scholarly journals Cardiac resynchronisation therapy optimisation of interventricular delay by the systolic dyssynchrony index: A comparative, randomised, 12-month follow-up study

2019 ◽  
Vol 60 (1) ◽  
pp. 16-25 ◽  
Author(s):  
Jiri Vondrak ◽  
Dan Marek ◽  
Jan Vecera ◽  
Klara Benesova ◽  
Jan Matejka
Keyword(s):  
Cardiac Resynchronisation Therapy ◽  
Follow Up Study ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Dyssynchrony Index

The Significance of Renal Function in Response to Cardiac Resynchronisation Therapy – The Piece of a Much Larger Puzzle

2020 ◽  
Vol 18 ◽  
Author(s):  
Agnieszka Dębska-Kozłowska ◽  
Izabela Warchoł ◽  
Marcin Książczyk ◽  
Andrzej Lubiński
Keyword(s):  
Renal Function ◽  
Nyha Class ◽  
Heart Association ◽  
Cardiac Resynchronisation Therapy ◽  
Study Groups ◽  
Creatinine Concentration ◽  
Significant Difference ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Background: Although cardiac resynchronisation therapy (CRT) is an important player in the treatment of heart failure (HF) patients, the proportion of CRT patients with no improvement in either echocardiographic or clinical parameters remains consistently high and accounts for about 30% despite meeting CRT implantation criteria. Furthermore, in patients suffering from HF, renal dysfunction accounts for as many as 30-60%. Accordingly, CRT may improve renal function inducing a systemic haemodynamic benefit leading to increased renal blood flow. Objectives: The aim of the present study was to evaluate the importance of renal function in response to resynchronisation therapy during a 12-month follow-up period. Materials and methods: The study consisted of 46 HF patients qualified for implantation of cardiac resynchronisation therapy defibrillator (CRT-D). A CRT responder is defined as a person without chronic HF exacerbations during observation whose physical efficiency has improved owing to New York Heart Association (NYHA) class improvement ≥1. Results: A statistically significant difference was noted between responders and non-responders regarding creatinine level at the 3rd month (p=0.04) and, particularly, at the 12th month (p=0.02) of follow-up (100±23 vs 139±78 μmol/l). Moreover, there was a remarkable difference between both study groups with regard to GFR CKD-EPI (glomerular filtration rate (GFR) assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula) at the 6th (p=0.03) and 12th month (p=0.01) of follow-up. The reference values for initial creatinine concentrations (101 μmol/l) as well as GFR CKD-EPI (63 ml/min/1.73m2 ) were empirically evaluated to predict favourable therapeutic CRT response. Conclusions: Predictive value of GFR CKD-EPI and creatinine concentration for a positive response to CRT were found relevant.

scholarly journals DIAGNOSIS OF ATRIAL FIBRILLATION IN HEART FAILURE PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATOR OR CARDIAC RESYNCHRONISATION THERAPY.

2021 ◽  
Author(s):  
Barbara Dominik ◽  
Mitkowski Przemyslaw ◽  
Wojciech Zorawski ◽  
Ilona Kowalik ◽  
Adam Ciesielski
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Resynchronisation Therapy ◽  
Predisposing Factors ◽  
Study Group ◽  
Cardioverter Defibrillator ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

IntroductionImplantable cardioverter defibrillators register various types of arrhythmias. Thus they can be exploited to better identify patients with atrial fibrillation episodes and increase the proportion of patients who may benefit from implementation of pharmacological prophylaxis of thromboembolic events, most of which it turns out are asymptomatic.Material and methodsAssessment of the frequency, symptoms and predisposing factors for the occurrence of atrial fibrillation episodes in patients with implanted ICD (implantable cardioverter defibrillator) and CRT-D (cardiac resynchronisation therapy with defibrillator) based on the analysis of intracardiac electrocardiograms (IEGM) records. The study included 174 consecutive outpatient cases with heart failure, sinus rhythm and Implanted Cardioverter Defibrillator and Cardiac Resynchronisation Therapy with Defibrillator. Control visits with analysis of IEGM records occurred every three months. During mean follow-up of 20 months, 901 visits were carried out. 147 patients had at least one year of follow-up.ResultsAtrial fibrillation episodes in the study group occurred in 54 (31.0%) of patients and 71.4% were asymptomatic. Predisposing factors were: history of paroxysmal atrial fibrillation (37.0% vs 13.3%, p ˂ 0.001), atrioventricular conduction abnormalities (42.6% vs. 20.0%, p = 0.002), intraventricular conduction abnormalities (59.3% vs 40.8%, p = 0.02) and more severe mitral regurgitation (7.4% vs 0.8%, p = 0.04). Chronic renal disease was a risk factor for death in the study group. No stroke occurred during the study.ConclusionsEpisodes of paroxysmal AF in patients with systolic heart failure and implanted cardioverter-defibrillator systems are quite common. The majority of the episodes recorded in the study were asymptomatic.

P534Central sleep apnea in pacing-induced cardiomyopathy: prevalence, improvement by upgrading to cardiac resynchronisation therapy and impact on structural responder rates and long-term outcome

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Barbieri ◽  
A Adukauskaite ◽  
A Heidbreder ◽  
E Brandauer ◽  
M Bergmann ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Right Ventricular Pacing ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Abstract Funding Acknowledgements ÖNB Jubiläumsfondsprojekt Nr. 15974, ISR grant by Boston Scientific, St. Paul, MN, USA Background Central sleep apnea (CSA) in pacing induced cardiomyopathy (PICM) is poorly studied. Specifically, it is unknown whether upgrading from right ventricular pacing (RVP) to cardiac resynchronisation therapy (CRT) improves CSA. Methods Fifty-three patients with impaired left ventricular ejection fraction, frequent right ventricular pacing due to high-grade atrioventricular block and heart failure symptoms despite optimal medical therapy underwent upgrading to CRT. Within one month after left ventricular lead implantation (but still not activated), sleep apnea was assessed in all participants by single-night polysomnography (PSG). Nineteen patients with moderate or severe CSA defined by an apnea hypopnea index (AHI) > 15 events per hour were re-scheduled for a follow up PSG 3-5 months after initiation of cardiac resynchronization therapy. Of this cohort, thirteen patients with stable mild heart failure agreed to be randomized to CRT versus RVP in a cross-over design. Results CSA (AHI > 5 events per hour) was diagnosed in 26 (49.1%), OSA in 16 (30.2%) patients suffering from PICM . Eleven (20.8%) patients did not have any form of sleep apnea. Moderate to severe CSA (AHI > 15 events per hour) was significantly improved (without specific CPAP therapy) by 102 (96-172) days of CRT: AHI decreased from 39.4 events per hour at baseline to 21.6 by CRT (p < 0.001). Furthermore, CRT led to a substantial decrease in left ventricular endsystolic volumes: baseline 141 ml (103-155), significant improvement under CRT (102 ml, 65-138; p < 0.001), whereas no effect with ongoing RV-pacing (147 ml, 130-161; p = 0.865). Preexistent CSA did not affect the structural response of CRT (56.5% in patients with CSA, 62.5% of patients with obstructive sleep apnea and 54.5% in patients without sleep apnea; p = 0.901) and had no impact on major adverse cardiac events (p = 0.412) and/or survival (p = 0.623) during long-term follow-up. Conclusions CSA is highly prevalent in patients with PICM and is significantly improved by upgrading to CRT. Preexistent CSA does not hamper structural improvement and long-term outcome after upgrading to CRT. Thus, CSA seems to occur as a consequence of PICM, rather than as a pathophysiological mediator. Abstract Figure.

scholarly journals Cardiac resynchronisation therapy in Chagas disease: results in 82 pp during 2 years of follow-up

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P3201-P3201
Author(s):  
J. R. Castro Dorticos ◽  
J. R. Castro Dorticos ◽  
J. Velasco Pucci ◽  
S. Dos Santos Galvao Filho ◽  
L. Leite ◽  
...  
Keyword(s):  
Chagas Disease ◽  
Cardiac Resynchronisation Therapy ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

scholarly journals Influence of cardiac resynchronisation therapy combined with other interventional methods on the neuro-immuno-humoral status of patients with ischemic cardiomyopathy

2015 ◽  
Vol 18 (4) ◽  
pp. 151
Author(s):  
V. A. Kuznetsov ◽  
T. N. Yenina ◽  
P. V. Shebeko ◽  
A. Yu. Rychkov ◽  
T. I. Petelina ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Systemic Inflammation ◽  
Plasma Levels ◽  
Ischemic Cardiomyopathy ◽  
Cardiac Resynchronisation Therapy ◽  
Group I ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Group Ii

The purpose of this research was to study the influence of cardiac resynchronisation therapy (CRT) in combination with other interventional techniques used during one hospital stay on systemic inflammation and neurohumoral status in patients with ischemic cardiomyopathy (ICMP). The best response to CRT was estimated in 59 patients with ICMP (mean age 588.3 years, 92% males).The patients were divided into 2 groups: Group I patients (n=48) included those with 'pure' CRT, while Group II patients (n=11) underwent CRT, coronary stenting (CS), radiofrequency atrioventricular node ablation (RFA). All interventions were performed during one hospital stay. There were no significant differences in demographic characteristics between the groups. Mean follow-up was 6.0 [2.0; 16.0] months. Plasma levels of Nt-proBNP, interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor-alpha (TNF-), C-reactive protein (CRP), urinary levels of epinephrine and norepinephrine (NE) were measured. The patients with a decrease in left ventricular end-systolic volume 15% were classified as responders. There were no significant differences in responders between the groups and was equal to 32 (67%) and 9 (82%) respectively. At baseline the plasma levels of IL-6 and CRP were higher in Group II as compared with Group I: 9.3 [4.6; 14.8] vs 3.3 [1.9; 5.2] pg/ml, respectively (p=0.004) and 8.0 [6.0; 10.2] vs 3.2 [1.5; 5.1] mg/ml respectively (p=0.065). At baseline the urinary NE level was lower in Group II as compared with Group I: 30.0 [17.6; 34.4] vs 58.0 [38.5; 74.6] nmol/ml respectively (p=0.023). During follow-up in Group I only Nt-proBNP level (p=0.015) tended to decrease. In Group II the levels of IL-6 (p=0.038), TNF- (p=0.024), CRP (p=0.031) decreased and NE level increased (p=0.038). Thus, the combination of CRT with other interventions is associated with a decrease in systemic inflammation and an impact on the neurohumoral status of patients with ICMP as compared with 'pure' CRT.

Predictors of functional mitral regurgitation improvement during a short-term follow-up after cardiac resynchronisation therapy

2016 ◽  
pp. 665-673 ◽  
Author(s):  
Barbara Brzezińska ◽  
Krystyna Łoboz-Grudzień ◽  
Krystian Wita ◽  
Katarzyna Mizia-Stec ◽  
Zbigniew Gąsior ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Cardiac Resynchronisation Therapy ◽  
Functional Mitral Regurgitation ◽  
Short Term ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

scholarly journals Electrocardiographic Parameters as Predictors of Response to Cardiac Resynchronization Therapy

2018 ◽  
Vol 6 (2) ◽  
pp. 297-302 ◽  
Author(s):  
Lidija Poposka ◽  
Vladimir Boskov ◽  
Dejan Risteski ◽  
Jane Taleski ◽  
Filip Janusevski ◽  
...  
Keyword(s):  
Selection Criteria ◽  
Cardiac Resynchronisation Therapy ◽  
Cardiac Resynchronization ◽  
Predictors Of Response ◽  
Significant Difference ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Electrocardiographic Parameters ◽  
Strict Selection

INTRODUCTION: Although strict selection criteria are used to select patients for cardiac resynchronisation therapy, up to 30% of patients do not have a positive clinical response.PATIENTS: A total of 102 consecutive patients who had biventricular pacemaker/defibrillator (CRT-P or CRT-D) implanted were enrolled in this prospective observational study.RESULTS: During the average follow-up period of 24.3 months 5 patients died and 17 (16.7%) patients were hospitalised with the symptoms of heart failure; 75 (73.5%) patients were responders based on the previously defined criteria. Responders in the group of LBBB patients kept the significant difference in a computed variable (S1 + R6) - (S6 + R1) and R6/S6 ratio. Responders in non-LBBB patients kept the significant difference only in the height of R waves in V6. The R6/S6 ratio tended to be higher, but it did not reach a statistical significance.CONCLUSION: None of the tested ECG parameters stands out as an independent predictor of response to cardiac resynchronisation therapy, but some of them were different in responder-compared to the non-responder group. The amplitude of R wave in V6, higher R/S ratio in V6 and higher computed variable (S1 + R6) - (S6 + R1) may predict the likelihood of response to CRT therapy in both LBBB-patients and non-LBBB patients.

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