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Pubblicazioni recenti - cardiac resynchronization
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The ESC Guidelines on cardiac pacing and resynchronization, and the many facets of atrial fibrillation.
Eur Heart J -
Non-cardiology vs. cardiology care of patients with heart failure and reduced ejection fraction is associated with lower use of guideline-based care and higher mortality: Observations from The Swedish Heart Failure Registry.
Int J Cardiol2021 Sep;():. doi: S0167-5273(21)01334-6.
Kapelios Chris J, Canepa Marco, Benson Lina, Hage Camilla, Thorvaldsen Tonje, Dahlström Ulf, Savarese Gianluigi, Lund Lars H,
Abstract
BACKGROUND:
Patients with heart failure (HF) are often cared for by non-cardiologists. The implications are unknown.
METHODS:
In a nationwide HF cohort with reduced ejection fraction (HFrEF), we compared demographics, clinical characteristics, guideline-based therapy use and outcomes in non-cardiology vs. cardiology in-patient and out-patient care.
RESULTS:
Between 2000 and 2016, 36,076 patients with HFrEF were enrolled in the Swedish HF registry (19,337 [54%] in-patients), with 44% of in-patients and 45% of out-patients managed in non-cardiology settings. Predictors of treatment in non-cardiology were age?>?75?years (adjusted odds ratio for non-cardiology 1.20; 95% confidence interval 1.14-1.27), lower education level (0.71; 0.66-0.76 for university vs. compulsory), valve disease (1.24; 1.18-1.31) and systolic blood pressure (SBP) >120?mmHg (1.05; 1.00-1.10). Non-cardiology care was significantly associated with lower use of beta-blockers (0.80; 0.74-0.86) and devices (intracardiac defibrillator [ICD] and/or cardiac resynchronization therapy [CRT]: 0.63; 0.56-0.71), and less frequent specialist follow-up (0.61; 0.57-0.65). Over 1-year follow-up the risk of all-cause mortality (adjusted hazard ratio 1.09; 1.03-1.15) was higher but the risk of first HF (re-) hospitalization was lower (0.93; 0.89-0.97) in non-cardiology vs. cardiology care.
CONCLUSIONS:
In HFrEF, non-cardiology care was independently associated with older age, lower education and lower income. After covariate adjustment, non-cardiology care was associated with lower use of beta-blockers and devices, higher mortality, and lower risk of HF hospitalization. Access to cardiology caremay not be equitable and this may have implications for use of guideline-based care and outcomes.
Copyright © 2018. Published by Elsevier B.V.
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Current clinical practice in patients with cardiac implantable electronic devices undergoing radiotherapy: a literature review.
Europace2021 Sep;():. doi: euab241.
Azraai Meor, D'Souza Daniel, Lin Yuan-Hong, Nadurata Voltaire,
Abstract
Patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy (RT) are more common due to the ageing of the population. With newer CIEDs' implementing the complementary metal-oxide semiconductor (CMOS) technology which allows the miniaturization of CIED, it is also more susceptible to RT. Effects of RT on CIED ranges from device interference, device operational/memory errors of permanent damage. These malfunctions can cause life-threatening clinical effects. Cumulative dose is not the only component of RT that causes CIED malfunction, as neutron use and dose rate effect also affects CIEDs. The management of this patient cohort in clinical practice is inconsistent due to the lack of a consistent guideline from manufacturers and physician specialty societies. Our review will focus on the current clinical practice and the recently updated guidelines of managing patients with CIED undergoing RT. We aim to simplify the evidence and provide a simple and easy to use guide based on the recent guidelines.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
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Shortening of time-to-peak left ventricular pressure rise (Td) in cardiac resynchronization therapy.
ESC Heart Fail2021 Sep;():. doi: 10.1002/ehf2.13601.
Odland Hans Henrik, Villegas-Martinez Manuel, Ross Stian, Holm Torbjørn, Cornelussen Richard, Remme Espen W, Kongsgard Erik,
Abstract
AIMS:
We tested the hypothesis that shortening of time-to-peak left ventricular pressure rise (Td) reflect resynchronization in an animal model and that Td measured in patients will be helpful to identify long-term volumetric responders [end-systolic volume (ESV) decrease >15%] in cardiac resynchronization therapy (CRT).
METHODS:
Td was analysed in an animal study (n = 12) of left bundle-branch block (LBBB) with extensive instrumentation to detect left ventricular myocardial deformation, electrical activation, and pressures during pacing. The sum of electrical delays from the onset of pacing to four intracardiac electrodes formed a synchronicity index (SI). Pacing was performed at baseline, with LBBB, right and left ventricular pacing and finally with biventricular pacing (BIVP). We then studied Td at baseline and with BIVP in a clinical observational study in 45 patients during the implantation of CRT and followed up for up to 88 months.
RESULTS:
We found a strong relationship between Td and SI in the animals (R = 0.84, P
CONCLUSIONS:
Prolongation of Td is associated with cardiac dyssynchrony and more wasted deformation during the preejection period. Shortening of a prolonged Td with CRT in patients accurately identifies volumetric responders to CRT with incremental value on top of current guidelines and practices. Thus, Td carries the potential to become a biomarker to predict long-term volumetric response in CRT candidates.
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation.
ESC Heart Fail2021 Sep;():. doi: 10.1002/ehf2.13599.
Rapacciuolo Antonio, Iacopino Saverio, D'Onofrio Antonio, Curnis Antonio, Pisanò Ennio C, Biffi Mauro, Della Bella Paolo, Dello Russo Antonio, Caravati Fabrizio, Zanotto Gabriele, Calvi Valeria, Rovaris Giovanni, Senatore Gaetano, Nicolis Daniele, Santamaria Matteo, Giammaria Massimo, Maglia Giampiero, Duca Antonio, Ammirati Giuseppe, Romano Salvo Andrea, Piacenti Marcello, Celentano Eduardo, Bisignani Giovanni, Vaccaro Paola, Miracapillo Gennaro, Bertini Matteo, Nigro Gerardo, Giacopelli Daniele, Gargaro Alessio, Bisceglia Caterina,
Abstract
AIMS:
There are conflicting data on the benefit of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with permanent atrial fibrillation (AF). We aimed to compare patient outcomes according to the presence or absence of permanent AF at device implantation.
METHODS AND RESULTS:
We retrospectively analysed remote monitoring data from 1141 CRT defibrillators. Propensity score with inverse-probability weighting method was used to balance AF and sinus rhythm (SR) groups. Analysis endpoints included total mortality, appropriate defibrillation shocks, and CRT percentage. There were 229 patients (20.1%) in the AF group and 912 patients (79.9%) in the SR group. Compared with SR patients, AF patients were older (median age, 77 vs. 72 years, P
CONCLUSIONS:
Although mortality was similar across patient groups, patients with permanent AF and suboptimal CRT had twofold higher risk of appropriate shocks than SR patients or AF patients with CRT ? 98%.
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Different reverse remodelling between left ventricle and right ventricle in fulminant heart failure due to giant cell myocarditis: a case report.
Eur Heart J Case Rep2021 Aug;5(8):ytab214. doi: 10.1093/ehjcr/ytab214.
Yokoyama Hiroaki, Yamaguchi Masashi, Tobita Kazuki, Saito Shigeru,
Abstract
Background:
Giant cell myocarditis (GCM) is a rare cause of fulminant heart failure (HF). The most common presentation is progressive hemodynamic deterioration, and a few cases present with idiopathic complete atrioventricular block (cAVB). The prognosis of GCM is poor, and GCM patients usually die of HF and ventricular arrhythmia unless cardiac transplantation is performed. Few reports have described the effects of treatments such as immunosuppression and detailed reverse remodelling in GCM patients.
Case summary:
A 69-year-old female presented with cAVB. Transvenous pacemaker was implanted via the left subclavian vein. One and a half months later, she exhibited left ventricular dyssynchrony and lower left ventricular ejection fraction (LVEF), resulting in hospitalization for HF. She received cardiac resynchronization therapy; however, this had no apparently positive effects on her cardiac function. To investigate the cause of the lower LVEF, an endomyocardial biopsy was taken from the right ventricular septum. She was diagnosed with GCM and immediately received immunosuppression therapy with prednisolone and ciclosporin. This resulted in the functional recovery of the right ventricle; on the other hand, the left ventricle had still not recovered based on transthoracic echocardiography. Fortunately, she successfully recovered from severe HF without recurrence.
Discussion:
This is a case of fulminant HF due to GCM which initially presented as cAVB. Moreover, this case demonstrates the quite difference of the functional recovery between the left ventricle and the right ventricle with immunosuppression therapy.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Association Between Changes in Physical Activity and New-Onset Atrial Fibrillation After ICD/CRT-D Implantation.
Front Cardiovasc Med2021 ;8():693458. doi: 10.3389/fcvm.2021.693458.
Sun Xuerong, Zhao Shuang, Chen Keping, Hua Wei, Su Yangang, Xu Wei, Wang Fang, Fan Xiaohan, Dai Yan, Liu Zhimin, Zhang Shu,
Abstract
Changes in physical activity (PA) after implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillators (CRT-D) implantation were unknown. The association of PA changes with new-onset atrial fibrillation (AF), cardiac death and all-cause mortality was unclear in patients at high risk of sudden cardiac death. Patients receiving ICD/CRT-D implantation from SUMMIT registry were retrospectively analyzed. Changes in PA were considered from baseline status to 1 year after implantation. New-onset AF was defined as the first atrial high-rate episode ?1% of the daily AF burden detected after implantation. Over a mean follow-up of 50.3 months, 124 new-onset AF events (36.2%), 61 cardiac deaths (17.8%), and 87 all-cause deaths (25.4%) were observed in 343 patients with ICD/CRT-D implantation. PA at 1 year after implantation was increased compared with PA at baseline (11.97 ± 5.83% vs. 10.82 ± 5.43%, = 0.008), and PA at 1 year was improved in 210 patients (61.2%). Per 1% decrease in PA was associated with 12.4, 18.3, and 14.3% higher risks of new-onset AF, cardiac death and all-cause mortality, regardless of different baseline characteristics. Patients with decreased PA had 2-fold risks of new-onset AF (hazard ratio [HR] = 1.972, 95% confidence interval [CI]: 1.352-2.877,
Copyright © 2021 Sun, Zhao, Chen, Hua, Su, Xu, Wang, Fan, Dai, Liu and Zhang.
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Cardiac Resynchronization Therapy and Cardiac Contractility Modulation in Patients with Advanced Heart Failure: How to Select the Right Candidate?
Heart Fail Clin2021 Oct;17(4):599-606. doi: S1551-7136(21)00058-1.
Abraham William T,
Abstract
Cardiac resynchronization therapy is a well-established treatment of heart failure with reduced left ventricular ejection fraction and a wide QRS complex. Cardiac contractility modulation therapy is an emerging electrical treatment indicated for use in patients with symptomatic heart failure caused by moderate-to-severe systolic left ventricular dysfunction (left ventricular ejection fraction ranging from 25% to 45%), with no indication for cardiac resynchronization therapy. Cardiac contractility modulation therapy improves functional status, exercise capacity, quality of life, and possibly prevents hospital admissions in indicated patients. An algorithm for patient selection for these two forms of electrical therapy for heart failure is presented.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Prevalence, clinical and instrumental features of left bundle branch block-induced cardiomyopathy: the CLIMB registry.
ESC Heart Fail2021 Sep;():. doi: 10.1002/ehf2.13568.
Sanna Giuseppe D, De Bellis Annamaria, Zecchin Massimo, Beccu Eleonora, Carta Patrizia, Moccia Eleonora, Canonico Mario E, Parodi Guido, Sinagra Gianfranco, Merlo Marco,
Abstract
AIMS:
Although increasingly recognized as a distinct pathological entity, left bundle branch block-induced cardiomyopathy (LBBB-ICMP) is not included among the possible aetiologies of acquired dilated cardiomyopathies (DCM). While diagnostic criteria have been proposed, its recognition remains principally retrospective, in the presence of clinical and instrumental red flags. We aimed to assess the prevalence and clinical and instrumental features of LBBB-ICMP in a large cohort of patients with DCM.
METHODS AND RESULTS:
We analysed a cohort of 242 DCM patients from a two-centre registry. Inclusion criteria were age > 18, non-ischaemic or non-valvular DCM, and LBBB on electrocardiogram. LBBB-ICMP was defined according to previously proposed diagnostic criteria: (i) neither family history nor clinically identifiable potential causes for DCM; (ii) negative genetic testing; (iii) echocardiographic features including non-severe chamber dilation, normal absolute and relative wall thickness, marked dyssynchrony, and normal right ventricular function; and (iv) absence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR). From the entire cohort, we identified 30 subjects (similar in terms of New York Heart Association class I or II in 80% vs. 75%, P = 0.56; QRS width of 150 ± 22 vs. 151 ± 24 ms, P = 0.82; and cardiac remodelling of baseline end-diastolic diameter 66 ± 8 vs. 65 ± 10 mm, P = 0.53) with a comprehensive dataset including CMR and genetic testing, required to verify the presence of the diagnostic criteria proposed for LBBB-ICMP. The main characteristics of this subgroup were 73% males, age 45 ± 13 years, left ventricular ejection fraction (LVEF) 30 ± 10%, LGE in 38% of patients, and QRS complex of 150 ± 22 ms. Patients were under guideline-directed medical therapy, and 57% of them were treated with cardiac resynchronization therapy (CRT). Two patients (6.67%, 50% males, age 53 ± 13 years) fulfilled the diagnostic criteria proposed for LBBB-ICMP. After a follow-up of 44 (12-76) months, LVEF was normal and QRS width significantly reduced (from 154 ± 25 to 116 ± 52 ms) in patients with LBBB-ICMP. Both patients were under optimal medical treatment, and one was implanted with CRT-D. Neither of the two patients experienced death, malignant ventricular arrhythmia, or heart failure hospitalization at follow-up.
CONCLUSIONS:
Left bundle branch block-induced cardiomyopathy emerges as a distinct pathological entity, promptly identifiable in a minority but not negligible proportion of patients with newly diagnosed DCM and LBBB, using a series of diagnostic criteria including CMR and genetic testing. Further studies are needed to better elucidate the clinical course of LBBB-ICMP.
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Primary care heart failure service identifies a missed cohort of heart failure patients with reduced ejection fraction.
Eur Heart J2021 Sep;():. doi: ehab629.
Kahn Matthew, Grayson Antony D, Chaggar Parminder S, Ng Kam Chuen Marie J, Scott Alison, Hughes Carol, Campbell Niall G,
Abstract
AIMS:
We explored whether a missed cohort of patients in the community with heart failure (HF) and left ventricular systolic dysfunction (LVSD) could be identified and receive treatment optimization through a primary care heart failure (PCHF) service.
METHODS AND RESULTS:
PCHF is a partnership between Inspira Health, National Health Service Cardiologists and Medtronic. The PCHF service uses retrospective clinical audit to identify patients requiring a prospective face-to-face consultation with a consultant cardiologist for clinical review of their HF management within primary care. The service is delivered via five phases: (i) system interrogation of general practitioner (GP) systems; (ii) clinical audit of medical records; (iii) patient invitation; (iv) consultant reviews; and (v) follow-up. A total of 78 GP practices (864 194 population) have participated. In total, 19 393 patients' records were audited. HF register was 9668 (prevalence 1.1%) with 6162 patients coded with LVSD (prevalence 0.7%). HF case finder identified 9725 additional patients to be audited of whom 2916 patients required LVSD codes adding to the patient medical record (47% increase in LVSD). Prevalence of HF with LVSD increased from 0.7% to 1.05%. A total of 662 patients were invited for consultant cardiologist review at their local GP practice. The service found that within primary care, 27% of HF patients identified for a cardiologist consultation were eligible for complex device therapy, 45% required medicines optimization, and 47% of patients audited required diagnosis codes adding to their GP record.
CONCLUSION:
A PCHF service can identify a missed cohort of patients with HF and LVSD, enabling the optimization of prognostic medication and an increase in device prescription.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Imaging in Cardiac Resynchronization Therapy Needs to Consider More Than Mechanical Delay.
JACC Cardiovasc Imaging2021 Sep;14(9):1881-1883. doi: S1936-878X(21)00577-5.
Marwick Thomas H, Chandrashekhar Y,
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Right ventricular dilatation and systolic dysfunction and relationship to QRS duration in patients with left bundle branch block and cardiomyopathy.
Pacing Clin Electrophysiol2021 Sep;():. doi: 10.1111/pace.14357.
Park Seung-Jung, Kwon Deborah H, Rickard John W, Varma Niraj,
Abstract
BACKGROUND:
Marked QRS widening in patients with left bundle branch block (LBBB) may reduce efficacy of cardiac resynchronization therapy (CRT). We hypothesized that extreme QRS prolongation may accompany right ventricular (RV) dilatation/systolic dysfunction (RVD/RVsD) as well as left ventricular dilatation/systolic dysfunction (LVD/LVsD).
METHODS:
We assessed rates of both ventricular dilatation and systolic dysfunction according to widening of QRS duration (QRSd) in 100 consecutive cardiomyopathy patients with true LBBB (QRSd ? 130 ms in female or ?140 ms in male, QS or rS in leads V1/V2, and mid-QRS notching/slurring in ?2 contiguous leads of I, aVL, and V1/V2/V5/V6). Ventricular dimensions and function were measured by cardiac magnetic resonance imaging.
RESULTS:
There was a trend toward an increase in the prevalence of LVD (13%, 20%, and 90%), LVsD (67%, 77%, and 90%), RVD (23%, 27%, and 50%), RVsD (27%, 27%, and 40%), RVD plus RVsD (13%, 17%, and 40%), or RVD/RVsD (37%, 37%, and 50%) according to the degree of QRS prolongation (
CONCLUSION:
The rates of RVD and/or RVsD increased with QRS widening, particularly when QRSd exceeded 180 ms. This may diminish anticipated CRT response rates in cardiomyopathy patients with LBBB.
© 2021 Wiley Periodicals LLC.
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Suppression of acute heart failure rehospitalization by biventricular pacing in wide QRS and mid-range ejection fraction.
ESC Heart Fail2021 Sep;():. doi: 10.1002/ehf2.13585.
Akamine Koshiro, Kondo Hidekazu, Yonezu Keisuke, Hirota Kei, Tawara Katsunori, Kodama Nozomi, Abe Ichitaro, Fukuda Tomoko, Yufu Kunio, Takahashi Naohiko,
Abstract
We present a 66-year-old male patient with heart failure, mid-range ejection fraction and QRS widening suffering from recurrent hospitalization due to acute heart failure. We measured intra-cardiac pressure by cardiac catheterization to clearly demonstrate the augmentation of afterload by a vasoconstricting drug induced increase of left ventricular end-diastolic blood pressure and pulmonary capillary wedge pressure with pulmonary arterial V-wave augmentation (indicator of worsening of mitral regurgitation). Because the patient was considered as refractory to optimal medication, cardiac resynchronization therapy (CRT) was performed. After CRT implantation, these factors were improved, and the patient has not experienced recurrent hospitalization for >2 years.
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Prognostic predictors and echocardiographic time course after device replacement in patients treated chronically with cardiac resynchronization therapy devices.
Heart Vessels2021 Sep;():. doi: 10.1007/s00380-021-01940-w.
Nagase Takahiko, Ishiguro Maya, Mabuchi Kei, Seki Ruiko, Asano So, Fukunaga Hiroshi, Inoue Kanki, Sekiguchi Yukio, Tanizaki Kohei, Nanasato Mamoru, Iguchi Nobuo, Nitta Junichi, Isobe Mitsuaki,
Abstract
The prognostic predictors of death or heart failure hospitalization and the echocardiographic response after initial cardiac resynchronization therapy (CRT) device replacement (CRT-r) remain unclear. We evaluated the predictors and the echocardiographic time course in patients after CRT-r. Consecutive 60 patients underwent CRT-r because of battery depletion. Patients were divided into two groups depending on the chronic echocardiographic response to CRT (left ventricular end-systolic volume [LVESV] reduction of???15%) at the time of CRT-r: CRT responders (group A; 35 patients) and CRT nonresponders (group B; 25 patients). The primary endpoint was a composite of death from any cause or heart failure hospitalization. Changes in LVESV and left ventricular ejection fraction (LVEF) after CRT-r were also analyzed. During the mean follow-up of 46?±?33 months after CRT-r, the primary endpoint occurred more frequently in group B (group A versus group B; 8/35 [23%] patients versus 19/25 [76%] patients, p?0.001). No significant changes in LVESV and LVEF were observed at the mean of 46?±?29 months after CRT-r in both groups. A multivariate analysis identified echocardiographic nonresponse to CRT, chronic kidney disease, atrial fibrillation, and New York Heart Association functional class III or IV at the time of CRT-r as independent predictors of the primary endpoint in all patients. Residual echocardiographic nonresponse, comorbidities, and heart failure symptoms at the time of CRT-r predict the subsequent very long-term prognosis after CRT-r. No further echocardiographic response to CRT was found after CRT-r.
© 2021. Springer Japan KK, part of Springer Nature.
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Optimal CRT Implantation-Where and How To Place the Left-Ventricular Lead?
Curr Heart Fail Rep2021 Sep;():. doi: 10.1007/s11897-021-00528-9.
Butter Christian, Georgi Christian, Stockburger Martin,
Abstract
PURPOSE OF REVIEW:
Cardiac resynchronization therapy (CRT) represents a well-established and effective non-pharmaceutical heart failure (HF) treatment in selected patients. Still, a significant number of patients remain CRT non-responders. An optimal placement of the left ventricular (LV) lead appears crucial for the intended hemodynamic and hence clinical improvement. A well-localized target area and tools that help to achieve successful lead implantation seem to be of utmost importance to reach an optimal CRT effect.
RECENT FINDINGS:
Recent studies suggest previous multimodal imaging (CT/cMRI/ECG torso) to guide intraprocedural LV lead placement. Relevant benefit compared to empirical lead optimization is still a matter of debate. Technical improvements in leads and algorithms (e.g., multipoint pacing (MPP), adaptive algorithms) promise higher procedural success. Recently emerging alternatives for ventricular synchronization such as conduction system pacing (CSP), LV endocardial pacing, or leadless pacing challenge classical biventricular pacing. This article reviews current strategies for a successful planning, implementation, and validation of the optimal CRT implantation. Pre-implant imaging modalities offer promising assistance for complex cases; empirical lead positioning and intraoperative testing remain the cornerstone in most cases and ensure a successful CRT effect.
© 2021. The Author(s).
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Mechanical Synchrony and Myocardial Work in Heart Failure Patients With Left Bundle Branch Area Pacing and Comparison With Biventricular Pacing.
Front Cardiovasc Med2021 ;8():727611. doi: 10.3389/fcvm.2021.727611.
Liu Wen, Hu Chunqiang, Wang Yanan, Cheng Yufei, Zhao Yingjie, Liu Yang, Zheng Shaoxin, Chen Haiyan, Shu Xianhong,
Abstract
Little is known about the efficacy of permanent left bundle branch area pacing (LBBAP) in delivering cardiac resynchronization therapy (CRT). This study aimed to evaluate the effect of LBBAP on mechanical synchronization and myocardial work (MW) in heart failure (HF) patients and to compare LBBAP with biventricular pacing (BVP). This is a multicenter, prospective cohort study. From February 2018 to January 2021, 62 consecutive HF patients with reduced ejection fraction (LVEF ? 35%) and complete left bundle branch block (CLBBB) who underwent LBBAP or BVP were enrolled in this study. Echocardiograms and electrocardiograms and were conducted before and 3-6 months after implantation. Intra- and interventricular synchronization were assessed using two-dimensional speckle tracking imaging (2D-STI). The left ventricular pressure-strain loop was obtained by combining left ventricular strain with non-invasive blood pressure to evaluate mechanical efficiency. The echocardiographic response rates were 68.6 and 88.9% in the BVP and LBBAP groups, respectively. Left bundle branch area pacing resulted in significant QRS narrowing (from 177.1 ± 16.7 to 113.0 ± 18.4 ms,
Copyright © 2021 Liu, Hu, Wang, Cheng, Zhao, Liu, Zheng, Chen and Shu.
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Improvement of LV Reverse Remodeling Using Dynamic Programming of Fusion-Optimized Atrioventricular Intervals in Cardiac Resynchronization Therapy.
Front Cardiovasc Med2021 ;8():700424. doi: 10.3389/fcvm.2021.700424.
Wang Zhongkai, Li Pan, Zhang Bili, Huang Jingjuan, Chen Shaoping, Cai Zhuhong, Qin Yingyi, Fan Jihai, Tang Wendong, Qin Yongwen, Li Ruogu, Zhao Xianxian,
Abstract
The patient-tailored SyncAV algorithm shortens the QRS duration (QRSd) beyond what conventional biventricular (BiV) pacing can. However, evidence of the ability of SyncAV to improve the cardiac resynchronization therapy (CRT) response is lacking. The aim of this study was to evaluate the impact of CRT enhanced by SyncAV on echocardiographic and clinical responses. Consecutive heart failure (HF) patients from three centers treated with a quadripolar CRT system (Abbott) were enrolled. The total of 122 patients were divided into BiV+SyncAV ( = 68) and BiV groups ( = 54) according to whether they underwent CRT with or without SyncAV. Electrocardiographic, echocardiographic, and clinical data were assessed at baseline and during follow-up. Echocardiographic response to CRT was defined as a ?15% decrease in left ventricular end-systolic volume (LVESV), and clinical response was defined as a NYHA class reduction of ?1. At the 6-month follow-up, the baseline QRSd and LVESV decreased more significantly in the BiV+SyncAV than in the BiV group (QRSd -36.25 ± 16.33 vs. -22.72 ± 18.75 ms,
Copyright © 2021 Wang, Li, Zhang, Huang, Chen, Cai, Qin, Fan, Tang, Qin, Li and Zhao.
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Cardiac electrophysiology and pacing educational and training needs among early-career cardiologists: a national survey of the Young Committee of the Italian Association of Arrhythmology and Cardiac Pacing.
J Cardiovasc Med (Hagerstown)2021 Oct;22(10):744-750. doi: 10.2459/JCM.0000000000001169.
Russo Vincenzo, Nesti Martina, Brunacci Michele, Tola Gianfranco, Santobuono Vincenzo Ezio, Dendramis Gregory, Picciolo Giuseppe, Lucciola Maria Teresa, D'Onofrio Antonio, Ricci Renato, de Ponti Roberto,
Abstract
BACKGROUND:
Over the past three decades, cardiac electrophysiology and pacing, including device therapy and catheter ablation of arrhythmias, has rapidly developed as a subspecialty in cardiology. Currently, there is no clear perception about the needs in cardiac electrophysiology and pacing among early-career cardiologists.
METHODS:
To address these concerns, the Young Committee of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) carried out a survey among those under the age of 40 years to obtain detailed information on practical activities and formal lessons during the fellowship in cardiology and their satisfaction and proficiency level at the end of the fellowship.
RESULTS:
We obtained 334 answers to the survey. In invasive cardiac electrophysiology and pacing, the percentage of participants attending the activity for a longer time (3-6 months) is lower compared with those in noninvasive subspecialties. About 40% of participants did not receive lessons on interventional cardiology, cardiac electrophysiology and pacing. On the contrary, 71% of participants received an adequate number of lessons on clinical arrhythmology. The vast majority of the participants expressed satisfaction for the education received in the echocardiographic, cardiac interventional laboratories and clinical arrhythmology, but about half of the participants were unsatisfied with the education received in cardiac electrophysiology and pacing. In interventional arrhythmology, the majority of the participants declare their lack of proficiency with two peaks for more complex procedures, namely interventional electrophysiology procedures (82%) and cardiac resynchronization therapy (CRT) procedures (76%).
CONCLUSION:
The present survey among Italian early-career cardiologists suggests that the majority of participants consider themselves not confident in performing cardiac electrophysiology and pacing procedures. Due to the complexity of the treatment for heart rhythm disorders and the long learning curve, structured additional training in cardiac electrophysiology and pacing procedures is required after cardiology fellowship.
Copyright © 2021 Italian Federation of Cardiology - I.F.C. All rights reserved.
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Cardiac resynchronization therapy with or without defibrillator in patients with heart failure.
Europace2021 Sep;():. doi: euab233.
Schrage Benedikt, Lund Lars H, Melin Michael, Benson Lina, Uijl Alicia, Dahlström Ulf, Braunschweig Frieder, Linde Cecilia, Savarese Gianluigi,
Abstract
AIMS:
Randomized data on the efficacy/safety of cardiac resynchronization therapy with vs. without defibrillator (CRT-D,-P) in heart failure with reduced ejection fraction (HFrEF) are scarce. We aimed to evaluate survival associated with use of CRT-D vs. CRT-P in a contemporary cohort with HFrEF.
METHODS AND RESULTS:
Patients from Swedish HF Registry treated with CRT-D/CRT-P and fulfilling criteria for primary prevention defibrillator use were included. Logistic regression was used to evaluate predictors of CRT-D non-use. All-cause mortality was compared in CRT-D vs. CRT-P by Cox regression in a 1?:?1 propensity-score-matched cohort. Of 1988 patients with CRT, 1108 (56%) had CRT-D and 880 (44%) CRT-P. Older age, higher ejection fraction (EF), female sex, and the lack of referral to HF nurse-led outpatient clinic were major determinants of CRT-D non-use. After matching, 645 CRT-D patients were compared with 645 with CRT-P. The CRT-D use was associated with lower 1- and 3-year all-cause mortality [hazard ratio (HR):0.76, 95% confidence interval (CI):0.58-0.98; HR: 0.82, 95% CI: 0.68-0.99, respectively]. Results were consistent in all pre-specified subgroups except for CRT-D use being associated with lower 3-year mortality in patients with an EF?30% but not in those with an EF???30% (HR: 0.73, 95% CI: 0.59-0.89 and HR: 1.24, 95% CI: 0.83-1.85, respectively; P-interaction?=?0.02).
CONCLUSION:
In a contemporary HFrEF cohort, CRT-D was associated with lower mortality compared with CRT-P. The CRT-D use was less likely in older patients, females, and in patients not referred to HF nurse-led outpatient clinic. Our findings support the use of CRT-D vs. CRT-P in HFrEF, in particular with severely reduced EF.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Comparing sensitivity and specificity of pacemaker ID application and cardiac rhythm management device-finder application in identifying cardiac implantable electronic device manufacturer using chest radiograph - An observational study.
Ann Med Surg (Lond)2021 Sep;69():102741. doi: 10.1016/j.amsu.2021.102741.
Shams Pirbhat, Mehdi Muhammad, Ali Jamshed, Ahmed Intisar, Saadia Sheema, Iqbal Sameen, Hameed Khan Aamir, Saeed Yawer,
Abstract
Background:
Smartphone-based applications to identify cardiac implantable electronic devices (CIED) are extremely useful in circumstances, where urgent device interrogation is needed, and a device identification card is not available. Few studies have provided insights regarding the utility of these applications. We have studied two widely available applications i.e., Pacemaker ID app (PMIDa) or Cardiac Rhythm Management Device-Finder (CRMD-f) to identify device manufacturers in CIEDs.
Methods:
547 patients who underwent CIED implantation from the year 2016-2020 in our institute were enrolled. There were 438 Medtronic and 109 St. Jude's devices. All chest radiographs were de-identified and resized into 225*225 pixels focusing on the CIED. PMIDa and CRMD-f applications were used to identify the CIED. Accuracy, sensitivity, specificity, negative predictive value, and positive predictive value for both applications were calculated and compared.
Results:
Overall, CRMD-f application has higher specificity (93.58 vs. 82.5%) but lower sensitivity (53.6 vs. 55%) than PMIDa. The accuracy of both applications was comparable (61.6% vs. 60.5%). Accuracy varied with CIED model and type tested, and radiograph projection used. Accuracy is greatest with Cardiac-Resynchronization-Therapy (CRT) devices for both applications, followed by a single lead pacemaker.
Conclusion:
CRMD-f has higher accuracy and specificity for CIED manufacturer identification. Both PMIDa and CRMD-f are specific tools to identify CIED but have low sensitivity.
© 2021 The Authors.
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