scholarly journals His-optimized cardiac resynchronization therapy in a patient with heart failure and right bundle branch block: a case report

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Dmytro Volkov ◽  
Dmytro Lopin ◽  
Stanislav Rybchynskyi ◽  
Dmytro Skoryi
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Right Bundle Branch Block ◽  
Clinical Status ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction

Abstract Background  Cardiac resynchronization therapy (CRT) is an option for treatment for chronic heart failure (HF) associated with left bundle branch block (LBBB). Patients with HF and right bundle branch block (RBBB) have potentially worse outcomes in comparison to LBBB. Traditional CRT in RBBB can increase mortality and HF deterioration rates over native disease progression. His bundle pacing may improve the results of CRT in those patients. Furthermore, atrioventricular node ablation (AVNA) for rate control in atrial fibrillation (AF) can be challenging in patients with previously implanted leads in His region. Case summary  We report the case of 74-year-old gentleman with a 5-year history of HF, permanent AF with a rapid ventricular response, and RBBB. He was admitted to the hospital with complaints of severe weakness and shortness of breath. Left ventricular ejection fraction (LVEF) was decreased (41%), right ventricle (RV) was dilated (41 mm), and QRS was prolonged (200 ms) with RBBB morphology. The patient underwent His-optimized CRT with further left-sided AVNA. As a result, LVEF increased to 51%, RV dimensions decreased to 35 mm with an improvement of the clinical status during a 6-month follow-up. Discussion  Patients with AF, RBBB, and HF represent the least evaluated clinical subgroup of individuals with less beneficial clinical outcomes according to CRT studies. Achieving the most effective resynchronization could require pacing fusion from sites beyond traditional with the intention to recruit intrinsic conduction pathways. This approach can be favourable for reducing RV dilatation, improving LVEF, and maximizing electrical resynchronization.

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.

scholarly journals Early Use of Cardiac Resynchronization Therapy to Accelerate Symptomatic Relief and Complete Left Ventricular Function Recovery in Peripartum Cardiomyopathy

Medicina ◽  
2019 ◽  
Vol 55 (6) ◽  
pp. 246
Author(s):  
Elizabeth Richard ◽  
Pierre Yves Turgeon ◽  
Michelle Dubois ◽  
Mario Sénéchal
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Symptomatic Relief ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction ◽  
Function Recovery

Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure that develops during the last month of pregnancy or within first months of delivery. We report the case of a 40-year-old woman diagnosed with severely symptomatic PPCM characterized by left ventricular ejection fraction (LVEF) of 10% and significant dyssynchrony secondary to a left bundle branch block (LBBB). Early cardiac resynchronization therapy (CRT) was used to achieve remarkable functional and LVEF recovery. This case suggests that early CRT must be considered for patients suffering from severely symptomatic PPCM despite optimal medical therapy for whom advanced heart failure therapies are proposed.

scholarly journals Cardiac strains as a tool for optimization of cardiac resynchronization therapy in non-responders: a pilot study

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 945-952
Author(s):  
David Šipula ◽  
Milan Kozák ◽  
Jaroslav Šipula ◽  
Miroslav Homza ◽  
Jiří Plášek
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Speckle Tracking ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction ◽  
Cardiac Strain ◽  
Maximum Improvement

AbstractBackgroundApproximately 30% of patients do not respond to implantation of Cardiac Resynchronization Therapy – Defibrillators (CRT-D). The aim of this study was to investigate the potential for cardiac strain speckle tracking to optimize the performance of CRT-D in non-responding patients.Methods30 patients not responding to Cardiac Resynchronization Therapy-Defibrillators after 3 months were randomly divided into control and intervention groups. Atrioventricular interval was adjusted so that E and A waves did not overlap, the interventricular interval was subsequently optimized to yield maximum improvement of the sum of longitudinal+radial+circumferential strains. The left ventricular ejection fraction (LVEF) and NYHA improvement 3 months after optimization were evaluated and use of other strain combinations assessed.ResultsA significant correlation between the (combined) strain change and LVEF improvement was detected (p<0.01). 75% of patients with non-ischemic etiology of heart failure who did not respond to the original CRT-D reacted favorably with significant LVEF and NYHA improvement. The area strain was the best predictor of LVEF/NYHA improvement in those patients. No significant improvement was recorded in patients with ischemic etiology.ConclusionsAV and VV optimization based on speckle tracking is a very promising method potentially leading to a significant improvement of the outcome of CRT-D, especially in patients with non-ischemic etiology of heart failure.

scholarly journals Electrical interventricular delay and left ventricular delay in right ventricular pacemaker pacing before upgrading to cardiac resynchronization therapy

2017 ◽  
Vol 3 (2) ◽  
pp. 245-248
Author(s):  
Matthias Heinke ◽  
Gudrun Dannberg ◽  
Tobias Heinke ◽  
Johannes Hörth ◽  
Helmut Kühnert
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction ◽  
Heart Failure Patients

AbstractCardiac resynchronization therapy with biventricular pacing is an established therapy for heart failure patients with sinus rhythm, reduced left ventricular ejection fraction and electrical ventricular desynchronization. The aim of the study was to evaluate electrical interventricular delay and left ventricular delay in right ventricular pacemaker pacing before upgrading to cardiac resynchronization therapy. Heart failure patients with right ventricular pacing, DDD pacemaker, DDD defibrillator and 24.5 ± 4.9 % left ventricular ejection fraction were measured by surface ECG and transesophageal bipolar left ventricular ECG before upgrading to cardiac resynchronization therapy. Interventricular and intraventricular desynchronization in right ventricular pacemaker pacing were 228.2 ± 44.8ms QRS duration, 86.5 ± 32.8ms interventricular delay and 94.4 ± 23.8ms left ventricular delay. Cardiac resynchronization therapy was optimized by impedance cardiography. Transesophageal electrical interventricular delay and left ventricular delay in right ventricular pacemaker pacing may be additional useful ventricular desynchronization parameters to improve patient selection for upgrading right ventricular pacemaker pacing to cardiac resynchronization therapy.

scholarly journals Role of electrocardiographic and echocardiographic types of left bundle branch block in prediction of response to cardiac resynchronization therapy

2018 ◽  
Vol 90 (12) ◽  
pp. 76-83 ◽  
Author(s):  
S Yu Kashtanova ◽  
N A Mironova ◽  
V N Shitov ◽  
E M Gupalo ◽  
V G Kiktev ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Bundle Branch Block ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Contraction Pattern ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction

Aim. To assess the value of the complex analysis of electrocardiographic (ECG) variants and echocardiographic (echo) manifestation of left bundle branch block (LBBB) in predicting the success of cardiac resynchronization therapy (CRT). Materials and methods. The study included 39 patients (mean age 61.49±9.0 years) on sinus rhythm with LBBB, QRS duration ≥130 ms, left ventricular ejection fraction (LVEF) ≤35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during 3 month. All patients had undergone CRT-D implantation. Depending on presence or absence of ECG-criteria, proposed by D.G. Strauss et al., patients were divided into 2 groups: 1 group - strict LBBB, proposed by D.G. Strauss et al. (n=29) and 2 group - other patients (n=10). In addition to standard echocardiography, global longitudinal 2-dimensional strain (GLS) and LBBB contraction pattern have been performed initially and in 6 months after implantation. Response to CRT was defined as decrease in LV end-systolic volume by >15% after 6 months of follow-up. Results and discussion. Typical LBBB echo contraction pattern was detected in 25 patients (64% of all included). These patients had more pronounced longitudinal dissynchrony and a more expressed global longitudinal strain before CPT-D implantation (p

scholarly journals Albumin-Bilirubin Score for Prediction of Outcomes in Heart Failure Patients Treated with Cardiac Resynchronization Therapy

2021 ◽  
Vol 10 (22) ◽  
pp. 5378
Author(s):  
Shinya Yamada ◽  
Takashi Kaneshiro ◽  
Akiomi Yoshihisa ◽  
Minoru Nodera ◽  
Kazuaki Amami ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Function ◽  
Cardiac Resynchronization Therapy ◽  
Assessment Tool ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction

Background: Liver function may be a useful indicator of response to cardiac resynchronization therapy (CRT). We aimed to investigate the clinical significance of albumin-bilirubin (ALBI) score, an assessment tool of liver function, on outcomes in heart failure (HF) patients treated with CRT. Methods: We studied 180 patients undergoing CRT. The ALBI score, derived from albumin and total bilirubin, and left ventricular ejection fraction (LVEF) were assessed before and 6 months after CRT. The patients were classified according to the ALBI score before CRT; High (>−2.60) or Low (≤−2.60) ALBI groups. The patients were then reclassified based on the ALBI score before and 6 months after CRT; High/High, High/Low, Low/High, and Low/Low ALBI groups. We evaluated the prognostic value of the ALBI score for HF deaths after CRT. Results: During a median follow-up period of 50 months, there were 41 (22.7%) HF deaths. A Cox proportional hazard analysis revealed that high ALBI scores at baseline were not related to HF deaths (hazard ratio, 1.907, p = 0.068). However, High/High ALBI scores, but not High/Low or Low/High ALBI scores, were an independent predictor of HF deaths compared with Low/Low ALBI scores (hazard ratio, 3.449, p = 0.008), implying that consistently high ALBI scores were associated with poor prognosis. The percentage change in LVEF from baseline to 6 months after CRT did not differ among the four groups, suggesting that left ventricular systolic function was not linked with the ALBI score. Conclusions: ALBI scores before and after CRT are a new indicator of CRT response, and have a predictive value for HF deaths in HF patients.

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