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Pubblicazioni recenti - cardiac resynchronization
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Meta-Analysis on Drug and Device Therapy of New York Heart Association Functional Class IV Heart Failure With Reduced Ejection Fraction.
Am J Cardiol2022 Dec;188():52-60. doi: 10.1016/j.amjcard.2022.11.001.
Batchelor Riley J, Nan Tie Emilia, Romero Lorena, Hopper Ingrid, Kaye David M,
Abstract
Heart failure with reduced ejection fraction (HFrEF) is associated with significant morbidity and mortality, particularly in patients with New York Heart Association (NYHA) functional class IV symptoms. Decades of discovery have heralded significant advancements in the pharmacologic management of HFrEF. However, patients with NYHA IV symptoms remain an under-represented population in almost every clinical trial to date, leaving clinicians with limited evidence with which to guide drug treatment decisions in this patient group with severe heart failure. Randomized controlled trials of adult patients with NYHA IV symptoms of HFrEF randomized to current guideline-recommended medical therapy were included in this systematic review and meta-analysis. The outcomes of interest included the rate of all-cause mortality, cardiovascular mortality, and heart failure hospitalization. A total of 39 randomized controlled trials were included. A total of 6 studies examined angiotensin converting enzyme inhibitors, with meta-analyses of 2 demonstrating a reduced risk of all-cause mortality (relative risk (RR) 0.76, 95% confidence interval 0.59 to 0.97, p = 0.03). A total of 11 studies examined ? blockers, with meta-analysis of 6 demonstrating a reduced risk of all-cause mortality (risk ratio 0.74, 95% confidence interval 0.60 to 0.92, p = 0.008). A study examined the mineralocorticoid antagonist spironolactone, reporting a reduced risk of all-cause mortality in the NYHA IV subgroup. A total of 6 studies examined device therapy, demonstrating the benefit of cardiac resynchronization therapy with or without an implantable cardiac defibrillator in reducing hospitalization in the NYHA IV subgroup. Although trial evidence exists for angiotensin converting enzyme inhibitors, ?-blockers, and mineralocorticoid antagonist therapy in the NYHA IV population, the role of angiotensin receptor blockers is unclear. Ivabradine, angiotensin receptor neprilysin inhibitors, and sodium-glucose transport protein 2 inhibitors remain underinvestigated and have not been proved to provide any benefit above standard heart failure therapy in patients with HFrEF and NYHA IV symptoms.
Crown Copyright © 2022. Published by Elsevier Inc. All rights reserved.
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Acute echocardiographic and electrocardiographic effects of triggered left ventricular pacing.
PLoS One2022 ;17(12):e0278531. doi: 10.1371/journal.pone.0278531.
Pfeffer Tobias Jonathan, Neuser Jonas, Mueller-Leisse Johanna, Hohmann Stephan, Duncker David, Bauersachs Johann, Veltmann Christian, Berliner Dominik,
Abstract
Cardiac resynchronization therapy (CRT) is an essential pillar in the therapy of heart failure patients with reduced ejection fraction (HFrEF) presenting with broad left bundle branch block (LBBB) or pacemaker dependency. To achieve beneficial effects, CRT requires high bi-ventricular (BiV) pacing rates. Therefore, device-manufacturers designed pacing algorithms which maintain high BiV pacing rates by a left ventricular (LV) pacing stimulus immediately following a right ventricular sensed beat. However, data on clinical impact of these algorithms are sparse. We studied 17 patients implanted with a CRT device providing triggered left ventricular pacing (tLVp) in case of atrioventricular nodal conduction. Assessment of LV dyssynchrony was performed using echocardiographic and electrocardiographic examination while CRT-devices were set to three different settings: 1. Optimized bi-ventricular-stimulation (BiV); 2. Physiological AV nodal conduction (tLVp-off); 3. Physiological AV nodal conduction and tLVp-algorithm turned on (tLVp-on). QRS duration increased when the CRT-device was set to tLVp-off compared to BiV-Stim, while QRS duration was comparable to BiV-Stim with the tLVp-on setting. Echocardiographic analysis revealed higher dyssynchrony during tLVp-off compared to BiV-Stim. TLVp-on did not improve LV dyssynchrony compared to tLVp-off. QRS duration significantly decreased using tLVp-algorithms compared to physiological AV nodal conduction. However, echocardiographic examination could not show functional benefit from tLVp-algorithms, suggesting that these algorithms are inferior to regular biventricular pacing regarding cardiac resynchronization. Therefore, medical treatment and ablation procedures should be preferred, when biventricular pacing rates have to be increased. TLVp-algorithms can be used in addition to these treatment options.
Copyright: © 2022 Pfeffer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Left bundle branch area pacing: A promising modality for cardiac resynchronization therapy.
Front Cardiovasc Med2022 ;9():901046. doi: 901046.
Fu Yuping, Liu Peng, Jin Lingyan, Li Yingqi, Zhang Yudi, Qin Xinghua, Zheng Qiangsun,
Abstract
Cardiac resynchronization therapy (CRT) is recognized as the first-line management for patients with heart failure (HF) and conduction disorders. As a conventional mode for delivering CRT, biventricular pacing (BVP) improves cardiac function and reduces HF hospitalizations and mortality, but there are still limitations given the high incidence of a lack of response rates. Alternative pacing methods are needed either for primary or rescue therapy. In recent years, conduction system pacing (CSP) has emerged as a more physiological pacing modality for simultaneous stimulation of the ventricles, including His bundle pacing (HBP) and left bundle branch pacing (LBBP). CSP activates the His-Purkinje system, allowing normal ventricular stimulation. However, HBP is technically challenging with a relatively low success rate, high pacing threshold, and failure to correct distal conduction abnormalities. Therefore, LBBP stands out as a novel ideal physiological pacing modality for CRT. Several non-randomized studies compared the feasibility and safety of LBBP with BVP and concluded that LBBP is superior to BVP for delivering CRT with a narrower QRS and greater improvements in left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) functional class. Concurrently, some studies showed lower and stable pacing thresholds and greater improvement of B-type natriuretic peptide (BNP) levels, as well as better mechanical synchronization and efficiency. LBBP ensures better ventricular electromechanical resynchronization than BVP. In this review, we discuss current knowledge of LBBP, compare LBBP with BVP, and explore the potential of LBBP to serve as an alternative primary therapy to realize cardiac resynchronization.
Copyright © 2022 Fu, Liu, Jin, Li, Zhang, Qin and Zheng.
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Scar imaging in the dyssynchronous left ventricle: Accuracy of myocardial metabolism by positron emission tomography and function by echocardiographic strain.
Int J Cardiol2022 Nov;():. doi: S0167-5273(22)01728-4.
Larsen Camilla Kjellstad, Galli Elena, Duchenne Jürgen, Aalen John M, Stokke Caroline, Fjeld Jan Gunnar, Degtiarova Ganna, Claus Piet, Gheysens Olivier, Saberniak Jorg, Sirnes Per Anton, Lyseggen Erik, Bogaert Jan, Kongsgaard Erik, Penicka Martin, Voigt Jens-Uwe, Donal Erwan, Hopp Einar, Smiseth Otto A,
Abstract
PURPOSE:
Response to cardiac resynchronization therapy (CRT) is reduced in patients with high left ventricular (LV) scar burden, in particular when scar is located in the LV lateral wall or septum. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) can identity scar, but is not feasible in all patients. This study investigates if myocardial metabolism by F-fluorodeoxyglucose positron emission tomography (FDG-PET) and contractile function by echocardiographic strain are alternatives to LGE-CMR.
METHODS:
In a prospective multicenter study, 132 CRT candidates (91% with left bundle branch block) were studied by speckle tracking strain echocardiography, and 53 of these by FDG-PET. Regional myocardial FDG metabolism and peak systolic strain were compared to LGE-CMR as reference method.
RESULTS:
Reduced FDG metabolism (10% could rule out transmural scar with high sensitivity (80%) and high negative predictive value (96%). Neither FDG-PET nor strain identified septal scars (for both, AUC?0.80).
CONCLUSIONS:
In CRT candidates, FDG-PET is an excellent alternative to LGE-CMR to identify scar in the LV lateral wall. Furthermore, preserved strain in the LV lateral wall has good accuracy to rule out transmural scar. None of the modalities could identify septal scar.
CLINICAL TRIAL REGISTRATION:
The present study is part of the clinical study "Contractile Reserve in Dyssynchrony: A Novel Principle to Identify Candidates for Cardiac Resynchronization Therapy (CRID-CRT)", which was registered at clinicaltrials.gov (identifier NCT02525185).
Copyright © 2022 The Author. Published by Elsevier B.V. All rights reserved.
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CRT-D replacement strategy: results of the BioCONTINUE study.
J Interv Card Electrophysiol2022 Dec;():. doi: 10.1007/s10840-022-01440-5.
Gras Daniel, Clémenty Nicolas, Ploux Sylvain, Guyomar Yves, Legallois Damien, Segreti Luca, Blangy Hugues, Laurent Gabriel, Bizeau Olivier, Fauquembergue Sophie, Lazarus Arnaud, ,
Abstract
BACKGROUND:
In patients with cardiac resynchronization therapy defibrillators (CRT-Ds), the need for implantable cardioverter-defibrillator (ICD) back-up may be questionable at time of CRT-D replacement (REP) if ICD implant criteria are no longer met due to an improved left ventricular ejection fraction (LVEF) and if no major ventricular arrhythmic event (VAE) occurred during the CRT-D lifetime. The aim of our study was to assess the relevance of ICD back-up and predictors of VAE after REP in primary prevention CRT-D patients.
METHODS:
The prospective, observational, international BioCONTINUE study investigated the rate of patients with at least 1 sustained VAE (sVAE) post-REP and searched for predictive factors of sVAE.
RESULTS:
Two hundred seventy-six patients (70?±?10 years, 77% men, mean LVEF 40.6?±?12.6%) were followed for 28.4?±?10.2 months. The rate of patients with sVAE was 8.3%, 10.3%, and 21.2% at 1, 2, and 4 years post-REP. Patients without persistent ICD indication at REP still had a sVAE rate of 5.7% (95% CI 2.3-11.5%) at 2 years. In multivariate analysis, predictive factors of subsequent sVAE were (i) persistent ICD indication (hazard ratio (HR) 3.6; 95% CI 1.6-8.3; p?=?0.003); (ii) 64-72 years of age as compared to???79 years (HR 3.7; 95% CI 1.4-9.7; p?=?0.008); and (iii) ischemic heart disease (HR 4.4; 95% CI 2.1-9.3; p?0.0001).
CONCLUSIONS:
The risk of sVAE (21.2% at 4 years post-REP) depends on age, ischemic heart disease, and ICD indication at the time of REP. A non-trivial risk of sVAE remains in patients without persistent ICD indication.
CLINICAL TRIAL REGISTRATION:
NCT02323503.
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Left Bundle Branch Area Pacing versus Biventricular Pacing for Cardiac Resynchronization Therapy on Morbidity and Mortality.
Cardiovasc Drugs Ther2022 Dec;():. doi: 10.1007/s10557-022-07410-3.
Liang Yixiu, Xiao Zilong, Liu Xi, Wang Jingfeng, Yu Ziqing, Gong Xue, Lu Hongyang, Yang Shengwen, Gu Min, Zhang Lei, Li Minghui, Pan Lei, Li Xiao, Chen Xueying, Su Yangang, Hua Wei, Ge Junbo,
Abstract
BACKGROUND:
Left bundle branch area pacing (LBBAP) has emerged as an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). We aimed to compare the morbidity and mortality associated with LBBAP versus BVP in patients undergoing CRT implantation.
METHODS:
Consecutive patients who received CRT from two high-volume implantation centers were retrospectively recruited. The primary endpoint was a composite of all-cause death and heart failure hospitalization, and the secondary endpoint was all-cause death.
RESULTS:
A total of 491 patients receiving CRT (154 via LBBAP and 337 via BVP) were included, with a median follow-up of 31 months. The primary endpoint was reached by 21 (13.6%) patients in the LBBAP group, as compared with 74 (22.0%) patients in the BVP group [hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.43-1.14, P?=?0.15]. There were 10 (6.5%) deaths in the LBBAP group, as compared with 31 (9.2%) in the BVP group (HR 0.91, 95% CI 0.44-1.86, P?=?0.79). No significant difference was observed in the risk of either the primary or secondary endpoint between LBBAP and BVP after multivariate Cox regression (HR 0.74, 95% CI 0.45-1.23, P?=?0.24, and HR 0.77, 95% CI 0.36-1.67, P?=?0.51, respectively) or propensity score matching (HR 0.72, 95% CI 0.41-1.29, P?=?0.28, and HR 0.69, 95% CI 0.29-1.65, P?=?0.40, respectively).
CONCLUSION:
LBBAP was associated with a comparable effect on morbidity and mortality relative to BVP in patients with indications for CRT.
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Multi-modality imaging to guide the implantation of cardiac electronic devices in heart failure: is the sum greater than the individual components?
Eur Heart J Cardiovasc Imaging2022 Dec;():. doi: jeac237.
Galli Elena, Baritussio Anna, Sitges Marta, Donnellan Eoin, Jaber Wael A, Gimelli Alessia,
Abstract
Heart failure is a clinical syndrome with an increasing prevalence and incidence worldwide that impacts patients' quality of life, morbidity, and mortality. Implantable cardioverter-defibrillator and cardiac resynchronization therapy are pillars of managing patients with HF and reduced left ventricular ejection fraction. Despite the advances in cardiac imaging, the assessment of patients needing cardiac implantable electronic devices relies essentially on the measure of left ventricular ejection fraction. However, multi-modality imaging can provide important information concerning the aetiology of heart failure, the extent and localization of myocardial scar, and the pathophysiological mechanisms of left ventricular conduction delay. This paper aims to highlight the main novelties and progress in the field of multi-modality imaging to identify patients who will benefit from cardiac resynchronization therapy and/or implantable cardioverter-defibrillator. We also want to underscore the boundaries that prevent the application of imaging-derived parameters to patients who will benefit from cardiac implantable electronic devices and orient the choice of the device. Finally, we aim at providing some reflections for future research in this field.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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Continuous Monitoring of Heart Rate Variability and Clinical Outcomes in Patients with Implantable Cardioverter Defibrillators.
Curr Probl Cardiol2022 Nov;():101520. doi: 10.1016/j.cpcardiol.2022.101520.
Peters Anthony E, Wu Angie, Chiswell Karen, Hofmann Paul, Nkulikiyinka Richard, Dinh Wilfried, Piccini Jonathan P, Mentz Robert J, Fudim Marat,
Abstract
While heart rate variability (HRV) is an established marker of cardiovascular health, the extent to which continuously measured HRV changes over time and the relationship between these changes and clinical outcomes are less clear. We performed a health system analysis of 225 patients implanted with a cardiac defibrillator or cardiac resynchronization device (CRT) with continuous HRV recording capabilities. We found that continuously measured HRV changed modestly over 2 years. Low baseline HRV, which is associated with low parasympathetic tone and/or increases in sympathetic tone, pertains a worse clinical prognosis as reflected by a significant association with all-cause hospitalization. Observed changes in HRV over 6-months of follow-up were not associated with subsequent outcomes.
Copyright © 2022. Published by Elsevier Inc.
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Myocardial Strain Imaging Using Feature Tracking Method of Cardiac MRI: Our Initial Experience of This Novel Parameter as an Additional Diagnostic Tool.
Indian J Radiol Imaging2022 Dec;32(4):479-487. doi: 10.1055/s-0042-1748760.
Chudgar Priya D, Burkule Nitin J, Kamat Nikhil V, Rege Gautam M, Jantre Mansi N,
Abstract
?Left ventricular ejection fraction (LVEF) is used as quantitative parameter to evaluate myocardial function. However, interobserver variation, limited reproducibility, and dependence on pre-load and after-load reduces its accuracy. The fall in LVEF occurs very late, when myocardial dysfunction is already advanced. Myocardial strain measurements (especially global longitudinal strain) is a new parameter to detect myocardial dysfunction before derangements in LVEF. The aim of this article is to share our experience of this novel diagnostic tool. ?Feature tracking method of strain assessment is performed using routine long and short axis cine images of cardiac MRI (CMR). Dedicated post-processing CMR software can perform off-line analysis and provide results in form of color-coded maps, percentage values as well as strain over time curve for each myocardial segments. ?Global longitudinal strain (GLS) is more sensitive than LVEF and can identify sub-clinical left ventricular (LV) dysfunction in various cardiomyopathies. It is also an important prognostic marker in serial assessment of heart failure patients. Regional differences in strain parameters can provide clues in hypertrophic cardiomyopathy as well as amyloidosis. GLS is recommended as routine measurement in patients undergoing chemotherapy to detect LV dysfunction prior to fall in LVEF. Strain imaging can be applied to guide placement of the LV pacing lead in patients receiving cardiac resynchronization therapy. More clinical data is needed to evaluate its role in ischemic heart disease. ?Strain imaging can identify LV dysfunction earlier than conventional methods and this opens a new perspective in risk stratification and therapeutic decision-making of various cardiac pathologies.
Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).
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Case report: Treatment of tachycardia-induced cardiogenic shock with permanent His bundle pacing and atrioventricular node ablation.
Front Cardiovasc Med2022 ;9():992675. doi: 992675.
?lahti? Tadej, Fister Mi?a, Rad?el Peter, No? Marko, ?inkovec Matja?, ?i?ek David,
Abstract
Tachycardia-induced cardiomyopathy (T-CMP) related to supraventricular arrhythmia is a rare and often unrecognized cause of refractory cardiogenic shock. When rhythm control interventions are ineffective or no longer pursued, atrioventricular node ablation (AVNA) with pacemaker implantation is indicated. Conduction system pacing provides normal synchronous activation of the ventricles after AVNA. However, there is a lack of data on pace and ablate strategy in hemodynamically unstable patients. We report on 2 patients with T-CMP presenting with refractory cardiogenic shock who were successfully treated with His bundle pacing in conjunction with AVNA.
Copyright © 2022 ?lahti?, Fister, Rad?el, No?, ?inkovec and ?i?ek.
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The Ventricular Hypokinesis at the Apical Pacing Site due to the Early Shortening and Rebound Stretch in a Case with Fontan Procedure.
Int Heart J2022 ;63(6):1205-1209. doi: 10.1536/ihj.22-255.
Suzuki Shunsuke, Miyazaki Aya, Takeuchi Yasuyo, Matsutani Hayato, Nii Masaki, Hiramatsu Naoki, Ikai Akio, Shimada Toshio,
Abstract
The left ventricular (LV) apex is recommended as the first choice for positioning the epicardial pacing. We encountered a patient with congenital heart disease (CHD) showing hypokinesis of the LV apical pacing site after implantation of a pacemaker with epicardial leads. This phenomenon was revealed by the early shortening and systolic rebound stretch of the same lesion on two-dimensional speckle tracking echocardiography, which developed in the intraventricular dyssynchrony between the LV apex and base. Cardiac resynchronization therapy provided an excellent result around the hypokinetic lesion. It is wise to arrange detailed evaluations in each patient with complicated CHD, aiming at a successful treatment to enable ventricular synchronicity.
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Dyssynchronous Heart Failure: A Clinical Review.
Curr Cardiol Rep2022 Nov;():. doi: 10.1007/s11886-022-01797-z.
Dikdan Sean J, Co Michael Lawrenz, Pavri Behzad B,
Abstract
PURPOSE OF THE REVIEW:
Dyssynchrony occurs when portions of the cardiac chambers contract in an uncoordinated fashion. Ventricular dyssynchrony primarily impacts the left ventricle and may result in heart failure. This entity is recognized as a major contributor to the development and progression of heart failure. A hallmark of dyssynchronous heart failure (HF) is left ventricular recovery after dyssynchrony is corrected. This review discusses the current understanding of pathophysiology of HF and provides clinical examples and current techniques for treatment.
RECENT FINDINGS:
Data show that HF responds poorly to medical therapy. Cardiac resynchronization therapy (CRT) in the form of conventional biventricular pacing (BVP) is of proven benefit in HF, but is limited by a significant non-responder rate. Recently, conduction system pacing (His bundle or left bundle branch area pacing) has also shown promise in correcting HF. HF should be recognized as a distinct etiology of heart failure; HF responds best to CRT.
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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The Association of Left Ventricular Remodeling with CRT Outcomes.
Heart Rhythm2022 Nov;():. doi: S1547-5271(22)02680-7.
Gold Michael R, Rickard John, Daubert J Claude, Cerkvenik Jeffrey, Linde Cecilia,
Abstract
BACKGROUND:
Cardiac resynchronization therapy (CRT) response stratified by left ventricular (LV) remodeling revealed differing mortality profiles for distinct patient cohorts. Measuring functional endpoints, as well as mortality, may better assess CRT efficacy and inform patient management. However, the association between LV remodeling and functional outcomes after CRT is not well understood.
OBJECTIVE:
To evaluate long-term CRT outcomes by extent of LV remodeling.
METHODS:
REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction (NCT00271154) was a prospective, double-blind, randomized CRT trial. Patients were classified based on LV end-systolic volume (LVESV) change from baseline to 6-months post-CRT: Worsened (increase); Stabilized (0 to ?15% reduction); Responder (>15 to
RESULTS:
The analyses included 353 patients randomized to CRT-ON arm. All-cause mortality was higher in the worsened group compared with the 3 other response groups (29.8% vs 8.0%, p
CONCLUSION:
Preventing further increase in LVESV with CRT was associated with reduced mortality, whereas functional measure improvement was associated with LV remodeling magnitude. These results support consideration of functional and mortality endpoints to assess CRT efficacy and provide further evidence the dichotomous 'responder and non-responder' classification should be modified.
Copyright © 2022. Published by Elsevier Inc.
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Electrocardiogram Belt Guidance for Left Ventricular Lead Placement and Biventricular Pacing Optimization.
Heart Rhythm2022 Nov;():. doi: S1547-5271(22)02679-0.
Rickard John, Jackson Kevin, Gold Michael, Biffi Mauro, Ziacchi Matteo, Silverstein Joshua, Ramza Brian, Metzl Mark, Grubman Eric, Abben Richard, Varma Niraj, Tabbal Ghiyath, Jensen Cory, Wouters Griet, Ghosh Subham, Vernooy Kevin, ,
Abstract
BACKGROUND:
Patients with ischemic cardiomyopathy, non-left bundle branch block (LBBB), or QRS duration
OBJECTIVE:
To evaluate the efficacy of the ECG Belt System (EBS) in patients less likely to respond to cardiac resynchronization therapy (CRT) and determine whether EBS use in lead placement guidance and device programming was superior compared with standard CRT care.
METHODS:
This was a prospective, randomized trial of heart failure patients with EBS-guided CRT implant and programming vs. standard CRT care. The primary endpoint was relative change in LV end-systolic volume from baseline to 6 months post-implant.
RESULTS:
A total of 408 subjects from centers in Europe and North America were randomized. Although both EBS and control patients had a mean improvement in LVESV, there was no significant difference in relative change from baseline (p=0.26). While patients with a higher baseline SDAT derived greater LV reverse remodeling, improvement in electrical dyssynchrony did not correlate with the extent of reverse remodeling.
CONCLUSION:
The findings of the present study do not support EBS-guided therapy for CRT management of heart failure with reduced ejection fraction.
Copyright © 2022. Published by Elsevier Inc.
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Advances in Cardiac Electrophysiology.
Circ Arrhythm Electrophysiol2022 Nov;():e009911. doi: 10.1161/CIRCEP.121.009911.
Piccini Jonathan P, Russo Andrea M, Sharma Parikshit S, Kron Jordana, Tzou Wendy, Sauer William, Park David S, Birgersdotter-Green Ulrika, Frankel David S, Healey Jeff S, Hummel John, Koruth Jacob, Linz Dominik, Mittal Suneet, Nair Devi G, Nattel Stanley, Noseworthy Peter A, Steinberg Benjamin A, Trayanova Natalia A, Wan Elaine Y, Wissner Erik, Zeitler Emily P, Wang Paul J,
Abstract
Despite the global COVID-19 pandemic, during the past 2 years, there have been numerous advances in our understanding of arrhythmia mechanisms and diagnosis and in new therapies. We increased our understanding of risk factors and mechanisms of atrial arrhythmias, the prediction of atrial arrhythmias, response to treatment, and outcomes using machine learning and artificial intelligence. There have been new technologies and techniques for atrial fibrillation ablation, including pulsed field ablation. There have been new randomized trials in atrial fibrillation ablation, giving insight about rhythm control, and long-term outcomes. There have been advances in our understanding of treatment of inherited disorders such as catecholaminergic polymorphic ventricular tachycardia. We have gained new insights into the recurrence of ventricular arrhythmias in the setting of various conditions such as myocarditis and inherited cardiomyopathic disorders. Novel computational approaches may help predict occurrence of ventricular arrhythmias and localize arrhythmias to guide ablation. There are further advances in our understanding of noninvasive radiotherapy. We have increased our understanding of the role of His bundle pacing and left bundle branch area pacing to maintain synchronous ventricular activation. There have also been significant advances in the defibrillators, cardiac resynchronization therapy, remote monitoring, and infection prevention. There have been advances in our understanding of the pathways and mechanisms involved in atrial and ventricular arrhythmogenesis.
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The Association of Interventricular Activation Delay With Clinical Outcomes in Cardiac Resynchronization Therapy.
Heart Rhythm2022 Nov;():. doi: S1547-5271(22)02674-1.
Haqqani Haris M, Burri Haran, Kayser Torsten, Carter Nathan, Gold Michael R,
Abstract
BACKGROUND:
Pacing at sites of longest interventricular delay has been associated with greater reverse remodeling in cardiac resynchronization therapy (CRT). However, the effects of pacing at such sites on clinical outcomes is less well studied.
OBJECTIVE:
To assess the association between interventricular delay and clinical outcomes in CRT patients implanted with quadripolar left ventricular (LV) leads.
METHODS:
RALLY-X4 was a registry study of the Acuity X4 quadripolar LV leads. Interventricular delay was measured during unpaced basal rhythm from the right ventricular (RV) lead to the LV lead electrode (E1 to E4) chosen for CRT pacing. Patients were stratified by median RV-LV delay (80 ms) into short and long delay groups, and they were also analysed by multivariable modelling. The primary composite outcome measure was all-cause mortality and heart failure hospitalization (HFH) at 18 months.
RESULTS:
There were 581 patients with complete RV-LV delay data. The mean LV ejection fraction (EF) was 27% and 73% had a typical left bundle branch block. Predictors of long RV-LV delay included female sex, LBBB and QRS duration >150ms. Survival free of the primary outcome at 18 months follow up was 87% in the long activation delay group compared with 77% in the short delay group (p=0.0042). Multivariate analysis showed that RV-LV delay was a, independent predictor of survival free of HFH (p=0.028).
CONCLUSIONS:
Among CRT patients with quadripolar LV pacing leads, longer baseline interventricular activation delay was significantly associated with the composite endpoint of all-cause mortality and heart failure hospitalization.
Copyright © 2022. Published by Elsevier Inc.
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Clinical implication of device-based algorithm that optimize atrioventricular delay during cardiac resynchronization therapy: author's reply.
Heart Vessels -
Finding New Insights in Cardiac Resynchronization Therapy and the Pathophysiology behind Left Ventricular Dyssynchrony.
J Clin Med2022 Nov;11(22):. doi: 6831.
Duchenne Jürgen,
Abstract
Over the past two decades, cardiac resynchronization therapy (CRT) became an established treatment option for patients with symptomatic heart failure [...].
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Should cardiac resynchronization therapy be prescribed before optimizing medical therapy in patients with left bundle branch block-induced cardiomyopathy?
Rev Esp Cardiol (Engl Ed) -
Successful cardiac resynchronization therapy by left bundle branch area pacing through a chronically occluded left subclavian system with limited vascular access preventing coronary sinus lead implant.
Pacing Clin Electrophysiol2022 Nov;():. doi: 10.1111/pace.14633.
Liu Xiaoke,
Abstract
BACKGROUND:
Conventional cardiac resynchronization therapy (CRT) involves implantation of a coronary sinus pacing lead through a delivery sheath, which typically requires a large venous access through a safe sheath of 9 French or greater in size. In patients who have very limited access due to scar tissue from previous implants or critical venous stenosis/closure, such large caliber access may not be available.
CASE REPORT:
We here report a case of CRT procedure in an 84-year-old male with a previous history of ischemic dilated cardiomyopathy (ejection fraction 40%) who was dependent on right ventricular pacing with worsening heart failure symptoms. The patient was incidentally discovered to have chronic total closure (CTO) of the left subclavian vein during the procedure. Although the CTO was crossed by a wire and dilated, the venous access was limited to a 7 French sheath which rendered conventional CRT through coronary sinus lead implant impossible. However, using the left bundle branch area pacing (LBBAP) technique which requires a smaller venous access, we were able to successfully achieve CRT. Post procedure, patient's paced QRS duration narrowed from 198ms to 130ms. The patient's heart failure symptoms improved, and ejection fraction increased to 45% one-month post procedure.
CONCLUSIONS:
In patients with vascular access limited to a small caliber sheath not suitable for conventional CRT, LBBAP may help achieve procedural success and improve clinical outcome This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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