SOSTIENICI
Pubblicazioni recenti - cardiac resynchronization
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Standard care vs. TRIVEntricular pacing in Heart Failure (STRIVE HF): a prospective multicentre randomized controlled trial of triventricular pacing vs. conventional biventricular pacing in patients with heart failure and intermediate QRS left bundle branch block.
Europace2021 Nov;():. doi: euab267.
Gould Justin, Claridge Simon, Jackson Thomas, Sieniewicz Benjamin J, Sidhu Baldeep S, Porter Bradley, Elliott Mark K, Mehta Vishal, Niederer Steven, Chadwick Humra, Kamdar Ravi, Adhya Shaumik, Patel Nikhil, Hamid Shoaib, Rogers Dominic, Nicolson William, Chan Cheuk F, Whinnett Zachary, Murgatroyd Francis, Lambiase Pier D, Rinaldi Christopher A,
Abstract
AIMS:
To determine whether triventricular (TriV) pacing is feasible and improves CRT response compared to conventional biventricular (BiV) pacing in patients with left bundle branch block (LBBB) and intermediate QRS prolongation (120-150 ms).
METHODS AND RESULTS:
Between October 2015 and November 2019, 99 patients were recruited from 11 UK centres. Ninety-five patients were randomized 1:1 to receive TriV or BiV pacing systems. The primary endpoint was feasibility of TriV pacing. Secondary endpoints assessed symptomatic and remodelling response to CRT. Baseline characteristics were balanced between groups. In the TriV group, 43/46 (93.5%) patients underwent successful implantation vs. 47/49 (95.9%) in the BiV group. Feasibility of maintaining CRT at 6 months was similar in the TriV vs. BiV group (90.0% vs. 97.7%, P = 0.191). All-cause mortality was similar between TriV vs. BiV groups (4.3% vs. 8.2%, P = 0.678). There were no significant differences in echocardiographic LV volumes or clinical composite scores from baseline to 6-month follow-up between groups.
CONCLUSION:
Implantation of two LV leads to deliver and maintain TriV pacing at 6 months is feasible without significant complications in the majority of patients. There was no evidence that TriV pacing improves CRT response or provides additional clinical benefit to patients with LBBB and intermediate QRS prolongation and cannot be recommended in this patient group.
CLINICAL TRIAL REGISTRATION NUMBER:
Clinicaltrials.gov: NCT02529410.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Baseline QRS area and reduction in QRS area are associated with lower mortality and risk of heart failure hospitalization after Cardiac Resynchronization Therapy.
Cardiology2022 Jan;():. doi: 10.1159/000522151.
Marinko Sofia, Platonov Pyotr G, Carlson Jonas, Borgquist Rasmus,
Abstract
INTRODUCTION:
Cardiac resynchronization therapy (CRT) is an established treatment for heart failure in selected patients. However, current guideline indications do not accurately predict individual prognosis with CRT, and up to 30% are non-responders. Previous studies have shown that QRS area reduction following CRT is associated with improved survival. This study evaluates the incremental value of using QRS area derived from digital ECG recordings, preoperatively and during CRT pacing.
METHODS:
Medical records of 445 patients receiving CRT implants at a large-volume tertiary care center in Sweden were retrospectively evaluated. Digital electrocardiograms (ECG) before and after CRT implantation were collected and ECG parameters were analyzed in relation to a primary composite endpoint of heart failure hospitalization or death from any cause.
RESULTS:
147 patients (33%) reached the primary endpoint (93 deaths and 103 heart failure hospitalizations) over a median follow-up time of 2.7 years. A larger pre-implant QRS area (HR, 0.89; [0.85-0.93]; p=
CONCLUSION:
Larger pre-implant QRS area and QRS area reduction was associated with better clinical outcome following CRT in this retrospective material. This knowledge could help optimize patient selection and postoperative management.
The Author(s). Published by S. Karger AG, Basel.
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Sex Differences in Implantation and Outcomes of Cardiac Resynchronization Therapy in Real-World Settings: A Systematic Review of Cohort Studies.
CJC Open2022 Jan;4(1):75-84. doi: 10.1016/j.cjco.2021.09.003.
Dewidar Omar, Dawit Haben, Barbeau Victoria, Birnie David, Welch Vivian, Wells George A,
Abstract
Background:
Evidence from randomized trials is conflicting on the effects of cardiac resynchronization therapy (CRT) by sex, and differences in access are unknown. We examined sex differences in the implantation rates and outcomes in patients treated with CRT using cohort studies.
Methods:
We followed a pre-specified protocol (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020204804). MEDLINE, Embase, and Web of Science were searched for cohort studies from January 2000 to June 2020 that evaluated the response to CRT in patients ? 18 years old and reported sex-specific information in any language.
Results:
We included 97 studies (1,172,654 men and 486,553 women). Men received CRT more frequently than women (median ratio, 3.16; 25th to 75th interquartile range, 2.48-3.62). In the unadjusted analysis, men had a greater long-term all-cause mortality rate after CRT, compared with women (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.38-1.63;
Conclusions:
We found in this large meta-analysis that men were more often implanted with CRT than women, yet men had a higher long-term all-cause mortality following CRT, compared with women, and smaller improvement in left ventricular ejection fraction. Reasons for this difference in implantation rates of CRT in real-world practice need to be investigated.
© 2021 The Authors.
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Utilizing preprocedural imaging and active fixation lead in cardiac resynchronization therapy device upgrade for persistent left superior vena cava.
HeartRhythm Case Rep2022 Jan;8(1):50-53. doi: 10.1016/j.hrcr.2021.11.003.
Kuo-Wei Chiang Christopher, Ka-Bo Chan William, So Aaron, Yee Raymond, Khan Habib,
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Deep septal pacing to upgrade patients with pacing-induced cardiomyopathy.
HeartRhythm Case Rep2022 Jan;8(1):9-12. doi: 10.1016/j.hrcr.2021.10.002.
Di Marco Andrea, Faga Valentina, Merce Jordi, Dallaglio Paolo, Rodriguez Julian, Anguera Ignasi,
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Clinical significance of the albumin-bilirubin score in patients with heart failure undergoing cardiac resynchronization therapy.
Heart Vessels2022 Jan;():. doi: 10.1007/s00380-021-02008-5.
Saito Yuki, Nakai Toshiko, Ikeya Yukitoshi, Kogawa Rikitake, Otsuka Naoto, Wakamatsu Yuji, Kurokawa Sayaka, Ohkubo Kimie, Nagashima Koichi, Okumura Yasuo,
Abstract
Despite emerging recognition of interactions between heart failure (HF) and liver dysfunction, the impact of cardiac hepatopathy on patients with HF undergoing cardiac resynchronization therapy (CRT) has not been fully elucidated. Albumin-bilirubin (ALBI) score is a new assessment of liver function. The relationship between liver dysfunction severity based on ALBI score and clinical outcomes of patients with HF receiving CRT is unclear. Clinical records of 274 patients who underwent CRT device implantation between March 2003 and October 2020 were retrospectively investigated. ALBI score was calculated based on serum albumin and total bilirubin levels obtained before CRT device implantation. Patients were divided into three groups based on ALBI score: first tertile (ALBI????-?2.62, n?=?91)), second tertile (-?2.62?
© 2021. Springer Japan KK, part of Springer Nature.
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Response Of Functional Mitral Regurgitation In Non-ischemic Cardiomyopathy To Left Bundle Branch Pacing.
Heart Rhythm2022 Jan;():. doi: S1547-5271(22)00034-0.
Ponnusamy Shunmuga Sundaram, Syed Thabish, Vijayaraman Pugazhendhi,
Abstract
BACKGROUND:
Functional mitral regurgitation(FMR) in patients with cardiomyopathy correlates with morbidity and mortality in heart failure. The response of FMR to cardiac resynchronization therapy(CRT) varies.
OBJECTIVES:
The aim of our study was to analyze the incidence and severity of FMR in patients with non-ischemic cardiomyopathy(NICM) and left bundle branch block(LBBB) and the response to left bundle branch pacing(LBBP).
METHODS:
Patients who had undergone LBBP for NICM, LBBB and FMR between 2019 to 2021 were included retrospectively in the study.
RESULTS:
A total of 79-patients were identified and six patients excluded(5-no consistent LBB-capture and 1-prosthetic-mitral valve). Patients(n=73) were divided into two groups based on the severity of FMR- Group-I(mild FMR)(n=35;48%) and Group-II(significant FMR)(n=38;52%). The mean follow-up duration was comparable in both groups. Group-II was characterized by higher NT-pro BNP levels, NYHA-function class and larger left-ventricular dimensions. LBBP resulted in significant reduction in QRS duration in both group-I(113.8±12.7ms;p
CONCLUSION:
LBBP resulted in excellent electrical resynchronization with significant reduction in the severity of FMR in the majority of patients with significant FMR and no worsening of FMR from baseline in any patient.
Copyright © 2022. Published by Elsevier Inc.
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Cardiac resynchronization therapy-defibrillator implantation guided by electroanatomic mapping in a young adult patient with congenital heart disease.
Indian Pacing Electrophysiol J2022 Jan;():. doi: S0972-6292(22)00003-1.
Ciriello Giovanni Domenico, Colonna Diego, Romeo Emanuele, Sarubbi Berardo,
Abstract
Cardiac resynchronization therapy-defibrillator (CRT-D) implantation is a therapeutic option for adult patients with congenital heart disease (CHD), bundle branch block, reduced ejection fraction and symptoms of heart failure. A new implantation approach guided by the electroanatomic mapping (EAM) has been developed to overcome some issues of the standard technique: non-responder patients, high x-ray exposure and use of iodinated contrast medium for coronary sinus angiography. This approach has not been previously described in the CHD population. We report a case of EAM-guided approach for CRT-D implantation in a young adult patient with CHD.
Copyright © 2022 Indian Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.
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Prognostic Implications of Right Ventricular Free Wall Strain in Recipients of Cardiac Resynchronization Therapy.
Am J Cardiol2022 Jan;():. doi: S0002-9149(21)01279-0.
Stassen Jan, van der Bijl Pieter, Galloo Xavier, Hirasawa Kensuke, Prihadi Edgard A, Marsan Nina Ajmone, Bax Jeroen J,
Abstract
Right ventricular (RV) function is an important prognostic marker in cardiac resynchronization therapy (CRT) recipients. Measuring RV systolic function with echocardiography, however, remains challenging due to the complexity of right heart morphology. Evaluation of RV function with RV free wall strain (FWS) may improve risk stratification in recipients of CRT compared with conventional RV function parameters. In 871 recipients of CRT (mean age 65 ± 11 years, 75% were men), RV function was assessed by RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and RV FWS measured by speckle tracking echocardiography. RV dysfunction was defined as RV FWS
Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.
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2021 ESC guidelines on cardiac pacing and cardiac resynchronization: what is the correct level of evidence for the superiority of cephalic vein cutdown? C, B or maybe A?-Author's reply.
Europace -
2021 ESC guidelines on cardiac pacing and cardiac resynchronization: what is the correct level of evidence for the superiority of cephalic vein cutdown? C, B or maybe A?
Europace2022 Jan;():. doi: euac001.
Iliodromitis Konstantinos, Deftereos Spyridon G, Bogossian Harilaos,
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His Bundle Pacing: Are We There Yet?
JACC Clin Electrophysiol -
Simultaneous Right and Left Bundle Pacing for Cardiac Resynchronization Therapy.
JACC Clin Electrophysiol -
Risk Factor Prediction of Infection Following Secondary CIED Procedures: Caution Prior to Clinical Practice Adoption.
JACC Clin Electrophysiol2022 Jan;8(1):112-114. doi: S2405-500X(21)00857-4.
Darden Douglas, Birgersdotter-Green Ulrika,
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A Rare Case of Left Ventricular Non-Compaction with Coronary Artery Anomaly Complicated by ST-Elevation Myocardial Infarction and Subcutaneous Defibrillator Implantation.
Int J Environ Res Public Health2022 Jan;19(2):. doi: 791.
Prandi Francesca Romana, Illuminato Federica, Galluccio Chiara, Milite Marialucia, Macrini Massimiliano, Di Landro Alessio, Idone Gaetano, Chiocchi Marcello, Sbordone Francesco Paolo, Sergi Domenico, Romeo Francesco, Barillà Francesco,
Abstract
Left ventricular non-compaction (LVNC) is a rare congenital cardiomyopathy caused by arrest of normal endomyocardial embryogenesis and characterized by the persistence of ventricular hypertrabeculation, isolated or associated to other congenital defects. A 33-year-old male, with family history of sudden cardiac death (SCD), presented to our ER with typical chest pain and was diagnosed with anterior STEMI. Coronary angiography showed an anomalous origin of the circumflex artery from the right coronary artery and a critical stenosis on the proximal left anterior descending artery, treated with primary percutaneous coronary intervention. The echocardiogram documented left ventricular severe dysfunction with lateral wall hypertrabeculation, strongly suggestive for non-compaction, confirmed by cardiac MRI. At 3 months follow up, for the persistence of the severely depressed EF (30%) and the family history for SCD, the patient underwent subcutaneous ICD (sICD) implantation for primary prevention. To the best of our knowledge, this is the first case of LVNC associated with anomalous coronary artery origin and STEMI reported in the literature. Arrhythmias are common in LVNC due to endocardial hypoperfusion and fibrosis. sICD overcomes the risks of transvenous ICD, and it is a valuable option when there is no need for pacing therapy for bradycardia, cardiac resynchronization therapy and anti-tachycardia pacing.
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Echocardiographic Parameters as Predictors for the Efficiency of Resynchronization Therapy in Patients with Dilated Cardiomyopathy and HFrEF.
Diagnostics (Basel)2021 Dec;12(1):. doi: 35.
Pescariu Silvius-Alexandru, ?o?dean Raluca, Tudoran Cristina, Ionac Adina, Pop Gheorghe Nicusor, Timar Romulus Zorin, Pescariu Sorin, Tudoran Mariana,
Abstract
Cardiac resynchronization therapy (CRT) represents an increasingly recommended solution to alleviate symptomatology and improve the quality of life in individuals with dilated cardiomyopathy (DCM) and heart failure (HF) with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal medical therapy (OMT). However, this therapy does have the desired results all cases, in that sometimes low sensing and high voltage stimulation are needed to obtain some degree of resynchronization, even in the case of perfectly placed cardiac pacing leads. Our study aims to identify whether there is a relationship between several transthoracic echocardiographic (TTE) parameters characterizing left ventricular (LV) performance, especially strain results, and sensing and pacing parameters. Between 2020-2021, CRT was performed to treat persistent symptoms in 48 patients with a mean age of 64 (53.25-70) years, who were diagnosed with DCM and HFrEF, and who were still symptomatic despite OMT. We documented statistically significant correlations between global longitudinal strain, posterolateral strain, and ejection fraction and LV sensing (r = 0.65, 0.469, and 0.534, respectively,
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Circulating miR-499a and miR-125b as Potential Predictors of Left Ventricular Ejection Fraction Improvement after Cardiac Resynchronization Therapy.
Cells2022 Jan;11(2):. doi: 271.
Moscoso Isabel, Cebro-Márquez María, Martínez-Gómez Álvaro, Abou-Jokh Charigan, Martínez-Monzonís María Amparo, Martínez-Sande José Luis, González-Melchor Laila, García-Seara Javier, Fernández-López Xesús Alberte, Moraña-Fernández Sandra, González-Juanatey José R, Rodríguez-Mañero Moisés, Lage Ricardo,
Abstract
Cardiac resynchronization therapy represents a therapeutic option for heart failure drug-refractory patients. However, due to the lack of success in 30% of the cases, there is a demand for an in-depth analysis of individual heterogeneity. In this study, we aimed to evaluate the prognostic value of circulating miRNA differences. Responder patients were defined by a composite endpoint of the presence of left ventricular reverse remodelling (a reduction ?15% in telesystolic volume and an increment ?10% in left ventricular ejection fraction). Circulating miRNAs signature was analysed at the time of the procedure and at a 6-month follow-up. An expression analysis showed, both at baseline and at follow-up, differences between responders and non-responders. Responders presented lower baseline expressions of miR-499, and at follow-up, downregulation of miR-125b-5p, both associated with a significant improvement in left ventricular ejection fraction. The miRNA profile differences showed a marked sensitivity to distinguish between responders and non-responders. Our data suggest that miRNA differences might contribute to prognostic stratification of patients undergoing cardiac resynchronization therapy and suggest that preimplant cardiac context as well as remodelling response are key to therapeutic success.
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Implantable Cardioverter Defibrillator Multisensor Monitoring during Home Confinement Caused by the COVID-19 Pandemic.
Biology (Basel)2022 Jan;11(1):. doi: 120.
Ziacchi Matteo, Calò Leonardo, D'Onofrio Antonio, Manzo Michele, Dello Russo Antonio, Santini Luca, Giubilato Giovanna, Carriere Cosimo, Santobuono Vincenzo Ezio, Savarese Gianluca, La Greca Carmelo, Arena Giuseppe, Talarico Antonello, Pisanò Ennio, Giammaria Massimo, Pangallo Antonio, Campari Monica, Valsecchi Sergio, Diemberger Igor,
Abstract
AIMS:
The utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic index combines multiple implantable cardioverter defibrillator (ICD) sensors and has proved to be a predictor of impending heart failure (HF) decompensation. We examined how multiple ICD sensors behave in the periods of anticipated restrictions pertaining to physical activity.
METHODS:
The HeartLogic feature was active in 349 ICD and cardiac resynchronization therapy ICD patients at 20 Italian centers. The period from 1 January to 19 July 2020, was divided into three phases: pre-lockdown (weeks 1-11), lockdown (weeks 12-20), post-lockdown (weeks 21-29).
RESULTS:
Immediately after the implementation of stay-at-home orders (week 12), we observed a significant drop in median activity level whereas there was no difference in the other contributing parameters. The median composite HeartLogic index increased at the end of the Lockdown. The weekly rate of alerts was significantly higher during the lockdown (1.56 alerts/week/100 pts, 95%CI: 1.15-2.06; IRR = 1.71, = 0.014) and post-lockdown (1.37 alerts/week/100 pts, 95%CI: 0.99-1.84; IRR = 1.50, = 0.072) than that reported in pre-lockdown (0.91 alerts/week/100 pts, 95%CI: 0.64-1.27). However, the median duration of alert state and the maximum index value did not change among phases, as well as the proportion of alerts followed by clinical actions at the centers and the proportion of alerts fully managed remotely.
CONCLUSIONS:
During the lockdown, the system detected a significant drop in the median activity level and generated a higher rate of alerts suggestive of worsening of the HF status.
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The Use of Machine Learning Algorithms in the Evaluation of the Effectiveness of Resynchronization Therapy.
J Cardiovasc Dev Dis2022 Jan;9(1):. doi: 17.
Krzowski Bartosz, Rokicki Jakub, G?ówczy?ska Renata, Fajkis-Zaj?czkowska Nikola, Barczewska Katarzyna, M?sior Mariusz, Grabowski Marcin, Balsam Pawe?,
Abstract
BACKGROUND:
Cardiovascular disease remains the leading cause of death in the European Union and worldwide. Constant improvement in cardiac care is leading to an increased number of patients with heart failure, which is a challenging condition in terms of clinical management. Cardiac resynchronization therapy is becoming more popular because of its grounded position in guidelines and clinical practice. However, some patients do not respond to treatment as expected. One way of assessing cardiac resynchronization therapy is with ECG analysis. Artificial intelligence is increasing in terms of everyday usability due to the possibility of everyday workflow improvement and, as a result, shortens the time required for diagnosis. A special area of artificial intelligence is machine learning. AI algorithms learn on their own based on implemented data. The aim of this study was to evaluate using artificial intelligence algorithms for detecting inadequate resynchronization therapy.
METHODS:
A total of 1241 ECG tracings were collected from 547 cardiac department patients. All ECG signals were analyzed by three independent cardiologists. Every signal event (QRS-complex) and rhythm was manually classified by the medical team and fully reviewed by additional cardiologists. The results were divided into two parts: 80% of the results were used to train the algorithm, and 20% were used for the test (Cardiomatics, Cracow, Poland).
RESULTS:
The required level of detection sensitivity of effective cardiac resynchronization therapy stimulation was achieved: 99.2% with a precision of 92.4%.
CONCLUSIONS:
Artificial intelligence algorithms can be a useful tool in assessing the effectiveness of resynchronization therapy.
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Life-threatening ventricular arrhythmia and left ventricular dysfunction associated with anti-mitochondrial antibody-positive myositis: a case report.
Eur Heart J Case Rep2021 Dec;5(12):ytab469. doi: 10.1093/ehjcr/ytab469.
Hasegawa Yuki, Izumi Daisuke, Kashimura Takeshi, Minamino Tohru,
Abstract
Background:
Anti-mitochondrial antibody (AMA)-positive myositis is an atypical inflammatory myopathy characterized by chronic progression of muscle atrophy and cardiac involvement. Few detailed reports have shown the clinical course of the cardiac complications of AMA-positive myositis.
Case summary:
A 47-year-old man presented with shortness of breath on exertion. Cardiac dilatation was visible on chest X-ray, and echocardiography demonstrated diffuse hypokinesis with a reduced left ventricular (LV) ejection fraction of 30%. He had mild muscle weakness in the bilateral iliopsoas muscles, and his creatine kinase (CK) and anti-mitochondrial M2 antibody levels were elevated. A liver biopsy showed no findings of primary biliary cholangitis. Coronary angiography revealed normal coronary arteries. An endomyocardial biopsy showed interstitial fibrosis and marked degeneration of the mitochondria. Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography showed circumferential abnormal accumulation in the LV myocardium, and he was diagnosed with cardiomyopathy associated with AMA-positive myositis. Optimal drug therapy for heart failure was started, and a cardiac resynchronization therapy-defibrillator was implanted. However, his cardiac function did not improve, and he was hospitalized due to ventricular tachycardia storm 5 years after the diagnosis. Ventricular tachycardia was terminated by radiofrequency catheter ablation on the LV-anterior papillary muscle. Steroid therapy was initiated and resulted in a decreased uptake of FDG and a normalized CK level at 3 months after his second discharge; however, LV systolic dysfunction remained 1 year later.
Discussion:
Anti-mitochondrial antibody-positive myositis can affect the myocardium and cause severe LV dysfunction and life-threatening ventricular arrhythmia over time.
Keywords:
Anti-mitochondrial antibody-positive myositis ? Endomyocardial biopsy ? Ventricular tachycardia ? Left ventricular dysfunction ? Case report ? Magnetic resonance imaging ? Near-infrared spectroscopy-intravascular ultrasound.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
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