scholarly journals P999A different cardiac resynchronization therapy technique might be needed in some patients with nonspecific intraventricular conduction disturbance pattern

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii211-iii211
Author(s):  
A. Vereckei ◽  
G. Katona ◽  
ZS. Szelenyi ◽  
L. Kophazi
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Conduction Disturbance ◽  
Intraventricular Conduction ◽  
Therapy Technique ◽  
Disturbance Pattern

scholarly journals A different cardiac resynchronization therapy technique might be needed in some patients with nonspecific intraventricular conduction disturbance pattern-final results

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Vereckei ◽  
G Katona ◽  
Z Szelenyi ◽  
B Kozman ◽  
G Szenasi
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Frontal Plane ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Electrode Position ◽  
Resynchronization Therapy ◽  
Conduction Disturbance ◽  
Intraventricular Conduction ◽  
St Segment ◽  
Surface Ecg

Abstract Background Current cardiac resynchronization therapy (CRT) works by pacing the latest activated left ventricular (LV) site. We hypothesized that the greater nonresponse rate of patients with nonspecific intraventricular conduction disturbance (NICD) than with left bundle branch block (LBBB) pattern to CRT might be due, besides less dyssynchrony, to the inability of the current CRT technique, devised to eliminate dyssynchrony caused by LBBB pattern, to eliminate dyssynchrony in some patients with NICD pattern, because their latest activated LV site is far away from that in LBBB. Methods We devised a novel surface ECG method to estimate the approximate location of the latest activated LV site based on the principle that the resultant ST vector of secondary ST segment alterations associated with wide QRS complexes is directed 180o away from the latest activated LV site. By measuring the amplitude and polarity of secondary ST segment alterations in two optional frontal and horizontal plane ECG leads and using a software, we determined the resultant 3D spatial secondary ST vector in 88 patients with LBBB and 57 patients with NICD patterns and heart failure. To validate the ECG method, we also estimated the latest activated LV region by echocardiography using 3D parametric imaging and 2D speckle tracking in 16 LBBB and 13 NICD patients. Patients with NICD pattern were subdivided according to their non-overlapping frontal plane resultant secondary ST vector ranges to NICD-1 (n=35) and NICD-2 (n=22) subgroups. Results The resultant 3D spatial secondary ST vector coordinates in the LBBB group were: (x axis: −0.228 mV, y axis: −0.062 mV, z axis: 0.63 mV); in the NICD-1 and NICD-2 subgroups: (x: 0.154 and 0.198 mV, y: −0.198 and 0.162 mV, z: 0.422 and 0.398 mV respectively). Consequently the latest activated LV sites were located leftward, posterosuperior in the LBBB group, right, posterosuperior in the NICD-1 and right, posteroinferior in the NICD-2 subgroups. The latest activated LV region determined by ECG and echocardiography matched in all patients, except 1. Conclusions The latest activated LV site was at the expected position in the LBBB group, while it was at an almost opposite site in the NICD-2 group [22/57 (39%)]. Thus, one potential reason for the unfavorable response to CRT, occurring in approx. 40% of patients with NICD pattern with a QRS duration of 120–149 ms in randomized studies, is that the current CRT technique using a left posterolateral LV electrode position may not be able to eliminate dyssynchrony in these patients. Funding Acknowledgement Type of funding source: None

scholarly journals Physiological pacing to improve cardiac resynchronization therapy non-responder and a tryst with calcified septum—a case report

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Vanita Arora ◽  
Francesco Zanon ◽  
Viveka Kumar ◽  
Vivek Kumar ◽  
Pawan Suri
Keyword(s):  
Case Report ◽  
Cardiac Resynchronization Therapy ◽  
Ischemic Cardiomyopathy ◽  
Cardiac Resynchronization ◽  
Conduction Delay ◽  
Resynchronization Therapy ◽  
Intraventricular Conduction ◽  
Technological Approach ◽  
Intraventricular Septum ◽  
Intraventricular Conduction Delay

Abstract Background As per the literature, patients with intraventricular conduction delay (IVCD) do not respond well to cardiac resynchronization therapy (CRT) alone. They need advanced technological approach and out of the box thinking for a good response. Case Ours is a case of ischemic cardiomyopathy with wide QRS-IVCD, a non-responder to CRT. While planning for replacement of the device for early replacement indicator (ERI), we decided to do His-optimized CRT/left bundle optimized CRT (HOT-CRT/LOT-CRT) for the patient. Conclusion The challenges we faced with the present available hardware paved a way for insisting on the limitation of the available lumenless lead to penetrate calcified the septum and importance of the pre-procedure evaluation of intraventricular septum (IVS) for calcification by more than just echocardiography.

scholarly journals Prognostic Implications of ‘Paced’ and ‘Native’ QRS Durations Following Cardiac Resynchronization Therapy

2016 ◽  
Vol 02 (01) ◽  
pp. 30
Author(s):  
Oguz Karaca ◽  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Response To Therapy ◽  
Cardiac Resynchronization ◽  
Current Evidence ◽  
Conduction Time ◽  
Resynchronization Therapy ◽  
Intraventricular Conduction ◽  
Surface Ecg ◽  
Future Outcomes ◽  
Electrocardiographic Parameters

Current evidence strongly suggests that the extent of electrical dyssynchrony within the left ventricle is determined by the delayed intraventricular conduction time reflected by a prolonged QRS duration (QRSd) on the surface (ECG). However, in cardiac resynchronization therapy (CRT) follow-up algorithms, the QRSd on the post-operative ECG has been relatively less frequently addressed, although the baseline QRSd is accepted as an essential ‘pre-operative’ marker for patient selection and prediction of response to therapy. In this review, we discuss the clinical impact of post-implantation electrocardiographic parameters, such as the ‘paced’ QRSd and ‘native’ QRSd (assessed when the device is temporarily switched off) on the efficacy of therapy and on prediction of future outcomes after CRT.

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.

Nonspecific intraventricular conduction delay: Definitions, prognosis, and implications for cardiac resynchronization therapy

Heart Rhythm ◽  
2015 ◽  
Vol 12 (5) ◽  
pp. 1071-1079 ◽  
Author(s):  
Romain Eschalier ◽  
Sylvain Ploux ◽  
Philippe Ritter ◽  
Michel Haïssaguerre ◽  
Kenneth A. Ellenbogen ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Conduction Delay ◽  
Resynchronization Therapy ◽  
Intraventricular Conduction ◽  
Intraventricular Conduction Delay
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