Left Ventricular Epicardial Lead Implantation for Resynchronisation Therapy Using a Video-Assisted Thoracoscopic Approach

Left ventricular (LV) lead in cardiac resynchronisation therapy (CRT) is the most important and difficult lead to place, leading to abandonment of up to 10–15 % of procedures. Here we discuss various difficulties encountered in percutaneous placement of LV leads and what all can be done to ensure successful placement of the same and to prevent the already compromised patient from the requirement of epicardial lead placement.

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P512New approaches to pacing in children with atrioventricular block

EP Europace ◽

10.1093/europace/euaa162.199 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

E Polyakova ◽

E Kulbachinskaya ◽

I Grishin ◽

S Termosesov ◽

M Shkolnikova

Keyword(s):

Atrioventricular Block ◽

Pacemaker Implantation ◽

Operation Time ◽

Left Ventricular ◽

Video Assisted ◽

Epicardial Lead ◽

Lead Placement ◽

Ventricular Lead ◽

Significant Difference

Abstract Introduction The placement of permanent pacemaker is presented as one of the most appropriate procedures in patients with congenital complete atrioventricular block (AVB). Despite video-assisted thoracic surgery (VATS) for epicardial lead placement has demonstrated positive results concerning the feasibility and freedom of complications in adults, its role in pacemaker implantation in children remains unclear. The study aimed to assess the intermediate-term outcomes of video-assisted thoracic pacing in children with congenital complete AVB. Methods From May 2017 to November 2018, six children with complete idiopathic AVB underwent minimally invasive left ventricular lead placements via thoracoscopic video assistance. The procedure was performed under complex intratracheal anesthesia with single-lung ventilation, median operation time was 180 minutes (120–240). Four incisions were made, three of them were used to place the lead on the left ventricular, and one was needed to place the device. All pacing parameters were evaluated in perioperative and follow-up periods. Results Median age at implantation was 3 years (2 to 15 years), median weight 13 kg (12–46 kg). All procedures were completed successfully, pacing thresholds for the active lead measured 0.5-1.1V, with R-wave amplitude of 8-18 mV and impedance of 404-1478 Ohm. Increasing pacing thresholds in the third month after pacemaker implantation occurred in one patient, so anti-inflammatory therapy was assigned. Satisfactory thresholds and impedances with no significant difference with initial values were obtained at the median follow-up of 21 months (range: 10–28 months). Conclusion Video-assisted thoracic pacing may provide a potential alternative to the transthoracic approach of epicardial lead placement in children with congenital AVB.

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P2125 Characterisation of left-ventricular activation in left bundle branch block; implications for cardiac resynchronisation therapy

European Heart Journal ◽

10.1016/s0195-668x(03)95119-0 ◽

2003 ◽

Vol 24 (5) ◽

pp. 396

Author(s):

O SEGAL

Keyword(s):

Left Bundle Branch Block ◽

Cardiac Resynchronisation Therapy ◽

Left Ventricular ◽

Bundle Branch Block ◽

Cardiac Resynchronisation ◽

Ventricular Activation ◽

Resynchronisation Therapy

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Optimisation of Cardiac Resynchronisation Therapy with MultiPoint™ Pacing

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2015.4.3.sup1 ◽

2015 ◽

Vol 4 (3) ◽

pp. 3

Author(s):

Antonio Curnis ◽

David O’Donnell ◽

Axel Kloppe ◽

Žarko Calovic ◽

◽

...

Keyword(s):

Systolic Function ◽

Biventricular Pacing ◽

Heart Rhythm ◽

Cardiac Resynchronisation Therapy ◽

Left Ventricular ◽

Optimal Placement ◽

Jude Medical ◽

Number Of Patients ◽

Cardiac Resynchronisation ◽

Resynchronisation Therapy

Cardiac resynchronisation therapy (CRT) using biventricular pacing is an established therapy for impairment of left ventricular (LV) systolic function in patients with heart failure (HF). Although technological advances have improved outcomes in patients undergoing biventricular pacing, the optimal placement of pacing leads remains challenging, and approximately one third of patients have no response to CRT. This may be due to patient selection and lead placement. Electrical mapping can greatly improve outcomes in CRT and increase the number of patients who derive benefit from the procedure. MultiPoint™ pacing (St Jude Medical, St Paul, MN, US) using a quadripolar lead increases the possibility of finding the best pacing site. In clinical studies, use of MultiPoint pacing in HF patients undergoing CRT has been associated with haemodynamic and clinical benefits compared with conventional biventricular pacing, and these benefits have been sustained at 12 months. This article describes the proceedings of a satellite symposium held at the European Heart Rhythm Association (EHRA) Europace conference held in Milan, Italy, in June 2015.

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Cardiac Resynchronisation Therapy – Evolving Strategies to Enhance Response

European Cardiology Review ◽

10.15420/ecr.2010.6.1.83 ◽

2010 ◽

Vol 6 (1) ◽

pp. 83

Author(s):

Jagmeet P Singh ◽

Keyword(s):

Heart Failure ◽

Systolic Heart Failure ◽

Cardiac Resynchronisation Therapy ◽

Left Ventricular ◽

Patient Specific ◽

Cardiac Resynchronisation ◽

Clinical Benefits ◽

Pacing Lead ◽

Resynchronisation Therapy ◽

Physiological Impact

Cardiac resynchronisation therapy (CRT) has gained widespread acceptance as a safe and effective therapeutic strategy for congestive heart failure (CHF) refractory to optimal medical therapy. The use of implantable devices has substantially altered the natural history of systolic heart failure. These devices exert their physiological impact through ventricular remodelling, associated with a reduction in left ventricular (LV) volumes and an improvement in ejection fraction (EF). Several prospective randomised studies have shown that this in turn translates into long-term clinical benefits such as improved quality of life, increased functional capacity and reduction in hospitalisation for heart failure and overall mortality. Despite these obvious benefits, there remain more than a few unresolved concerns, the most important being that up to one-third of patients treated with CRT do not derive any detectable benefit. There are several determinants of successful delivery and response to CRT, including selecting the appropriate patient, patient-specific optimal LV pacing lead placement and appropriate post-implant device care and follow-up. This article highlights the importance of collectively working on all of these aspects of CRT to enhance and maximise response.

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Emerging Cardiac Resynchronisation Therapy Indications

European Cardiology Review ◽

10.15420/ecr.2011.7.1.29 ◽

2011 ◽

Vol 7 (1) ◽

pp. 29

Author(s):

Charlotte Eitel ◽

Gerhard Hindricks ◽

Christopher Piorkowski ◽

◽

...

Keyword(s):

Heart Failure ◽

Systolic Heart Failure ◽

Cardiac Resynchronisation Therapy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Current Evidence ◽

Class Iii ◽

Ventricular Ejection Fraction ◽

Cardiac Resynchronisation ◽

Resynchronisation Therapy

Cardiac resynchronisation therapy (CRT) is an efficacious and cost-effective therapy in patients with highly symptomatic systolic heart failure and delayed ventricular conduction. Current guidelines recommend CRT as a class I indication for patients with sinus rhythm, New York Heart Association (NYHA) functional class III or ambulatory class IV, a QRS duration ≥120ms, and left ventricular ejection fraction (LVEF) ≤35%, despite optimal pharmacological therapy. Recent trials resulted in an extension of current recommendations to patients with mild heart failure, patients with atrial fibrillation, and patients with an indication for permanent right ventricular pacing with the aim of morbidity reduction. The effectiveness of CRT in patients with narrow QRS, patients with end-stage heart failure and cardiogenic shock, and patients with an LVEF >35% still needs to be proved. This article reviews current evidence and clinical applications of CRT in heart failure and provides an outlook on future developments.

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Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02174-7 ◽

2021 ◽

Author(s):

Philippe C. Wouters ◽

Geert E. Leenders ◽

Maarten J. Cramer ◽

Mathias Meine ◽

Frits W. Prinzen ◽

...

Keyword(s):

Systolic Function ◽

Cardiac Resynchronisation Therapy ◽

Left Ventricular ◽

Lv Function ◽

Peak Strain ◽

Cardiac Resynchronisation ◽

Reverse Remodelling ◽

Resynchronisation Therapy ◽

Lv Systolic Function

AbstractPurpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.

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