scholarly journals 16-57: The impact of remote monitoring of implanted cardioverter–defibrillator (ICD) and cardiac resynchronization therapy device (CRT–D) patients on healthcare costs: 3-year follow-up

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i15-i15
Author(s):  
Piotr Buchta ◽  
Mateusz Tajstra ◽  
Anna Kurek ◽  
Michał Skrzypek ◽  
Małorzata ŚWietlińska ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Remote Monitoring ◽  
Healthcare Costs ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardioverter Defibrillator ◽  
The Impact ◽  
Cardiac Resynchronization Therapy Device

Device clinic and follow-up

2018 ◽  
pp. 341-352
Author(s):  
Nicola Meldrum ◽  
Andrew Mitchell
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Resynchronization ◽  
History Taking ◽  
Resynchronization Therapy ◽  
Cardioverter Defibrillator ◽  
Additional Information ◽  
Advantages And Disadvantages ◽  
Management Diagnosis

This chapter describes the device clinic. Requirements for a suitable facility, including maintaining patient dignity, are covered, and the development of remote follow-up is defined, including advantages and disadvantages. The follow-up schedule is covered, and history taking and examination are covered. Pacemaker testing and interrogation are shown, to aid the physician in management, diagnosis, and optimization of programming. Implantable cardioverter defibrillator (ICD) follow-up is also described, with all additional information required for follow-up described. Finally, cardiac resynchronization therapy (CRT) follow-up differences from standard pacemaker checks are covered.

P3805Mortality predictors and outcome in patients after upgrade from implantable cardioverter-defibrillator to cardiac resynchronization therapy in comparison to CRT-D de novo implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Jedrzejczyk-Patej ◽  
M Mazurek ◽  
W Kowalska ◽  
M Bugajski ◽  
A Konieczny-Kozielska ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Cardiac Resynchronization Therapy ◽  
Implantable Cardioverter Defibrillator ◽  
De Novo ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardioverter Defibrillator ◽  
Mortality Predictors

Abstract Background Over a quarter of all cardiac resynchronization therapy (CRT) implants are upgrades from previous devices, mainly from implantable cardioverter-defibrillator (ICD). In comparison to CRT with defibrillator (CRT-D) de novo implantation, upgrade from ICD to CRT-D carries higher risk of complications. Limited number of studies evaluated predictors of death in patients undergoing upgrade from ICD to CRT-D. Aim To determine mortality predictors and outcome in patients undergoing upgrade from ICD to CRT-D in comparison to subjects with CRT-D de novo implantation. Methods Study population consisted of 595 consecutive patients with CRT-D implanted between 2002 and 2015 in tertiary care university hospital, in a densely inhabited, urban region of Poland (480 subjects [84.3%] with CRT-D de novo implantation; 115 patients [15.7%] upgraded from ICD to CRT-D). Results The median follow-up was 1692 days (range: 457–3067). All-cause mortality in patients upgraded from ICD was significantly higher than in subjects with CRT-D implanted de novo (43.5% vs. 35.5%, P=0.045). On multivariable regression analysis, left ventricular end-systolic diameter (HR 1.07, 95% CI 1.02–1.11, P=0.002), creatinine level at baseline (HR 1.01, 95% CI 1.00–1.02, P=0.01), NYHA IV class at baseline (HR 2.36, 95% CI 1.00–5.53, P=0.049) and cardiac device-related infective endocarditis (CDRIE) during follow up (HR 2.42, 95% CI 1.02–5.75, P=0.046) were identified as independent predictors of higher mortality in patients with CRT-D upgraded from ICD. Conclusions Mortality rate in patients upgraded from ICD is higher in comparison to CRT-D de novo implanted subjects, and reaches almost 45% within 4.5 years. Left ventricular dimensions, creatinine level, high NYHA class at baseline and infective endocarditis during follow up are independent mortality predictors in patients with CRT-D upgraded from ICD.

scholarly journals 414 Ventricular-arterial interaction predicts response to cardiac resynchronization therapy: a link with improvement of endothelial function and arterial elastic properties

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N Karamichalakis ◽  
I Ikonomidis ◽  
J Parissis ◽  
P Simitsis ◽  
S Xydonas ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Endothelial Function ◽  
Cardiac Resynchronization Therapy ◽  
Vascular Function ◽  
Global Longitudinal Strain ◽  
Endothelial Glycocalyx ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
The Impact

Abstract Background Endothelial dysfunction (ED) is a hall mark of chronic heart failure and has been linked to disease progression, hospitalizations and mortality. Purpose to evaluate the impact of cardiac resynchronization therapy (CRT) in ED and to determine predictors of response to CRT Methods CRT recipients from 19/07/2016 until 19/10/2018 were studied at baseline and 3 months after. In each visit we evaluated a 12 lead ECG, carotid to femoral pulse wave velocity (cfPWV), flow-mediated dilatation of the brachial artery (FMD), left ventricle ejection fraction (LVEF) and left ventricle (LV) global longitudinal strain (GLS). We evaluated arterial elastance (Ea) to ventricular elastance (Ees) ratio (Ea/Ees) by echocardiography and the ratio of cfPWV to GLS, as valid markers of ventricular-arterial interaction. We also assessed the layer of endothelial glycocalyx by measurement of Perfused Boundary Region (PBR) of the sublingual microvessel range:5-25 microns. Results 32 patients with a mean age 65.5 (±10.9) years and severe LV systolic dysfunction were enrolled. During follow-up, LVEF, GLS, LVESV and all ED markers exhibited significant improvement (table 1). 23 patients were responders. Among the baseline vascular function markers, only the ratio cfPWV/GLS predicted response to CRT (OR: 0.245, 95%CI: 0.042-0.759, p = 0.044).Threshold analysis showed that the best threshold of cfPWV/GLS for response to CRT was 2.75 (specificity: 0.67%, sensitivity: 0.94%). Conclusions After 3 months of CRT, endothelial function, arterial elasticity and ventricular arterial interaction are improved. The baseline ratio cfPWV/GLS, a novel marker of ventricular arterial interaction, can be applied to predict response to CRT. table 1 Baseline Follow-up Change Measurement mean (sd) mean (sd) mean (sd) p-value SBP (mmHg) 126 (19) 128 (16) 2.18 (11.98) 0,465 DBP (mmHg) 79 (9) 80 (9) 1.06 (8.58) 0,618 LVEF (%) 27 (7) 35 (9) 7.50 (4.77) <0.001 LVESV (mL) 151 (42) 120 (46) -26.91 (17.20) <0.001 GLS (%) 6.47 (2.89) 9.33 (4.18) 2.85 (2.28) <0.001 FMD (%) 5.88 (2.79) 10.25 (3.67) 4.37 (3.34) <0.001 Ea/Ees 2.81 (1.10) 2.04 (0.99) -0.77 (0.47) <0.001 cfPWV 11.11 (2.61) 10.01 (2.45) -1.10 (1.56) 0,003 PBR 5-25(microns) 2.26 (0.20) 2.14 (0.24) -0.13 (0.25) 0,028 cfPWV/GLS 2.18 (1.46) 1.45 (1.11) -0.73 (0.55) <0.001 Measurements at baseline, follow-up and their change during study Abstract 414 Figure. picture 1

scholarly journals Improvement in circulating endothelial progenitor cells pool after cardiac resynchronization therapy: increasing the list of benefits

2020 ◽  
Author(s):  
Gonçalo Cristóvão ◽  
James Milner ◽  
Pedro Sousa ◽  
Miguel Ventura ◽  
João Cristóvão ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Progenitor Cells ◽  
Endothelial Progenitor Cells ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Endothelial Progenitor ◽  
Circulating Endothelial Progenitor Cells ◽  
The Impact

Abstract Background Recent studies suggest that circulating endothelial progenitor cells (EPCs) may influence the response to cardiac resynchronization therapy (CRT). The aim of this study was to evaluate the effect of CRT on EPCs levels and to assess the impact of EPCs on long-term clinical outcomes. Population and methods Prospective study of 50 patients submitted to CRT. Two populations of circulating EPCs were quantified previously to CRT implantation: CD34 + KDR + and CD133 + KDR + cells. EPCs levels were reassessed 6 months after CRT. Endpoints during the long-term follow-up were all-cause mortality, heart transplantation and hospitalization for heart failure (HF) management. Results The proportion of non-responders to CRT was 42% and tended to be higher in patients with an ischemic vs non-ischemic etiology (64% vs 35%, p=0.098). Patients with ischemic cardiomyopathy (ICM) showed significantly lower CD34+KDR+ EPCs levels when compared to non-ischemic dilated cardiomyopathy patients (DCM) (0.0010 ± 0.0007 vs 0.0030 ± 0.0024 cells/100 leukocytes, p=0.032). There were no significant differences in baseline EPCs levels between survivors and non-survivors nor between patients who were rehospitalized for HF management during follow-up or not. At 6-month follow-up, circulating EPCs levels were significantly higher than baseline levels (0.0024 ± 0.0023 vs 0.0047 ± 0.0041 CD34 + KDR + cells/100 leukocytes, p=0.010 and 0.0007 ± 0.0004 vs 0.0016 vs 0.0013 CD133 + /KDR + cells/100 leukocytes, p=0.007). Conclusions Patients with ICM showed significantly lower levels of circulating EPCs when compared to their counterparts. CRT seems to improve the pool of endogenously circulating EPCs and reduced baseline EPCs levels seem not influence long-term outcomes after CRT.

scholarly journals Improvement of LV Reverse Remodeling Using Dynamic Programming of Fusion-Optimized Atrioventricular Intervals in Cardiac Resynchronization Therapy

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhongkai Wang ◽  
Pan Li ◽  
Bili Zhang ◽  
Jingjuan Huang ◽  
Shaoping Chen ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Nyha Class ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Resynchronization Therapy ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
The Impact

Background: The patient-tailored SyncAV algorithm shortens the QRS duration (QRSd) beyond what conventional biventricular (BiV) pacing can. However, evidence of the ability of SyncAV to improve the cardiac resynchronization therapy (CRT) response is lacking. The aim of this study was to evaluate the impact of CRT enhanced by SyncAV on echocardiographic and clinical responses.Methods and Results: Consecutive heart failure (HF) patients from three centers treated with a quadripolar CRT system (Abbott) were enrolled. The total of 122 patients were divided into BiV+SyncAV (n = 68) and BiV groups (n = 54) according to whether they underwent CRT with or without SyncAV. Electrocardiographic, echocardiographic, and clinical data were assessed at baseline and during follow-up. Echocardiographic response to CRT was defined as a ≥15% decrease in left ventricular end-systolic volume (LVESV), and clinical response was defined as a NYHA class reduction of ≥1. At the 6-month follow-up, the baseline QRSd and LVESV decreased more significantly in the BiV+SyncAV than in the BiV group (QRSd −36.25 ± 16.33 vs. −22.72 ± 18.75 ms, P < 0.001; LVESV −54.19 ± 38.87 vs. −25.37 ± 36.48 ml, P < 0.001). Compared to the BiV group, more patients in the BiV+SyncAV group were classified as echocardiographic (82.35 vs. 64.81%; P = 0.036) and clinical responders (83.82 vs. 66.67%; P = 0.033). During follow-up, no deaths due to HF deterioration or severe procedure related complications occurred.Conclusion: Compared to BiV pacing, BiV combined with SyncAV leads to a more significant reduction in QRSd and improves LV remodeling and long-term outcomes in HF patients treated with CRT.

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