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Pubblicazioni recenti - cardiac resynchronization
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Effect of single ventricular premature contractions on response to cardiac resynchronization therapy.
BMC Cardiovasc Disord2022 Jun;22(1):289. doi: 10.1186/s12872-022-02725-3.
Merkel Eperke Dóra, Boros András Mihaly, Schwertner Walter Richárd, Behon Anett, Kovács Attila, Lakatos Bálint Károly, Gellér László, Kosztin Annamária, Merkely Béla,
Abstract
BACKGROUND:
We lack data on the effect of single premature ventricular contractions (PVCs) on the clinical and echocardiographic response after cardiac resynchronization therapy (CRT) device implantation. We aimed to assess the predictive value of PVCs at early, 1 month-follow up on echocardiographic response and all-cause mortality.
METHODS:
In our prospective, single-center study, 125 heart failure patients underwent CRT implantation based on the current guidelines. Echocardiographic reverse remodeling was defined as a???15% improvement in left ventricular ejection fraction (LVEF), end-systolic volume (LVESV), or left atrial volume (LAV) measured 6 months after CRT implantation. All-cause mortality was investigated by Wilcoxon analysis.
RESULTS:
The median number of PVCs was 11,401 in those 67 patients who attended the 1-month follow-up. Regarding echocardiographic endpoints, patients with less PVCs develop significantly larger LAV reverse remodeling compared to those with high number of PVCs. During the mean follow-up time of 2.1 years, 26 (21%) patients died. Patients with a higher number of PVCs than our median cut-off value showed a higher risk of early all-cause mortality (HR 0.97; 95% CI 0.38-2.48; P?=?0.04). However, when patients were followed up to 9 years, its significance diminished (HR 0.78; 95% CI 0.42-1.46; P?=?0.15).
CONCLUSIONS:
In patients undergoing CRT implantation, lower number of PVCs predicted atrial remodeling and showed a trend for a better mortality outcome. Our results suggest the importance of the early assessment of PVCs in cardiac resynchronization therapy and warrant further investigations.
© 2022. The Author(s).
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The Gallant? system heart rhythm management device: making a connection.
Future Cardiol2022 Jun;():. doi: 10.2217/fca-2021-0117.
Corbisiero Raffaele, Muller David,
Abstract
Implantable cardiac defibrillators have revolutionized the way we prevent sudden cardiac death via arrhythmias. The addition of cardiac resynchronization pacing to defibrillators has broadened that treatment to include patients with heart failure and reduced ejection fraction. As with all technology, new devices and platforms expand the capabilities and interface with patients across the world. This review discusses the evolution from the initial modalities and methods of communication of implantable devices up to the most recent advances in implantable defibrillators and their integration into patient lives and clinical practice. This review is focused on the integration of Bluetooth communication into modern healthcare with the Gallant? family of devices, the first branded launch by Abbott Laboratories.
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Impact of cardiac resynchronization therapy optimization inside a heart failure programme: a real-world experience.
ESC Heart Fail2022 Jun;():. doi: 10.1002/ehf2.14043.
Moulin Thibaut, Hamon David, Djouadi Kamila, D'Humières Thomas, Elbaz Nathalie, Boukantar Madjid, Zerbib Céline, Rouffiac Ségolène, Dhanjal Tarvinder S, Ernande Laura, Derumeaux Geneviève, Teiger Emmanuel, Damy Thibaud, Lellouche Nicolas,
Abstract
AIMS:
This study sought to describe and evaluate the impact of a routine in-hospital cardiac resynchronization therapy (CRT) programme, including comprehensive heart failure (HF) evaluation and systematic echo-guided CRT optimization.
METHODS AND RESULTS:
CRT implanted patients were referred for optimization programme at 3 to 12 months from implantation. The program included clinical and biological status, standardized screening for potential cause of CRT non-response and systematic echo-guided atrioventricular and interventricular delays (AVd and VVd) optimization. Initial CRT-response and improvement at 6 months post-optimization were assessed with a clinical composite score (CCS). Major HF events were tracked during 1 year after optimization. A total of 227 patients were referred for CRT optimization and enrolled (71 ± 11 years old, 77% male, LVEF 30.6 ± 7.9%), of whom 111 (48.9%) were classified as initial non-responders. Left ventricular lead dislodgement was noted in 4 patients (1.8%), and loss or ?90% biventricular capture in 22 (9.7%), mostly due to arrhythmias. Of the 196 patients (86%) who could undergo echo-guided CRT optimization, 71 (36.2%) required VVd modification and 50/144 (34.7%) AVd modification. At 6 months post-optimization, 34.3% of the initial non-responders were improved according to the CCS, but neither AVd nor VVd echo-guided modification was significantly associated with CCS-improvement. After one-year follow-up, initial non-responders maintained a higher rate of major HF events than initial responders, with no significant difference between AVd/VVd modified or not.
CONCLUSIONS:
Our study supports the necessity of a close, comprehensive and multidisciplinary follow-up of CRT patients, without arguing for routine use of echo-guided CRT optimization.
© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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A Variable-Volume Heart Model for Galvanic Coupling-Based Conductive Intracardiac Communication.
Sensors (Basel)2022 Jun;22(12):. doi: 4455.
Liu Yiming, Gao Yueming, Chen Liting, Liu Tao, Yang Jiejie, Pun Siohang, Vai Mangi, Du Min,
Abstract
Conductive intracardiac communication (CIC) has become one of the most promising technologies in multisite leadless pacemakers for cardiac resynchronization therapy. Existing studies have shown that cardiac pulsation has a significant impact on the attenuation of intracardiac communication channels. In this study, a novel variable-volume circuit-coupled electrical field heart model, which contains blood and myocardium, is proposed to verify the phenomenon. The influence of measurements was combined with the model as the equivalent circuit. Dynamic intracardiac channel characteristics were obtained by simulating models with varying volumes of the four chambers according to the actual cardiac cycle. Subsequently, in vitro experiments were carried out to verify the model's correctness. Among the dependences of intracardiac communication channels, the distance between pacemakers exerted the most substantial influence on attenuation. In the simulation and measurement, the relationship between channel attenuation and pulsation was found through the variable-volume heart model and a porcine heart. The CIC channel attenuation had a variation of less than 3 dB.
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Cardiac I-IBG Imaging in Heart Failure.
Pharmaceuticals (Basel)2022 May;15(6):. doi: 656.
Verschure Derk O, Nakajima Kenichi, Verberne Hein J,
Abstract
Cardiac sympathetic upregulation is one of the neurohormonal compensation mechanisms that play an important role in the pathogenesis of chronic heart failure (CHF). In the past decades, cardiac I-IBG scintigraphy has been established as a feasible technique to evaluate the global and regional cardiac sympathetic innervation. Although cardiac I-IBG imaging has been studied in many cardiac and neurological diseases, it has extensively been studied in ischemic and non-ischemic CHF. Therefore, this review will focus on the role of I-IBG imaging in CHF. This non-invasive, widely available technique has been established to evaluate the prognosis in CHF. Standardization, especially among various combinations of gamma camera and collimator, is important for identifying appropriate thresholds for adequate risk stratification. Interestingly, in contrast to the linear relationship between I-IBG-derived parameters and overall prognosis, there seems to be a "bell-shape" curve for I-IBG-derived parameters in relation to ventricular arrhythmia or appropriate implantable cardioverter defibrillator (ICD) therapy in patients with ischemic CHF. In addition, there is a potential clinical role for cardiac I-IBG imaging in optimizing patient selection for implantation of expensive devices such as ICD and cardiac resynchronization therapy (CRT). Based on cardiac I-IBG data risk models and machine learning, models have been developed for appropriate risk assessment in CHF.
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Impact of synchronized left ventricular pacing rate on risk for ventricular tachyarrhythmias after cardiac resynchronization therapy in patients with heart failure.
J Interv Card Electrophysiol2022 Jun;():. doi: 10.1007/s10840-022-01284-z.
Okajima Takashi, Inden Yasuya, Yanagisawa Satoshi, Suga Kazumasa, Shimojo Masafumi, Nakagomi Toshifumi, Tsurumi Naoki, Watanabe Ryo, Suzuki Noriyuki, Shibata Rei, Murohara Toyoaki,
Abstract
BACKGROUND:
The adaptive cardiac resynchronization therapy (aCRT) algorithm automatically produces synchronized left ventricular pacing (sLVP) with intrinsic atrioventricular conduction to improve clinical outcomes. However, relationship between sLVP percentage and risk for ventricular tachyarrhythmia (VT/VF) remains unclear. This study aimed to evaluate the clinical impact of sLVP rate on VT/VF occurrence.
METHODS:
In total, 1,419 device interrogation data from 42 consecutive patients who underwent new aCRT device implantation were retrospectively analyzed. The primary endpoint was the first time VT/VF episode after aCRT device implantation.
RESULTS:
During a median follow-up of 34 months, 15 patients had VT/VF episodes. Patients were divided into a high sLVP (the average sLVP percentage of???51.5%, n?=?27) or low sLVP group (51.5%, n?=?15). The high sLVP group had a significantly lower VT/VF incidence (22% vs. 60%; p?=?0.014) and an independent predictor for VT/VF occurrence on multivariate analysis (hazard ratio 0.21; p?=?0.007). LV ejection fraction improvements after 6 months (12.3?±?8.7% vs. 2.8?±?10.3%; p?=?0.004) and 12 months (13.8?±?9.3% vs. 6.2?±?11.1%; p?=?0.030) were significantly greater in the high sLVP group than in the low sLVP group. Age, PR interval, and left atrial diameter were significantly associated with the sLVP rate after aCRT.
CONCLUSIONS:
Patients with high sLVP percentage after aCRT had lower long-term risk of VT/VF incidence with a favorable response to CRT. A synchronized pacing algorithm using intrinsic conduction may prevent malignant arrhythmias, as well as recover cardiac functions.
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Reduction in Ventricular Tachyarrhythmia Burden in Patients Enrolled in the RAID Trial.
JACC Clin Electrophysiol2022 Jun;8(6):754-762. doi: S2405-500X(22)00302-4.
Younis Arwa, Goldenberg Ilan, Farooq Shamroz, Yavin Hagai, Daubert James, Raitt Merritt, Mazur Alexander, Huang David T, Mitchell Brent L, Rashtian Mayer R, Winters Stephen, Vloka Margot, Aktas Mehmet, Bernabei Matthew A, Beck Christopher A, McNitt Scott, Zareba Wojciech,
Abstract
BACKGROUND:
The RAID (Ranolazine Implantable Cardioverter-Defibrillator) randomized placebo-controlled trial showed that ranolazine treatment was associated with reduction in recurrent ventricular tachycardia (VT) requiring appropriate implantable cardioverter-defibrillator (ICD) therapy.
OBJECTIVES:
This study aimed to identify groups of patients in whom ranolazine treatment would result in the highest reduction of ventricular tachyarrhythmia (VTA) burden.
METHODS:
Andersen-Gill analyses were performed to identify variables associated with risk for VTA burden among 1,012 patients enrolled in RAID. The primary endpoint was VTA burden defined as VTA episodes requiring appropriate treatment.
RESULTS:
Multivariate analysis identified 7 factors associated with increased VTA burden: history of VTA, age ?65 years, New York Heart Association functional class ?III, QRS complex (?130 ms), low ejection fraction (
CONCLUSIONS:
In patients with high risk for VTA, ranolazine is effective in reducing VTA burden, with significantly greater effect in CRT-treated patients, those without AF, and those not treated with concomitant AADs. In patients already on AADs or those with AF, the addition of ranolazine did not affect VTA burden. (Ranolazine Implantable Cardioverter-Defibrillator Trial [RAID]; NCT01215253).
Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.
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Cardiac resynchronization therapy defibrillator: implant in a COVID-19 patient by an echo-guided axillary venous approach.
Future Cardiol2022 Jun;():. doi: 10.2217/fca-2021-0055.
Agea Aldo, Bellino Maria C, Gianfrancesco Domenico, Palma Francesco, Carpagnano Giuseppe A, Torraco Rita Mr, Marino Maria M, Persichella Paola, Zingaro Sebastiano, Siena Fabio, Di Tullio Roberto, Deluca Giovanni,
Abstract
The COVID-19 pandemic has seriously revolutionized the management of patients who need an implanted cardiac implantable electronic device. We report, for the first time, a successful cardiac resynchronization therapy defibrillator implantation procedure in an 82-year-old man affected by COVID-19, recent myocardial infarction, second-degree 2:1 atrioventricular block and left bundle branch block.
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Leadless Left Bundle Branch Area Pacing in Cardiac Resynchronisation Therapy: Advances, Challenges and Future Directions.
Front Physiol2022 ;13():898866. doi: 10.3389/fphys.2022.898866.
Wijesuriya Nadeev, Elliott Mark K, Mehta Vishal, Sidhu Baldeep S, Strocchi Marina, Behar Jonathan M, Niederer Steven, Rinaldi Christopher A,
Abstract
Leadless left bundle branch area pacing (LBBAP) represents the merger of two rapidly progressing areas in the field of cardiac resynchronisation therapy (CRT). It combines the attractive concepts of pacing the native conduction system to allow more physiological activation of the myocardium than conventional biventricular pacing, with the potential added benefits of avoiding long-term complications associated with transvenous leads via leadless left ventricular endocardial pacing. This perspective article will first review the evidence for the efficacy of leadless pacing in CRT. We then summarise the procedural steps and pilot data for leadless LBBAP, followed by a discussion of the safety and efficacy of this novel technique. Finally, we will examine how further mechanistic evidence may shed light to which patients may benefit most from leadless LBBAP, and how improvements in current experience and technology could promote widespread uptake and expand current clinical indications.
Copyright © 2022 Wijesuriya, Elliott, Mehta, Sidhu, Strocchi, Behar, Niederer and Rinaldi.
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2D speckle tracking: a diagnostic and prognostic tool of paramount importance.
Eur Rev Med Pharmacol Sci2022 Jun;26(11):3903-3910. doi: 28958.
Morariu V I, Arnautu D A, Morariu S I, Popa A M, Parvanescu T, Andor M, Abhinav S, David V L, Ionescu A, Tomescu M C,
Abstract
OBJECTIVE:
We aimed to conduct a review of the literature relevant to cardiac imaging techniques and summarize the use of different non-invasive imaging modalities in the assessment of ventricular size, function, and mechanics. The current review emphasizes the benefits of speckle tracking imaging (STI), highlighting its use in demonstrating myocardial strain. This robust technique is a recent addition to the existing imaging techniques that are used to assess the myocardium. In terms of effectively determining the left ventricle ejection fraction, it is a comparable technique to cardiac magnetic resonance. The use of STI method for image acquisition relies on semiautomatic identification of the border and deformation of the region of interest, and is also independent of the angle of insonation, thus it increases the inter-and intra-observer reproducibility in contrast to the conventional tissue doppler imaging.
MATERIALS AND METHODS:
The databases of PubMed, Scopus, and Embase were thoroughly searched for the following keywords: 2- dimensional/ two-dimensional/ 2-D, speckle/strain tracking, systolic dysfunction, and heart failure. The studies selected described image acquisition techniques and the application of this imaging modality in various clinical settings. The selected journal articles were perused to provide the best possible analysis of STI.
RESULTS:
Our comparative analysis demonstrated that the STI, when compared with the conventional echocardiography, is a more sensitive image acquiring technique for detecting subclinical myocardial dysfunction. Based on the analysis it can be stated that the STI can provide valuable information on both regional and global myocardial function, and it can also quantify cardiac synchronicity and rotation. Additionally, it serves as a better prognostic indicator.
CONCLUSIONS:
The change in longitudinal strain can serve as an early marker of the left ventricular systolic dysfunction, and therefore, monitoring via STI has both diagnostic and prognostic value in heart failure, ischemic heart disease, valvulopathies, chemotherapy-induced cardiotoxicity, and cardiac resynchronization therapy. Despite the lack of standardization, the method is also effective in assessing the right ventricle and left atrial function and arterial rigidity.
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Computational electrophysiology of the coronary sinus branches based on electro-anatomical mapping for the prediction of the latest activated region.
Med Biol Eng Comput2022 Jun;():. doi: 10.1007/s11517-022-02610-3.
Vergara Christian, Stella Simone, Maines Massimiliano, Africa Pasquale Claudio, Catanzariti Domenico, Demattè Cristina, Centonze Maurizio, Nobile Fabio, Quarteroni Alfio, Del Greco Maurizio,
Abstract
This work dealt with the assessment of a computational tool to estimate the electrical activation in the left ventricle focusing on the latest electrically activated segment (LEAS) in patients with left bundle branch block and possible myocardial fibrosis. We considered the Eikonal-diffusion equation and to recover the electrical activation maps in the myocardium. The model was calibrated by using activation times acquired in the coronary sinus (CS) branches or in the CS solely with an electroanatomic mapping system (EAMS) during cardiac resynchronization therapy (CRT). We applied our computational tool to ten patients founding an excellent accordance with EAMS measures; in particular, the error for LEAS location was less than 4 mm. We also calibrated our model using only information in the CS, still obtaining an excellent agreement with the measured LEAS. The proposed tool was able to accurately reproduce the electrical activation maps and in particular LEAS location in the CS branches, with an almost real-time computational effort, regardless of the presence of myocardial fibrosis, even when information only at CS was used to calibrate the model. This could be useful in the clinical practice since LEAS is often used as a target site for the left lead placement during CRT. Overall picture of the computational pipeline for the estimation of LEAS.
© 2022. The Author(s).
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Real-world clinical burden among patients with and without heart failure worsening after cardiac resynchronization therapy.
Curr Med Res Opin2022 Jun;():1-30. doi: 10.1080/03007995.2022.2092374.
Chung Eugene S, Rickard John, Lu Xiaoxiao, DerSarkissian Maral, Zichlin Miriam L, Cheung Hoi Ching, Swartz Natalia, Greatsinger Alexandra, Duh Mei S,
Abstract
OBJECTIVE:
Cardiac resynchronization therapy (CRT) can improve cardiac function in patients with heart failure (HF); however, in some patients HF worsens despite CRT. This study characterized the long-term clinical burden of patients with and without HF worsening (HFW) within 6 months post CRT implantation.
METHODS:
A claims database (2007-2018) was used to identify two cohorts of adults: those with HFW within 180 days post-CRT and those with no HFW (NHFW). The evaluated clinical outcomes were cardiovascular events/complications, HF-related interventions, hospice enrollment, and all-cause mortality. Inverse probability of treatment weighting (IPTW) was used to adjust for confounders; adjusted comparisons were assessed using weighted Cox proportional hazard ratios (HRs).
RESULTS:
Among the 12,753 adults analyzed (HFW: N?=?4,785; NHFW: N?=?7,968), the mean age was 72 years and mean duration of follow-up was approximately 2 years. The clinical burden was greater for HFW than for NHFW in terms of all-cause mortality (19.7% vs. 12.1%) and occurrence of atrial fibrillation (57.4% vs. 51.2%). In the IPTW-adjusted Cox proportional hazard analyses, patients with HFW had a 54% higher average hazard of experiencing all-cause mortality compared to NHFW (adjusted average HR =1.54, 95% confidence interval [CI]: 1.41-1.70; p?0.001). Of the clinical events experienced by ?5% of patients, the greatest differences in average hazard were for HF decompensation (adjusted average HR =1.83, 95% CI: 1.60-2.09) and HF decompensation or death (HR =1.63, 95%CI: 1.50-1.77).
CONCLUSION:
Patients with early HFW post-CRT experienced a significantly higher clinical burden than those without HFW. Vigilance for signs of worsening HF in the first 6 months post-CRT is warranted.
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Tracking Early Systolic Motion for Assessing Acute Response to Cardiac Resynchronization Therapy in Real Time.
Front Physiol2022 ;13():903784. doi: 10.3389/fphys.2022.903784.
Villegas-Martinez Manuel, Krogh Magnus Reinsfelt, Andersen Øyvind S, Sletten Ole Jakob, Wajdan Ali, Odland Hans Henrik, Elle Ole Jakob, Remme Espen W,
Abstract
An abnormal systolic motion is frequently observed in patients with left bundle branch block (LBBB), and it has been proposed as a predictor of response to cardiac resynchronization therapy (CRT). Our goal was to investigate if this motion can be monitored with miniaturized sensors feasible for clinical use to identify response to CRT in real time. Motion sensors were attached to the septum and the left ventricular (LV) lateral wall of eighteen anesthetized dogs. Recordings were performed during baseline, after induction of LBBB, and during biventricular pacing. The abnormal contraction pattern in LBBB was quantified by the septal flash index (SFI) equal to the early systolic shortening of the LV septal-to-lateral wall diameter divided by the maximum shortening achieved during ejection. In baseline, with normal electrical activation, there was limited early-systolic shortening and SFI was low (9 ± 8%). After induction of LBBB, this shortening and the SFI significantly increased (88 ± 34%,
Copyright © 2022 Villegas-Martinez, Krogh, Andersen, Sletten, Wajdan, Odland, Elle and Remme.
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Implantable cardioverter defibrillators for primary prevention of sudden cardiac death: what are the barriers to implementation in the "real world"?
Eur J Heart Fail2022 Jun;():. doi: 10.1002/ejhf.2581.
Boriani Giuseppe, Vitolo Marco, Leyva Francisco,
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Natural language processing for computer-assisted chart review to assess documentation of substance use and psychopathology in heart failure patients awaiting cardiac resynchronization therapy.
J Pain Symptom Manage2022 Jun;():. doi: S0885-3924(22)00783-7.
Yusufov Miryam, Pirl William F, Braun Ilana, Tulsky James A, Lindvall Charlotta,
Abstract
CONTEXT:
Advanced heart failure (HF) patients often experience distressing psychological symptoms, frequently meeting diagnostic criteria for psychological disorders, including anxiety, depression, and substance use disorder. Patients with device-based HF therapies have added risk for psychological disorders, with consequences for their physiological functioning, including adverse cardiac outcomes.
OBJECTIVES:
This study used natural language processing (NLP) for computer-assisted chart review to assess documentation of mental health and substance use in HF patients awaiting cardiac resynchronization therapy (CRT), a device-based HF therapy.
METHODS:
We applied NLP to clinical notes from electronic health records (EHR) of 965 consecutive patients, with 9,821 total clinical notes, at two academic medical centers between 2004 and 2015. We developed and validated a keyword library capturing terms related to mental health and substance use, while balancing specificity and sensitivity.
RESULTS:
Mean age was 71.6 years (SD?=?11.8), 78% male, and 87% non-Hispanic White. Of the 544 patients (56.4%) with documentation of mental health history, 9.7% had their mental health assessed and 6.6% had a plan documented. Of the 773 patients (80.1%) with documentation of substance use history, 10 (1.0%) had an assessment, and 3 (0.3%) had a plan.
CONCLUSION:
Despite clinical recommendations and standards of care, clinicians are under documenting assessments and plans prior to CRT. Future research should develop an algorithm to prompt clinicians to document this content. Such quality improvement efforts may ensure adherence to standards of care and clinical guidelines.
Copyright © 2022. Published by Elsevier Inc.
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Generating Evidence to Support the Physiologic Promise of Conduction System Pacing: Status and Update on Conduction System Pacing Trials.
Card Electrophysiol Clin2022 Jun;14(2):345-355. doi: S1877-9182(22)00002-8.
Kaza Nandita, Keene Daniel, Whinnett Zachary I,
Abstract
Conduction system pacing avoids the potential deleterious effects of right ventricular pacing in patients with bradycardia and provides an alternative approach to cardiac resynchronization therapy. We focus on the available observational and randomized evidence and review studies supporting the safety, feasibility, and physiologic promise of conduction system approaches. We evaluate the randomized data generated from the available clinical trials of conduction system pacing, which have led to the recent inclusion of CSP in international guidelines. The scope for future randomized trials will building on the physiologic promise of conduction system approaches and offering information on clinical end points is explored.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Status and Update on Cardiac Resynchronization Therapy Trials.
Card Electrophysiol Clin2022 Jun;14(2):323-343. doi: S1877-9182(21)00118-0.
Auricchio Angelo, Özkartal Tardu,
Abstract
After decades of clinical use, cardiac resynchronization therapy (CRT) can be considered an established therapy. However, there are multiple open questions to be addressed that shall further improve the proportion of patients responding to CRT. Progress in better understanding the relationship between electrical and mechanical disorder in patients with heart failure with ventricular conduction abnormalities is important. This article presents and discusses ongoing studies in different areas of CRT research, including patient selection by novel diagnostic tools, extension of clinical criteria, left ventricular lead positioning and pacing site selection, optimization of CRT delivery and programming, and selection of device type.
Copyright © 2021 Elsevier Inc. All rights reserved.
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His-Optimized and Left Bundle Branch-Optimized Cardiac Resynchronization Therapy: In Control of Fusion Pacing.
Card Electrophysiol Clin2022 Jun;14(2):311-321. doi: S1877-9182(21)00117-9.
Zweerink Alwin, Burri Haran,
Abstract
Fusion pacing, which exploits conduction via the intrinsic His-Purkinje system, forms the basis of recent cardiac resynchronization therapy (CRT) optimization algorithms. However, settings need to be constantly adjusted to accommodate for changes in AV conduction, and the algorithms are not always available (eg, depending on the device, in case of AV block or with atrial fibrillation). His-optimized cardiac resynchronization therapy (HOT-CRT), and left-bundle branch optimized cardiac resynchronization therapy (LOT-CRT) which combines conduction system pacing with ventricular fusion pacing, provide constant fusion with ventricular activation (irrespective of intrinsic AV conduction). These modalities provide promising treatment strategies for patients with heart failure, especially in those with chronic atrial fibrillation who require CRT (in whom the atrial port is usually plugged and can be used to connect the conduction system pacing lead).
Copyright © 2021 Elsevier Inc. All rights reserved.
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Conduction System Pacing for Cardiac Resynchronization Therapy.
Card Electrophysiol Clin2022 Jun;14(2):297-310. doi: S1877-9182(21)00116-7.
Herweg Bengt, Welter-Frost Allan, Wilson Ii David R, Vijayaraman Pugazhendhi,
Abstract
Although conventional biventricular pacing has been shown to benefit patients with heart failure and conduction system disease, there are limitations to its therapeutic success, resulting in widely variable clinical response. Limitations of conventional biventricular pacing evolve around myocardial scar, fibrosis, and inability to effectively stimulate diseased tissue. Several observational and acute hemodynamic studies have demonstrated improved electrical resynchronization and echocardiographic response with conduction system pacing. This article provides a systematic review of conduction system pacing as a physiologic alternative to conventional CRT, which is currently undergoing rigorous investigation.
Copyright © 2021 Elsevier Inc. All rights reserved.
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What Have We Learned in the Last 20 Years About CRT Non-Responders?
Card Electrophysiol Clin2022 Jun;14(2):283-296. doi: S1877-9182(21)00130-1.
Green Peregrine G, Herring Neil, Betts Timothy R,
Abstract
Although cardiac resynchronization therapy (CRT) has become well established in the treatment of heart failure, the management of patients who do not respond after CRT remains a key challenge. This review will summarize what we have learned about non-responders over the last 20 years and discuss methods for optimizing response, including the introduction of novel therapies.
Copyright © 2022 Elsevier Inc. All rights reserved.
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