scholarly journals Comparison of Echocardiographic and Electrocardiographic Mapping for Cardiac Resynchronisation Therapy Optimisation

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Helder Pereira ◽  
Tom A. Jackson ◽  
Simon Claridge ◽  
Jonathan M. Behar ◽  
Cheng Yao ◽  
...  
Keyword(s):  
Inverse Correlation ◽  
Cardiac Resynchronisation Therapy ◽  
Activation Time ◽  
Significant Inverse Correlation ◽  
Cardiac Resynchronisation ◽  
Ventricular Activation ◽  
Resynchronisation Therapy ◽  
Activation Times ◽  
Study Hypothesis ◽  
Crt Response

Study hypothesis. We sought to investigate the association between echocardiographic optimisation and ventricular activation time in cardiac resynchronisation therapy (CRT) patients, obtained through the use of electrocardiographic mapping (ECM). We hypothesised that echocardiographic optimisation of the pacing delay between the atrial and ventricular leads—atrioventricular delay (AVD)—and the delay between ventricular leads—interventricular pacing interval (VVD)—would correlate with reductions in ventricular activation time. Background. Optimisation of AVD and VVD may improve CRT patient outcome. Optimal delays are currently set based on echocardiographic indices; however, acute studies have found that reductions in bulk ventricular activation time correlate with improvements in acute haemodynamic performance. Materials and methods. Twenty-one patients with established CRT criteria were recruited. After implantation, patients underwent echo-guided optimisation of the AVD and VVD. During this procedure, the participants also underwent noninvasive ECM. ECM maps were constructed for each AVD and VVD. ECM maps were analysed offline. Total ventricular activation time (TVaT) and a ventricular activation time index (VaT10-90) were calculated to identify the optimal AVD and VVD timings that gave the minimal TVaT and VaT10-90 values. We correlated cardiac output with these electrical timings. Results. Echocardiographic programming optimisation was not associated with the greatest reductions in biventricular activation time (VaT10-90 and TVaT). Instead, bulk activation times were reduced by a further 20% when optimised with ECM. A significant inverse correlation was identified between reductions in bulk ventricular activation time and improvements in LVOT VTI (p<0.001), suggesting that improved ventricular haemodynamics are a sequelae of more rapid ventricular activation. Conclusions. EAM-guided programming optimisation may achieve superior fusion of activation wave fronts leading to improvements in CRT response.

scholarly journals Response to cardiac resynchronisation therapy in men and women: a secondary analysis of the SMART-AV randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e049017
Author(s):  
Stacey Howell ◽  
Timothy M Stivland ◽  
Kenneth Stein ◽  
Kenneth Ellenbogen ◽  
Larisa G Tereshchenko
Keyword(s):  
Logistic Regression ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Randomised Controlled ◽  
Crt Response

ObjectivesThere is a controversy about whether both sexes’ response to cardiac resynchronisation therapy (CRT) is similar. We aimed to assess a causal effect of sex on CRT response.DesignSecondary analysis of a randomised controlled trial (RCT) data. Doubly robust augmented-inverse-probability-weighted (AIPW) estimation of sex effect on CRT response.SettingThe SmartDelay Determined Atrioventricular (AV) Optimisation (SMART-AV) RCT.ParticipantsThe SMART-AV RCT enrolled New York Heart Association class III-IV patients with heart failure (HF) with left ventricular ejection fraction (LVEF) ≤35% despite optimal medical therapy and QRS duration ≥120 ms, in sinus rhythm. After exclusion of those with missing outcome or covariates, 741 participants (age 66±11 years; 33% female; 78% white; LVEF 28%±9%; 58% ischaemic cardiomyopathy; 75% left bundle branch block; left ventricular end-systolic volume index (LVESVI) 65±30 mL/m2) were included.InterventionsImplanted CRT defibrillator with randomly assigned AV delay as either (1) fixed at 120 ms, or (2) echocardiography-determined, or (3) SmartDelay algorithm-programmed.OutcomeA composite of freedom from death and HF hospitalisation and a >15% reduction in LVESVI at 6 month post-CRT was the endpoint.ResultsThe primary endpoint was met by 337 patients (45.5%); 134 were women (55.6% response) and 203 were men (40.6% response); p<0.0001. After conditioning for 33 covariates that included baseline demographic, clinical, ECG, echocardiographic and biomarker characteristics, known predictors of CRT response, logistic regression showed a higher probability for composite CRT response for women versus men (OR 1.79; 95% CI 1.08 to 2.98; p<0.0001), whereas AIPW estimation showed no difference in CRT response (average treatment effect 0.88; 95% CI 0.41 to 1.89; p=0.739). After removing colliders from the model, both logistic regression (OR 1.00; 95% CI 0.69 to 1.44) and AIPW (ATE 1.06; 95% CI 0.96 to 1.16) reported similar results.ConclusionsBoth sexes’ response to CRT is similar. Sex differences in HF substrate, treatment and comorbidities explain sex disparities in CRT outcomes.Trial registration numberClinicalTrials.gov Identifier; NCT00677014.

scholarly journals CRT response score predicts the effects of cardiac resynchronisation therapy

Heart ◽  
2011 ◽  
Vol 97 (Suppl 3) ◽  
pp. A221-A221
Author(s):  
Y. Ji ◽  
C. Kangyu ◽  
X. Jian ◽  
F. Xizhen ◽  
S. Xianlin ◽  
...  
Keyword(s):  
Cardiac Resynchronisation Therapy ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Response Score ◽  
Crt Response

scholarly journals Fusion Pacing with Biventricular, Left Ventricular-only and Multipoint Pacing in Cardiac Resynchronisation Therapy: Latest Evidence and Strategies for Use

2021 ◽  
Vol 10 (2) ◽  
pp. 91-100
Author(s):  
Peter H Waddingham ◽  
Pier Lambiase ◽  
Amal Muthumala ◽  
Edward Rowland ◽  
Anthony WC Chow
Keyword(s):  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Response Dynamic ◽  
Av Conduction ◽  
Cardiac Resynchronisation ◽  
Ventricular Activation ◽  
Resynchronisation Therapy ◽  
Modifiable Factor ◽  
The Right

Despite advances in the field of cardiac resynchronisation therapy (CRT), response rates and durability of therapy remain relatively static. Optimising device timing intervals may be the most common modifiable factor influencing CRT efficacy after implantation. This review addresses the concept of fusion pacing as a method for improving patient outcomes with CRT. Fusion pacing describes the delivery of CRT pacing with a programming strategy to preserve intrinsic atrioventricular (AV) conduction and ventricular activation via the right bundle branch. Several methods have been assessed to achieve fusion pacing. QRS complex duration (QRSd) shortening with CRT is associated with improved clinical response. Dynamic algorithm-based optimisation targeting narrowest QRSd in patients with intact AV conduction has shown promise in people with heart failure with left bundle branch block. Individualised dynamic programming achieving fusion may achieve the greatest magnitude of electrical synchrony, measured by QRSd narrowing.

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