862Syncav with multipoint pacing improves acute left ventricular hemodynamics

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Chow ◽  
P Waddingham ◽  
T Betts ◽  
J Mangual ◽  
N Badie ◽  
...  
Keyword(s):  
Biventricular Pacing ◽  
Pressure Change ◽  
Left Ventricular ◽  
Maximum Pressure ◽  
Conduction Time ◽  
Multipoint Pacing ◽  
Surface Ecg ◽  
Intrinsic Conduction ◽  
Qrs Duration ◽  
Incremental Improvement

Abstract Funding Acknowledgements Abbott Introduction SyncAV has been shown to improve electrical synchronization by automatically adjusting atrioventricular delay (AVD) according to the intrinsic atrioventricular conduction time. Additional incremental electrical synchronization may be gained by the addition of second left ventricular (LV) pulse with MultiPoint Pacing (MPP). While the electrical synchronization benefits of SyncAV have been previously explored, there has been no assessment of the acute hemodynamic impact of SyncAV with or without MPP. Objective  Evaluate the acute LV hemodynamic impact of SyncAV with and without MPP. Methods Heart failure patients with LBBB and QRS duration (QRSd) > 140 ms undergoing CRT-P/D implant with a quadripolar LV lead were enrolled in this prospective study. A guidewire or catheter with pressure transducer was placed in the LV chamber and the maximum pressure change (dP/dtmax) was recorded during the following pacing modes:  intrinsic conduction, conventional biventricular pacing with SyncAV (BiV + SyncAV), and MPP with SyncAV (MPP + SyncAV). Twelve-lead surface ECG was used to determine the patient-tailored SyncAV offset that minimized QRSd. Results Twenty-seven patients (67% male, 44% ischemic, 30 ± 7% ejection fraction) completed the acute recordings. Relative to the intrinsic QRSd of 163 ms, BiV + SyncAV reduced QRSd by 21.5% to 124 ms (p < 0.001 vs. intrinsic) and MPP + SyncAV reduced QRSd by 26.6% to 120 ms (p < 0.05 vs. BiV + SyncAV). Beyond electrical synchronization, SyncAV significantly improved acute hemodynamics. Relative to the intrinsic dP/dtmax of 842 mmHg/s, BiV + SyncAV elevated dP/dtmax by 6.3% to 900 mmHg/s (p < 0.001 vs. intrinsic) and MPP + SyncAV elevated dP/dtmax by 8.8% to 926 mmHg/s (p < 0.005 vs. BiV + SyncAV). Despite both QRSd and dP/dtmax improvement with SyncAV and MPP, correlation between electrical and hemodynamic measurements was poor (R2 = 0.0 for BiV + SyncAV, R2 = 0.1 for MPP + SyncAV). Conclusion SyncAV may significantly improve acute LV hemodynamics in addition to electrical synchrony in LBBB patients. Further incremental improvement was achieved by combining SyncAV with MPP. Abstract Figure.

scholarly journals Use of Cardiac Resynchronisation Therapy – Change of Clinical Settings

2014 ◽  
Vol 3 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Khang-Li Looi ◽  
Anthony SL Tang ◽  
Sharad Agarwal
Keyword(s):  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Severe Left Ventricular Dysfunction ◽  
Surface Ecg ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Qrs Duration

Current guidelines recommend cardiac resynchronisation therapy (CRT) for patients with severe left ventricular dysfunction (left ventricular ejection fraction [LVEF] ≤35 %), QRS duration of ≥120–150 ms (Class IA and IB indications) on surface electrocardiogram (ECG) and New York Heart Association (NYHA) class III or IV heart failure (HF) symptoms. Ongoing studies aim to expand the use of CRT in patients with asymptomatic or minimal symptoms left ventricular dysfunction. There have been studies that have shown benefit of CRT extended to this group of patients. There have also been different implications of the role of CRT in patients with atrial fibrillation (AF), patients with narrow QRS duration or with right bundle branch block (RBBB) on surface ECG, as well as patients with end-stage renal failure on dialysis therapy. This article aims to review the current body of evidence of expanding use of CRT in these populations.

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.

Biventricular mechanical asynchrony predicts hemodynamic effect of uni- and biventricular pacing

2003 ◽  
Vol 285 (6) ◽  
pp. H2788-H2796 ◽  
Author(s):  
Yinghong Yu ◽  
Andrew Kramer ◽  
Julio Spinelli ◽  
Jiang Ding ◽  
Walter Hoersch ◽  
...  
Keyword(s):  
New York ◽  
Contractile Function ◽  
Biventricular Pacing ◽  
Quantitative Relationship ◽  
Left Ventricular ◽  
Ventricular Pacing ◽  
Class Iii ◽  
Loop Area ◽  
Association Class ◽  
Qrs Duration

We tested whether biventricular resynchronization explains contractile function changes with univentricular and biventricular pacing in heart failure patients with varying magnitudes of baseline biventricular asynchrony. Thirty patients (New York Hospital Association class ≥ III, QRS duration ≥120 ms) were tested. Contractile function was measured by left ventricular maximum first derivative of pressure over time (dP/d tmax). Biventricular mechanical asynchrony was quantified by the normalized pressure-pressure (NPP) loop area formed by the cross-plot of right and left intraventricular pressure curves from each cardiac cycle. Any ventricular pacing increased dP/d tmax if it decreased baseline NPP loop area and almost always worsened dP/d tmax and asynchrony when baseline NPP loop area <0.3. The quantitative relationship between dP/d tmax and NPP loop area change depended on ventricular pacing site and timing relative to intrinsic activation. For similar NPP loop decreases, dP/d tmax increased 16% more with left and biventricular pacing compared with right ventricular pacing. In conclusion, right, left, or biventricular pacing can improve contractile function only in patients having sufficient baseline biventricular asynchrony. However, biventricular resynchronization is only one of the improvement mechanisms.

scholarly journals Multipoint pacing by a left ventricular quadripolar lead improves the acute hemodynamic response to CRT compared with conventional biventricular pacing at any site

Heart Rhythm ◽  
2015 ◽  
Vol 12 (5) ◽  
pp. 975-981 ◽  
Author(s):  
Francesco Zanon ◽  
Enrico Baracca ◽  
Gianni Pastore ◽  
Lina Marcantoni ◽  
Chiara Fraccaro ◽  
...  
Keyword(s):  
Biventricular Pacing ◽  
Hemodynamic Response ◽  
Left Ventricular ◽  
Multipoint Pacing

scholarly journals Improvement in pump function with endocardial biventricular pacing increases with activation time at the left ventricular pacing site in failing canine hearts

2011 ◽  
Vol 301 (4) ◽  
pp. H1447-H1455 ◽  
Author(s):  
Elliot J. Howard ◽  
James W. Covell ◽  
Lawrence J. Mulligan ◽  
Andrew D. McCulloch ◽  
Jeffrey H. Omens ◽  
...  
Keyword(s):  
Heart Failure ◽  
Biventricular Pacing ◽  
Pressure Change ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Activation Time ◽  
Lead Placement ◽  
Anterolateral Wall ◽  
The Right ◽  
Transmural Function

Recently, attention has been focused on comparing left ventricular (LV) endocardial (ENDO) with epicardial (EPI) pacing for cardiac resynchronization therapy. However, the effects of ENDO and EPI lead placement at multiple sites have not been studied in failing hearts. We hypothesized that differences in the improvement of ventricular function due to ENDO vs. EPI pacing in dyssynchronous (DYSS) heart failure may depend on the position of the LV lead in relation to the original activation pattern. In six nonfailing and six failing dogs, electrical DYSS was created by atrioventricular sequential pacing of the right ventricular apex. ENDO was compared with EPI biventricular pacing at five LV sites. In failing hearts, increases in the maximum rate of LV pressure change (dP/d t; r = 0.64), ejection fraction ( r = 0.49), and minimum dP/d t ( r = 0.51), relative to DYSS, were positively correlated ( P < 0.01) with activation time at the LV pacing site during ENDO but not EPI pacing. ENDO pacing at sites with longer activation delays led to greater improvements in hemodynamic parameters and was associated with an overall reduction in electrical DYSS compared with EPI pacing ( P < 0.05). These findings were qualitatively similar for nonfailing hearts. Improvement in hemodynamic function increased with activation time at the LV pacing site during ENDO but not EPI pacing. At the anterolateral wall, end-systolic transmural function was greater with local ENDO compared with EPI pacing. ENDO pacing and intrinsic activation delay may have important implications for management of DYSS heart failure.

scholarly journals Activation pattern during his pacing: how close are we to normal physiology?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Yasin ◽  
V Vaidya ◽  
J Tri ◽  
M Van Zyl ◽  
A Ladejobi ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Ventricular ◽  
Conduction System ◽  
Funding Source ◽  
Activation Pattern ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Surface Ecg ◽  
Qrs Duration ◽  
The Right

Abstract Background His bundle pacing aims to mimic the activation pattern of normal conduction to maintain ventricular synchrony. However, selective His capture can be challenging, and the activation sequence during His pacing may not replicate normal conduction. Purpose Compare the right ventricular (RV) and left ventricular (LV) activation pattern in sinus rhythm and His bundle pacing. Methods Baseline LV and RV map was created in sinus rhythm using Rhythmia mapping system (Boston Scientific Corporation) in canine animal model. Medtronic 3830 lead was placed near the bundle of His under fluoroscopic, intracardiac echocardiogram, and electroanatomic guidance. Conduction system capture was confirmed by observing a QRS duration &lt;120ms and an isoelectric segment between pacing artifact and QRS on surface ECG. Repeat LV and RV activation map was obtained during His pacing. Average QRS, HV and pacing to V intervals were calculated with standard deviation. Results Mapping was performed successfully in four animals. At baseline, the average QRS duration was 44±2.6ms and HV interval was 32±4.2ms. Earliest site of myocardial activation was in the mid-septal LV region. The earliest RV myocardial activation was also at the septum closer to the apex, but later than the LV (Figure1A). With His pacing, the average QRS duration was 70±17.0ms and the average stim to V interval was 31±8.7ms. During His pacing, the earliest site of activation was in the RV septum, with an activation pattern from base to apex in both the RV and LV. Conclusion Unlike normal physiology, the activation pattern during conduction system pacing is from base to apex with earliest site in the RV. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Mayo Clinic

Heart failure: definitions, investigation, and management

2017 ◽  
pp. 837-846
Author(s):  
John G. F. Cleland ◽  
John Baxter
Keyword(s):  
Heart Failure ◽  
Pharmacological Treatment ◽  
Beta Blockers ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Qrs Duration ◽  
Robust Evidence

Heart failure is among the most common chronic debilitating conditions among older adults. The diagnosis is complex and usually made late, only after severe symptoms develop. Natriuretic peptides (BNP or NT-proBNP) are the key to early diagnosis of heart failure and echocardiography to its cause; most commonly ventricular dysfunction [either with a reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction] or valve disease. For patients with HFrEF, pharmacological treatment with angiotensin converting-enzyme (ACE) inhibitors and mineralo-corticoid receptor antagonists and for those in sinus rhythm beta-blockers and ivabradine have transformed prognosis. For patients with a QRS duration >140 msec, cardiac resynchronization with atrio-biventricular pacing should be considered. Iron deficiency should be sought for and treated. For patients with HFpEF, robust evidence that treatments improve outcome is lacking but for symptoms, the pharmacological treatment of HFpEF and HFrEF may be rather similar.

scholarly journals Left cardiac atrioventricular delay and inter-ventricular delay in cardiac resynchronization therapy responder and non-responder

2016 ◽  
Vol 2 (1) ◽  
pp. 247-250 ◽  
Author(s):  
Matthias Heinke ◽  
Helmut Kühnert ◽  
Tobias Heinke ◽  
Jonas Tumampos ◽  
Gudrun Dannberg
Keyword(s):  
New York ◽  
Cardiac Resynchronization Therapy ◽  
Biventricular Pacing ◽  
Heart Association ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Atrioventricular Delay ◽  
Surface Ecg ◽  
New York Heart Association

AbstractCardiac resynchronization therapy is an established therapy for heart failure patients. The aim of the study was to evaluate electrical left cardiac atrioventricular delay and interventricular desynchronization in sinus rhythm cardiac resynchronization therapy responder and non-responder. Cardiac electrical desynchronization were measured by surface ECG and focused transesophageal bipolar left atrial and left ventricular ECG before implantation of cardiac resynchronization therapy defibrillators. Preoperative electrical cardiac desynchronization was 195.7 ± 46.7 ms left cardiac atrioventricular delay and 74.8 ± 24.5 ms interventricular delay in cardiac resynchronization therapy responder. Cardiac resynchronization therapy responder New York Heart Association class improved during long term biventricular pacing. Transesophageal left cardiac atrioventricular delay and interventricular delay may be additional useful parameters to improve patient selection for cardiac resynchronization therapy.

Sign in / Sign up

Export Citation Format

Share Document