1963 Clinical efficacy of one year cardiac resynchronization therapy in heart failure patients stratified by QRS duration: results of the PATH-CHF II trial

2003 ◽  
Vol 24 (5) ◽  
pp. 363 ◽  
Author(s):  
C BUTLER
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Clinical Efficacy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Heart Failure Patients ◽  
Qrs Duration ◽  
One Year

scholarly journals Cardiac index in atrio- and interventricular delay optimized cardiac resynchronization therapy and cardiac contractility modulation

2015 ◽  
Vol 1 (1) ◽  
pp. 89-91 ◽  
Author(s):  
J. Tumampos ◽  
N. Wulf ◽  
H. Kühnert ◽  
O. Solbrig ◽  
J. Querengässer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Index ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardiac Contractility Modulation ◽  
Heart Failure Patients ◽  
Qrs Duration

AbstractCardiac resynchronization therapy (CRT) is an established therapy for heart failure patients and improves quality of life in patients with sinus rhythm, reduced left ventricular ejection fraction (LVEF), left bundle branch block and wide QRS duration. Since approximately sixty percent of heart failure patients have a normal QRS duration they do not benefit or respond to the CRT. Cardiac contractility modulation (CCM) releases nonexcitatoy impulses during the absolute refractory period in order to enhance the strength of the left ventricular contraction. The aim of the investigation was to evaluate differences in cardiac index between optimized and nonoptimized CRT and CCM devices versus standard values. Impedance cardiography, a noninvasive method was used to measure cardiac index (CI), a useful parameter which describes the blood volume during one minutes heart pumps related to the body surface. CRT patients indicate an increase of 39.74 percent and CCM patients an improvement of 21.89 percent more cardiac index with an optimized device.

scholarly journals Effects of Adaptive Cardiac Resynchronization Therapy With Left-Bundle-Branch Area Pacing and Coronary Sinus Pacing

2021 ◽  
Author(s):  
Xiang-Fei Feng ◽  
Ren-Hua Chen ◽  
Rui Zhang ◽  
Yi-Chi Yu ◽  
Bo Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Statistical Significance ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Resynchronization Therapy ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients ◽  
Av Conduction ◽  
Qrs Duration

Abstract Adaptive cardiac resynchronization therapy (aCRT) is associated with improved clinical outcomes. Left bundle branch area pacing (LBBAP) has shown encouraging results as an alternative option for CRT. In this study, we observed the clinical and echocardiographic outcome of LBB-optimized aCRT in combination with synchronized LV pacing (LOT-aCRT) in heart failure patients with reduced ejection fraction and LBBB. Heart failure patients with preserved AV conduction and LBBB morphology, who underwent aCRT from February 1, 2019, to September 30, 2020 were included. The eligible patients with or without LBBAP were divided into LOT-aCRT group or BV-CRT group. In LOT-aCRT group, the CS lead was connected to the pace-sensing portion of the RV port, and the LBBAP lead was connected to the LV port. Seventeen patients were enrolled in this study (8 cases in LOT-aCRT group, 9 cases in BV-CRT group). Patients were matched for ischemic cardiomyopathy (ICM) at baseline (5 cases vs. 4 cases). QRS duration (QRSd) via BVP was narrowed from 158.0 ± 13.0 ms at baseline to 132.0 ± 4.5 ms in LOT-aCRT group (P=0.019), and further narrowed to 123.0 ± 5.7 ms (P < 0.01) via LBBAP. However, LOT-aCRT resulted in further reduction of the QRSd (121.0 ± 3.8 ms), but no statistical significance (P > 0.05). In BV-CRT group, BVP resulted in significant reduction of the QRSd from 176.7 ±19.7 ms at baseline to 143.3 ±8.2 ms (P=0.011). However, compared with LOT-aCRT, BVP has no any advantage in reducing QRSd (P > 0.05). During follow-up, patients in LOT-aCRT group showed significant improvement in LVEF and NT-proBNP levels (P < 0.01), while patients in BV-CRT group showed non-significant changes in these parameters (P >0.05). The study demonstrates that LOT-aCRT is clinically feasible in patients with systolic HF and LBBB. LOT-aCRT was associated with significant narrowing of the QRSd and improvement in LV function, especially in patients with ICM.

scholarly journals The prognostic significance of cardiac sympathetic activity and dyssynchrony in cardiac resynchronization therapy in ischemic and non-ischemic heart failure patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Mishkina ◽  
K Zavadovsky ◽  
V Saushkin ◽  
D Lebedev ◽  
Y Lishmanov
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Sympathetic Activity ◽  
Gated Spect ◽  
Prognostic Significance ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardiac Sympathetic Activity ◽  
Heart Failure Patients ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Russian Foundation for Basic Research Introduction Impaired cardiac sympathetic activity and contractility are associated with poor prognosis in patients with heart failure after cardiac resynchronization therapy (CRT). There are few prognostic data of the cardiac sympathetic activity and dyssynchrony in patients with chronic heart failure of various etiologies. Purpose To examine the prognostic significance of scintigraphic cardiac sympathetic activity and contractility in predicting the response to CRT and to assess the differences between patients with ischemic (IHF) and non-ischemic (NIHF) heart failure. Methods This study included 38 heart failure patients (24 male; mean age of 56 ± 11 years; 16 patients with ischemic etiology), who were submitted to CRT. Before CRT all patients underwent 123I-metaiodobenzylguanidine (123I-MIBG) imaging for cardiac sympathetic activity evaluating: early and delay heart to mediastinum ratio (eH/M and dH/M), summed MIBG Score (eSMS and dSMS). Moreover all patients underwent gated SPECT with the assessments of left ventricle dyssynchrony indexes: standard deviation (SD) and histogram bandwidth (HBW). In addition, all patients underwent gated blood-pool SPECT (GBPS) to assessed ejection fraction (EF) and stroke volume (SV) of both ventricles. Results One year after CRT response defined as LV ESV decreased by≥15% and/or LV EF increase by≥5%. Baseline cardiac sympathetic activity parameters showed significant differences between responders and non-responders only in NIHF patients: eH/M: 2.27 (2.02–2.41) vs. 1.64 (1.32–2.16); dH/M: 2.18 (2.11–2.19) vs. 1.45 (1.23 – 1.61); eSMS: 7 (5-7) vs. 15.5 (10–28.5); dSMS: 10 (10–13) vs. 16.5 (15.5–29). Significant differences in baseline LV dyssynchrony indexes between responders and non-responders were in patients of both group: in NIHF patients - SD: 54.3 (43–58) degree vs. 65 (62–66) degree; HBW: 179.5 (140–198) degree vs. 211 (208-213) degree, p &lt; 0.054 in IHF patients - HBW: 162 (115.2–180) degree vs.  115.2 (79.2–136.8) degree. Contractility of RV was significantly differed between responders and non-responders in IHF patients: RV EF: 54.5 (41-56) % vs. 44.5 (37–49.5) %; RV SV: 80 (69-101) ml vs. 55.5 (50–72.5) ml. According to univariate logistic regression analyses in IHF patients LV dyssynchrony indexes – SD (OR = 1.55; 95% CI 1.09-2.2; p &lt; 0.5) and HBW (OR = 1.13; 95% CI 1.02-1.24; p &lt; 0.5), as well as RV indexes – RV EF (OR = 1.11; 95% CI 1.001-1.23; p &lt; 0.5), RV SV (OR = 1.07; 95% CI 1.003-1.138; p &lt; 0.5) were predictors of CRT response. In the group of NIHF patients, dH/M (OR = 1.47; 95% CI 1.08-2; p &lt; 0.5), SD (OR = 0.83; 95% CI 0.73-0.95; p &lt; 0.5), HBW (OR = 0.96; 95% CI 0.93-0.99; p &lt; 0.5) showed the predictive value in terms of CRT response. Conclusion  Scintigraphic methods can be used to select patients for CRT. Cardiac 123I-MIBG scintigraphy and gated SPECT may be used for predicting CRT response in NIHF patients. Whereas in IHF patients ECG-gated SPECT and GBPS may be valuable for predicting the response to CRT.

scholarly journals A case report of advanced heart failure refractory to pharmacological therapy who was successfully recovered by combinatory usage of cardiac resynchronizing therapy, Impella and MitraClip

2020 ◽  
Author(s):  
Mitsuo Sobajima ◽  
Nobuyuki Fukuda ◽  
Hiroshi Ueno ◽  
Koichiro Kinugawa
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Therapeutic Option ◽  
Bed Rest ◽  
Pharmacological Therapy ◽  
Advanced Heart Failure ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Resynchronization Therapy ◽  
Qrs Duration

Abstract Background  The safety and efficacy of MitraClip for advanced heart failure (HF) patients who are inotrope-dependent or mechanically supported are unknown. Case summary  The patient was a 71-year-old man diagnosed as dilated cardiomyopathy in 2003. He was admitted due to worsening HF in January 2019 and became dependent upon intravenous infusion of inotropes. During the 8-month hospitalization, his haemodynamics were relatively static with bed rest and continuous inotropes, but he was definitely dependent on them. Our multidisciplinary team decided to perform both cardiac resynchronization therapy (CRT) and MitraClip under Impella support. First, Impella was inserted from left subclavian artery. After a week, CRT was implanted from right subclavian vein, and the QRS duration of electrocardiogram became remarkably narrow. MitraClip was performed 2 weeks after Impella, and functional mitral regurgitation improved from severe to mild, and Impella was removed on the same day. Inotropes could be ceased, and he was discharged 2 months after MitraClip. Discussion  During inotrope-dependent status, there was a risk that HF would worsen with haemodynamic collapse when performing CRT implantation, and we firstly supported his haemodynamics by Impella. Cardiac resynchronization therapy implantation before MitraClip seemed to be crucial. In fact, the mitral valve morphology before Impella insertion had very poor coaptation of the anterior and posterior leaflets that was not optimal for MitraClip procedure. But the Impella support and correction of dyssynchrony by CRT markedly improved the coaptation of those leaflets. The combination therapy of CRT and MitraClip unloading with Impella maybe a new therapeutic option for advanced HF.

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