Left bundle branch pacing improved heart function in a 10-year-old child after a 3-month follow-up

EP Europace ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. 1234-1239
Author(s):  
Wei Ji ◽  
Xueying Chen ◽  
Jie Shen ◽  
Diqi Zhu ◽  
Yiwei Chen ◽  
...  
Keyword(s):  
Heart Function ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction ◽  
Intracardiac Electrogram ◽  
Ventricular Activation ◽  
Pacing Lead

Abstract Aims As a physiological pacing strategy, left bundle branch pacing (LBBP) were used to correct left bundle branch block (LBBB), however, there is no relevant report in children. We aimed to evaluate the feasibility of LBBP in children. Methods and results Left bundle branch pacing was performed in a 10-year-old girl with a second-degree atrioventricular and LBBB. Under the guide of fluoroscopy, the pacing lead was deeply screwed into the interventricular septum to gain right bundle branch block (RBBB) pattern of paced QRS. Selective LBBP was achieved with a typical RBBB pattern of paced morphology and a discrete component between stimulus and ventricular activation in intracardiac electrogram and reached the standard of the stimulus to left ventricular activation time of 56 ms. At a 3-month follow-up, the LBBP acquired the reduction of left ventricular size and enhancement of left ventricular ejection fraction. Conclusion The application of LBBP in a child was first achieved with inspiring preliminary results. The LBBP can be carried out in children by cautiousness under the premise of strict grasp of indications.

Lead performance and clinical outcomes of patients with permanent His-Purkinje system pacing: a single-centre experience

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii45-ii53
Author(s):  
Zhiyong Qian ◽  
Yuanhao Qiu ◽  
Yao Wang ◽  
Zeyu Jiang ◽  
Hongping Wu ◽  
...  
Keyword(s):  
Cardiac Function ◽  
Clinical Outcomes ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Purkinje System ◽  
Pacing Lead ◽  
Qrs Morphology

Abstract Aims His-Purkinje system (HPS) pacing, including His bundle (HB) and left bundle branch (LBB) pacing, has emerged as a highlighted topic in recent years. Comparisons in lead performance and clinical outcomes between HB and LBB pacing were seldom reported. We aimed to investigate the mid-long-term lead performance and clinical outcomes of permanent HPS pacing patients in our centre. Methods and results Permanent HB pacing was implemented by placing the pacing lead helix at the HB area. Left bundle branch pacing was achieved by placing the lead helix in the left-side sub-endocardium of the interventricular septum. Pacing parameters, 12-lead ECG, echocardiography, and clinical outcomes were evaluated during follow-up. A total of 64 patients with HB pacing and 185 with LBB pacing were included. Left bundle branch pacing exhibited a slightly longer paced QRS duration than HB pacing (117.7 ± 11.0 vs. 113.7 ± 19.8 ms, P = 0.04). Immediate post-operation, LBB pacing had a significant higher R-wave amplitude (16.5 ± 7.5 vs. 4.3 ± 3.6 mV, P < 0.001) and lower capture threshold (0.5 ± 0.1 vs. 1.2 ± 0.8 V, P < 0.001) compared with HB pacing. During follow-up, an increase in capture threshold of >1.0 V from baseline was found in eight (12.5%) patients in the HB pacing group and none in LBB pacing. Paced QRS morphology changed from Qr to QS in lead V1 in seven patients (3.8%) with LBB pacing. Both HB and LBB pacing preserved cardiac function in patients with left ventricular ejection fraction (LVEF) over 50%. In patients with LVEF <50%, both HB and LBB pacing improved clinical outcomes during follow-up. Conclusion His-Purkinje system pacing produced favourable electrical synchrony and improved cardiac function in patients with heart failure. Left bundle branch pacing showed superior pacing parameters over HB pacing. Lead micro-displacement with changes in paced QRS morphology posts a concern in LBB pacing.

scholarly journals P1760 Cardiac prognosis of patients with subaortic membrane according to their morphology

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F R E Graterol Torres ◽  
S Moral ◽  
R Robles ◽  
E Ballesteros ◽  
M Morales ◽  
...  
Keyword(s):  
Heart Failure ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
The Other ◽  
Left Ventricular Ejection ◽  
Cardiac Complications ◽  
Pathophysiological Mechanism ◽  
Ventricular Ejection Fraction ◽  
Subaortic Membrane

Abstract INTRODUCTION Subaortic membrane is an entity which evolves during adulthood and can associate cardiac complications. Different morphologies have been described, although it is unknown if their prognosis varies according to these patterns. The aim of this study was to evaluate the cardiac prognosis of patients with subaortic membrane according to their morphological characteristics in adulthood. METHODS Forty-five patients diagnosed with subaortic membrane by imaging techniques were consecutively included (March 1999-August 2018). Three morphologies were described: fibromuscular ridge (FR), crescent-shaped (CS) and filamentous-shaped (FS). Cardiac complications were defined as mortality due to heart failure and/or necessity of aortic valve surgery and/or membrane resection. RESULTS Twenty-six cases (58%) had FR, 16 (35%) had CS and 3 (7%) presented FS (7%) (Fig.1). No differences were found in basal clinical parameters between groups. FR type was associated with the presence of dynamic gradient in baseline study (27% vs 0%, p = 0.014), but there were no differences in left ventricular ejection fraction (68 ± 8% vs 64 ± 8%; p = 0.092), nor in maximum thickness of basal interventricular septum (12.1 ± 3.9mm vs 11.7 ± 4.1mm, p = 0.699), nor in the presence of moderate/severe aortic stenosis (15% vs 11%, p > 0.999) with the other morphologies. During follow-up (mean ± SD= 5.8 ± 4.4years) 15 (33%) patients presented cardiac complications (2 deaths due to heart failure and 12 valvular interventions and/or membrane resection). FR type patients presented a higher cardiac complication rate (50% vs 11%, p = 0.006) and greater necessity of open-heart surgery (46% vs 11%, p = 0.011) than the other groups during follow-up. CONCLUSIONS FR type is associated with a higher rate of cardiac complications during follow-up than other subaortic membrane morphologies. Dynamic gradient associated to this pattern could be the basis of a possible pathophysiological mechanism related to the worst prognosis of these patients. Figure 1. Different morphologies of subaortic membranes. (A) Fibromuscular ridge type; (B) Crescent-shaped type; (C) Filamentous-shaped type. aL: anterior leaflet of mitral valve ; Ao: aorta; LA: left atrium; LV: left ventricle; RV: right ventricle. Abstract P1760 Figure.

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 The Effect of 3-Month Growth Hormone Administration and 12-Month Follow-Up Duration among Heart Failure Patients Four Weeks after Myocardial Infarction: A Randomized Double-Blinded Clinical Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Afshin Amirpour ◽  
Mehrbod Vakhshoori ◽  
Reihaneh Zavar ◽  
Hadi Zarei ◽  
Masoumeh Sadeghi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Growth Hormone ◽  
Randomized Clinical Trials ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Probable Impact ◽  
Double Blinded

Background. The probable impact of growth hormone (GH) as a heart failure (HF) treatment strategy is still less investigated. Therefore, we aimed to evaluate the relation of 3-month GH prescription on left ventricular ejection fraction (LVEF), interventricular septum (IVS), posterior left ventricle (LV) thickness, end systolic and end diastolic diameters (ESD and EDD), and pulmonary arterial pressure (PAP) among Iranian individuals suffering from HF due to MI attack. Methods. A total of 16 clinically stable participants with HF diagnosis and LVEF < 40 % were selected for enrollment in this pilot randomized double-blinded study. They were randomly assigned equally to groups received 5 IU subcutaneous GH or placebo. Injections were done every other day for a total of 3-month duration. After termination of intervention and nine months afterwards, cardiac outcomes were assessed. Results. Baseline and 12-month posttrial participants’ characteristics were similar. LVEF was increased significantly by three months started from baseline in individuals receiving GH ( 32 ± 3.80 % to 43.80 ± 4.60 %, P = 0.002 ). During the next 9 months of follow-up concurrent with cessation of injections, LVEF was declined ( 43.80 ± 4.60 % to 32.20 ± 6.97 %, P = 0.008 ). LVEF and ESD were remarkably higher and lower in GH group compared with controls by the end date of injections ( 43.80 ± 4.60 % vs. 33.14 ± 4.84 %, P = 0.02 and 39.43 ± 3.45  mm vs. 33 ± 3.16  mm, P = 0.03 , respectively). No other considerable association was found in terms of other predefined variables in neither GH nor placebo groups. Conclusions. GH administration in HF patients was associated with increased LVEF function. Several randomized clinical trials are necessary proving this relation. This trial is registered with IRCT201704083035N1.

The role of timely measurement of galectin-3, NT-proBNP, cystatin C and hsTnT in predicting prognosis and heart function after heart transplantation

2016 ◽  
Vol 54 (2) ◽  
Author(s):  
Janka Franeková ◽  
Lenka Hošková ◽  
Peter Sečník ◽  
Michal Pazderník ◽  
Markéta Kotrbatá ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Cystatin C ◽  
Heart Function ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Galectin 3

AbstractChanges of biomarkers measured soon after heart transplantation (HTx) can reflect different processes: cardiomyocyte necrosis (troponins, high-sensitivity cardiac TnT and TnI), heart function (natriuretic peptides, BNP and NT-proBNP), fibrosis (galectin-3 and ST2), and global cardiorenal risk (cystatin C). We assessed the prognostic role of hsTnT, NT-proBNP, galectin-3 and cystatin C during the early post-transplant period.A total of 121 consecutive post-HTx patients were assessed. The main outcomes were survival, left ventricular ejection fraction (LVEF) and rejection periods. Survival was assessed after intermediate (12 months) and long periods (total follow-up during study, median of survival 763 days, IR 527–1038 days). LVEF was assessed 12 months after HTx. Rejection was evaluated during follow-up. We report biomarker concentrations measured 10 days and 12 months after HTx.Ten days after HTx, cystatin C and hsTnT predicted death both under univariable and multivariable analysis. These two biomarkers along with galectin-3 were increased in patients with decreased LVEF measured 1 year after HTx. NT-proBNP did not show early prognostic power. None of the measured biomarkers predicted rejection, but hsTnT and NT-proBNP were increased significantly 12 months after HTx in patients with at least one rejection.Cystatin C and hsTnT measured 10 days after HTx can provide prognostic information on survival and galectin-3 measured at the same time may display a relationship to heart function assessed 1 year after HTx. Further study should be carried out in a large cohort of patients.

scholarly journals Left Anterior Fascicular Block After Transcatheter Closure of Ventricular Septal Defect in Children

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhijun Wu ◽  
Penghui Yang ◽  
Ping Xiang ◽  
Xiaojuan Ji ◽  
Jie Tian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Large Diameter ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction

Background: Arrhythmia is the most common complication after transcatheter closure of a ventricular septal defect (VSD). However, the effects of postprocedural left anterior fascicular block are not clear. This study presents the clinical characteristics, prognosis, and related risk factors of left anterior fascicular block after transcatheter closure of a VSD in children.Methods: The clinical and follow-up data of the patients in the Heart Center of Children's Hospital of Chongqing Medical University from June 2009 to October 2018 were reviewed. And 30 cases were eligible out of all 1,371 cases.Results: An electrocardiogram showed a left anterior fascicular block within 3 days, and most patients gradually returned to normal within 1–2 years, showing a dynamic change. Left ventricular end-diastolic dimension Z-score ranged from −2 to 2 in all children, and no decrease of left ventricular ejection fraction was found in all children. The high ratio between VSD size and body surface area [p &lt; 0.05, odds ratio (OR) 2.6, 95% CI: 1.136–6.113] and large diameter difference between the occluder size and VSD size (p &lt; 0.05, OR 2.1, 95% CI: 1.036–4.609) were independent risk factors for postprocedural left anterior fascicular block.Conclusions: The incidence of postprocedural left anterior fascicular block is not that low, and the overall prognosis is quite good at the current follow-up stage. No progressive severity has been found, such as complete left bundle branch block, double (triple) bundle branch block, and atrioventricular block, to have an influence on cardiac systolic and diastolic function.

scholarly journals Efficacy of left bundle branch area pacing in patients with indication for cardiac resynchronization therapy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Elvira Ruiz ◽  
P Penafiel-Verdu ◽  
C Munoz-Esparza ◽  
J Martinez-Sanchez ◽  
J J Sanchez-Munoz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Conduction Delay ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction ◽  
Ventricular Activation

Abstract Background Cardiac resynchronization therapy (CRT) with biventricular pacing has demonstrated clinical benefits in heart failure patients with left bundle branch block (LBBB) and ventricular dysfunction. Left bundle branch area pacing (LBBAP) results in a relatively short QRS duration (QRSd) with fast left ventricular activation and could be considered as an alternative to conventional CRT. Purpose The aim of the present study was to evaluate the feasibility and outcomes of LBBAP in patients with indications for CRT. Methods Consecutive patients with indications for CRT were included. LBBAP was performed via transventricular septal approach (1–3). We aimed to achieve a paced QRS with right bundle branch conduction delay morphology, a stimulus to peak left ventricular activation time (S-LVAT) &lt;100ms and/or a QRSd ≤130ms. AV delay programming was individualized in patients in sinus rhythm, taking consideration of the AV conduction, programming the one that generated the shortest QRSd at rest. Rate adaptive AV was also activated in these patients. Pacing electrical and echocardiographic parameters were recorded at baseline and during follow-up. Results LBBAP was achieved in 19 of 21 (90.5%) patients with indication for CRT. Indications were heart failure with LBBB and left ventricular ejection fraction (LVEF) ≤35% in 8 (42%), AV node ablation or AV block with LVEF &lt;50% and high expected RV pacing burden in 9 (47%), 1 pacing-induced cardiomyopathy and 1 patient with biventricular pacemaker malfunction (high LV capture threshold). The mean follow-up was 4.6±1.7 months and the percentage of ventricular pacing was 93.4±13.9%. There were no device-related complications during this period. LBBA capture threshold was 0.6±0.3V at 0.4ms at the implantation, and remained stable (0.7±0.1 V, p=0.17). The lead impedance and R-wave amplitude at implantation were 636±106 ohms and 13.4±6.8 mV, and 541±88 ohms and 13.0±5.1 mV during the follow-up (p&lt;0.001 and p=0.27, respectively). Mean S-LVAT was 85.5±13.9 ms, and mean QRSd was 122±9 ms, that remained stable during follow-up (122 vs 124 ms, p=0.21). In patients with LBBB, a significant narrowing of paced QRSd was achieved (160.9±16.7 vs. 123.9±9.7 ms, p&lt;0.001). Mean LVEF increased by 15.9%, from 35.4±8.9% at baseline to 51.3±9.8% at follow-up (p&lt;0.001) in the overall population, and 14.5% (from 32.7±4.8% to 47.2±10.7%, p=0.001) in patients with LBBB. After one month, estimated time for elective replacement was 11.9±0.4 years. Conclusions LBBPA was successfully achieved in 90.5% of the patients with indication for CRT, with good and stable pacing electrical parameters, long estimated battery longevity and relatively narrow QRS, and was associated with improvement in cardiac function. LBBAP may be considered as a first-line option for patients with indications for CRT. FUNDunding Acknowledgement Type of funding sources: None.

Peak Oxygen Consumption and Resting Left Ventricular Ejection Fraction Changes After Cardiomyoplasty at 6-Month Follow-up

Circulation ◽  
1995 ◽  
Vol 92 (9) ◽  
pp. 216-222 ◽  
Author(s):  
Edimar Alcides Bocchi ◽  
Guilherme Veiga Guimarães ◽  
Luiz Felipe P. Moreira ◽  
Fernando Bacal ◽  
Alvaro Vilela de Moraes ◽  
...  
Keyword(s):  
Oxygen Consumption ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Peak Oxygen Consumption ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

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