0300: A Short-Term Follow-Up Study of Left Ventricular Epicardial Lead Placement for Cardiac Resynchronization Therapy

2009 ◽  
Vol 35 (8) ◽  
pp. S38
Author(s):  
Ye Zhang ◽  
Zhian Li ◽  
Yihua He ◽  
Ya Yang ◽  
Xiaoyan Gu ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Short Term ◽  
Follow Up Study ◽  
Epicardial Lead ◽  
Lead Placement

Feasibility and efficacy of left bundle branch area pacing in patients indicated for cardiac resynchronization therapy

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii54-ii60
Author(s):  
Yuqiu Li ◽  
Lirong Yan ◽  
Yan Dai ◽  
Yu’an Zhou ◽  
Qi Sun ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction ◽  
Intraventricular Conduction ◽  
Lead Placement

Abstract Aims The present study was to evaluate the feasibility and clinical outcomes of left bundle branch area pacing (LBBAP) in cardiac resynchronization therapy (CRT)-indicated patients. Methods and results LBBAP was performed via transventricular septal approach in 25 patients as a rescue strategy in 5 patients with failed left ventricular (LV) lead placement and as a primary strategy in the remaining 20 patients. Pacing parameters, procedural characteristics, electrocardiographic, and echocardiographic data were assessed at implantation and follow-up. Of 25 enrolled CRT-indicated patients, 14 had left bundle branch block (LBBB, 56.0%), 3 right bundle branch block (RBBB, 12.0%), 4 intraventricular conduction delay (IVCD, 16.0%), and 4 ventricular pacing dependence (16.0%). The QRS duration (QRSd) was significantly shortened by LBBAP (intrinsic 163.6 ± 29.4 ms vs. LBBAP 123.0 ± 10.8 ms, P < 0.001). During the mean follow-up of 9.1 months, New York Heart Association functional class was improved to 1.4 ± 0.6 from baseline 2.6 ± 0.6 (P < 0.001), left ventricular ejection fraction (LVEF) increased to 46.9 ± 10.2% from baseline 35.2 ± 7.0% (P < 0.001), and LV end-diastolic dimensions (LVEDD) decreased to 56.8 ± 9.7 mm from baseline 64.1 ± 9.9 mm (P < 0.001). There was a significant improvement (34.1 ± 7.4% vs. 50.0 ± 12.2%, P < 0.001) in LVEF in patients with LBBB. Conclusion The present study demonstrates the clinical feasibility of LBBAP in CRT-indicated patients. Left bundle branch area pacing generated narrow QRSd and led to reversal remodelling of LV with improvement in cardiac function. LBBAP may be an alternative to CRT in patients with failure of LV lead placement and a first-line option in selected patients such as those with LBBB and heart failure.

Merits of Different Ventricular Lead Locations on Left Ventricular Myocardial Strain and Dyssynchrony in Patients with Cardiac Resynchronization Therapy

Cardiology ◽  
2019 ◽  
Vol 145 (1) ◽  
pp. 13-20
Author(s):  
Alaa S. Algazzar ◽  
Mohamed M. Elbably ◽  
Azza A. Katta ◽  
Neama  Elmeligy ◽  
Khaled Elrabbat ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Circumferential Strain ◽  
Nyha Class ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Short Term

Background: The idea behind cardiac resynchronization therapy (CRT) is to pace both ventricles resulting in a synchronized electro-mechanical coupling of the left ventricle (LV), meaning every effort should be made to improve the percentage of CRT responders. Objectives: This study aimed at demonstrating the short-term effect of right ventricular apical (RVA) and mid-septal (RVS) lead locations combined with different LV lead positions on LV myocardial strain, dyssynchrony, and clinical outcomes. Methods: We examined 60 patients with indication for CRT before and after 6 months of implantation for clinical outcome and CRT response (6-min walk test [6MWT], NYHA class, decrease in left ventricular end systolic volume [LVESV] by >15%), dyssynchrony, and myocardial strain. Results: After 6 months of follow-up, the two RV lead locations represented a significant improvement in 6MWT, left ventricular ejection fraction, and LVESV in comparison to baseline values, but no significant difference was found between both groups. With regards to NYHA class improvement, p values were insignificant between the groups (0.44 and 0.88) at baseline and 6 months after implantation, respectively. The mean 6MWT was 273.8 m in the RVA group compared to 279.0 m in the RVS group (p = 0.84) at baseline. After 6 months of CRT implantation, the 6MWT mean was 326.5 m in the RVA group compared to 316.2 m in the RVS group (p = 0.74). The posterolateral cardiac vein site showed a significant improvement when combined with RVS location in interventricular and intraventricular dyssynchrony, global longitudinal strain, global circumferential strain, and apical circumferential strain (p = 0.01 0.032, 0.02, 0.005, and 0.049), respectively. Conclusion: RVS is not inferior and provides a good alternative to RVA pacing in short-term follow-up. However, the QRS duration, myocardial strain, and dyssynchrony varies depending on RV and LV stimulation sites. Long-term morbidity and mortality outcomes according to LV lead location in coronary sinus need more assessment.

Biventricular pacing-induced acute response in baroreflex sensitivity has predictive value for midterm response to cardiac resynchronization therapy

2009 ◽  
Vol 297 (1) ◽  
pp. H233-H237 ◽  
Author(s):  
Maaike G. J. Gademan ◽  
Rutger J. van Bommel ◽  
C. Jan Willem Borleffs ◽  
SumChe Man ◽  
Joris C. W. Haest ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Predictive Value ◽  
Baroreflex Sensitivity ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Arterial Baroreflex ◽  
Resynchronization Therapy ◽  
Acute Response

In a previous study we demonstrated that the institution of biventricular pacing in chronic heart failure (CHF) acutely facilitates the arterial baroreflex. The arterial baroreflex has important prognostic value in CHF. We hypothesized that the acute response in baroreflex sensitivity (BRS) after the institution of cardiac resynchronization therapy (CRT) has predictive value for midterm response. One day after implantation of a CRT device in 33 CHF patients (27 male/6 female; age, 66.5 ± 9.5 yr; left ventricular ejection fraction, 28 ± 7%) we measured noninvasive BRS and heart rate variability (HRV) in two conditions: CRT device switched on and switched off (on/off order randomized). Echocardiography was performed before implantation (baseline) and 6 mo after implantation (follow-up). CRT responders were defined as patients in whom left ventricular end-systolic volume at follow-up had decreased by ≥15%. Responders (69.7%) and nonresponders (30.3%) had similar baseline characteristics. In responders, CRT increased BRS by 30% ( P = 0.03); this differed significantly ( P = 0.02) from the average BRS change (−2%) in the nonresponders. CRT also increased HRV by 30% in responders ( P = 0.02), but there was no significant difference found compared with the increase in HRV (8%) in the nonresponders. Receiver-operating characteristic curve analysis revealed that the percent BRS increase had predictive value for the discrimination of responders and nonresponders (area under the curve, 0.69; 95% confidence interval, 0.51–0.87; maximal accuracy, 0.70). Our study demonstrates that a CRT-induced acute BRS increase has predictive value for the echocardiographic response to CRT. This finding suggests that the autonomic nervous system is actively involved in CRT-related reverse remodeling.

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