Minimally Invasive Video-Assisted Epicardial Lead Cardiac Resynchronization Therapy for the Dilated Cardiomyopathy Heart Failure Cases

2010 ◽  
Vol 5 (5) ◽  
pp. 345-348 ◽  
Author(s):  
Hai-Bo Zhang ◽  
Xu Meng ◽  
Jie Han ◽  
Yan Li ◽  
Ya-Ping Zeng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Minimally Invasive ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Video Assisted ◽  
Epicardial Lead ◽  
The Mean

Objective Cardiac resynchronization therapy (CRT) with biventricular pacing has demonstrated cardiac function improvement in treating congestive heart failure. Traditional CRT through coronary sinus lead method is difficult to perform. Minimally invasive video-assisted epicardial lead (Epi-lead) CRT for the dilated cardiomyopathy heart failure cases was explored. Methods From April 2007 to June 2009, a total of 12 patients (age, 63 ± 9 years) with depressed systolic left ventricular (LV) function (ejection fraction, <35%), left bundle branch block (mean QRS [Q wave, R wave, S wave], 158 ± 15 milliseconds), and congestive heart failure of New York Heart Association class III/IV were enrolled. The patients received minimally invasive video-assisted epicardial steroid-eluting LV lead implantation for the CRT. The right atrial and right ventricle leads were implanted, guided by x-ray. The mean follow-up time was 13.7 months (range, 7–27 months). Results All patients received LV lead implantation at the most late-activated site. The mean QRS duration decreased significantly from 158 ± 15 to 124 ± 11 milliseconds (P < 0.05). There was no surgical or hospital mortality in the entire series. The mean procedure duration (skin to skin) of the LV lead implantation was 52.4 ± 15.8 minutes. The mean postoperative stay was 7.1 ± 2.7 days. During the follow-up, cardiac function improved significantly in 11 patients. Threshold capture of the Epi-leads remained stable at 1.12 ± 0.3 V/0.5 ms during the follow-up. None died during the follow-up. Conclusions Surgical Epi-lead placement for the resynchronization therapy is a safe and reliable technique and should be considered as an equal alternative.

scholarly journals Impact of Depressive Symptoms on All-Cause Mortality in Patients with Congestive Heart Failure After Cardiac Resynchronization Therapy

Kardiologiia ◽  
2019 ◽  
Vol 59 (1) ◽  
pp. 5-11 ◽  
Author(s):  
G. S. Pushkarev ◽  
V. A. Kuznetsov ◽  
Y. A. Fisher ◽  
A. M. Soldatova ◽  
А. D. Sapozhnikova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Depressive Symptoms ◽  
Cardiac Resynchronization Therapy ◽  
Beck Depression Inventory ◽  
Cox Proportional Hazards ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
All Cause Mortality

Purpose:to assess the association between depression and all-cause mortality in patients with congestive heart failure (CHF) after cardiac resynchronization therapy (CRT).Materials and Methods.We enrolled in this study 156 patients (mean age 55.3±9.6 years) with CHF and implanted devices for CRT. Mean duration of follow-up was 51.6±33.4 months. The Beck Depression Inventory (BDI) was used to evaluate depressive symptoms (DS); DS were considered absent for a score 0–9, mild to moderate – 10–18, severe – ≥19. For assessment of association of DS and mortality we used multivariate Cox proportional hazards regression model with estimation of hazard ratios (HR) with 95 % confidence intervals (95 %CI).Results. Average Beck Depression Inventory score was 12.4±8.3. In 66 patients (42.3 %) there were no DS, 57 patients (36.5 %) had mild, and 33 (21.2 %) – severe DS. These groups did not differ by main clinical-functional and laboratory indicators. Among individuals without DS prevailed men (90.9 vs. 69.7 % among those with severe DS, p=0.007). Hypercholesterolemia was more frequent in patients with DS (63.3 vs. 43.9 % in patients without DS, p=0.02). During follow-up 33 patients died (21.2 %). Adjusted HR of death from all-causes for DS score as continuous parameter was 1.05, 95 % CI 1.01–1.09, p=0.02. Patients without DS were used as reference (HR=1.0) in analysis of categorical indicator. HR was 1.08, 95 % CI 0.46–2.54, p=0.9 in patients with mild, and 2.92, 95 % CI 1.17–7.32, p=0.02 – with severe DS.Conclusion:DS were associated with gender and hypercholesterolemia. Severe DS were independently associated with all-cause mortality in patients with CHF and implanted CRT devices.

Abstract 1604: Response to Cardiac Resynchronization Therapy Differs Between Patients With and Without Previous Right Ventricular Pacing

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Andrea M Thelen ◽  
Christopher L Kaufman ◽  
Kevin V Burns ◽  
Daniel R Kaiser ◽  
Aaron S Kelly ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Systolic Function ◽  
Radial Strain ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Peak Displacement

Background: Previous large studies on the effects of cardiac resynchronization therapy (CRT) in patients with heart failure have generally excluded patients previously paced from the right ventricle (RV). Previously RV paced patients (RVp) can exhibit an iatrogenic cause of dyssynchrony and reduced systolic function and thus, may respond differently to CRT than patients not previously RV paced (nRVp). The purpose of this study was to test the hypothesis that RVp patients have greater improvements in left ventricular systolic function, volumes, and dyssynchrony in response to CRT than nRVp. Methods: Standard echocardiograms with tissue Doppler imaging were performed before and after chronic CRT in RVp (n = 21, 16 male) and nRVp (n = 70, 54 male) heart failure patients. Ejection fraction (EF), left ventricular end diastolic (LVEDV) and systolic (LVESV) volumes were calculated using the biplane Simpson’s method. Longitudinal dyssynchrony was calculated as the standard deviation of time to peak displacement (TT-12) of 12 segments in the apical views. Using mid-ventricular short axis views and speckle-tracking methods, radial dyssynchrony (Rad dys ) was calculated as the maximal time difference between six myocardial segments for peak radial strain. Echo response was defined as ≥ 15% reduction in LVESV. Results are reported as mean ± SD. Results: Significant baseline differences (p < 0.05) were observed between groups (RVp vs. nRVp) for age (74 ± 13 vs. 67 ± 13 year), follow-up time (6.1 ± 1.8 vs. 4.6 ± 2.1 months), LVEDV (154.3±50.8 vs.185.3±56.9 mL), and a trend for LVESV (112.4 ± 40.6 vs. 134.9 ± 47 mL, p = 0 .05). No differences were observed for EF, etiology of heart failure, and dyssynchrony measures between groups at baseline. Echo response rate was significantly ( p < 0.05) greater in RVp (76%) than nRVp (57%). After adjusting for baseline differences, RVp had greater improvement in EF (14 ± 9 vs. 8 ± 7%, p < 0.05) and LVESV (−33 ± 18 vs. −20 ± 21%, p < 0.05). After adjustment for follow-up time, no difference was observed for change in dyssynchrony between groups. Conclusion: RVp patients upgraded to CRT exhibit greater improvements in systolic function and ventricular remodeling as compared to nRVp patients.

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