scholarly journals Percutaneous left ventricular endocardial leads: adverse outcomes and a percutaneous extraction case series

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
Jonathan M Behar ◽  
Malcolm C Finlay ◽  
Edward Rowland ◽  
Vivienne Ezzat ◽  
Simon Sporton ◽  
...  
Keyword(s):  
Biventricular Pacing ◽  
Safety Data ◽  
Case Series ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Cardiac Resynchronization ◽  
Venous Anatomy ◽  
Percutaneous Extraction ◽  
Alternative Approaches

Abstract Background Conventional cardiac resynchronization therapy (CRT) involves the placement of an epicardial left ventricular (LV) lead through the coronary venous tree. However, alternative approaches of delivering CRT have been sought for patients who fail to respond to conventional methods or for those where coronary venous anatomy is unfavourable. Biventricular pacing through an endocardial LV lead has potential advantages; however, the long-term clinical and safety data are not known. Case summary This article details a case series of four patients with endocardial LV leads; three of these for previously failed conventional CRT and a fourth for an inadvertently placed defibrillator lead. Discussion We describe the clinical course and adverse events associated with left-sided leads and subsequently describe the safe and feasible method of percutaneous extraction.

P1171Optimal fusion vs. biventricular pacing in cardiac resynchronization therapy: long-term results of 540 consecutive patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
D A Radu ◽  
C N Iorgulescu ◽  
S N Bogdan ◽  
A I Deaconu ◽  
A Nastasa ◽  
...  
Keyword(s):  
Biventricular Pacing ◽  
Statistical Significance ◽  
Left Ventricular ◽  
Long Term Results ◽  
Cardiac Resynchronization ◽  
P Value ◽  
Data Set ◽  
P Values

Abstract Background Right ventricular (RV) stimulation induces supplemental dyssynchrony in case of left bundle branch block (LBBB) patients. Isolated left ventricular (LV) pacing has been proven superior to biventricular pacing (BiV) in terms of acute hemodynamic response. Purpose We sought to determine whether an optimised isolated LV pacing algorithm called "optimal fusion" (OFu) produces better and sustainable effects when compared to BiV in the long term. Methods 540/760 (reasonable data collection) consecutive patients implanted with CRT in CEHB were analysed. The follow-up included 7 hospital visits for each patient (between baseline and 3 years). Demographics, risk factors, usual serum levels, pre-procedural planning factors, clinical, ECG, TTE and biochemical markers were recorded. Statistical analysis was performed using software. Data were reported as either p-values from crosstabs (discrete) or mean differences, p-values and confidence intervals from t-tests (continuous). A p-value of .05 was chosen for statistical significance (SS). Results The overall group consisted of 51% OFu (275) and the rest BiV patients. Subjects in OFu were younger (-4.379 ys; <.001; (-7.028;-1.729)), more often females (40.9 vs. 24.9%; <.002), more obese (40.1 vs. 29.6%; <0.40) and had more structural disease other than ischaemic scar burden (10.8 vs. 2.7%; <.005). Procedures in OFu were mainly "de novo" (93 vs. 73.4%; <.000), more often CRT-Ds (58.2 vs. 42.9%; <.005) and more frequently in sinus rhythm (99.4 vs. 62.3%; <.000) and with typical LBBB (77.2 vs. 45%; <.000). Baseline PR interval was shorter in OFu (-32.20 msec; <.033; (-61.58;-2.58)). Notably, OFu patients started from a lower EF (-3.29%; <.001; (-5.156;-1.441)), had more dyssynchrony as evaluated by Pitzalis’ index (34.32 msec; <.017; (6.132;62.522)) and poorer initial mechanical performance by dP/dt (-104.83 mm Hg/sec; <.012; (-185.301;-24.366)). There was no SS difference in clinical parameters at 3 years. Mean EF was higher in OFu (38.59 vs. 34.82%; NS; (4.183;-4.755)) while both EDVs (170.40 vs. 161.40 ml; NS; (-82.40;100.40)) and ESVs (115.36 vs. 102.67 ml; NS; (-82.65;108.03)) were lower. When looking at absolute Δs, OFu performed much better in the long term: EF (+15.81 vs. +8.86%; NS; (-17.06877;3.17710)), EDV (-46.07 vs. – 10.1 ml; NS; (-19.88;102.60)) and ESV (-55.91 vs. -17.46 ml; NS; (-39.88;124.71)). The cumulated super-responder/responder (SR/R) percentage at 1 year was much higher in OFu (83.43 vs. 57.75; <.040). Conclusions The benefit of OFu is definitely sustainable in the long term. Structural response is constantly superior with OFu when compared to BiV although the current data set did not yield SS when comparing absolute means. However, parameter Δs are clearly in favor of OFu which produced a SS higher cumulated rate of SR/Rs over 3 years of follow-up.

scholarly journals Very Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis

2021 ◽  
Vol 11 (11) ◽  
pp. 1176
Author(s):  
Patrick Leitz ◽  
Julia Köbe ◽  
Benjamin Rath ◽  
Florian Reinke ◽  
Gerrit Frommeyer ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Clinical Response ◽  
Biventricular Pacing ◽  
Nyha Class ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Long Term Follow Up

Background: Different electrocardiogram (ECG) findings are known to be independent predictors of clinical response to cardiac resynchronization therapy (CRT). It remains unknown how these findings influence very long-term prognosis. Methods and Results: A total of 102 consecutive patients (75 males, mean age 65 ± 10 years) referred to our center for CRT implantation had previously been included in this prospective observational study. The same patient group was now re-evaluated for death from all causes over a prolonged median follow-up of 10.3 years (interquartile range 9.4–12.5 years). During follow-up, 55 patients died, and 82% of the clinical non-responders (n = 23) and 44% of the responders (n = 79) were deceased. We screened for univariate associations and found QRS width during biventricular (BIV) pacing (p = 0.02), left ventricular (LV) pacing (p < 0.01), Δ LV paced–right ventricular (RV) paced (p = 0.03), age (p = 0.03), New York Heart Association (NYHA) class (p < 0.01), CHA2DS2-Vasc score (p < 0.01), glomerular filtration rate (p < 0.01), coronary artery disease (p < 0.01), non-ischemic cardiomyopathy (NICM) (p = 0.01), arterial hypertension (p < 0.01), NT-proBNP (p < 0.01), and clinical response to CRT (p < 0.01) to be significantly associated with mortality. In the multivariate analysis, NICM, the lower NYHA class, and smaller QRS width during BIV pacing were independent predictors of better outcomes. Conclusion: Our data show that QRS width duration during biventricular pacing, an ECG parameter easily obtainable during LV lead placement, is an independent predictor of mortality in a long-term follow-up. Our data add further evidence that NICM and lower NYHA class are independent predictors for better outcome after CRT implantation.

scholarly journals Time delay to peak left ventricular pressure rise identifies the substrate for dyssynchronous heart failure and detects disease modification with resynchronization- an observational clinical study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
H Odland ◽  
T Holm ◽  
S Ross ◽  
LO Gammelsrud ◽  
R Cornelussen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Pressure Rise ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Ventricular Pressure ◽  
Cardiac Resynchronization ◽  
Disease Modification ◽  
Volumetric Response

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian South East Health Authorities Introduction Identification of disease modification prior to implantation of Cardiac Resynchronization Therapy may help select the right patients, increase responder-rates and promote the utilization of CRT. We tested the hypothesis that shortening of time-to-peak left ventricular pressure rise (Td) with CRT is useful to predict long-term volumetric response (End-systolic volume (ESV) decrease &gt;15%) to CRT. Methods Forty-five heart failure patients admitted for CRT implantation with a class I/IIa indication according to current ESC/AHA guidelines were included in the study. Td was measured from onset QRS at baseline and from onset of pacing with CRT. Results Baseline characteristics were mean age 63 ± 10 years , 71% males, NYHA class 2.5, 87% LBBB, QRS duration 173 ± 15ms, EF biplane 31 ± 1%, ESV 144 ± 12mL and end-diastolic volume 2044 ± 14mL. At 6-months follow-up six patients increased ESV by 5 ± 8%, while 37 responders (85%) had a mean ESV decrease of 40 ± 2%.  Responders presented with a higher Td at baseline compared to non-responders (163 ± 4ms vs 119 ± 9ms, p &lt; 0.01). Td decreased to 156 ± 4ms (p = 0.02) with CRT in responders, while in non-responders Td increased to 147 ± 10ms (p &lt; 0.01) with CRT. A decrease in Td of less than +3.5ms from baseline accurately identified responders to therapy (AUC 0.98, p &lt; 0.01, sensitivity 97%, specificity 100%). AUC was 0.92 for baseline Td and a cut-off at 120ms yielded a sensitivity of 100% and specificity of 80% to identify volumetric responders. A linear relationship between the change in Td from baseline and ESV decrease on long term was found (β=-61, R = 0.58, P &lt; 0.01). Conclusions Td at baseline and the shortening of Td with CRT accurately identifies responders to CRT, with incremental value on top of current guidelines, in a population with already high response rates. Td carries the potential to become the marker for prediction of long-term volumetric response in CRT candidates. Abstract Figure.

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.

Cardiac resynchronization therapy: optimization and follow-up

2015 ◽  
pp. 420-431
Author(s):  
Marta Sitges ◽  
Genevieve Derumeaux
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Imaging Techniques ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Cardiac Imaging Techniques ◽  
Resynchronization Therapy

Cardiac imaging techniques have an important role in the follow-up of patients undergoing cardiac resynchronization therapy (CRT) as they provide objective evidence of changes in cardiac dimensions and function. The role of echocardiography is well established in the assessment of left ventricular reverse remodelling and the evaluation of secondary (functional) mitral regurgitation. Additionally, echocardiography might be used for optimizing the programming of atrio-ventricular (AV) and inter-ventricular (VV) delays of current CRT devices. Acute benefits from this optimization have been demonstrated, but longer follow-up studies have failed to show a clear benefit of optimized CRT on top of simultaneous biventricular pacing on the outcome of patients with CRT. This chapter reviews the role of imaging in assessing follow-up and outcome of patients undergoing CRT, as well as the rationale, the methods used, and the clinical impact of optimization of the programming of CRT devices.

45Improving the optimization of cardiac resynchronization therapy: Does multipoint left ventricular pacing shorten the paced-QRS duration compared to the fusion-optimized intervals method?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R San Antonio ◽  
M Pujol-Lopez ◽  
R Jimenez-Arjona ◽  
A Doltra ◽  
F Alarcon ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Prospective Clinical Study ◽  
Battery Life ◽  
Resynchronization Therapy ◽  
Qrs Duration ◽  
Phrenic Stimulation

Abstract Funding Acknowledgements Cardiac Pacing Scholarship from the Spanish Society of Cardiology (SEC) Background Electrocardiogram-based optimization of cardiac resynchronization therapy (CRT) using the fusion-optimized intervals (FOI) method has demonstrated to improve both acute hemodynamic response and left ventricle (LV) reverse remodeling compared to nominal programming of CRT. FOI optimizes the atrioventricular (AV) and ventriculo-ventricular (VV) intervals to achieve the shortest paced-QRS duration. The recent development of multipoint pacing (MPP) enables the activation of the LV from 2 locations, also shortening the QRS duration compared to conventional biventricular pacing. Purpose To determine if MPP reduces the paced-QRS duration compared to FOI optimization.  Methods This prospective clinical study included 25 consecutive patients who successfully received a CRT with MPP pacing capability. All patients were in sinus rhythm and had an PR interval below 250 ms. The QRS duration was measured with a 12-lead digital electrocardiography (screen speed of 200 mm/s) at baseline and using 3 different configurations: MPP, FOI and a combined FOI-MPP strategy. In MPP, the intervals were (based on previous studies): 1) AV 130 ms, 2) Right ventricular (RV)-LV2 (Δ1) 5 ms, and 3) LV1-LV2 (Δ2) 5 ms. In FOI, AV and VV intervals were optimized to achieve fusion between intrinsic conduction and biventricular pacing. In FOI-MPP, the Δ2 was set at 5 ms, while AV and Δ1 intervals were optimized using the FOI method. The CRT device was programmed with the configuration that achieved a greater paced-QRS shortening. After 45 days, battery life was estimated. Results   Mean age was 65 ± 10 years, 20 were men (80%) and baseline QRS duration was 177 ± 17 ms. The FOI method bested nominal MPP (QRS shortened by 58 ± 16 ms vs 43 ± 16 ms, respectively, p = 0.002). Adding MPP to the narrowest QRS by FOI did not result in further shortening (FOI: 58 ± 16 ms vs FOI-MPP: 59 ± 13 ms, p = 0.81). The final configuration was FOI method alone in most cases (n = 16, 64%) and FOI-MPP in all others (n = 9, 36%; figure). In total, 10 out of 25 patients (40%) were not candidates to MPP due to: 1) pacing thresholds exceeding 3.5 V/0.4 ms at the distal or proximal electrode (8, 32%), and 2) phrenic stimulation (2, 8%). Estimated battery longevity was longer in patients receiving FOI as compared to MPP (8.3 ± 2.1 years vs. 6.2 ± 2.2 years, p = 0.04). Conclusion In CRT, the FOI method is not improved by coupling with MPP.  Up to 40% of patients are not candidates for MPP due to high thresholds or phrenic stimulation. The use of MPP in unselected patients would result in a decrease of battery longevity, without any additional benefit over FOI. Abstract Figure.

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