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Pubblicazioni recenti - cardiac resynchronization
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Clinical risk factors for the prediction of acute kidney injury post cardiac resynchronization therapy in an elderly population.
Int J Cardiol Heart Vasc2020 Oct;30():100594. doi: 10.1016/j.ijcha.2020.100594.
Marschall Alexander, Del Castillo Carnevalli Hugo, De la Flor Merino José Carlos, Rubio Alonso Miguel, De Miguel Gómez Ramón, Palazuelos Molinero Jorge, Goncalves Sánchez María de Fatima, López Soberon Edurne, Fernández Pascual Concepción, Concepción Suárez Ricardo, Carballeira Puentes Dámaris, Delgado Calva Freddy Andrés, Álvarez Antón Salvador, Martí Sánchez David,
Abstract
Background:
Data on the occurrence of acute kidney injury (AKI) in patients undergoing cardiac resynchronization therapy (CRT) implantation is limited and no previous studies investigated its impact in an elderly population. CRT implantation requires a relatively low quantity of contrast medium. Previous studies, however, focused primarily on contrast medium as etiological factor for AKI, reporting a high incidence (8-14%). The high incidence of AKI in absence of use of substantial amounts of contrast volume, suggests the existence of other factors that contribute to AKI.
Objectives:
To determine the predictive value of patient and procedure-related risk factors for the occurrence of AKI post CRT, as well as the AKIs impact on length of in-hospital stay (LOS) and 1-year mortality.
Methods:
Retrospective observational study, including consecutive patients that underwent CRT implantation in a single center.
Results:
60 patients with a mean age of 77 ± 8.4 years were included in the study and Twelve (20%) developed AKI. Prior renal insufficiency (p = 0.03; OR = 15.4), larger procedure time (p = 0.02; OR = 1.03), intra-operative hypotension (p < 0.01; OR = 1.72) and bleeding (p = 0.01 (OR = 7.86), showed to predict AKI significantly. AKI associated a significantly longer LOS (12 vs 3 days, p < 0.01). No significant differences regarding 1-year mortality were observed (p = 0.19; HR = 2.7 for patients with AKI).
Conclusions:
AKI is a frequent complication of CRT implantation with an important impact on in-hospital stay, especially in the elderly. In addition to contrast administration, clinical factors could play a significant role in the occurrence of AKI.
© 2020 The Author(s).
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Electrical synchronization achieved by multipoint pacing combined with dynamic atrioventricular delay.
J Interv Card Electrophysiol2020 Aug;():. doi: 10.1007/s10840-020-00842-7.
O'Donnell David, Wisnoskey Brian, Badie Nima, Odgers Lisa, Smart Taylah, Ord Michelle, Lin Tina, Mangual Jan O, Cranke Gary, McSpadden Luke C, Ryu Kyungmoo, Bianchi Valter, D'Onofrio Antonio, Pappone Carlo, Calò Leonardo, Chow Anthony, Betts Tim R, Thibault Bernard, Varma Niraj,
Abstract
PURPOSE:
Multipoint pacing (MPP) improves left ventricular (LV) electrical synchrony in cardiac resynchronization therapy (CRT). SyncAV automatically adjusts atrioventricular delay (AVD) according to intrinsic AV intervals and may further improve synchrony. Their combination has not been assessed. The objective was to evaluate the improvement in electrical synchrony achieved by SyncAV combined with MPP in an international, multicenter study.
METHODS:
Patients with LBBB undergoing CRT implant with a quadripolar lead (Abbott Quartet?) were prospectively enrolled. QRS duration (QRSd) was measured by blinded observers from 12-lead ECG during: intrinsic conduction, BiV pacing (conventional biventricular pacing, nominal static AVD), MPP (2 LV cathodes maximally spaced, nominal static AVD), BiV?+?SyncAV, and MPP?+?SyncAV. All SyncAV offsets were individualized for each patient to yield the narrowest QRSd during BiV pacing. QRSd changes were compared by ANOVA and post hoc Tukey-Kramer tests.
RESULTS:
One hundred and three patients were enrolled (65.7?±?12.1 years, 67% male, 37% ischemic, EF 26.4?±?6.5%, PR 190.3?±?39.1 ms). Relative to intrinsic conduction (QRSd of 165?±?16 ms), BiV reduced QRSd by 11.9% to 145?±?18 ms (P
CONCLUSION:
SyncAV can significantly improve acute electrical synchrony beyond conventional CRT, with further improvement achieved by superimposing MPP.
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Second European Society of Cardiology Cardiac Resynchronization Therapy Survey: the Italian cohort.
J Cardiovasc Med (Hagerstown)2020 Sep;21(9):634-640. doi: 10.2459/JCM.0000000000001035.
Botto Giovanni L, Gasparini Maurizio, Brasca Francesco M A, Casale Maria C, Occhetta Eraldo, Racheli Marco, Bertaglia Manuel, Zanon Francesco, Zardini Marco, Rapacciuolo Antonio, Mascioli Giosuè, Curnis Antonio, Metra Marco, Normand Camilla, Dickstein Kenneth, Linde Cecilia,
Abstract
AIM:
Adherence to guidelines was not homogeneous in Europe, according to the survey on cardiac resynchronization therapy conducted in 2008-2009. The aim of our study was to compare the results in the Italian and European cohorts of the Second European Cardiac Resynchronization Therapy Survey.
METHODS:
Patients' characteristics, procedural data and follow-up were collected. Italian records were compared with European countries.
RESULTS:
Italian hospitals enrolled 526 patients. The italian cohort was older (71.6?±?9.5 vs. 68.4?±?10.8; P?II 47.2 vs. 59.6%; P?
CONCLUSION:
The survey demonstrates important similarities as well as substantial differences regarding most of the aspects evaluated. Efforts to implement adherence to guidelines will be endorsed in Italy.
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Second European Society of Cardiology Cardiac Resynchronization Therapy Survey: the Italian cohort.
J Cardiovasc Med (Hagerstown)2020 Jul;():. doi: 10.2459/JCM.0000000000001035.
Botto Giovanni L, Gasparini Maurizio, Brasca Francesco M A, Casale Maria C, Occhetta Eraldo, Racheli Marco, Bertaglia Manuel, Zanon Francesco, Zardini Marco, Rapacciuolo Antonio, Mascioli Giosuè, Curnis Antonio, Metra Marco, Normand Camilla, Dickstein Kenneth, Linde Cecilia,
Abstract
AIM:
Adherence to guidelines was not homogeneous in Europe, according to the survey on cardiac resynchronization therapy conducted in 2008-2009. The aim of our study was to compare the results in the Italian and European cohorts of the Second European Cardiac Resynchronization Therapy Survey.
METHODS:
Patients' characteristics, procedural data and follow-up were collected. Italian records were compared with European countries.
RESULTS:
Italian hospitals enrolled 526 patients. The italian cohort was older (71.6?±?9.5 vs. 68.4?±?10.8; P?II 47.2 vs. 59.6%; P?
CONCLUSION:
The survey demonstrates important similarities as well as substantial differences regarding most of the aspects evaluated. Efforts to implement adherence to guidelines will be endorsed in Italy.
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Rapid-rate Non-sustained Ventricular Tachycardias in High-Risk Dilated Cardiomyopathy Patients.
Pacing Clin Electrophysiol2020 Jul;():. doi: 10.1111/pace.14027.
Lee Wei-Chieh, Masaya Watanabe, Yokoshiki Hisashi, Temma Taro, Kamada Rui, Takahashi Masayuki, Hagiwara Hikaru, Takahashi Yumi, Anzai Toshihisa,
Abstract
AIMS:
Non-sustained ventricular tachycardia (NSVT) occurs frequently in patients with dilated cardiomyopathy (DCM), especially in high-risk patients. The role of rapid-rate NSVT (RR-NSVT) documented by an implantable cardioverter defibrillator (ICD) in DCM patients has not been fully explored. This study aimed to determine the relationship between RR-NSVT and the occurrence of ventricular tachyarrhythmias (VTAs) in DCM patients with ICD.
METHODS:
From December 2000 to December 2017, 136 DCM patients received ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation for primary or secondary prevention of VTAs. Based on the occurrence of documented RR-NSVT, patients were classified into RR-NSVT (-) or RR-NSVT (+) groups.
RESULT:
During the median follow-up of 4.5 years, 50.0% (68/136) of patients experienced ? 1 episode, and 25.0% (34/136) of patients experienced ? 3 episodes of RR-NSVT. Event-free survival for VTAs was significantly higher in the RR-NSVT (-) group whereas those for heart failure admission and cardiovascular mortality were comparable between groups. In the multivariate cox regression analysis, any RR-NSVT showed a positive association with the occurrence of VTAs (HR: 5.087; 95% CI: 2.374-10.900; p<0.001). In RR-NSVT (+) patients, a cluster (? 3 times/6 months) and frequent pattern (? 3 runs/day) of RR-NSVT were observed in 42.6% (29/68) and 30.9% (21/68) of patients, respectively, who showed further increased incidence of VTAs.
CONCLUSION:
In DCM patients with ICD/CRT-D, 50.0% experienced at least 1 episode of RR-NSVT. RR-NSVT documentation showed a positive association with subsequent occurrence of VTAs, suggesting the importance of constructive arrhythmia management for patients with RR-NSVT. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Pseudo-loss of left ventricular capture due to interventricular crosstalk.
J Cardiovasc Electrophysiol2020 Jul;():. doi: 10.1111/jce.14700.
Zagkli Fani, Despotopoulos Stefanos, Chiladakis John,
Abstract
An 82-year-old man was admitted to our clinic for evaluation of chronic heart failure (CHF) often punctuated by acute exacerbations. The patient had undergone placement of a biventricular implantable cardioverter-defibrillator (ICD) capable of cardiac resynchronization therapy (CRT-D; Unify Quadra 3251-40Q; St. Jude Medical, St Paul, MN) six years ago in a tertiary centre due to nonischemic cardiomyopathy, left bundle branch block (LBBB) QRS pattern of QRS duration 250 ms and drug refractory congestive heart failure with left ventricular ejection fraction (LVEF) of 25%. St. Jude Medical leads had been implanted using an Durata? 7120Q passive right ventricular (RV) lead in the apex, an Tendril? 1888 bipolar screw-in lead in the right atrium (RA) and an Quartet? 1458Q quadripolar LV lead in an anterolateral coronary vein. Follow-up in-person outpatient visits occurred regularly at another hospital. Overall, the non-pacemaker dependent patient had unchanged NYHA functional class III-IV symptomatology and similar LVEF. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Spectral Analysis and Mutual Information Estimation of Left and Right Intracardiac Electrograms during Ventricular Fibrillation.
Sensors (Basel)2020 Jul;20(15):. doi: E4162.
Pérez-Gutiérrez Milton Fabricio, Sánchez-Muñoz Juan José, Erazo-Rodas Mayra, Guerrero-Curieses Alicia, Everss Estrella, Quesada-Dorador Aurelio, Ruiz-Granell Ricardo, Ibáñez-Criado Alicia, Bellver-Navarro Alex, Rojo-Álvarez José Luis, García-Alberola Arcadi,
Abstract
Ventricular fibrillation (VF) signals are characterized by highly volatile and erratic electrical impulses, the analysis of which is difficult given the complex behavior of the heart rhythms in the left (LV) and right ventricles (RV), as sometimes shown in intracardiac recorded Electrograms (EGM). However, there are few studies that analyze VF in humans according to the simultaneous behavior of heart signals in the two ventricles. The objective of this work was to perform a spectral and a non-linear analysis of the recordings of 22 patients with Congestive Heart Failure (CHF) and clinical indication for a cardiac resynchronization device, simultaneously obtained in LV and RV during induced VF in patients with a Biventricular Implantable Cardioverter Defibrillator (BICD) Contak Renewal IV (Boston Sci.). The Fourier Transform was used to identify the spectral content of the first six seconds of signals recorded in the RV and LV simultaneously. In addition, measurements that were based on Information Theory were scrutinized, including Entropy and Mutual Information. The results showed that in most patients the spectral envelopes of the EGM sources of RV and LV were complex, different, and with several frequency peaks. In addition, the Dominant Frequency (DF) in the LV was higher than in the RV, while the Organization Index (OI) had the opposite trend. The entropy measurements were more regular in the RV than in the LV, thus supporting the spectral findings. We can conclude that basic stochastic processing techniques should be scrutinized with caution and from basic to elaborated techniques, but they can provide us with useful information on the biosignals from both ventricles during VF.
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Coronary Sinus Phlebography in Cardiac Resynchronization Therapy Patients: Identifying and Solving Demanding Cases.
J Innov Card Rhythm Manag2020 Jul;11(7):4161-4170. doi: 10.19102/icrm.2020.110703.
Alves Silva Lenine Angelo, de Souza Meira Enoch Brandão, Curimbaba Jefferson, Pimenta João A,
Abstract
Cardiac resynchronization therapy (CRT) improves symptoms and reduces morbidity and mortality in select heart failure patients but remains challenging to deploy widely because of difficult or unsuccessful coronary sinus (CS) access in up to 10% to 15% of patients. This report describes the radiological and anatomical aspects for improving CS catheterization and left ventricular (LV) lead positioning, focusing on the radioscopic and anatomical aspects, based on phlebography, to identify demanding cases in patients with dilated cardiomyopathy referred for CRT implantation. Anatomical and radiological aspects were explored in the anteroposterior, 30° left anterior oblique, and 30° right anterior oblique (RAO) views. In total, 117 phlebographies were performed in 39 consecutive procedures (one reintervention). Access to the CS was successful 37 times (94.9%). The most difficult cases were complicated by issues related to the altered spatial orientation of the CS ostium toward the tricuspid annular plane (TAP), which was best perceived in the 30° RAO projection and occurred in 37% of patients. One of two catheterization failures that occurred was caused by anomalous coronary venous drainage into the left atrium. Final LV lead positioning was successful in 36 (92.3%) of 39 procedures. More severe heart failure and worse LV ejection fraction did not translate into greater difficulty in LV lead implantation. As such, understanding anatomical and radiological relationships is the key to successful LV lead positioning. RAO projection can be particularly useful in the assessment of demanding CRT implant cases, especially when the CS ostium pointed to the TAP.
Copyright: © 2020 Innovations in Cardiac Rhythm Management.
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LV Only Pacing-Mediated Electrical Storm with Cardiac Resynchronization Therapy Managed by Simultaneous Biventricular Pacing.
J Cardiovasc Electrophysiol2020 Jul;():. doi: 10.1111/jce.14697.
Kella Danesh K, Kantipudi Charan, Stambler Bruce S,
Abstract
Ventricular arrhythmia (VA) is a rare complication of CRT (Cardiac Resynchronization Therapy). Little is known about ventricular proarrhythmia related to the pacing vector of CRT. This case report describes the elimination of ventricular arrythmia using biventricular pacing in a patient with VT-storm related to LV only pacing as part of the AdaptivCRT? algorithm (Medtronic Inc). Simultaneous biventricular pacing was effective in eliminating polymorphic ventricular tachycardia. Changing the pacing vector is a non-invasive treatment strategy that should be considered to manage VA due to CRT. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Electrocardiographic patterns predictive of Left Bundle Branch Block correction with His Bundle Pacing.
Pacing Clin Electrophysiol2020 Jul;():. doi: 10.1111/pace.14021.
Moriña-Vázquez Pablo, Moraleda-Salas Maria Teresa, Arce-León Álvaro, Fernández-Gómez Juan Manuel, Venegas-Gamero José,
Abstract
INTRODUCTION:
Permanent His bundle pacing (p-HBP) could be an alternative for traditional cardiac resynchronization therapy (CRT), but an important limitation is that p-HBP cannot always correct the left bundle branch block (LBBB). The purpose of this article is to assess electrocardiographic patterns of LBBB that can predict electrocardiographic response (QRS narrowing) to His bundle pacing.
METHODS:
We designed a prospective descriptive study of patients with LBBB and CRT indication proposed for CRT by p-HBP. We analyzed the correlation between the different electrocardiographic patterns and the correction of conduction disturbance (LBBB).
RESULTS:
We included 70 patients. Pacing at the location where His bundle electrogram was recorded achieved narrowed the QRS in 81.4% (n = 57). Basically, we identified two electrocardiographic patterns in lead V1: QS or rS. The QS pattern was a sensitivity of 56%, a specificity of 84.6% and a positive predictive value (PPV) of 94.1% to predict the correction of the LBBB (AUC 0.70). In patients with rS pattern, a ratio between the descending and the ascending S wave component duration ? 0.64, was a very good predictor of the correction of the LBBB (AUC 0.968); with a value ? 0.64, the sensitivity, specificity, and PPV was 92%, 100% and 100% respectively.
CONCLUSIONS:
In patients with LBBB and CRT indication, the QS pattern in lead V1 predicts the correction of the QRS with HBP. In the case of rS pattern in lead V1, the ratio descending/ascending S wave component duration has a strong correlation with the LBBB correction. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Retrieval of a retained guide wire from the deltoid muscle-A rare and delayed presentation post cardiac resynchronization therapy lead replacement.
J Card Surg2020 Jul;():. doi: 10.1111/jocs.14901.
Yadav Vimal Kant, Jhanwar Shailesh, Goyal Brij Mohan, Patel Surendra,
Abstract
BACKGROUND AND AIMS:
Fracture and retention of a guidewire after cardiac resynchronization therapy device implantation has not been reported in the literature so far, although it is an uncommon but known complication during cardiac interventions like percutaneous coronary interventions and other cardiac catheterization procedures.
METHODS:
A 53 years old female patient presented with severe pain over the left arm and shoulder for a period of 1 to 2 days. The patient had a history of dilated cardiomyopathy with severe left ventricular dysfunction and underwent cardiac resynchronization therapy device implant 3 years back with subsequent lead replacement 6 months back due to lead dysfunction. On evaluation, a coronary guidewire which might have fractured and been retained inadvertently during previous surgical procedure, was discovered in her deltoid muscle. Her symptoms were attributed to the guide wire which may have been aggravated by the movements of her arm. Emergency surgical exploration was done and the guidewire was removed.
RESULTS AND CONCLUSION:
We are reporting a case of unlikely and unusual delayed presentation of retained intervention guide-wire post cardiac resynchronization therapy, which was retrieved from the left deltoid muscle.
© 2020 Wiley Periodicals LLC.
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Machine learning versus conventional clinical methods in guiding management of heart failure patients-a systematic review.
Heart Fail Rev2020 Jul;():. doi: 10.1007/s10741-020-10007-3.
Bazoukis George, Stavrakis Stavros, Zhou Jiandong, Bollepalli Sandeep Chandra, Tse Gary, Zhang Qingpeng, Singh Jagmeet P, Armoundas Antonis A,
Abstract
Machine learning (ML) algorithms "learn" information directly from data, and their performance improves proportionally with the number of high-quality samples. The aim of our systematic review is to present the state of the art regarding the implementation of ML techniques in the management of heart failure (HF) patients. We manually searched MEDLINE and Cochrane databases as well the reference lists of the relevant review studies and included studies. Our search retrieved 122 relevant studies. These studies mainly refer to (a) the role of ML in the classification of HF patients into distinct categories which may require a different treatment strategy, (b) discrimination of HF patients from the healthy population or other diseases, (c) prediction of HF outcomes, (d) identification of HF patients from electronic records and identification of HF patients with similar characteristics who may benefit form a similar treatment strategy, (e) supporting the extraction of important data from clinical notes, and (f) prediction of outcomes in HF populations with implantable devices (left ventricular assist device, cardiac resynchronization therapy). We concluded that ML techniques may play an important role for the efficient construction of methodologies for diagnosis, management, and prediction of outcomes in HF patients.
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Effect of QRS area reduction and myocardial scar on the hemodynamic response to cardiac resynchronization therapy.
Heart Rhythm2020 Jul;():. doi: S1547-5271(20)30683-4.
Okafor Osita, Umar Fraz, Zegard Abbasin, van Dam Peter, Walton Jamie, Stegemann Berthold, Marshall Howard, Leyva Francisco,
Abstract
BACKGROUND:
Vectorcardiographic QRS area (QRS ) predicts clinical outcomes after cardiac resynchronization therapy (CRT). Myocardial scar adversely affects clinical outcomes after CRT.
OBJECTIVE:
To determine whether, in patients with an ideally deployed quadripolar left ventricular (LV) lead (QUAD), reducing QRS leads to an acute hemodynamic response (AHR); and, whether scar affects this interaction.
METHODS:
Patients (n=26, aged 69.2 ± 9.12 years [mean ± SD]) underwent assessment of the maximum rate of change of LV pressure (?LV dP/dt) during CRT using various LV pacing locations (LVPLs). A cardiac magnetic resonance (CMR) scan was used to localize LV myocardial scar.
RESULTS:
Interindividually, ?QRS (area under the receiver-operating characteristic curve AUC]: 0.81, p<0.001) and change in QRS duration (?QRSd) (AUC: 0.76, p<0.001) predicted ?LV dP/dt after CRT. Scar burden correlated with ?QRS (r=0.35, p=0.003), ?QRS (r=0.35, p=0.003) and ?QRSd (r=0.46, p<0.001). A reduction in QRS was observed with LVPLs remote from scar (-3.28 ± 38.1?Vs) or in LVPLs in patients with no scar at all (-43.8 ± 36.8 ?Vs), whereas LVPLs over scar increased QRS (22.2 ± 58.4 ?Vs) (p<0.001 for all comparisons). LVPLs within 1 scarred LV segment were associated with a lower ?LV dP/dt (-2.21 ± 11.5%) than LVPLs remote from scar (5.23 ± 10.3%, p<0.001) or LVPLs in patients with no scar at all (10.2 ± 7.75%) (both p<0.001).
CONCLUSION:
Reducing QRS improves the AHR to CRT. Myocardial scar adversely affects ?QRS and the AHR. These findings may support the use of ?QRS and CMR in optimizing CRT using QUAD.
Copyright © 2020. Published by Elsevier Inc.
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A Ghost Left Behind After Transvenous Lead Extraction: A Finding to be Feared.
Am J Case Rep2020 Jul;21():e924243. doi: 10.12659/AJCR.924243.
El-Zein Rayan S, Stelzer Mitchell, Hatanelas John, Goodlive Thomas W, Amin Anish K,
Abstract
BACKGROUND Following transvenous lead extraction (TLE) for infective endocarditis, a fibrinous remnant, or "ghost", that previously encapsulated the lead may remain. The main aim of this case report was to highlight the importance of identification of ghosts, their negative implications, and the importance of close monitoring. CASE REPORT A 72-year-old male with a history of heart failure with non-ischemic cardiomyopathy and remote cardiac resynchronization therapy defibrillator (CRT-D) placement as well as atrioventricular node ablation for atrial fibrillation presented following a mechanical fall. An initial evaluation revealed methicillin-resistant Staphylococcus aureus bacteremia; the suspected nidus was an indwelling chemotherapy port for non-Hodgkin's lymphoma. Echocardiography demonstrated vegetations on the aortic and mitral valves, and the right atrial device lead concerning for infective endocarditis. After TLE, a temporary transvenous wire was placed. Definitive pacing was then achieved by a Micra leadless pacemaker (LP). We opted with LP technology via the Micra device with plan for subcutaneous implantable cardioverter defibrillator (SICD) implantation to mitigate the risk of infection recurrence. After completion of 6 weeks of antibiotics, a pre-SICD transesophageal echocardiogram identified a 1.3 cm mobile echo-dense "ghost" in the right atrium. SICD was implanted as planned. Following expert consensus, no specific therapy was implemented when the ghost was identified. At 3 months, echocardiography revealed the absence of the ghost. At 1-year follow-up, no infection recurrence was noted. CONCLUSIONS The presence of ghosts after transvenous lead extraction is associated with poor outcome and infection recurrence thus requiring diligent monitoring and serial echocardiography as optimal management is yet to be defined.
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A novel index combining diastolic and systolic tissue Doppler parameters for predicting cardiac resynchronization therapy response.
Echocardiography2020 Jul;():. doi: 10.1111/echo.14797.
Ari Selma, Ari Hasan, Tütüncü Ahmet, Çamci Sencer, Vatansever A?ca Fahriye, Melek Mehmet,
Abstract
OBJECTIVE:
Identification of patients who are nonresponders to cardiac resynchronization therapy (CRT) with the use of simple and objective parameters may be helpful in tailoring treatment. The aim of this study is to investigate whether E/(Ea × Sa) could be a predictor of CRT nonresponders (E = early diastolic transmitral velocity, Ea = early diastolic mitral annular velocity, Sa = systolic mitral annular velocity).
METHODS:
In total, 53 heart failure patients were evaluated for this study, and 33 patients were included according to the study criteria. Before and 6 months after CRT-D(CRT with a defibrillator) implantation, E, Ea, and Sa were determined at the medial and lateral mitral annular sites, and the average values were obtained. E/(Ea × Sa) was calculated (medial, lateral, average). The patients were followed for 6 months to monitor their CRT response. A responder was defined as a patient with a reduction in end-systolic volume of ?15% and an increase in 6-minute walking distance of 50 m.
RESULTS:
At a 6-month follow-up, 24 (72.7%) of the 33 patients responded to CRT. At the 6-month follow-up, in the responder group, the E/Ea ratio, lateral mitral, and average E/(Ea × Sa) indices were significantly reduced (P < .01 for all). The baseline lateral mitral, medial mitral, and average E/(Ea × Sa) indices were significantly lower in the responder group than in the nonresponder group (P ? .01 for all). The receiver operating characteristic analysis showed that all the E/(Ea × Sa) indices predict the CRT nonresponder patients. The AUC values were 0.89 (lateral E/(Ea × Sa)), 0.85 (average E/(Ea × Sa)), and 0.77 (medial E/(Ea × Sa)) (P ? .01 for all).
CONCLUSION:
We found that the E/(Ea × Sa) index is a novel predictor of CRT nonresponder patients.
© 2020 Wiley Periodicals LLC.
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His-Bundle Pacing: A Novel Treatment for Left Bundle Branch Block mediated Cardiomyopathy.
J Cardiovasc Electrophysiol2020 Jul;():. doi: 10.1111/jce.14692.
Singh Rajeev, Devabhaktuni Subodh, Ezzeddine Fatima, Simon Joel, Khaira Kavita, Dandamudi Gopi,
Abstract
BACKGROUND:
Chronic left bundle branch block (LBBB) can lead to LBBB mediated cardiomyopathy from left ventricular dysynchrony. His-bundle pacing (HBP) results in direct electrical synchrony using the native His Purkinje system, providing a novel treatment for this cardiomyopathy.
OBJECTIVE:
To assess the feasibility of HBP for cardiac resynchronization therapy (CRT) in LBBB mediated cardiomyopathy patients.
METHODS:
Retrospective database review was conducted on patients who underwent cardiac resynchronization therapy by the HBP capable provider at Indiana University Health and Ezkenazi Hospital from August 2015 to August 2017. A subset of patients who met the pre-defined syndrome criteria of LBBB mediated cardiomyopathy who underwent HBP were identified. Clinical, echocardiographic, and electrocardiographic variables were extracted at baseline and follow-up.
RESULTS:
Nine patients had cardiomyopathy and LBBB. Among those two were lost to follow up. Seven patients were included in the analysis. The average time from device implantation to last follow-up was 14.5 months. Left ventricular ejection fraction improved on average from 25% to 50% (p= 0.0001). Left ventricular end systolic dimension (LVESD) decreased from 47 mm to 37 mm (p = 0.003) and left ventricular end diastolic dimension (LVEDD) decreased from 55 mm to 48 mm (p= 0.03). QRS duration with HBP-CRT decreased from 152ms to 115ms. New York Heart Association (NYHA) classification improved from an average of 2.7 to 2.
CONCLUSION:
His-bundle pacing is a viable technique for pursuing cardiac resynchronization therapy in patients with LBBB mediated cardiomyopathy. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Cardiac resynchronization therapy setting personalization utilizing noninvasive hemodynamics.
Heart Lung2020 Jul;():. doi: S0147-9563(20)30302-2.
Blanchette Michael,
Abstract
BACKGROUND:
Cardiac resynchronization therapy (CRT) has been an important adjunct to goal directed medical therapy in heart failure patients who qualify for this device. Too often, when heart failure patients complain about severe fatigue, beta-blockers are immediately reduced. Personalization of settings, verified by noninvasive hemodynamics, can allow for maximizing medical therapy.
CASE:
A newly diagnosed 40 year-old male presented to the heart failure clinic post hospital discharge with a severely dilated, non-ischemic cardiomyopathy. Even with an ejection fraction (EF) of 15-20%, he reports "feeling great". Increasing medications resulted in excessive fatigue. Non-invasive studies showed an average cardiac index (CI) of 1.5l/min/m. It was decided to personalize his settings. Changes made increased his CI to 3.9l/min/m.
CONCLUSION:
Combining current available technology with noninvasive studies significantly improved his CI and no reduction in beta-blocker therapy was necessary. CRT personalization can be of significant value for the heart failure patient.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Electrocardiographic Analysis for His Bundle Pacing at Implantation and Follow-Up.
JACC Clin Electrophysiol2020 Jul;6(7):883-900. doi: S2405-500X(20)30238-3.
Burri Haran, Jastrzebski Marek, Vijayaraman Pugazhendhi,
Abstract
His bundle pacing (HBP) is steadily gaining interest for providing physiological cardiac stimulation. Careful analysis of the electrocardiogram (ECG) is crucial to confirm capture of conduction tissue, which is a prerequisite for successful HBP at implantation and follow-up. However, interpretation of the ECG with HBP can be challenging. This review provides the reader with practical guidance on how to best use and troubleshoot the 12-lead ECG for HBP in daily clinical practice.
Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.
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Left Bundle Branch Pacing: A Contender Emerges to Challenge the 25-Year Run of Cardiac Resynchronization Therapy.
JACC Clin Electrophysiol -
Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy Using Left Bundle Branch Pacing.
JACC Clin Electrophysiol2020 Jul;6(7):849-858. doi: S2405-500X(20)30266-8.
Huang Weijian, Wu Shengjie, Vijayaraman Pugazhendhi, Su Lan, Chen Xueying, Cai Bingni, Zou Jiangang, Lan Rongfang, Fu Guosheng, Mao Guangyun, Ellenbogen Kenneth A, Whinnett Zachary I, Tung Roderick,
Abstract
OBJECTIVES:
The aim of this study was to assess the feasibility and efficacy of left bundle branch pacing (LBBP) using a novel intraseptal technique to deliver cardiac resynchronization therapy (CRT) in patients with left bundle branch block (LBBB) and nonischemic cardiomyopathy.
BACKGROUND:
His bundle pacing to correct LBBB is a viable alternative approach to achieve CRT but is limited by suboptimal lead delivery and high thresholds.
METHODS:
This was a prospective, multicenter study performed between June 2017 and August 2018 at 6 centers. Patients with nonischemic cardiomyopathy, complete LBBB, and left ventricular ejection fractions (LVEFs) ?50% who had indications for CRT and/or ventricular pacing in whom LBBP was attempted were included. Success rates, QRS duration, LVEF, left ventricular end-systolic volume, and improvement in functional class were assessed.
RESULTS:
LBBP was successful in 61 of 63 patients (97%, mean age 68 ± 11 years, 52.4% men). During LBBP, QRS duration narrowed from 169 ± 16 to 118 ± 12 ms (p < 0.001). Pacing threshold and R-wave amplitude remained stable at 1-year follow-up compared with implantation values (0.5 ± 0.15 V/0.5 ms vs. 0.58 ± 0.14 V/0.5 ms and 11.1 ± 4.9 mV vs. 13.3 ± 5.3 mV, respectively). LVEF increased significantly (33 ± 8% vs. 55 ± 10%; p < 0.001), with a reduction in left ventricular end-systolic volume (123 ± 61 ml vs. 67 ± 39 ml; p < 0.001). LVEF had normalized (?50%) in 75% of patients at 1 year. New York Heart Association functional class improved significantly from 2.8 ± 0.6 at baseline to 1.4 ± 0.6 at 1 year. No deaths or heart failure hospitalizations were observed during follow-up.
CONCLUSIONS:
LBBP is a feasible and effective method for achieving electric resynchronization of LBBB, with resultant improvements in left ventricular structure and function. Low and stable pacing thresholds may be advantageous over His bundle pacing for CRT in patients with LBBB and nonischemic cardiomyopathy.
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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