scholarly journals Heart failure patient selection for cardiac resynchronization therapy: Is QRS dispersion better than maximum QRS duration?

2000 ◽  
Vol 2 ◽  
pp. 71-71
Author(s):  
C. Butter ◽  
J. Vogt ◽  
A. Auricchio ◽  
B. Lamp ◽  
M. Schlegl ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Patient Selection ◽  
Heart Failure Patient ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Qrs Duration ◽  
Selection For ◽  
Better Than

scholarly journals New echocardiographic techniques in optimal patient selection for cardiac resynchronization therapy in the treatment of chronic heart failure

2009 ◽  
Vol 137 (5-6) ◽  
pp. 304-309
Author(s):  
Milan Petrovic ◽  
Bosiljka Vujisic-Tesic ◽  
Goran Milasinovic ◽  
Danijela Zamaklar-Trifunovic ◽  
Ivana Nedeljkovic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Cardiac Resynchronization Therapy ◽  
Patient Selection ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Selection For ◽  
Consensus Report

Cardiac resynchronization therapy (CRT) has important role in the contemporary treatment of heart failure, systolic dysfunction and mechanical disynchrony. Classical indications for CRT are severe heart failure (NYHA class III or IV), a broad QRS (more than 120 ms) and left ejection fraction less than 35% despite optimal medical therapy. Several have studies demonstrated the important role of echocardiography in patient selection for CRT, follow up and estimation of CRT effects, as well as the optimization of biventricular pacemaker. Basically, there are three types of cardiac asynchrony: interventricular asynchrony, between the right and left ventricle, intraventricular asynchrony, between the myocardial segments within the left ventricle and atrioventricular asynchrony, between the atria and ventricles. Although many echocardiographic techniques are used in patient selection for CRT, no ideal approach has yet been found. There are several techniques and parameters used in the assessment of myocardial asynchrony: two dimensional (2D) echocardiography, one dimensional echocardiography (M-mode), Doppler echocardiography, different modalities of tissue Doppler including Colour Coded Tissue Doppler Imaging - TDI, measurements of local tissue deformation indices (strain and strain rate), speckle tracking, 3D echocardiography, semiquantitative assessment of myocardial border, vector velocity imaging. Each of these techniques has advantages and limitations. A special accent in this revue is on the consensus report from the American Society of Echocardiography Dyssynchrony Writing group. According to this consensus report color coded tissue Doppler is the most appropriate technique for myocardial asynchrony estimation and patients selection for CRT. The same group recommended that definitive decision for CFT implantation should not be based only on echocardiographic analysis, but rather on the whole clinical aspect of the patient.

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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