scholarly journals 589Cardiac resynchronization therapy using quadripolar versus non-quadripolar left ventricular leads programmed to single-site left ventricular pacing impact on survival and heart failure hospitalization

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii120-iii120 ◽  
Author(s):  
A. Zegard ◽  
T. Qiu ◽  
E. Acquaye ◽  
H. Marshall ◽  
F. Leyva
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Single Site ◽  
Ventricular Pacing ◽  
Resynchronization Therapy ◽  
Heart Failure Hospitalization ◽  
Impact On Survival ◽  
Left Ventricular Pacing

scholarly journals Electrocardiographic Outcome of Resynchronization Therapy

2017 ◽  
pp. S523-S528 ◽  
Author(s):  
O. KITTNAR ◽  
L. RIEDLBAUCHOVÁ ◽  
J. TOMIS ◽  
M. LOŽEK ◽  
A. VALERIÁNOVÁ ◽  
...  
Keyword(s):  
Heart Failure ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
The Body ◽  
Ventricular Pacing ◽  
Resynchronization Therapy ◽  
Left Ventricular Pacing ◽  
Activation Times ◽  
The Impact ◽  
Spontaneous Rhythm

Cardiac resynchronization therapy (CRT) has proven efficacious in reducing or even eliminating cardiac dyssynchrony and thus improving heart failure symptoms. However, quantification of mechanical dyssynchrony is still difficult and identification of CRT candidates is currently based just on the morphology and width of the QRS complex. As standard 12-lead ECG brings only limited information about the pattern of ventricular activation, we aimed to study changes produced by different pacing modes on the body surface potential maps (BSPM). Total of 12 CRT recipients with symptomatic heart failure (NYHA II-IV), sinus rhythm and QRS width ≥120 ms and 12 healthy controls were studied. Mapping system Biosemi (123 unipolar electrodes) was used for BSPM acquisition. Maximum QRS duration, longest and shortest activation times (ATmax and ATmin) and dispersion of QT interval (QTd) were measured and/or calculated during spontaneous rhythm, single-site right- and left-ventricular pacing and biventricular pacing with ECHO-optimized AV delay. Moreover we studied the impact of CRT on the locations of the early and late activated regions of the heart. The average values during the spontaneous rhythm in the group of patients with dyssynchrony (QRS 140.5±10.6 ms, ATmax 128.1±10.1 ms, ATmin 31.8±6.7 ms and QTd 104.3±24.7 ms) significantly differed from those measured in the control group (QRS 93.0±10.0 ms, ATmax 79.1±3.2 ms, ATmin 24.4±1.6 ms and QTd 43.6±10.7 ms). Right ventricular pacing (RVP) improved significantly only ATmax [111.2±10.6 ms (p<0.05)] but no other measured parameters. Left ventricular pacing (LVP) succeeded in improvement of all parameters [QRS 105.1±8.0 ms (p<0.01), ATmax 103.7±7.1 ms (p<0.01), ATmin 20.2±3.7 ms (p<0.01) and QTd 52.0±9.4 ms (p<0.01)]. Biventricular pacing (BVP) showed also a beneficial effect in all parameters [QRS 121.3±8.9 ms (p<0.05), ATmax 114.3±8.2 ms (p<0.05), ATmin 22.0±4.1 ms (p<0.01) and QTd 49.8±10.0 ms (p<0.01)]. Our results proved beneficial outcome of LVP and BVP in evaluated parameters (what seems to be important particularly in the case of activation times) and revealed a complete return of activation times to normal distribution when using these CRT modalities.

Abstract 5926: Cardiac Electrical Resynchronization Therapy Combining HIS Bundle and Left Ventricular Pacing is Effective in the Treatment of Severe Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Stanley Tung ◽  
Kesava Rajagopalan ◽  
Andy Ignaszewski ◽  
Jonathan Affolter
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Severe Heart Failure ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Ventricular Pacing ◽  
Resynchronization Therapy ◽  
His Bundle ◽  
Left Ventricular Pacing

Introduction: It is known that Cardiac Resynchronization Therapy (CRT) combining right ventricular (RV) apex pacing and left ventricular pacing (LVP) is ineffective in up to 35% of heart failure (HF) patients. Our hypothesis is that RV apical pacing bypasses the rapidly conducting right bundle and may further impede ventricular activation with LBBB hence a more physiological CRT is via HIS Bundle pacing (HBP) and LVP. We report of our early experience with Cardiac Electrical Resynchronization Therapy (CERT) incorporating HBP with LVP in patients with severe HF. Methods: Patients indicated for CRT were approached for CERT. In addition to an atrial and LV lead, patients also received a HBP lead. An active fixation lead (SelectSecure/Site® Medtronic) was used directly for HIS Bundle mapping and pacing. HBP implant thresholds, procedure and fluoroscopy times, pre and post implant QRS, PR interval, and NYHA class were collected. Student t -test was used for analysis. Results: 15 patients (13 male, mean age 70yrs) referred for CRT underwent successful CERT with mean follow up of 3.5±4.3 months. The mean implant HBP threshold, procedure and fluoroscopy time were 1.6V/0.6ms, 150min, and 26min respectively. All patients had QRS shortening with a mean of 64±21ms (pre CERT 182ms, post CERT 118ms, p<0.0001, figure ) and mean PR shortening of 81±101ms (pre CERT 254ms, post CERT 173ms, p<0.05). 13 patients had improvement of at least one NYHA class. Conclusions: HBP with LVP is effective in achieving electrical resynchronization, and has resulted in early improvement of HF symptoms. Evidence of reverse remodeling is pending. CERT needs to be further validated before considering for wide adoption.

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