Cardiac resynchronization therapy for patients with atrial fibrillation

2011 ◽  
Vol 152 (44) ◽  
pp. 1757-1763
Author(s):  
Attila Mihálcz ◽  
Pál Ábrahám ◽  
Attila Kardos ◽  
Csaba Földesi ◽  
Tamás Szili-Török
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Rate Control ◽  
Randomized Trials ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure

Atrial fibrillation and chronic heart failure are two major and even growing cardiovascular conditions that often coexist. Cardiac resynchronization therapy is an important, device-based, non-pharmacological approach in a selected group of chronic heart failure patients that has been shown to improve left ventricular function and to reduce both morbidity and mortality in large randomized trials. The latest European and American guidelines have considered atrial fibrillation patients with heart failure eligible for cardiac resynchronization therapy. This review summarizes current literature concerning the following topics: prognostic relevance of atrial fibrillation in heart failure, effects of cardiac resynchronization therapy in atrial fibrillation, relevance and strategies of rhythm and rate control in this group of patients. Authors explain how atrial fibrillation may interfere with the delivery of adequate cardiac resynchronization therapy, how to reduce the burden of atrial tachyarrhythmias, and finally present a brief overview. Orv. Hetil., 2011, 152, 1757–1763.

scholarly journals Prediction of 5-year survival in patients with heart failure and implanted cardiac resynchronization therapy devices

2021 ◽  
Vol 26 (6) ◽  
pp. 4409
Author(s):  
A. M. Soldatova ◽  
V. A. Kuznetsov ◽  
E. A. Gorbatenko ◽  
T. N. Enina ◽  
L. M. Malishevsky
Keyword(s):  
Heart Failure ◽  
Survival Rate ◽  
Cardiac Resynchronization Therapy ◽  
Nyha Class ◽  
Training Sample ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure

Aim. Based on clinical parameters and diagnostic investigations, to create a complex model of personalized selection of patients with heart failure (HF) for cardiac resynchronization therapy (CRT). To establish the diagnostic value of the created model in predicting 5-year survival.Material and methods. The study included 141 patients with HF (men, 77,3%; women, 22,7%). The mean age of patients at the time of implantation was 60,0 [53,0; 66,0] years. All patients had New York Heart Association (NYHA) class II-IV HF, left ventricular ejection fraction (LVEF) ≤35%, and QRS ≥130 ms. Patients were randomly divided into training (n=95) and test (n=36) samples, which were comparable in main clinical and functional characteristics.Results. The index included parameters that had a significant relationship with 5-year survival according to the Cox regression: male sex, prior myocardial infarction, hypertension, QRS <150 ms, no left bundle branch block, PR ≥200 ms with sinus rhythm/absence of radiofrequency ablation in atrial fibrillation, NYHA class III, IV HF, LVEF <30%, left ventricular end-diastolic volume ≥235,0 ml, NT-proBNP ≥2692,0 ng/ml. All variables were scored based on the в-coefficients. In the training sample, a value ≥45 points demonstrated a sensitivity of 82,4% and a specificity of 67,2% in predicting 5-year survival (AUC, 0,873; p<0,001). The index use on the test sample showed comparable results (AUC, 0,718; p=0,020; sensitivity — 71,4%, specificity — 62,5%). Also, in the training sample, the index ≥45 points was associated with1-year survival (sensitivity — 84,6%, specificity — 58,1%, AUC, 0,811; p<0,001).Conclusion. An index of personalized selection for CRT has been created, which makes it possible to accurately predict the 5-year survival rate, as well as the 1-year survival rate, regardless of the current selection criteria.

scholarly journals In silico screening method for non-responders to cardiac resynchronization therapy in patients with heart failure: a pilot study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Minki Hwang ◽  
Jae-Sun Uhm ◽  
Min Cheol Park ◽  
Eun Bo Shim ◽  
Chan Joo Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Simulation Model ◽  
In Silico ◽  
Clinical Observation ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure

Abstract Background Cardiac resynchronization therapy (CRT) is an effective treatment option for patients with heart failure (HF) and left ventricular (LV) dyssynchrony. However, the problem of some patients not responding to CRT remains unresolved. This study aimed to propose a novel in silico method for CRT simulation. Methods Three-dimensional heart geometry was constructed from computed tomography images. The finite element method was used to elucidate the electric wave propagation in the heart. The electric excitation and mechanical contraction were coupled with vascular hemodynamics by the lumped parameter model. The model parameters for three-dimensional (3D) heart and vascular mechanics were estimated by matching computed variables with measured physiological parameters. CRT effects were simulated in a patient with HF and left bundle branch block (LBBB). LV end-diastolic (LVEDV) and end-systolic volumes (LVESV), LV ejection fraction (LVEF), and CRT responsiveness measured from the in silico simulation model were compared with those from clinical observation. A CRT responder was defined as absolute increase in LVEF ≥ 5% or relative increase in LVEF ≥ 15%. Results A 68-year-old female with nonischemic HF and LBBB was retrospectively included. The in silico CRT simulation modeling revealed that changes in LVEDV, LVESV, and LVEF by CRT were from 174 to 173 mL, 116 to 104 mL, and 33 to 40%, respectively. Absolute and relative ΔLVEF were 7% and 18%, respectively, signifying a CRT responder. In clinical observation, echocardiography showed that changes in LVEDV, LVESV, and LVEF by CRT were from 162 to 119 mL, 114 to 69 mL, and 29 to 42%, respectively. Absolute and relative ΔLVESV were 13% and 31%, respectively, also signifying a CRT responder. CRT responsiveness from the in silico CRT simulation model was concordant with that in the clinical observation. Conclusion This in silico CRT simulation method is a feasible technique to screen for CRT non-responders in patients with HF and LBBB.

Cardiac resynchronization therapy: Selection of candidates

2021 ◽  
pp. 577-586
Author(s):  
Victoria Delgado ◽  
Jens-Uwe Voigt
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Multimodality Imaging ◽  
Treatment Guideline ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure ◽  
Left Ventricular Mechanics ◽  
Selection Of

Cardiac resynchronization therapy (CRT) is an established therapy for patients with heart failure who remain symptomatic despite optimal medical treatment. Guideline recommendations for patient selection have been published by all major scientific societies including the ESC and are regularly updated. Unfortunately, the rate of patients who do not respond to CRT remains stable in the range of 30–40%, even in indication class I. In the selection of patients with heart failure who may benefit from cardiac resynchronization therapy (CRT), evaluation of left ventricular mechanics and dyssynchrony, extent, and location of myocardial scar and cardiac venous anatomy are most important. Multimodality imaging is pivotal to obtain this information and understand how CRT exerts its effects. This chapter will review the current state-of-the-art of multimodality imaging to select patients for CRT implantation.

Sign in / Sign up

Export Citation Format

Share Document