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Pubblicazioni recenti - cardiac resynchronization
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The Value of Left Ventricular Mechanical Dyssynchrony and Scar Burden in the Combined Assessment of Factors Associated with Cardiac Resynchronization Therapy Response in Patients with CRT-D.
J Clin Med2023 Mar;12(6):. doi: 2120.
Atabekov Tariel A, Khlynin Mikhail S, Mishkina Anna I, Batalov Roman E, Sazonova Svetlana I, Krivolapov Sergey N, Saushkin Victor V, Varlamova Yuliya V, Zavadovsky Konstantin V, Popov Sergey V,
Abstract
BACKGROUND:
Cardiac resynchronization therapy (CRT) improves the outcome in patients with heart failure (HF). However, approximately 30% of patients are nonresponsive to CRT. The aim of this study was to determine the role of the left ventricular (LV) mechanical dyssynchrony (MD) and scar burden as predictors of CRT response.
METHODS:
In this study, we included 56 patients with HF and the left bundle-branch block with QRS duration ? 150 ms who underwent CRT-D implantation. In addition to a full examination, myocardial perfusion imaging and gated blood-pool single-photon emission computed tomography were performed. Patients were grouped based on the response to CRT assessed via echocardiography (decrease in LV end-systolic volume ?15% or/and improvement in the LV ejection fraction ?5%).
RESULTS:
In total, 45 patients (80.3%) were responders and 11 (19.7%) were nonresponders to CRT. In multivariate logistic regression, LV anterior-wall standard deviation (adjusted odds ratio (OR) 1.5275; 95% confidence interval (CI) 1.1472-2.0340; = 0.0037), summed rest score (OR 0.7299; 95% CI 0.5627-0.9469; = 0.0178), and HF nonischemic etiology (OR 20.1425; 95% CI 1.2719-318.9961; = 0.0331) were the independent predictors of CRT response.
CONCLUSION:
Scar burden and MD assessed using cardiac scintigraphy are associated with response to CRT.
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Considering Diastolic Dyssynchrony as a Predictor of Favorable Response in LV-Only Fusion Pacing Cardiac Resynchronization Therapy.
Diagnostics (Basel)2023 Mar;13(6):. doi: 1186.
Gurgu Andra, Luca Constantin-Tudor, Vacarescu Cristina, Petrescu Lucian, Goanta Emilia-Violeta, Lazar Mihai-Andrei, Arn?utu Diana-Aurora, Cozma Dragos,
Abstract
CRT improves systolic and diastolic function, increasing cardiac output. Aim of the study: to assess the outcome of LV diastolic dyssynchrony in a population of fusion pacing CRT. Diastolic dyssynchrony was measured by offline speckle-tracking-derived TDI timing assessment of the simultaneity of E? and A? basal septal and lateral walls. New parameters introduced: E? and, respectively, A? time (E?T/A?T) as the time difference between E? (respectively, A?) peak septal and lateral wall. Patients were divided into super-responders (SR), responders (R), and non-responders (NR). Baseline characteristics: 62 pts (62 ± 11 y.o.) with idiopathic DCM, EF 27 ± 5.2%; 29% type III diastolic dysfunction (DD), 63% type II, 8% type I. Average follow-up 45 ± 19 months: LVEF 37 ± 7.9%, 34%SR, 61%R, 5%NR. The E?T decreased from 90 ± 20 ms to 25 ± 10 ms in SR with significant LV reverse remodeling (LV end-diastolic volume 193.7 ± 81 vs. 243.2 ± 82 mL at baseline, 80 ms and A?T > 30 msec. The study identifies the cut-off values of diastolic dyssynchrony parameters as predictors of favorable outcomes in responders and super-responder patients with fusion CRT pacing. These findings may have important implications in patient selection and follow-up.
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Electrical Stimulation Increases the Secretion of Cardioprotective Extracellular Vesicles from Cardiac Mesenchymal Stem Cells.
Cells2023 Mar;12(6):. doi: 875.
Zhang Haitao, Shen Yan, Kim Il-Man, Liu Yutao, Cai Jingwen, Berman Adam E, Nilsson Kent R, Weintraub Neal L, Tang Yaoliang,
Abstract
Clinical trials have shown that electric stimulation (ELSM) using either cardiac resynchronization therapy (CRT) or cardiac contractility modulation (CCM) approaches is an effective treatment for patients with moderate to severe heart failure, but the mechanisms are incompletely understood. Extracellular vesicles (EV) produced by cardiac mesenchymal stem cells (C-MSC) have been reported to be cardioprotective through cell-to-cell communication. In this study, we investigated the effects of ELSM stimulation on EV secretion from C-MSCs (C-MSC). We observed enhanced EV-dependent cardioprotection conferred by conditioned medium (CM) from C-MSC compared to that from non-stimulated control C-MSC (C-MSC). To investigate the mechanisms of ELSM-stimulated EV secretion, we examined the protein levels of neutral sphingomyelinase 2 (nSMase2), a key enzyme of the endosomal sorting complex required for EV biosynthesis. We detected a time-dependent increase in nSMase2 protein levels in C-MSC compared to C-MSC. Knockdown of nSMase2 in C-MSC by siRNA significantly reduced EV secretion in C-MSC and attenuated the cardioprotective effect of CM from C-MSC in HL-1 cells. Taken together, our results suggest that ELSM-mediated increases in EV secretion from C-MSC enhance the cardioprotective effects of C-MSC through an EV-dependent mechanism involving nSMase2.
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Minimally invasive epicardial left-ventricular lead implantation and simultaneous left atrial appendage closure.
Front Cardiovasc Med2023 ;10():1129410. doi: 1129410.
Petersen Johannes, Alassar Yousuf, Yildirim Yalin, Tönnis Tobias, Reichenspurner Hermann, Pecha Simon,
Abstract
BACKGROUND:
Atrial fibrillation (AF) is common in patients with heart failure resulting in a high prevalence of AF in patients receiving Cardiac Resynchronization Therapy (CRT) implantation. In patients, unsuitable for transvenous left ventricular (LV)-lead implantation, epicardial LV-lead implantation represents a valuable alternative. Epicardial LV-lead placement can be achieved totally thoracoscopical or minimally invasive left lateral thoracotomy. In patients with atrial fibrillation, concomitant left atrial appendage (LAA) clipping is feasible the same access. Therefore, the aim of our study was the analysis of safety and efficacy of epicardial LV lead implantation and concomitant LAA clipping minimally invasive left-lateral thoracotomy.
METHODS:
Between December 2019 and March 2022, 8 patients received minimally invasive left atrial LV-lead implantation with concomitant LAA closure using the AtriClip. Transesophageal echocardiography (TEE) was performed to intraoperatively guide and control LAA closure.
RESULTS:
Mean patients age was 64?±?11.2 years, 67% were male patients. Minimally invasive left-lateral thoracotomy was used in 6 patients while a totally thoracoscopic approach was performed in 2 cases. Epicardial lead implantation was successfully performed in all patients with good pacing threshold (mean 0.8?±?0.2?V) and sensing values (10.1?±?2.3?mV). Posterolateral position of the LV lead was achieved in all patients. Furthermore, successful LAA closure was confirmed during TEE in all patients. No procedure-related complications occurred in any of the patients. Two patients additionally received simultaneous laser lead extraction during the same procedure. Complete lead extraction was achieved in both patients. All patients were extubated in the OR and had an uneventful postoperative course.
CONCLUSION:
Our study highlights a novel treatment approach for patients with atrial fibrillation and the necessity of epicardial LV leads. Placement of a posterolateral LV lead position with concomitant occlusion of the left atrial appendage a minimally-invasive left-lateral thoracotomy or even a totally thoracoscopic approach is safe and feasible with superior cosmetic result and complete occlusion of the left atrial appendage.
© 2023 Petersen, Alassar, Yildirim, Tönnis, Reichenspurner and Pecha.
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Variation in hospital use of cardiac resynchronization therapy-defibrillator among eligible patients and association with clinical outcomes.
Heart Rhythm2023 Mar;():. doi: S1547-5271(23)00293-X.
Chui Philip W, Lan Zhou, Freeman James V, Enriquez Alan D, Khera Rohan, Akar Joseph G, Masoudi Fred A, Ong Emily L, Curtis Jeptha P,
Abstract
BACKGROUND:
Despite strong guideline recommendations for cardiac resynchronization therapy-defibrillator (CRT-D) In select patients, this therapy is underutilized with substantial variation among hospitals, and the association of this variation with outcomes is unknown.
OBJECTIVE:
To assess if facility variation in CRT-D utilization is associated with differences in hospital-level outcomes METHODS: We linked Medicare claims data with the NCDR ICD Registry from 2010 to 2015. We assessed the intraclass correlation coefficient to quantify the degree of variation in patient-level CRT usage that can be explained by interfacility variation on a hospital level. To quantify the degree of hospital variation in patient-level outcomes (all-cause mortality, readmissions, and cardiac readmissions) that can be attributed to variations in CRT-D usage, we utilized multi-level modeling.
RESULTS:
The study included 30,134 patients across 1,377 hospitals. The median rate of CRT-D implantation among those meeting guideline indications was 89%, but there was a wide variation across hospitals. After adjustment, most of the variation (74%) in hospital rates of CRT-D utilization was attributable to the hospital in which the patient was treated. Differences in hospital CRT-D utilization was associated with 8.76%, 5.26%, and 4.71% of differences in hospital mortality, readmissions, and cardiac readmission rates, respectively (p
CONCLUSIONS:
There is wide variation in the use of CRT-D across hospitals that was not explained by case mix. Hospital-level variation in CRT-D utilization was associated with clinically significant differences in outcomes. A measure of CRT-D utilization in eligible patients may serve as a useful metric for quality improvement efforts.
Copyright © 2023. Published by Elsevier Inc.
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Timing of cardiac resynchronization therapy implantation.
Europace2023 Mar;():. doi: euad059.
Leyva Francisco, Zegard Abbasin, Patel Peysh, Stegemann Berthold, Marshall Howard, Ludman Peter, Walton Jamie, de Bono Joseph, Boriani Giuseppe, Qiu Tian,
Abstract
AIMS:
The optimum timing of cardiac resynchronization therapy (CRT) implantation is unknown. We explored long-term outcomes after CRT in relation to the time interval from a first heart failure hospitalization (HFH) to device implantation.
METHODS AND RESULTS:
A database covering the population of England (56.3 million in 2019) was used to quantify clinical outcomes after CRT implantation in relation to first HFHs. From 2010 to 2019, 64 968 patients [age: 71.4 ± 11.7 years; 48 606 (74.8%) male] underwent CRT implantation, 57% in the absence of a previous HFH, 12.9% during the first HFH, and 30.1% after ?1 HFH. Over 4.54 (2.80-6.71) years [median (interquartile range); 272 989 person-years], the time in years from the first HFH to CRT implantation was associated with a higher risk of total mortality [hazard ratio (HR); 95% confidence intervals (95% CI)] (1.15; 95% CI 1.14-1.16, HFH (HR: 1.26; 95% CI 1.24-1.28), and the combined endpoint of total mortality or HFH (HR: 1.19; 95% CI 1.27-1.20) than CRT in patients with no previous HFHs, after co-variate adjustment. Total mortality (HR: 1.67), HFH (HR: 2.63), and total mortality or HFH (HR: 1.92) (all P
CONCLUSION:
In this study of a healthcare system covering an entire nation, delays from a first HFH to CRT implantation were associated with progressively worse long-term clinical outcomes. The best clinical outcomes were observed in patients with no previous HFH and in those undergoing CRT implantation during the first HFH.
CONDENSED ABSTRACT:
The optimum timing of CRT implantation is unknown. In this study of 64 968 consecutive patients, delays from a first heart failure hospitalization (HFH) to CRT implantation were associated with progressively worse long-term clinical outcomes. Each year from a first HFH to CRT implantation was associated with a 21% higher risk of total mortality and a 34% higher risk of HFH. The best outcomes after CRT were observed in patients with no previous HFHs and in those undergoing implantation during their first HFH.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Impact of Q wave in synthesized V7-9 lead on long-term outcomes after cardiac resynchronization therapy.
J Cardiol2023 Mar;():. doi: S0914-5087(23)00053-9.
Ugata Yusuke, Hayashi Tatsuya, Yamamoto Shingo, Fujita Hideo,
Abstract
BACKGROUND:
To investigate the relationship between the Q wave in synthesized V7-9 leads of a baseline electrocardiogram and clinical outcomes in patients with heart failure after cardiac resynchronization therapy (CRT) device implantation.
METHODS:
Consecutive patients with heart failure and a left ventricular (LV) ejection fraction
RESULTS:
We included 108 eligible patients. Twenty-nine patients were classified into the qV7-9 group and 79 patients were classified into the non-qV7-9 group. There were 22 patients (20?%) with ischemic etiology, 67 (62?%) with New York Heart Association functional class II or III heart failure, and 91 (84?%) with a defibrillator. The presence of Q waves in the synthesized V7-9 lead was significantly associated with worse outcomes, even with optimal medical treatment (adjusted hazard ratio, 2.1; 95?% confidence interval, 1.16-3.72; p?=?0.03).
CONCLUSION:
In patients with heart failure and an LV ejection fraction of
Copyright © 2023. Published by Elsevier Ltd.
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Clinical Predictors of Incomplete CS Lead Removal during Transvenous Lead Extraction in the Patients with Cardiac Resynchronization Therapy.
Heart Rhythm2023 Mar;():. doi: S1547-5271(23)00244-8.
Hayashi Katsuhide, Younis Arwa, Callahan Thomas, Baranowski Bryan, Martin David O, Nakhla Shady, Wilkoff Bruce L,
Abstract
BACKGROUND:
Reports of coronary sinus (CS) lead removal include small studies with short implant durations. Procedural outcomes for mature CS leads removed with long duration implantation are unavailable.
OBJECTIVE:
To examine the safety, efficacy, and clinical predictors for incomplete CS lead removal by Transvenous Lead Extraction (TLE) in a large, long implant duration cardiac resynchronization therapy (CRT) patient cohort.
METHODS:
Consecutive patients with CRT devices in the Cleveland Clinic Prospective TLE Registry who had TLE between 2013 and 2022.
RESULTS:
CS leads, n=231, implant duration = 6.1±4.0 years, removed from 226 patients were included, employing powered sheaths for 137 leads (59.3%). Complete CS lead success was achieved in 95.2% of leads (n=220) and in 95.6% of patients (n=216). Major complications occurred in 5 patients (2.2%). Patients who had the CS lead extracted 1st had significantly higher incomplete removal rates than when the other leads were 1st removed. Multivariable analysis showed that older CS lead age (OR 1.35, 95% CI 1.01-1.82; P = 0.03), and removing the CS lead 1st (OR 7.48, 95% CI 1.02-54.95; P = 0.045) were independent predictors of incomplete CS lead removal.
CONCLUSION:
Complete and safe lead removal rate of long implant duration CS leads by TLE was 95%. However, CS lead age and the order that leads were extracted were the independent predictors of incomplete CS lead removal. Therefore, before the CS lead is extracted, physicians should first extract the leads from the other chambers and employ powered sheaths.
Copyright © 2023. Published by Elsevier Inc.
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Improvement in electrocardiographic parameters of repolarization related to sudden death in patients with ventricular dysfunction and left bundle branch block after cardiac resynchronization through His bundle pacing.
J Interv Card Electrophysiol2023 Mar;():. doi: 10.1007/s10840-023-01526-8.
Moriña-Vázquez Pablo, Moraleda-Salas María Teresa, López-Masjuan-Ríos Álvaro, Esteve-Ruiz Irene, Arce-León Álvaro, Lluch-Requerey Carmen, Rodríguez-Albarrán Adrián, Venegas-Gamero José, Gómez-Menchero Antonio Enrique,
Abstract
BACKGROUND:
Cardiac resynchronization therapy (CRT) through permanent His bundle pacing (p-HBP) normalizes interventricular conduction disorders and QRS. Similarly, there are immediate and long-term changes in repolarization, which could be prognostic of a lower risk of sudden death (SD) at follow-up. We aimed to compare the changes in different electrocardiographic (ECG) repolarization parameters related to the risk of SD before and after CRT through p-HBP.
METHODS:
In this prospective, descriptive single-center study (May 2019 to December 2021), we compared the ECG parameters of repolarization related to SD in patients with non-ischemic dilated cardiomyopathy, left bundle branch block (LBBB), and CRT indications, at baseline and after CRT through p-HBP.
RESULTS:
Forty-three patients were included. Compared to baseline, after CRT through p-HBP, there were immediate significant changes in the QT interval (ms): 445 [407.5-480] vs 410 [385-440] (p?=?0.006), QT dispersion (ms): 80 [60-100] vs 40 [40-65] (p?0.001), Tp-Te (ms): 90 [80-110] vs 80 [60-95] (p?0.001), Tp-Te/QT ratio: 0.22 [0.19-0.23] vs 0.19 [0.16-0.21] (p?0.001), T wave amplitude (mm): 6.25 [4.88-10] vs?-?2.5 [-?7-2.25] (p?0.001), and T wave duration (ms): 190 [157.5-200] vs 140 [120-160] (p?=?0.001). In the cases of the corrected QT (Bazzett and Friederichia) and the Tp-Te dispersion, changes only became significant at 1 month post-implant (468.5 [428.8-501.5] vs 440 [410-475.25] (p?=?0.015); 462.5 [420.8-488.8] vs 440 [400-452.5] (p?=?0.004), and 40 [30-52.5] vs 30 [20-40] (p?0.001), respectively) (Table 1). Finally, two parameters did not improve until 6 months post-implant: the rdT/JT index, 0.25 [0.21-0.28] baseline vs 0.20 [0.19-0.23] 6 months post-implant (p?=?0.011), and the JT interval, 300 [240-340] baseline vs 280 [257-302] 6 months post-implant (p?=?0.027). Additionally, most of the parameters continued improving as compared with immediate post-implantation.
CONCLUSIONS:
After CRT through His bundle pacing and LBBB correction, there was an improvement in all parameters of repolarization related to increased SD reported in the literature.
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Modified Glasgow Prognost?c Score May Be Useful to Predict Major Adverse Cardiac Events in Heart Failure Patients Undergone Cardiac Resynchronization Treatment.
Turk Kardiyol Dern Ars2023 Mar;51(2):104-111. doi: 10.5543/tkda.2022.99448.
Erdogan Güney, Yenerça? Mustafa, Uçar Melisa, Öztürk Onur, ?eker Onur Osman, Yontar Osman Can, Çakmak Ender Özgün, Karagöz Ali, ?ahin ?rfan, Arslan U?ur,
Abstract
OBJECTIVE:
Whether modi?ed Glasgow prognostic score predicts prognosis in patients with cardiac resynchronization therapy with de?brillation is unknown. Our aim was to investigate the association of modi?ed Glasgow prognostic score with death and hospitalization in cardiac resynchronization therapy with de?brillation patients.
METHODS:
A total of 306 heart failure with reduced ejection fraction patients who underwent cardiac resynchronization therapy with de?brillation implantation were categorized into 3 groups based on their modi?ed Glasgow prognostic score categorical levels. C-reactive protein >10 mg/L or albumin
RESULTS:
Age, New York Heart Association functional class, modi?ed Glasgow prognostic score prior to cardiac resynchronization therapy with de?brillation, sodium levels, and left atrial diameter were higher in the major adverse cardiac events(+) group. Age, left atrial diameter, and higher modi?ed Glasgow prognostic score were found to be predictors of heart failure hospitalization/death in multivariable penalized Cox regression analysis. Besides, patients with lower modi?ed Glasgow prognostic score showed better reverse left ventricular remodeling demonstrated by increase in left ventricle ejection fraction and decline in left ventricle end systolic volume.
CONCLUSION:
Modi?ed Glasgow prognostic score prior to cardiac resynchronization therapy with de?brillation can be used as a predictor of long-term heart failure hospitalization and death in addition to age and left atrial diameter. These results can guide the patient selection for cardiac resynchronization therapy with de?brillation therapy and highlight the importance of nutritional status.
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Late Incidental Discovery of Compression of the Left Anterior Descending Coronary Artery by an Endocardial Defibrillator Lead.
Case Rep Cardiol2023 ;2023():6646715. doi: 6646715.
Scripcariu Alex, Gaty Denis, Maury Philippe,
Abstract
Coronary artery compression/damage by cardiac pacing/defibrillation leads is very rare and often an unknown complication of pacemaker implantation. Here, we present the case of a 71-year-old woman with late discovery of an asymptomatic compression of the left anterior descending (LAD) coronary artery by a defibrillation lead implanted ten years before. This dissuaded us in removing this now malfunctioning lead with high threshold, and an additional right ventricular (RV) lead was implanted along with atrial and left ventricular (LV) leads for allowing resynchronization therapy. Based on the published data, a majority of RV leads are currently implanted in the "anteroseptal area," which is neighboring the course of the LAD.
Copyright © 2023 Alex Scripcariu et al.
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Impact of baseline right ventricular function on the response to cardiac resynchronization therapy - A meta-analysis.
Hellenic J Cardiol2023 Mar;():. doi: S1109-9666(23)00033-7.
Sidiropoulos Georgios, Antoniadis Antonios, Saplaouras Athanasios, Bazoukis Georgios, Letsas ?onstantinos P, Karamitsos Theodoros D, Giannopoulos Georgios, Fragakis Nikolaos,
Abstract
Baseline RV function potentially determines response to Cardiac Resynchronization Therapy (CRT) but is not included in the current selection criteria for CRT. In this meta-analysis, we examine the value of echocardiographic indices of RV function as potential predictors of CRT outcomes in patients with standard indications for CRT. Baseline tricuspid annular plane systolic excursion (TAPSE) was consistently higher in CRT responders, and this association appears independent of age, sex, ischemic etiology of HF, and baseline left-ventricular ejection fraction (LVEF). This proof-of-concept meta-analysis of observational data may justify a more detailed assessment of RV function as an additional component in the selection process of CRT candidates.
Copyright © 2023 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.
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Acute and Long-term Outcomes of quadripolar IS-4 versus bipolar IS-1 Left Ventricular Leads in Cardiac Resynchronization Therapy: A Retrospective Registry Study.
Pacing Clin Electrophysiol2023 Mar;():. doi: 10.1111/pace.14686.
Maurhofer Jens, Asatryan Babken, Haeberlin Andreas, Noti Fabian, Roten Laurent, Seiler Jens, Baldinger Samuel H, Franzeck Florian, Lam Anna, Kueffer Thomas, Reichlin Tobias, Tanner Hildegard, Servatius Helge,
Abstract
BACKGROUND:
The implantation procedure of left ventricular (LV) leads and the management of cardiac resynchronization therapy (CRT) patients can be challenging. The IS-4 standard for CRT offers additional pacing vectors compared to bipolar leads (IS-1). IS-4 leads improve procedural outcome and may also result in lower adverse events during follow-up (FU) and improve clinical outcome in CRT patients. Further long-term FU data comparing the two lead designs are necessary.
METHODS:
In this retrospective, single-center study we included adult patients implanted with a CRT-Defibrillator (CRT-D) or CRT-Pacemaker (CRT-P) with a quadripolar (IS-4 group) or bipolar (IS-1 group) LV lead and with available ?3 years clinical FU. The combined primary endpoint was a combination of predefined, lead-related adverse events. Secondary endpoints were all single components of the primary endpoint.
RESULTS:
Overall, 133 patients (IS-4 n = 66; IS-1 n = 67) with a mean FU of 4.03±1.93 years were included. Lead-related adverse events were less frequent in patients with an IS-4 lead than with an IS-1 lead (n = 8, 12.1% vs. n = 23, 34.3%; p = 0.002). The secondary outcomes showed a lower rate of LV lead deactivation/explantation and LV lead dislodgement/dysfunction (4.5% vs 22.4%; p = 0.003; 4.5% vs. 17.9%; p = 0.015, respectively) in the IS-4 patient group. Less patients suffered from unresolved phrenic nerve stimulation with an IS-4 lead (3.0% vs. 13.4%; p = 0.029). LV lead-related re-interventions were fewer in case of an IS-4 lead (6.1% vs. 17.9%; p = 0.036).
CONCLUSION:
In this retrospective analysis, the IS-4 LV lead is associated with lower lead-related complication rates than the IS-1 lead at long-term FU. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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The usefulness of QRS Index for prediction of echocardiographic response in cardiac resynchronization therapy: a multicenter study.
Minerva Cardiol Angiol2023 Mar;():. doi: 10.23736/S2724-5683.23.06245-2.
Mugnai Giacomo, Donazzan Luca, Tomasi Luca, Piccoli Anna, Cavedon Stefano, Pescoller Felix, Bolzan Bruna, Perrone Cosimo, Rauhe Werner G, Oberhollenzer Rainer, Bilato Claudio, Ribichini Flavio L,
Abstract
BACKGROUND:
The association between QRS narrowing and response to cardiac resynchronization therapy (CRT) has been investigated by several studies, but their findings remain inconclusive. Aim of our study was to explore the relationship between QRS Index and echocardiographic response to CRT.
METHODS:
This multicenter, retrospective analysis included 326 consecutive patients (mean age was 70.0±10.1 years old; males 76.7%) who underwent CRT-D implantation in primary and secondary prevention between 2018 and 2020. The estimation of QRS shortening after CRT-D implantation was precisely assessed through the QRS Index, calculated as follows: [(QRS duration before implantation - paced QRS duration)/QRS duration before implantation]*100.
RESULTS:
After a mean follow-up of 12.7±4.5 months, 55.2% (180/326) of the patients showed an echocardiographic response to CRT. The median [25-75] QRS Index was 3.85% [-14.1% - +13.9%]. The best predictive cut-off value of QRS Index was 1.40% (sensitivity 70.4%, specificity 64.5%, AUC 0.70). In patients with left bundle branch block, the median [25-75] QRS Index was 9.85% [+3.87% - +16.7%]. In this subgroup, the AUC was 0.737 and the best predictive cut-off of QRS Index was 2.20% (sensitivity 78.3%, specificity 67%). The multivariable model showed that only left ventricular ejection fraction and QRS Index were independently associated with CRT response (respectively OR 0.92, CI 95% 0.86-0.98, P=0.01 and OR 1.057, CI 95% 1.026-1.089, P
CONCLUSIONS:
the QRS Index tightly correlated with CRT response. Only LVEF and QRS Index were independently associated with echocardiographic response to CRT.
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Case report: An unusual case of phrenic nerve stimulation in a patient with single chamber implantable cardioverter defibrillator.
Front Cardiovasc Med2023 ;10():1088697. doi: 1088697.
De Innocentiis Carlo, Astore Pasquale, Buonpane Angela, Santamaria Antonia Pia, Patragnoni Francesco, Santamaria Matteo,
Abstract
BACKGROUND:
Phrenic nerve stimulation is a well-recognized complication related to cardiac implantable electronic devices, in particular with left ventricular coronary sinus pacing leads for cardiac resynchronization therapy.
CASE PRESENTATION:
We report an unusual case of symptomatic phrenic nerve stimulation due to inadvertent placement of a right ventricular defibrillation lead in coronary sinus posterior branch in a patient with heart failure with reduced ejection fraction with a recently implanted single-chamber cardioverter defibrillator.
DISCUSSION:
Phrenic nerve stimulation is a relatively common complication of left ventricular pacing. Inadvertent placement of a right ventricular lead in a coronary sinus branch is a rare but possible cause of phrenic nerve stimulation. Careful evaluation of intraprocedural fluoroscopic and electrocardiographic appearance of pacing and defibrillation leads during implantation may prevent inadvertent placement of a right ventricular lead in the coronary sinus.
Copyright © 2023 De Innocentiis, Astore, Buonpane, Santamaria, Patragnoni and Santamaria.
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Quadripolar left ventricle only single lead pacing in a patient with a tricuspid mechanical valve: A less invasive approach.
J Cardiol Cases2023 Mar;27(3):105-107. doi: 10.1016/j.jccase.2022.11.004.
Grazina André, Teixeira Barbara Lacerda, Cunha Pedro Silva, Oliveira Mário Martins,
Abstract
UNLABELLED:
In the presence of prosthetic tricuspid valve, the inaccessibility to the right ventricle makes permanent pacing challenging. The placement of a left ventricle (LV) single lead in the coronary sinus (CS) is a well-accepted alternative, with some limitations regarding sensing and threshold. We describe a clinical case of a patient who had a previous LV only lead in the CS due to the presence of a prosthetic tricuspid valve and, after a surgical valvular intervention, presented with recurrent syncope episodes due to lead malfunction with lack of pacing capture and significant ventricular pauses. A quadripolar lead was chosen to be placed in the CS connected to a cardiac resynchronization therapy pacemaker device, programmed at biventricular VVI and using a specific manufacturer T-wave protection algorithm to prevent pacemaker-induced arrhythmias and to use the patient's own rhythm. This approach prevented a fourth surgical intervention to place an epicardial lead and resulted in reasonable LV sensing and pacing threshold.
LEARNING OBJECTIVES:
This paper reports an alternative and atypical approach that could solve some of the limitations associated with ventricular pacing in patients with tricuspid prosthetic valves and multiple previous surgeries.
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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Left Bundle Branch Area Pacing From a Femoral Approach in a Patient Without Superior Access.
JACC Case Rep2023 Mar;9():101748. doi: 101748.
Dhakal Bishnu P, Prenner Stuart B, Magargee Edward R, Modi Danesh S, Movsowitz Colin, Schaller Robert D,
Abstract
Limited venous access and lateral left ventricular scar are impediments to traditional cardiac resynchronization therapy. We present a case where placement of an implantable cardioverter-defibrillator from a femoral approach while using left bundle branch area pacing led to clinical improvement. ().
© 2023 The Authors.
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Conduction system versus biventricular pacing in heart failure with non-left bundle branch block.
J Cardiovasc Electrophysiol2023 Mar;():. doi: 10.1111/jce.15881.
Tan Eugene S J, Soh Rodney, Lee Jie-Ying, Boey Elaine, de Leon Jhobeleen, Chan Siew Pang, Yeo Wee Tiong, Lim Toon Wei, Seow Swee-Chong, Kojodjojo Pipin,
Abstract
INTRODUCTION:
The benefits of cardiac resynchronization therapy (CRT) with biventricular pacing (BiV) is significantly lower when applied to heart failure (HF) patients with non-left bundle branch block (LBBB) conduction delay. We investigated clinical outcomes of conduction system pacing (CSP) for CRT in non-LBBB HF.
METHODS:
Consecutive HF patients with non-LBBB conduction delay undergoing CSP were propensity matched for age, sex, HF-etiology, and atrial fibrillation (AF) in a 1:1 ratio to BiV from a prospective registry of CRT recipients. Echocardiographic response was defined as an increase in left ventricular ejection fraction (LVEF) by ?10%. The primary outcome was the composite of HF-hospitalizations or all-cause mortality.
RESULTS:
A total of 96 patients were recruited (mean age 70?±?11years, 22% female, 68% ischemic HF and 49% AF). Significant reductions in QRS duration and LV dimensions were seen only after CSP, while LVEF improved significantly in both groups (p?0.05). Echocardiographic response occurred more frequently in CSP than BiV (51% vs. 21%, p?0.01), with CSP independently associated with four-fold increased odds (adjusted odds ratio 4.08, 95% confidence interval [CI] 1.34-12.41). The primary outcome occurred more frequently in BiV than CSP (69% vs. 27%, p?0.001), with CSP independently associated with 58% risk reduction (adjusted hazard ratio [AHR] 0.42, 95% CI 0.21-0.84, p?=?0.01), driven by reduced all-cause mortality (AHR 0.22, 95% CI 0.07-0.68, p?0.01), and a trend toward reduced HF-hospitalization (AHR 0.51, 95% CI 0.21-1.21, p?=?0.12).
CONCLUSIONS:
CSP provided greater electrical synchrony, reverse remodeling, improved cardiac function and survival compared to BiV in non-LBBB, and may be the preferred CRT strategy for non-LBBB HF.
© 2023 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.
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Comparison of the relation of the ESC 2021 and ESC 2013 definitions of left bundle branch block with clinical and echocardiographic outcome in cardiac resynchronization therapy.
J Cardiovasc Electrophysiol2023 Mar;():. doi: 10.1111/jce.15882.
Rijks Jesse, Ghossein Mohammed A, Wouters Philippe C, Dural Muhammet, Maass Alexander H, Meine Mathias, Kloosterman Mariëlle, Luermans Justin, Prinzen Frits W, Vernooy Kevin, van Stipdonk Antonius M W,
Abstract
INTRODUCTION:
We aimed to investigate the impact of the 2021 European Society of Cardiology (ESC) guideline changes in left bundle branch block (LBBB) definition on cardiac resynchronization therapy (CRT) patient selection and outcomes.
METHODS:
The MUG (Maastricht, Utrecht, Groningen) registry, consisting of consecutive patients implanted with a CRT device between 2001 and 2015 was studied. For this study, patients with baseline sinus rhythm and QRS duration ??130ms were eligible. Patients were classified according to ESC 2013 and 2021 guideline LBBB definitions and QRS duration. Endpoints were heart transplantation, LVAD implantation or mortality (HTx/LVAD/mortality) and echocardiographic response (LVESV reduction ?15%).
RESULTS:
The analyses included 1.202, typical CRT patients. The ESC 2021 definition resulted in considerably less LBBB diagnoses compared to the 2013 definition (31.6% vs. 80.9%, respectively). Applying the 2013 definition resulted in significant separation of the Kaplan-Meier curves of HTx/LVAD/mortality (p?.0001). A significantly higher echocardiographic response rate was found in the LBBB compared to the non-LBBB group using the 2013 definition. These differences in HTx/LVAD/mortality and echocardiographic response were not found when applying the 2021 definition.
CONCLUSION:
The ESC 2021 LBBB definition leads to a considerably lower percentage of patients with baseline LBBB then the ESC 2013 definition. This does not lead to better differentiation of CRT responders, nor does this lead to a stronger association with clinical outcomes after CRT. In fact, stratification according to the 2021 definition is not associated with a difference in clinical or echocardiographic outcome, implying that the guideline changes may negatively influence CRT implantation practice with a weakened recommendation in patients that will benefit from CRT.
© 2023 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.
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Prediction of a super-response to cardiac resynchronization therapy as guided by left ventricular end-systolic volume size.
J Clin Ultrasound2023 Mar;51(3):394-397. doi: 10.1002/jcu.23393.
Kerkhof Peter L M, Diaz-Navarro Rienzi A,
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