scholarly journals Initial experience, feasibility and safety of permanent left bundle branch pacing; a retrospective single centre study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
JLPM Van Den Broek ◽  
FALE Bracke ◽  
I Stranders ◽  
MNJ Op "T Hof ◽  
LM Rademakers
Keyword(s):  
Success Rate ◽  
Left Ventricular ◽  
Previous Experience ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Complication Rates ◽  
Success Rates ◽  
Ventricular Ejection Fraction ◽  
Delivery Sheath

Abstract Funding Acknowledgements Type of funding sources: None. Background Physiologic pacing by left bundle branch pacing (LBBP) is characterized by direct stimulation of the intrinsic His-Purkinje system and results in physiologic ventricular depolarization and repolarization. This technique has emerged as an alternative to both traditional right ventricular pacing for bradycardia and classic cardiac resynchronization therapy (CRT). High success rates and low complication rates are reported, however the majority of literature is reported by relatively few, highly experienced centres. Purpose This retrospective study aims to describe success rate, feasibility and safety of LBBP for both bradycardia and CRT indications in a high volume referral centre, performed by three physicians without previous experience with LBBP. Methods 100 patients who underwent attempted LBBP from January 2020 to September 2020 were analysed. LBBP was performed using the Medtronic SelectSecure 3830 pacing lead and the Medtronic C315HIS delivery sheath. The primary end points are acute LBBP success rates and LBBP related complications within 3-6 months from implantation. Success was defined as a paced QRS with QR or RSr’ in V1 and left ventricular activation time (LVAT) <90ms. Device follow-up data was acquired at 1 month and 3-6 months after implantation. Results The mean age was 70 ± 11.4 years and 67% were men. 57% had a left ventricular ejection fraction <0.50 and QRS was 146 ± 33.7ms. Pacing indication was CRT in 48, bradycardia in 42 and planned AV node ablation in 9. LBBP was successful in 83/100 patients (83%), with paced QRS of 121 ± 19.7ms and LVAT of 81 ± 13.8ms. A learning curve could not be demonstrated; the success rates in the first and latter half were 78% and 88% respectively (p = 0.183). Pacing parameters at implantation were satisfactory; R-wave 11.9 ± 5.9mV, impedance 736 ± 153Ω and capture threshold 0.7 ± 0.4V. R-wave increased to 14.6 ± 6.3mV at 1 month (p < 0.001) and remained stable at 13.6 ± 5.5mV after 3-6 months (p = 0.829). Impedance decreased to 572 ± 82Ω at 1 month (p < 0.001) and further decreased to 536 ± 81Ω after 3-6 months (p < 0.001). Capture threshold remained stable at 1 and 3-6 months (0.7 ± 0.2V (p = 0.287) and 0.8 ± 0.2V (p = 0.055), respectively). No LBBP related complications, e.g. lead perforation or dislodgement, occurred during the follow-up of 249 ± 64 days. The main reasons for unsuccessful implantation (n = 17) were insufficient reach of the delivery sheath (n = 8) and inability to penetrate the septum due to fibrosis (n = 5). Conclusion This study shows that LBBP is a safe and feasible method for delivering physiological pacing. Without previous experience, our initial success rate is comparable to highly experienced centres. Pacing parameters remained stable after 6 months and no LBBP complications occurred. Success rate of implantation could further improve with dedicated LBBP delivery sheaths. Large randomized controlled trials are needed to further confirm safety and efficacy of LBBP.

scholarly journals Long-term Safety and Feasibility of Left Bundle Branch Pacing in A Large Single Center Study

2021 ◽  
Author(s):  
Lan Su ◽  
Songjie Wang ◽  
Shengjie Wu ◽  
Lei Xu ◽  
Zhouqing Huang ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Complication Rates ◽  
Success Rates ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Long Term Follow Up ◽  
Large Observational Study

Background - Left bundle branch pacing (LBBP) is a novel pacing method and has been observed to have low and stable pacing thresholds in prior small short-term studies. The objective of this study was to evaluate the feasibility and safety of LBBP in a large consecutive diverse group of patients with long-term follow up. Methods - This study prospectively enrolled 632 consecutive pacemaker patients with attempted LBBP from April 2017 to July 2019. Pacing parameters, complications, ECG, and echocardiographic measurements were assessed at implant, and during follow-up of 1, 6, 12 and 24 months. Results - LBBP was successful in 618/632 (97.8%) patients according to strict criteria for LBB capture. Mean follow-up time was 18.6±6.7 months. 231 patients had follow-up over 2 years. LBB capture threshold at implant was 0.65±0.27 [email protected] and 0.69±0.24 [email protected] at 2-year follow-up. A significant decrease in QRS duration was observed in patients with LBBB (167.22 ± 18.99ms vs. 124.02 ± 24.15ms, p<0.001). Post implantation left ventricular ejection fraction improved in patients with QRS≥120ms (48.82±17.78 % vs. 58.12±13.04 %, p<0.001). The number of patients with moderate and severe tricuspid regurgitation decreased at 1-year. Permanent right bundle branch injury occurred in 55 (8.9%) patients. LBB capture threshold increased to more than 3 V or loss of bundle capture in 6 patients (1%), 2 patients of them had loss of conduction system capture. Two patients required lead revision due to dislodgement. Conclusions - This large observational study suggests that LBBP is feasible with high success rates and low complication rates during long term follow up. Therefore, LBBP appears to be a reliable method for physiological pacing for patients with either a bradycardia or heart failure pacing indication.

Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

Cardiology ◽  
2020 ◽  
Vol 145 (5) ◽  
pp. 275-282 ◽  
Author(s):  
Pablo Díez-Villanueva ◽  
Lourdes Vicent ◽  
Francisco de la Cuerda ◽  
Alberto Esteban-Fernández ◽  
Manuel Gómez-Bueno ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Functional Class ◽  
Ventricular Ejection ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. Methods: We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (>35%: group R, or ≤35%: group NR). Results: After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF >35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, p = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, p = 0.096) and higher blood pressure before and after SV (both, p < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, p = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, p = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, p < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13–0.47, p < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, p < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, p < 0.0001). Functional class improved in both groups, mainly in group R (p = 0.035), with fewer visits to the emergency department (11.5 vs. 21.6%, p = 0.07). Conclusions: In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.

855Performance of a multisensor icd algorithm in heart failure patient management

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Santini ◽  
V Bianchi ◽  
A Dello Russo ◽  
L Calo ◽  
D Pecora ◽  
...  
Keyword(s):  
Heart Failure ◽  
Threshold Value ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Office Visits ◽  
Ventricular Ejection Fraction ◽  
Associated Conditions ◽  
Clinical Conditions

Abstract Funding Acknowledgements No funding Background The HeartLogic index combines data from multiple implantable cardioverter-defibrillator (ICD)-based sensors and has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation. Purpose To describe a multicenter experience of remote HF management of patients who received a HeartLogic-enabled ICD or cardiac resynchronization therapy ICD (CRT-D). Methods The HeartLogic feature was activated in 104 patients (76 male, 71 ± 10 years, left ventricular ejection fraction 29 ± 7%). In accordance with a standardized follow-up protocol, remote data reviews and patient phone contacts were performed monthly and at the time of HeartLogic alerts (when the index crossed the nominal threshold value of 16), to assess the patient decompensation status. In-office visits were performed every 6 months or when deemed necessary. Results During a median follow-up of 13[11-18] months, 100 HeartLogic alerts were reported (0.82 alerts/pt-year) in 53 patients. 60 HeartLogic alerts were judged clinically meaningful (i.e. associated with worsening of HF or resulted in active clinical actions). Specifically, multiple associated conditions were reported: 45 (75%) symptoms or signs of clinical deterioration of HF, 13 (22%) discontinuations or reductions of prescribed HF therapy, 11 (18%) declines in CRT percentage (with or without new onset atrial fibrillation), 8 (13%) recurrences of previous HF events. For 48 out of 60 alerts the clinician was not previously aware of the condition. Of these, 43 alerts triggered multiple clinical actions. Alert-triggered actions were: 30 (70%) diuretic dosage increases, 15 (35%) other drug adjustments, 6 (14%) HF hospitalizations, 3 (7%) device reprogramming/revisions, 1 (2%) cardioversion, 1 (2%) patient education on therapy adherence. Out of 40 non-clinically meaningful alerts (0.33 alerts/pt-year), 8 (20%) were associated with non-HF therapy changes or interventions, 3 (8%) with pulmonary events, 29 (72%) remained unexplained. The overall number of HF hospitalizations was 16 (rate 0.13 hospitalizations/pt-year). Five HF hospitalizations were not preceded by HeartLogic alert (0.04 hospitalizations/pt-year). Conclusions The HeartLogic index provided clinically meaningful information and allowed to remotely identify relevant HF related clinical conditions, with a low rate of unexplained detections and undetected HF events. In this experience, remote monitoring using HeartLogic alerts allowed to drive HF care and take effective clinical actions.

scholarly journals 5 years follow-up of patients with heart failure and cardiac resynchronization: baseline variables associated to death

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Oliveira ◽  
PEDRO Cunha ◽  
MIGUEL Carmo ◽  
BRUNO Valente ◽  
INÊS Ricardo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Demographic Data ◽  
Left Ventricular ◽  
Lifestyle Changes ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Spearman Test

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  Chronic Heart Failure (HF) has proven to be an increasing challenge for the global health management. Prognosis is affected by pharmacological optimization, comorbidities and risk factors control, lifestyle changes and invasive treatments like resynchronization (CRT) and transplant.  Purpose  To evaluate the association of baseline variables in HF patients, before CRT, with death event at 5 years follow up (FU).  Methods  Single center, post-hoc analysis of a prospective cohort of consecutive HF patients referred to CRT (2013-2015). Demographic data, HF etiology and NYHA class were evaluated at baseline as well as plasmatic of natriuretic peptide (BNP), heart to mediastinum ratio (HMR), left ventricular ejection fraction (LVEF) and volumes. Mortality was evaluated at 5 years. Patients were divided in two groups: "non survivors" and "survivors". Data were analyzed using descriptive statistics. Spearman test was used to evaluate the correlation between baseline variables and death.  Results  102 patients were included (age 68.8 ± 10 years), 68.6% male, 29% ischemic cardiomyopathy, 74% NYHA III/IV, baseline LVEF 26 ± 7. 27% were CRT non-responders. At 5 years follow up 43% died, with 1.96% lost FU. Baseline variables in the two groups are displayed in table 1. Statistical analysis correlating baseline variables with death (Spearman test) showed weak correlation, with the strongest correlation obtained: late HMR with negative correlation 0.34; LV tele-diastolic volume with positive correlation 0.26.  Conclusion The mortality at 5 years of HF patients with CRT was high (43%). Baseline variables (late HMR, LV tele-diastolic volume) were associated to death. These results should call early attention for a possible worst prognosis in severe HF patients to CRT. Table 1 "Non survivors" vs "Survivors" “Non Survivors”(n = 44) “Survivors”(n = 56) Age 67,11 ± 11,17 68,14 ± 10,51 Male 35 (80%) 35 (63%) NYHA III/IV 31 (70%) 43 (77%) Ischemic 15 (34%) 14 (25%) BNP 640,95 ± 606,23 370,41 ± 353,36 Late HMR 1,35 ± 0,16 1,47 ± 0,17 LVEF 27 ± 6,77 26 ± 7,47 Non responders 16 (36%) 12 (21%) LVTdV 225 ± 73,28 191 ± 58,5 PCR 10,33 ± 22,85 5,02 ± 9,27

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 &lt; 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 &lt; 0.001), left ventricular ejection fraction (LVEF) increased to 46.9 ± 10.2% from baseline 35.2 ± 7.0% (P &lt; 0.001), and LV end-diastolic dimensions (LVEDD) decreased to 56.8 ± 9.7 mm from baseline 64.1 ± 9.9 mm (P &lt; 0.001). There was a significant improvement (34.1 ± 7.4% vs. 50.0 ± 12.2%, P &lt; 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.

Towards a Personalized and Dynamic CRT-D

2012 ◽  
Vol 51 (06) ◽  
pp. 495-506 ◽  
Author(s):  
L. Santini ◽  
G. B. Forleo ◽  
V. Minni ◽  
K. Mafhouz ◽  
D. G. Della Rocca ◽  
...  
Keyword(s):  
Numerical Model ◽  
Cardiovascular System ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

SummaryBackground: In spite of cardiac resynchronization therapy (CRT) benefits, 25 – 30% of patients are still non responders. One of the possible reasons could be the non optimal atrioventricular (AV) and interventricular (VV) intervals settings. Our aim was to exploit a numerical model of cardiovascular system for AV and VV intervals optimization in CRT.Methods: A numerical model of the cardiovascular system CRT-dedicated was previously developed. Echocardiographic parameters, Systemic aortic pressure and ECG were collected in 20 consecutive patients before and after CRT. Patient data were simulated by the model that was used to optimize and set into the device the intervals at the baseline and at the follow up. The optimal AV and VV intervals were chosen to optimize the simulated selected variable/s on the base of both echocardiographic and electrocardiographic parameters.Results: Intervals were different for each patient and in most cases, they changed at follow up. The model can well reproduce clinical data as verified with Bland Altman analysis and T-test (p > 0.05). Left ventricular remodeling was 38.7% and left ventricular ejection fraction increasing was 11% against the 15% and 6% reported in literature, respectively.Conclusions: The developed numerical model could reproduce patients conditions at the baseline and at the follow up including the CRT effects. The model could be used to optimize AV and VV intervals at the baseline and at the follow up realizing a personalized and dynamic CRT. A patient tailored CRT could improve patients outcome in comparison to literature data.

P1487Cardiac resynchronization through His bundle pacing in patients with heart failure

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M T Moraleda Salas ◽  
A Sigismondi ◽  
A Arce Leon ◽  
J M Fernandez Gomez ◽  
A Manovel Sanchez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Patients With Heart Failure

Abstract Introduction and purpose Permanent His bundle pacing (p-HBP) can correct intraventricular conduction disorders and could be a physiological alternative for traditional cardiac resynchronization therapy (CRT) via the coronary sinus: our aim was to describe our results in patients with heart failure and ventricular dysfunction who were resynchronized by p-HBP. Methods Prospective descriptive study of patients with CRT indication and who were resynchronized by p-HBP, using the specific tools. The correction of bundle branch block (BBB) by His bundle pacing (HBP) has been previously checked. We analyzed: the global success of the implant, the His thresholds, and the improvement in left ventricular ejection fraction (LVEF) at one month of follow-up. Results We included 54 patients (median age 66 (56-72)) with an indication for CRT: 89% (n = 48) with heart failure (HF), left bundle block branch (LBBB) and LVEF &lt;35%; 3% (n = 2) with HF, right bundle block branch (RBBB) and LVEF &lt;35%; 2% (n = 1) with permanent pacemaker, ventricular dysfunction and ventricular pacing &gt;40%; and 6 % (n = 3) with complete AV block, LBBB and ventricular dysfunction. With HBP we corrected the BBB in 83% of patients (n = 45), and we achieved cardiac resynchronization through p-HBP in 93% of this patients (n = 42), with a global success (including those in whom HBP did not correct the BBB) of 78% (n = 42). The basal QRS was 160 ms (151-162) and the paced QRS was 132 ms (125-145). The median of His acute threshold was 1.6 volts (0.9-1.9), stable at one month of follow-up, excluding one patient whose His threshold progressively increased to 5.5 volts. There was no dislocation of leads in the follow-up. LVEF improved in all patients: basal 30% (27-35) and at one month follow-up 52% (48-64). Median fluoroscopy times of device implantation including the time taken for temporary HBP were 8.1 minutes (range 6.1-9.9). There were no relevant complications during the implant or follow-up; all patients showed clinical subjective improvement. Conclusions CRT by p-HBP is feasible and safe in a high percentage of patients, with reasonable times of fluoroscopy, acceptable capture thresholds, and an early improvement in LVEF in patients with HF and an indication for CRT.

scholarly journals Five-year follow-up of transvenous and epicardial left ventricular leads: experience with more than 1000 leads

2019 ◽  
Author(s):  
Heiko Burger ◽  
Simon Pecha ◽  
Samer Hakmi ◽  
Bastian Opalka ◽  
Markus Schoenburg ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Coronary Vein ◽  
Ventricular Ejection Fraction ◽  
Early Revision ◽  
And Performance ◽  
Observation Period

Abstract OBJECTIVES Transvenous coronary sinus leads are considered to be the gold standard for cardiac resynchronization therapy (CRT). However, in patients with abnormal coronary vein anatomy, the epicardial leads can be an alternative. Data comparing durability and performance of these 2 lead types are limited. In order to provide clarity, we investigated patients receiving CRT system in our centre. METHODS One thousand and fifty-three consecutive patients scheduled for CRT implantation were retrospectively analysed. From these, 895 received transvenous coronary sinus and 158 epicardial left ventricular (LV) leads. Lead-specific as well as LV functional parameters have been evaluated in 60 months’ follow-up. RESULTS Technical characteristics (pacing threshold, impedance and sensing) of both lead types remained stable during the whole observation period. Whereas an early revision (<6 month) was noted in 5.4% of transvenous leads, no reintervention has been necessary for epicardial leads. During the 5-year observation period, a lead revisions rate of 10.2% for transvenous leads and 1.9% for epicardial leads were detected. Regarding CRT efficacy, excellent results were achieved for both electrode types. In both groups, a statistically significant reduction of New York Heart Association class (2.85–2.13 and 2.96–2.09), increase in left ventricular ejection fraction (24.6–32.6% and 27.2–34.6%), reduction of left ventricular end-systolic diameter/left ventricular end-diastolic diameter and reduction in degree of mitral valve insufficiency could be observed over the time. CONCLUSIONS Our data demonstrate safety and functional efficacy of both transvenous and epicardial leads. Moreover, in long-term follow-up, a commendable durability and performance were found for both lead types. Thus, epicardial leads represent a good alternative when transvenous implantation fails.

scholarly journals Reattempt Percutaneous Coronary Intervention of Chronic Total Occlusions after Prior Failures: A Single-Center Analysis of Strategies and Outcomes

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Mingqiang Fu ◽  
Shufu Chang ◽  
Lei Ge ◽  
Dong Huang ◽  
Kang Yao ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Success Rate ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Complication Rates ◽  
Ventricular Ejection Fraction ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
Collateral Channel

Objective. The initial recanalization rate of coronary chronic total occlusions (CTOs) is >85% when performed by experienced operators, but only 10% of prior failed CTO patients receive reattempted recanalization. This retrospective study analyzed the success rate and strategies used in reattempt percutaneous coronary intervention (PCI) of CTOs after prior failures. Methods. Overall, 206 patients with 212 CTOs were enrolled. All patients with prior recanalization failures received reattempt PCIs from January 2015 to March 2019 at Zhongshan Hospital, Fudan University. Data on clinical factors (age, sex, comorbidities, left ventricular ejection fraction, history of cigarette usage, and revascularization), angiographic characteristics of CTOs (target lesion, Japanese Chronic Total Occlusion (J-CTO) score, the morphology of CTO lesions, and collateral channel scale), strategies (procedural approach and use of devices), and major adverse events were obtained and analyzed. Results. The mean age of enrolled patients was 60.96 ± 12.36 years, with a male predominance of 90.3%. Of the patients, 47.1% had a prior myocardial infarction and 70.4% underwent stent implantation previously, while the in-stent occlusion rate was 6.6%. CTOs were primarily localized in the left anterior descending artery (43.9%) and the right coronary artery (43.9%). 80.7% of lesions were classified as very difficult (J-CTO score ≥3), and the overall success rate was 81.1%. In multivariable regression analysis, J-CTO score, collateral channel scale, application of coronary multispiral computed tomography angiography, dual injection, intravascular ultrasound, active greeting technique, parallel wiring, and CTO morphology were predictors of recanalization success. There were no significant differences in rates of procedural complications between the final recanalization success and failure groups. Conclusions. Recanalization of complex CTOs is associated with high success rate and low complication rates when performed by high-volume CTO operators and after multiple reattempts.

P1240Is resynchronization therapy really efficient in laminopathy?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Burdeau ◽  
G Viart ◽  
E Gandjbakhch ◽  
A Savoure ◽  
B Godin ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Heart Transplantation ◽  
Nyha Class ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction

Abstract Introduction Laminopathy (LMNA) is a group of rare disease caused by a mutation of lamin A/C genes. Heart transplantation (HT) is often required. Cardiac resynchronization therapy (CRT) may be an option to postpone HT. Purpose To describe characteristics and outcome of LMNA patients receiving CRT. Methods All consecutive LMNA patients implanted with a CRT device for conventional indications were included in the study. Clinical and echocardiographic (TTE) data were collected during the follow-up period. Results From 2002 to 2017, 68 LMNA patients had CRT implantation. Despite CRT, 30/68 patients (44%) had HT. Population divided into two groups according to response to CRT. Patients were considered without benefit (WHOB-CRT group) if they experienced severe events (inscription on heart transplantation list or death) within two years after CRT implantation. Other patients were in the WB-CRT group. TTE and clinical parameters are described in Table 1. Table 1 Parameters WB-CRT (n=33) WHOB-CRT (n=35) P-value At implantation   Age (years) 52.3±9.7 50.6±9.5 0.27   Women 9 (27%) 13 (37%) 0.45   NYHA class 2.7±0.6 2.8±0.7 0.45   LVEF (%) 33.2±8.8 31.3±7 0.64   LVEDD (mm) 60±6.9 60±6.9 0.96   TAPSE (mm) 23±3.7 14±4.8 0.002 At last follow up   NYHA class 2.2±0.6 2.9±0.7 <0.001   LVEF (%) 36.4±11 27±9 <0.001   LVEDD (mm) 59±5.5 59±7.7 0.98   TAPSE (mm) 19.9±5.5 12.3±3.3 0.003 Left ventricular ejection fraction (LVEF); Left ventricular end diastolic diameter (LVEDD); Tricuspid annular plane systolic excursion (TAPSE). Conclusion Cardiac resynchronization therapy is less efficient in LMNA patients. An impaired right ventricular stroke function seems to be the only predictive factor leading to poor response to CRT.

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