation therapy response prediction. Med Image Anal 2017; 35:669-84. [PMID: 27770718 DOI: 10.1016/j.media.2016.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 11/21/2022]
Abstract
We present a framework for combining a cardiac motion atlas with non-motion data. The atlas represents cardiac cycle motion across a number of subjects in a common space based on rich motion descriptors capturing 3D displacement, velocity, strain and strain rate. The non-motion data are derived from a variety of sources such as imaging, electrocardiogram (ECG) and clinical reports. Once in the atlas space, we apply a novel supervised learning approach based on random projections and ensemble learning to learn the relationship between the atlas data and some desired clinical output. We apply our framework to the problem of predicting response to Cardiac Resynchronisation Therapy (CRT). Using a cohort of 34 patients selected for CRT using conventional criteria, results show that the combination of motion and non-motion data enables CRT response to be predicted with 91.2% accuracy (100% sensitivity and 62.5% specificity), which compares favourably with the current state-of-the-art in CRT response prediction.
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46
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Verschure DO, van Eck-Smit BLF, Somsen GA, Knol RJJ, Verberne HJ. Cardiac sympathetic activity in chronic heart failure: cardiac 123I-mIBG scintigraphy to improve patient selection for ICD implantation. Neth Heart J 2016; 24:701-708. [PMID: 27677744 PMCID: PMC5120011 DOI: 10.1007/s12471-016-0902-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Heart failure is a life-threatening disease with a growing incidence in the Netherlands. This growing incidence is related to increased life expectancy, improvement of survival after myocardial infarction and better treatment options for heart failure. As a consequence, the costs related to heart failure care will increase. Despite huge improvements in treatment, the prognosis remains unfavourable with high one-year mortality rates. The introduction of implantable devices such as implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) has improved the overall survival of patients with chronic heart failure. However, after ICD implantation for primary prevention in heart failure a high percentage of patients never have appropriate ICD discharges. In addition 25–50 % of CRT patients have no therapeutic effect. Moreover, both ICDs and CRTs are associated with malfunction and complications (e. g. inappropriate shocks, infection). Last but not least is the relatively high cost of these devices. Therefore, it is essential, not only from a clinical but also from a socioeconomic point of view, to optimise the current selection criteria for ICD and CRT. This review focusses on the role of cardiac sympathetic hyperactivity in optimising ICD selection criteria. Cardiac sympathetic hyperactivity is related to fatal arrhythmias and can be non-invasively assessed with 123I-meta-iodobenzylguanide (123I-mIBG) scintigraphy. We conclude that cardiac sympathetic activity assessed with 123I-mIBG scintigraphy is a promising tool to better identify patients who will benefit from ICD implantation.
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Affiliation(s)
- D O Verschure
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Cardiology, Zaans Medical Center, Zaandam, The Netherlands.
| | - B L F van Eck-Smit
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G A Somsen
- Cardiology Centres of the Netherlands, Amsterdam, The Netherlands
| | - R J J Knol
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - H J Verberne
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Swampillai J. Cardiac resynchronisation therapy after percutaneous mitral annuloplasty. World J Clin Cases 2016; 4:127-129. [PMID: 27182527 PMCID: PMC4857008 DOI: 10.12998/wjcc.v4.i5.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/14/2016] [Accepted: 03/23/2016] [Indexed: 02/05/2023] Open
Abstract
Percutaneous approaches to reduce mitral regurgitation in ischemic cardiomyopathy have stirred interest recently. Patients with ischemic cardiomyopathy and functional mitral regurgitation often meet criteria for cardiac resynchronisation therapy to improve left ventricular function as well as mitral regurgitation, and alleviate symptoms. This case shows that implantation of a pacing lead in the coronary sinus to restore synchronous left and right ventricular contraction is feasible, despite the presence of a remodeling device in the coronary sinus.
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Ter Horst IAH, van 't Sant J, Wijers SC, Vos MA, Cramer MJ, Meine M. The risk of ventricular arrhythmias in a Dutch CRT population: CRT-defibrillator versus CRT-pacemaker. Neth Heart J 2016; 24:204-13. [PMID: 26797979 PMCID: PMC4771627 DOI: 10.1007/s12471-015-0800-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Patients eligible for cardiac resynchronisation therapy (CRT) have an indication for primary prophylactic implantable cardioverter defibrillator (ICD) therapy. However, response to CRT might influence processes involved in arrhythmogenesis and therefore change the necessity of ICD therapy in certain patients. Method In 202 CRT-defibrillator patients, the association between baseline variables, 6-month echocardiographic outcome (volume response: left ventricular end-systolic volume decrease < ≥15 % and left ventricular ejection fraction (LVEF) ≤ >35 %) and the risk of first appropriate ICD therapy was analysed retrospectively. Results Fifty (25 %) patients received appropriate ICD therapy during a median follow-up of 37 (23–52) months. At baseline ischaemic cardiomyopathy (hazard ratio (HR) 2.0, p = 0.019) and a B-type natriuretic peptide level > 163 pmol/l (HR 3.8, p < 0.001) were significantly associated with the risk of appropriate ICD therapy. After 6 months, 105 (52 %) patients showed volume response and 51 (25 %) reached an LVEF > 35 %. Three (6 %) patients with an LVEF > 35 % received appropriate ICD therapy following echocardiography at ± 6 months compared with 43 patients (29 %) with an LVEF ≤ 35 % (p = 0.001). LVEF post-CRT was more strongly associated to the risk of ventricular arrhythmias than volume response (LVEF > 35 %, HR 0.23, p = 0.020). Conclusion Assessing the necessity of an ICD in patients eligible for CRT remains a challenge. Six months post-CRT an LVEF > 35 % identified patients at low risk of ventricular arrhythmias. LVEF might be used at the time of generator replacement to identify patients suitable for downgrading to a CRT-pacemaker.
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Affiliation(s)
- I A H Ter Horst
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, PO Box 85500, Utrecht, The Netherlands.
| | - J van 't Sant
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - S C Wijers
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, PO Box 85500, Utrecht, The Netherlands.,Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J Cramer
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, PO Box 85500, Utrecht, The Netherlands
| | - M Meine
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, PO Box 85500, Utrecht, The Netherlands
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Niederer S, Walker C, Crozier A, Hyde ER, Blazevic B, Behar JM, Claridge S, Sohal M, Shetty A, Jackson T, Rinaldi C. The impact of beat-to-beat variability in optimising the acute hemodynamic response in cardiac resynchronisation therapy. Clin Trials Regul Sci Cardiol 2016; 12:18-22. [PMID: 26844303 PMCID: PMC4696127 DOI: 10.1016/j.ctrsc.2015.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/19/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Acute indicators of response to cardiac resynchronisation therapy (CRT) are critical for developing lead optimisation algorithms and evaluating novel multi-polar, multi-lead and endocardial pacing protocols. Accounting for beat-to-beat variability in measures of acute haemodynamic response (AHR) may help clinicians understand the link between acute measurements of cardiac function and long term clinical outcome. METHODS AND RESULTS A retrospective study of invasive pressure tracings from 38 patients receiving an acute pacing and electrophysiological study was performed. 602 pacing protocols for left ventricle (LV) (n = 38), atria-ventricle (AV) (n = 9), ventricle-ventricle (VV) (n = 12) and endocardial (ENDO) (n = 8) optimisation were performed. AHR was measured as the maximal rate of LV pressure development (dP/dtMx) for each beat. The range of the 95% confidence interval (CI) of mean AHR was ~ 7% across all optimisation protocols compared with the reported CRT response cut off value of 10%. A single clear optimal protocol was identifiable in 61%, 22%, 25% and 50% for LV, AV, VV and ENDO optimisation cases, respectively. A level of service (LOS) optimisation that aimed to maximise the expected AHR 5th percentile, minimising variability and maximising AHR, led to distinct optimal protocols from conventional mean AHR optimisation in 34%, 78%, 67% and 12.5% of LV, AV, VV and ENDO optimisation cases, respectively. CONCLUSION The beat-to-beat variation in AHR is significant in the context of CRT cut off values. A LOS optimisation offers a novel index to identify the optimal pacing site that accounts for both the mean and variation of the baseline measurement and pacing protocol.
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Affiliation(s)
- Steven Niederer
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Cameron Walker
- Department of Engineering Science, University of Auckland, New Zealand
| | - Andrew Crozier
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Eoin R Hyde
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Bojan Blazevic
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Jonathan M Behar
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Simon Claridge
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Manav Sohal
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Anoop Shetty
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Tom Jackson
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Christopher Rinaldi
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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Abstract
Cardiac resynchronisation therapy (CRT) is an important therapy for patients with heart failure with a reduced ejection fraction and interventricular conduction delay. Large trials have established the role of CRT in reducing heart failure hospitalisations and improving symptoms, left ventricular (LV) function and mortality. Guidelines from major medical societies are consistent in support of CRT for patients with New York Health Association (NYHA) class II, III and ambulatory class IV heart failure, reduced LV ejection fraction and QRS prolongation, particularly left bundle branch block. The current challenge facing practitioners is to maximise the rate of patients who respond to CRT and the magnitude of that response. Current areas of interest for achieving these goals include tailoring patient selection, individualising LV lead placement and application of new technologies and techniques for CRT delivery.
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Affiliation(s)
- Geoffrey F Lewis
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, US
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, US
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