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Pubblicazioni recenti - cardiac resynchronization
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Trends of Cardiovascular Implantable Electronic Device Infection in 3 Decades: A Population-Based Study.
JACC Clin Electrophysiol2019 Sep;5(9):1071-1080. doi: S2405-500X(19)30477-3.
Dai Mingyan, Cai Cheng, Vaibhav Vaidya, Sohail M Rizwan, Hayes David L, Hodge David O, Tian Ying, Asirvatham Roshini, Cochuyt Jordan J, Huang Congxin, Friedman Paul A, Cha Yong-Mei,
Abstract
OBJECTIVES:
This study assessed trends in the incidence of cardiovascular implantable electronic device (CIED) infection in the last 3 decades using a population-based records linkage study.
BACKGROUND:
Infection remains an important issue associated with increased implantation rate and dwell time of CIEDs.
METHODS:
We identified a cohort of all adults with CIEDs who resided in Olmsted County, Minnesota, from 1988 to 2015, using the medical linkage system of the Rochester Epidemiology Project. Standardized criteria were used to identify all CIED infection cases. The cumulative rate of CIED infection was estimated using the Kaplan-Meier method, and the trends of CIED infection incidence were calculated with person-years of follow-up after device implantation.
RESULTS:
The cumulative probabilities of overall CIED infection were 6.2% (95% confidence interval [CI]: 4.0% to 8.4%) at 15 years and 11.7% (95% CI: 6.8% to 17.3%) at 25 years of follow-up. The incidence of CIED infection every 7 years from 1988 to 2015 was 1.3, 5.7, 4.1, and 4.7 per 1,000-person years, respectively. The 15-year cumulative probabilities of CIED infection after the initial, second, and third procedures were 2.6% (95% CI: 1.4% to 3.8%), 2.7% (95% CI: 1.2% to 4.2%), and 24.1% (95% CI: 3.8% to 44.4%), respectively. Generator changes (hazard ratio [HR]: 3.91; 95% CI: 1.47 to 10.37; p = 0.006) and upgrades (HR: 3.08; 95% CI: 1.24 to 7.62; p = 0.02) were significantly associated with infection.
CONCLUSIONS:
The incidence of CIED infection had a trend of increasing in the past 2 decades. Contemporary implantable cardioverter-defibrillator and cardiac resynchronization therapies and repeated manipulation of device pockets introduced a greater risk of CIED infection.
Copyright © 2019. Published by Elsevier Inc.
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Sex-Related Procedural Aspects and Complications in CRT Survey II: A Multicenter European Experience in 11,088 Patients.
JACC Clin Electrophysiol2019 Sep;5(9):1048-1058. doi: S2405-500X(19)30410-4.
Auricchio Angelo, Gasparini Maurizio, Linde Cecilia, Dobreanu Dan, Cano Óscar, Sterlinski Maciej, Bogale Nigussie, Stellbrink Christoph, Refaat Marwan M, Blomström-Lundqvist Carina, Lober Christiane, Dickstein Kenneth, Normand Camilla,
Abstract
OBJECTIVES:
This study sought to compare sex difference for procedural aspects and complications in the European Society of Cardiology CRT Survey II, exploring whether adverse events were related to the type of CRT device implanted.
BACKGROUND:
Sex-related differences in procedural aspects and complications in patients undergoing cardiac resynchronization therapy (CRT) implantation has not been explored in a real-life population.
METHODS:
A post-hoc analysis of procedural data and complications in different sexes and factors associated with events was performed from data collected in the European Society of Cardiology CRT Survey II.
RESULTS:
Of all patients (n = 11,088) included, 24.3% were women. The mean age (70 years of age) of male and female recipients was similar. Female patients more frequently had an idiopathic cardiomyopathy (67.4% vs. 44.1%) and fewer comorbidities, including atrial fibrillation (34.8% vs. 42.8%), diabetes (29.1% vs. 32.1%), chronic obstructive lung disease (10.3% vs. 12.6%), and renal failure (28.7% vs. 31.9%), compared with men. More women compared with men had a pacemaker (56.6% vs. 46.3%) and much less often an implantable cardioverter-defibrillator (CRT-D) (19.0% vs. 34.7%) implant. Periprocedural event rate was the highest in women with CRT with defibrillator (7.1% vs. 4.8% in men), followed by women with a CRT with pacing (5.5% vs. 4.4% in men). The higher periprocedural event rate in CRT-D women was attributable primarily to the occurrence of pneumothorax (1.4%), coronary sinus dissection (2.1%), and pericardial tamponade (0.3%). The rate of in-hospital major adverse events (6.0%) and complications necessitating reoperation (4.0%) was not different among sex and device type.
CONCLUSIONS:
Women are more likely to experience adverse procedure-related events during CRT implantation. Thus, preventive strategies should be employed to minimize complication rate.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Cardiac Resynchronization Therapy Favors Women-For Ventricular Arrhythmias Too.
JACC Clin Electrophysiol -
Cardiac Resynchronization in Women: A Substudy of the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial.
JACC Clin Electrophysiol2019 Sep;5(9):1036-1044. doi: S2405-500X(19)30417-7.
de Waard Dominique, Manlucu Jaimie, Gillis Anne M, Sapp John, Bernick Jordan, Doucette Steve, Tang Anthony, Wells George, Parkash Ratika,
Abstract
OBJECTIVES:
This study sought to evaluate the effect of cardiac resynchronization therapy with defibrillator (CRT-D) as compared with implantable cardioverter-defibrillator (ICD) on mortality, heart failure (HF) hospitalization, and ventricular arrhythmia in women versus men.
BACKGROUND:
CRT-D has demonstrated reduced mortality and HF hospitalizations with greater benefit observed in women compared with men. However, whether CRT-D prevented ventricular arrhythmias in women compared with men was unclear.
METHODS:
The RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) study randomized 1,798 patients to an ICD or CRT-D. In this post hoc analysis, women and men were compared by randomized group. By using a multivariable model, the outcomes of death and HF hospitalization and incidence of ventricular arrhythmia were compared between men and women.
RESULTS:
There were 1,490 (83%) men (732, ICD; 758, CRT-D) and 308 (17%) women (172, ICD; 136, CRT-D) included in the analysis. Women with CRT-D had a significantly reduced incidence of death and HF hospitalization compared with men with CRT-D (hazard ratio: 0.52; 95% confidence interval: 0.33 to 0.81; p < 0.001) on multivariable analysis. Women with a primary prevention indication and CRT-D had the lowest rate of ventricular arrhythmia compared with men (hazard ratio: 0.59; 95% confidence interval: 0.39 to 0.91; p = 0.016).
CONCLUSIONS:
Women have improved rates of death and HF hospitalization with CRT-D and were less likely to experience ventricular arrhythmia when compared with men, after adjusting for differences in baseline characteristics over a prolonged follow-up. Whether these improved outcomes reflect inherent sex differences in the underlying myocardial substrate resulting in an enhanced response to CRT-D requires further research.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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A Novel Quadripolar Active Fixation Left-Ventricular Pacing Lead for Cardiac Resynchronization Therapy: Initial United Kingdom Experience.
JACC Clin Electrophysiol2019 Sep;5(9):1028-1035. doi: S2405-500X(19)30331-7.
Chapman Michael, Bates Matthew G D, Behar Nathan M, Williams Ian, Dewhurst Matthew, Monkhouse Christopher, Hayward Carl, Muthumala Amal, Chow Anthony, Linker Nicholas J, Thornley Andrew R, Turley Andrew J,
Abstract
OBJECTIVES:
This study sought to assess immediate and short-term performance of the Medtronic Attain Stability Quadripolar 4798 lead (Medtronic, Dublin, Ireland).
BACKGROUND:
Cardiac resynchronization therapy (CRT) is an established treatment for appropriately selected patients with left ventricular (LV) systolic dysfunction. The most common reason for failure to implant a lead is the lack of a suitable epicardial vein, due either to an absent vessel in the target site, an unacceptably high threshold, lead instability, phrenic nerve stimulation, or a combination of reasons. In August 2017, a novel quadripolar active fixation LV lead (Medtronic) was released. This paper reports the initial clinical experience with lead implantation and specifically immediate and short-term pacing parameters across 3 United Kingdom centers.
METHODS:
Consecutive patients eligible for CRT were deemed suitable for this lead. Immediate and short-term lead performance data regarding LV threshold, impedance, and displacement rates were collected at standard pacing checks (1 day, 5 weeks, 3 months, and 9 months post-implantation).
RESULTS:
CRT using this lead was attempted in 82 cases and was successful in 81 cases (98.8%). LV thresholds and impedance levels were 1.22 ± 0.75 V and 737 ± 319 ? at implantation; 1.16 ± 0.71 V and 597 ± 218 ? at day 1; 1.02 ± 0.48 V and 579 ± 148 ? at week 6; 0.98 ± 0.49 V and 569 ± 133 ? at 3 months; and 1.06 ± 0.48 V and 570 ± 140 ? at 9 months. As of the publication of this paper, no LV lead has been displaced.
CONCLUSIONS:
CRT using the Medtronic lead was successful in more than 98% of the patients. Short-to-medium-term data regarding lead performance and stability were excellent, with zero displacements as of the publication of this paper.
Copyright © 2019 American College of Cardiology Foundation. All rights reserved.
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Optimization of Cardiac Resynchronization Therapy: Should Perioperative Hemodynamic Measurements Be Routine?
JACC Clin Electrophysiol2019 Sep;5(9):1026-1027. doi: S2405-500X(19)30498-0.
Payne Joshua E, Gold Michael R,
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Hemodynamic Optimization in Cardiac Resynchronization Therapy: Should We Aim for dP/dt or Stroke Work?
JACC Clin Electrophysiol2019 Sep;5(9):1013-1025. doi: S2405-500X(19)30394-9.
Zweerink Alwin, Salden Odette A E, van Everdingen Wouter M, de Roest Gerben J, van de Ven Peter M, Cramer Maarten J, Doevendans Pieter A, van Rossum Albert C, Vernooy Kevin, Prinzen Frits W, Meine Mathias, Allaart Cornelis P,
Abstract
OBJECTIVES:
This study evaluated the acute effect of dP/dt- versus stroke work (SW)-guided cardiac resynchronization therapy (CRT) optimization and the related acute hemodynamic changes to long-term CRT response.
BACKGROUND:
Hemodynamic optimization may increase benefit from CRT. Typically, maximal left ventricular (LV) pressure rise dP/dt is used as an index of ventricular performance. Alternatively, SW can be derived from pressure-volume (PV) loops.
METHODS:
Forty-one patients underwent CRT implantation followed by invasive PV loop measurements. The stimulation protocol included 16 LV pacing configurations using each individual electrode of the quadripolar lead with 4 atrioventricular (AV) delays. Conventional CRT was defined as pacing from the distal electrode with an AV delay of approximately 120 ms.
RESULTS:
Compared with conventional CRT, dP/dt-guided optimization resulted in a one-third additional dP/dt increase (17 ± 11% vs. 12 ± 9%; p < 0.001). Similarly, SW-guided optimization resulted in a one-third additional SW increase (80 ± 55% vs. 53 ± 48%; p < 0.001). Comparing both optimization strategies, dP/dt favored contractility (8 ± 12% vs. 5 ± 10%; p = 0.015), whereas SW optimization improved ventricular-arterial (VA) coupling (45% vs. 32%; p < 0.001). After 6 months, mean LV ejection fraction (LVEF) change was 10 ± 9% with 23 (56%) patients becoming super-responders to CRT (?10% LVEF improvement). Although acute changes in SW were predictive for long-term CRT response (area under the curve: 0.78; p = 0.002), changes in dP/dt were not (area under the curve: 0.65; p = 0.112).
CONCLUSIONS:
PV-guided hemodynamic optimization in CRT results in approximately one-third SW improvement on top of conventional CRT, caused by a mechanism of enhanced VA coupling. In contrast, dP/dt optimization favored LV contractility. Ultimately, acute changes in SW showed larger predictive value for long-term CRT response compared with dP/dt.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Cardiac Resynchronization Therapy in Patients With Non-Left Bundle Branch Morphologies: Does Reverse Remodeling Matter?
JACC Clin Electrophysiol -
Left Ventricular Reverse Remodeling in Cardiac Resynchronization Therapy and Long-Term Outcomes.
JACC Clin Electrophysiol2019 Sep;5(9):1001-1010. doi: S2405-500X(19)30541-9.
Naqvi Syed Y, Jawaid Anas, Vermilye Katherine, Biering-Sørensen Tor, Goldenberg Ilan, Zareba Wojciech, McNitt Scott, Polonsky Bronislava, Solomon Scott D, Kutyifa Valentina,
Abstract
OBJECTIVES:
The aim of this study was to evaluate the association between improvement in left ventricular end-systolic volume (LVESV) with cardiac resynchronization therapy (CRT) and mortality and whether this relationship was modified by the presence of a left bundle branch block (LBBB) electrocardiographic pattern.
BACKGROUND:
Left ventricular reverse remodeling in patients receiving CRT has been shown to predict outcomes. However, the extent to which reverse remodeling contributes to long-term survival is not well understood.
METHODS:
Changes in LVESV were assessed in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) patients receiving CRT with a defibrillator (CRT-D) and echocardiograms available at 1 year (n = 752), stratified by LBBB, relative to long-term all-cause mortality, compared with those with implantable cardioverter-defibrillators (ICDs) only (n = 684).
RESULTS:
In patients with LBBB, a reduction in LVESV of >35% (median) translated into significantly lower risk for long-term mortality (hazard ratio [HR]: 0.34; p < 0.001), heart failure (HF) events (HR: 0.21; p < 0.001), and HF or death (HR: 0.27; p < 0.001) compared with patients with ICDs only. Patients with reductions in LVESV ?35% had a significantly lower risk for HF, and HF or death, and a nonsignificantly lower rate of death compared with those with ICDs only (HR: 0.74; p = 0.13). Risk reduction in HF events was uniform across all LVESV quartiles. In patients without LBBB, there was no survival benefit (HR: 0.68; p = 0.271) despite an LVESV reduction greater than the median (>27.6%). CRT-D patients without LBBB with the least reverse remodeling (quartile 1) had a more than 3-fold increased risk for death compared with those with ICDs only (HR: 3.11; p < 0.001).
CONCLUSIONS:
In patients with LBBB, CRT-D-induced reduction in LVESV at 1 year is associated with long-term survival benefit. Despite left ventricular reverse remodeling with CRT-D, there is no survival benefit and potential harm in patients without LBBB.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Cardiac resynchronization therapy-heart failure (CRT-HF) clinic: A novel model of care.
PLoS One2019 ;14(9):e0222610. doi: 10.1371/journal.pone.0222610.
Gorodeski Eiran Z, Magnelli-Reyes Christina, Moennich Laurie Ann, Grimaldi Adam, Rickard John,
Abstract
BACKGROUND:
Post-implant care of patients with heart failure (HF) undergoing cardiac resynchronization therapy (CRT) is not addressed in current HF or CRT guidelines and is often fragmented with poor communication between specialties. We sought to develop a new model of post-CRT care which could be implemented in busy clinical settings.
METHODS AND RESULTS:
We designed a novel, multidisciplinary approach to standardizing post CRT care. All patients receiving a CRT device at the Cleveland Clinic between March 2017 and August 2018 were invited to be seen in the clinic 6 months post implant. A one-time collaborative visit encompassing cardiac imaging, heart failure, and electrophysiology care was performed. We recorded the operational feasibility of the clinic in terms of patient throughput as well as patient characteristics, interventions, and new diagnoses made. Between September 2017 and February 2019, 150 patients were seen in the clinic. Of these, 125 patients had their index CRT implanted for standard indications and were included in the current analysis. Approximately 45 minutes were dedicated for each patient visit. Interventions in care were made in 95% of patients, with CRT non-responders offered a higher number of interventions as compared to responders (median 3 versus 2 interventions). Types of interventions were device-related (26% of population), medication-related (74%), and referral for alternate medical services (80%).
CONCLUSIONS:
Multidisciplinary post-implant care of patients with HF receiving CRT devices, regardless of CRT response status, is feasible and results in frequent medical interventions.
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Non-Invasively Quantified Changes in Left Ventricular Activation Predict Outcomes in Patients Undergoing Cardiac Resynchronization Therapy.
J Cardiovasc Electrophysiol2019 Sep;():. doi: 10.1111/jce.14192.
Friedman Daniel J, Emerek Kasper, Hansen Steen Møller, Polcwiartek Christoffer, Sørensen Peter L, Loring Zak, Sutter Joanne, Søgaard Peter, Kisslo Joseph, Graff Claus, Atwater Brett D,
Abstract
BACKGROUND:
Changes in left ventricular (LV) activation after cardiac resynchronization therapy (CRT) influence survival but are difficult to quantify non-invasively.
METHODS AND RESULTS:
We studied 527 CRT patients to assess whether non-invasive quantification of changes in LV activation, defined by change (?) in QRS area(QRSA), can predict outcomes after CRT. The study outcome was time until LV assist device(LVAD), cardiac transplant, or death. The 3-dimensional QRSA was measured from clinical 12 lead ECGs which were transformed into vectorcardiograms using the Kors method. QRSA was calculated as (QRSx +QRSy +QRSz ) ; ?QRSA was calculated as post-QRSA minus pre-QRSA, where a negative value represents a reduction in LV activation delay. Kaplan Meier plots and multivariable Cox proportional hazards models were used to relate ?QRSA area with outcomes after stratifying the population into quartiles of ?QRSA. The median baseline QRSA of 93.6µVs decreased to 59.7µVs after CRT. Progressive reductions in QRSA with CRT were associated with a lower rate of LVAD, transplant, or death across patient quartiles(p<0.001). In Cox regression analyses, ?QRSA was associated with outcomes independent of QRS morphology and other clinical variables [Q1(greatest decrease) vs. Q4(smallest change = reference), HR 0.45, CI 0.30-0.70, p<0.001]. There was no interaction between ?QRSA and QRS morphology.
CONCLUSIONS:
CRT induced ?QRSA was associated with clinically meaningful changes in event free survival. ?QRSA may be a novel target to guide lead implantation and device optimization. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Adherence to heart failure management medications following cardiac resynchronization therapy.
Curr Med Res Opin2019 Sep;():1. doi: 10.1080/03007995.2019.1670474.
Shah Bimal R, DerSarkissian Maral, Tsintzos Stelios I, Xiao Yongling, May Damian, Lu Xiaoxiao, Kinrich David, Davis Eric, Lefebvre Patrick, Duh Mei S, Dasta Joseph F,
Abstract
The purpose of this study is to assess the real-world impact of cardiac resynchronization therapy (CRT) on adherence to heart failure (HF) medications. MarketScan® administrative health care claims data from 2008 to 2014 among patients with HF were used. The date of first CRT implantation served as the index date. Adherence to guideline-directed medical therapy (GDMT) classes were compared during pre- and post-index periods using proportion of days covered (PDC). Comparisons between the two periods were made using the Wilcoxon sign-rank test for continuous PDC and McNemar's test for dichotomized PDC. Increases in medication adherence were observed for major classes of HF GDMT medications. Specifically, adherence to angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), beta blockers (BB), and furosemide increased by 22%, 24%, 32%, and 28% (all p?
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Visualization of Cardiac Implantable Electronic Device Data for Older Adults Using Participatory Design.
Appl Clin Inform2019 Aug;10(4):707-718. doi: 10.1055/s-0039-1695794.
Ahmed Ryan, Toscos Tammy, Rohani Ghahari Romisa, Holden Richard J, Martin Elizabeth, Wagner Shauna, Daley Carly, Coupe Amanda, Mirro Michael,
Abstract
Patients with heart failure (HF) are commonly implanted with cardiac resynchronization therapy (CRT) devices as part of their treatment. Presently, they cannot directly access the remote monitoring (RM) data generated from these devices, representing a missed opportunity for increased knowledge and engagement in care. However, electronic health data sharing can create information overload issues for both clinicians and patients, and some older patients may not be comfortable using the technology (i.e., computers and smartphones) necessary to access this data. To mitigate these problems, patients can be directly involved in the creation of data visualization tailored to their preferences and needs, allowing them to successfully interpret and act upon their health data. We held a participatory design (PD) session with seven adult patients with HF and CRT device implants, who were presently undergoing RM, along with two informal caregivers. Working in three teams, participants used drawing supplies and design cards to design a prototype for a patient-facing dashboard with which they could engage with their device data. Information that patients rated as a high priority for the "Main Dashboard" screen included average percent pacing with alerts for abnormal pacing, other device information such as battery life and recorded events, and information about who to contact with for data-related questions. Preferences for inclusion in an "Additional Information" display included a daily pacing chart, health tips, aborted shocks, a symptom list, and a journal. These results informed the creation of an actual dashboard prototype which was later evaluated by both patients and clinicians. Additionally, important insights were gleaned regarding the involvement of older patients in PD for health technology.
Georg Thieme Verlag KG Stuttgart · New York.
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The effect of sacubitril/valsartan on the occurrence of ventricular arrhythmia and the risk of sudden cardiac death in patients with chronic heart failure with reduced left ventricular ejection fraction. Expert opinion of the Heart Rhythm and Heart Failure Associations of the Polish Cardiac Society.
Kardiol Pol2019 Sep;():. doi: 10.33963/KP.14972.
Grabowski Marcin, Oziera?ski Krzysztof, Balsam Pawe?, D?browski Rafa?, Farkowski Micha? M, Gackowski Andrzej, J?drzejczyk-Patej Ewa, Kalarus Zbigniew, Leszek Przemys?aw, Nessler Jadwiga, Sterli?ski Maciej, Opolski Grzegorz, Przybylski Andrzej,
Abstract
Exacerbation of chronic heart failure (HF) is the most common cause of hospitalization in adults, which is associated with high morbidity and mortality, mainly in the mechanism of exacerbation of chronic HF or sudden cardiac death (SCD). A novelty in the treatment of HF with reduced left ventricular ejection fraction (HFrEF) in recent years has been registration of sacubitril/valsartan - a drug belonging to the angiotensin II receptor and neprilysin inhibitors (ARNI). Sacubitril/valsartan significantly reduces the severity of HF symptoms, the risk of hospitalization and death and is characterized by a good safety profile, due to which it has a strong position in the guidelines of international cardiac societies. However, the precise mechanism in which ARNI has a beneficial effect on cardiovascular mortality is not known. The advantages of ARNI are likely to result from improvement of left ventricle ejection fraction, reduced myocardial remodeling and increased natriuretic peptide availability. Therefore, sacubitril/valsartan may potentially exhibit anti-arrhythmic properties and reduce risk of ventricular arrhythmias and SCD in patients with HFrEF. What is important, the improvement of the function and the electrical stabilization of cardiomyocytes may translate to decrease of the risk of adequate and inadequate interventions of cardioverter defibrillator and an improvement of biventricular pacing of resynchronization systems. The following expert opinion of the Heart Rhythm and Heart Failure Sections of the Polish Cardiac Society presents a summary and interpretation of current knowledge regarding the influence of sacubitril/valsartan on the occurrence of ventricular arrhythmias and the risk of SCD in patients with chronic HFrEF.
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Impact of Chronic Thrombocytopenia on Outcomes After Transcatheter Valvular Intervention and Cardiac Devices Implantation (From a National Inpatient Sample).
Am J Cardiol2019 Aug;():. doi: S0002-9149(19)30951-8.
Shokr Mohamed, Adegbala Oluwole, Elmoghrabi Adel, Saleh Mohammed, Ajam Mustafa, Ali Abdelrahman, Yassin Ahmed S, Ando Tomo, Eperjesiova Bianka, Aly Ahmed, Pahuja Mohit, Ashraf Said, Abubakar Hossam, Ahmed Abdelrahman, Subahi Ahmed, Lieberman Randy, Afonso Luis,
Abstract
To evaluate the impact of chronic thrombocytopenia (cTCP) on outcomes of transcatheter valvular procedures such as aortic valve implantation (TAVI), MitraClip, permanent pacemaker (PPM), implantable-cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT), left atrial appendage closure, and pericardiocentesis. Impact of cTCP on clinical outcomes following TAVI, Mitraclip, PPM, ICD, CRT, left atrial appendage closure, and pericardiocentesis procedures is not well described. Utilizing the National Inpatient Sample and (ICD-9-CM) procedural codes, we evaluated patients (age ?18 years) who underwent these procedures, from January 1, 2009 to December 31, 2014, with or without cTCP as a chronic condition variable indicator. Propensity score matching model implemented to derive 2 matched groups. Propensity score matching created 47,292 and 47,351 hospitalizations matched pairs with and without cTCP, respectively. Patients with cTCP were older (mean age, 74.27 vs 72.26 years; absolute standardized differences [ASD]?=?15.6) and less likely to be female (36.76% vs 43.74%, ASD?=?-14.31). They experienced higher in-hospital mortality (3.0% vs 2.0%; odds ratio [OR], 1.53; 95% confidence interval [CI], 1.27 to 1.83) and higher odds of vascular injury requiring surgery (2.63% vs 1.10%; OR, 2.43; 95% CI, 1.93 to 3.05). Postoperative hematoma and bleeding were 2-fold higher (4.57% vs 2.24%; OR, 2.08; 95% CI, 1.77 to 2.45) and 3-fold higher (6.34% vs 2.45%; OR, 2.69; 95% CI, 2.31 to 3.13) respectively among cTCP patients. They had greater health-care cost ($47,163 vs $35,763, p <0.0001) and longer hospital stay (mean 9.26 days vs 6.84 days, p <0.0001). In conclusion, cTCP patients had higher risk of complications after TAVI, MitraClip, PPM, ICD, CRT, left atrial appendage closure, and pericardiocentesis, including a 1.5-fold increased risk of in-hospital mortality.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Cardiac resynchronization therapy by left bundle branch area pacing in heart failure patients with left bundle branch block.
Heart Rhythm2019 Sep;():. doi: S1547-5271(19)30827-6.
Zhang Weiwei, Huang Jingjuan, Qi Yiding, Wang Fei, Guo Lina, Shi Xuerui, Wu Weihua, Zhou Xiaohong, Li Ruogu,
Abstract
BACKGROUND:
Cardiac resynchronization therapy (CRT) via bi-ventricular pacing has demonstrated clinical benefits in heart failure (HF) patients with ventricular dyssynchrony. Other approaches of CRT is little known.
OBJECTIVE:
This study assessed the feasibility, safety, and efficacy of left bundle branch area pacing (LBBAP) in HF patients with left bundle branch block (LBBB).
METHODS:
Eleven consecutive HF patients with reduced left ventricular ejection fraction (LVEF) and LBBB and indicated for CRT were recruited. LBBAP was achieved via trans-ventricular septal approach and characterized by narrowed QRS duration (QRSd), shortened peak left ventricular activation time (LVAT) and right bundle branch conduction delay in electrocardiogram. Electrocardiogram, echocardiogram and cardiac function were evaluated at baseline and follow-up. Interventricular mechanical delay (IVMD) and 3D-tissue synchronization imaging (3D-TSI) during LBBAP and intrinsic LBBB status were measured by echocardiogram at follow-up.
RESULTS:
LBBAP significantly shortened QRSd (129.09±15.94 ms from native 180.00±15.86 ms, P <0.01) and LVAT (80.91±9.95 ms from native 108.18±15.54 ms, P <0.01). IVMD and the standard deviation of TSI of 12 left ventricular (LV) segments were significantly shorter during LBBAP than in intrinsic LBBB status (both with P <0.01). At average follow-up of 6.7 months, NYHA functional class, plasma levels of B-type natriuretic peptide, LV end systolic diameter and LVEF were significantly improved (all with P <0.05 vs. baseline).
CONCLUSIONS:
The study demonstrates that LBBAP is clinically feasible in patients with systolic HF and LBBB. LBBAP can be a new CRT to correct LBBB, provide ventricular synchrony and improve clinical symptoms with LV reverse remodeling.
Copyright © 2019. Published by Elsevier Inc.
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S wave in ECG lead V6 predicts poor response to cardiac resynchronization therapy and long-term outcome.
Heart Rhythm2019 Sep;():. doi: S1547-5271(19)30828-8.
Jiang Zeyu, Qiu Yuanhao, Qian Zhiyong, Wang Yao, Zhao Yongwei, Hou Xiaofeng, Liang Yanchun, Zheng Liangrong, Xu Geng, Su Yangang, Gu Xiang, Zou Jiangang,
Abstract
BACKGROUND:
Cardiac resynchronization therapy (CRT) is a standard treatment for selected patients with chronic heart failure (HF). However, up to 30-50% of patients still do not respond to CRT.
OBJECTIVE:
Our aim was to identify the predictive value of S wave in lead V6 on CRT response in patients with complete left bundle branch block (CLBBB).
METHODS:
The CLBBB definition included the Strauss LBBB criteria and the absence of q waves in leads I, V5 and V6. According to electrocardiogram (ECG) at baseline, CLBBB patients were divided into 3 groups: T-CLBBB group (CLBBB without S wave in V5 or V6), V5S group (CLBBB with S wave in V5 and no S wave in V6) and V5&V6S group (CLBBB with S wave in V5 and V6). CRT response was defined as left ventricular end-systolic volume (LVESV) reduction ? 15% at 6-month follow-up. The combined endpoint included HF rehospitalization or all-cause death.
RESULTS:
Of 181 LBBB-like pattern patients, 112 CLBBB patients were included into 3 groups: 54 in T-CLBBB, 32 in V5S and 26 in V5&V6S group. CRT response rate was 85.2%, 65.6% and 38.5% respectively (p<0.001). Kaplan-Meier curves demonstrated that patients in V5&V6S group had higher incidence of HF rehospitalization or all-cause death than that in the other two groups (P<0.001). In a multivariate logistic regression model analysis, S wave in lead V6 was significantly associated with CRT non-response (HR: 0.33; 95% CI:0.11-0.96; P=0.042).
CONCLUSIONS:
S wave in lead V6 can predict low response to CRT and poor long-term outcome.
Copyright © 2019. Published by Elsevier Inc.
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Intracardiac flow analysis in cardiac resynchronization therapy: A new challenge?
Echocardiography2019 Sep;():. doi: 10.1111/echo.14477.
Mele Donato, Smarrazzo Vittorio, Pedrizzetti Gianni, Bertini Matteo, Ferrari Roberto,
Abstract
In the past years, assessment of cardiac function has become possible through the analysis of intracardiac flow dynamics, performed noninvasively using phase-contrast cardiac magnetic resonance and contrast and noncontrast ultrasound techniques. From 2013 to 2019, 9 echocardiographic investigations have considered 215 patients with cardiac resynchronization therapy (CRT) as a model for assessing flow dynamics within the left ventricle. Preliminary results have been reported about the acute hemodynamic effects of CRT and programming of the CRT device, showing the potential of an approach based on analysis of intracardiac flows. At present, there are only scarce data on the capability of intracardiac flow dynamics to predict LV remodeling after CRT and no information on clinical outcome prediction. Future investigations should be aimed at clarifying the mechanisms and impact of maladaptive intracardiac vortex dynamics on progressive LV remodeling as well as the prognostic meaning of implanted CRT device based on cardiac flow analysis.
© 2019 Wiley Periodicals, Inc.
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How to upgrade a leadless pacemaker to cardiac resynchronization therapy.
J Cardiovasc Electrophysiol2019 Sep;():. doi: 10.1111/jce.14169.
Lacour Thibaud, Bisson Arnaud, Bernard Anne, Fauchier Laurent, Babuty Dominique, Clementy Nicolas,
Abstract
INTRODUCTION:
We sought to develop an efficient method to upgrade pacing-induced cardiomyopathy (PICM) patients from a leadless pacemaker (LPM) to cardiac resynchronization therapy.
METHODS AND RESULTS:
Three consecutive patients with chronic atrial fibrillation, implanted with a leadless pacemaker, with permanent right ventricular pacing, and who developed left ventricular systolic dysfunction due to PICM, were included. A conventional biventricular pacemaker with two different coronary sinus leads, one used for left lateral ventricular pacing, one for early right ventricular sensing, was implanted. It was then synchronized with the LPM working as the right ventricular pacing lead to provide biventricular pacing. The upgrading technique was feasible in all cases, without any peri-operative complication. All patients had an improved clinical status during follow-up.
CONCLUSION:
This new upgrading technique allows efficient cardiac resynchronization therapy in leadless pacemaker patients, while preventing tricuspid valve crossing and providing an increased battery longevity. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Utility of diastolic dyssynchrony in the setting of cardiac resynchronization therapy.
J Nucl Cardiol
