Biventricular Versus His Bundle Pacing After Atrioventricular Node Ablation in Heart Failure Patients With Narrow QRS

2020 ◽  
Author(s):  
David Žižek ◽  
Bor Antolič ◽  
Anja Zupan Mežnar ◽  
Dinko Zavrl Džananović ◽  
Matevž Jan ◽  
...  
Keyword(s):  
New York ◽  
Atrioventricular Node ◽  
Heart Association ◽  
Left Ventricular ◽  
Ventricular Rate ◽  
Complication Rates ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Narrow Qrs ◽  
New York Heart Association

Abstract Background His bundle pacing (HBP) is a physiological alternative to biventricular (BiV) pacing. Our goal was to compare short-term results of both pacing approaches in ventricular rate refractory atrial fibrillation (AF) patients who underwent atrioventricular node ablation (AVNA).Methods Consecutive symptomatic AF patients with moderately reduced left ventricular (LV) ejection fraction (EF ≥35% and <50%) and narrow QRS (≤120ms) who received HBP in conjunction with AVNA were compared to historical BiV pacing controls. Electrocardiographic, echocardiographic, and clinical data at baseline and 6 months after the procedure were assessed. Results Among 24 patients (age 68.8 ± 6.5 years, 50% female, EF 39.6 ± 4%, QRS 95 ± 10ms) who underwent AVNA, 12 received BiV pacing and 12 HBP. Both pacing modalities had similar acute procedure-related success and complication rates. HBP was superior to BiV pacing in terms of post-implant QRS duration, implantation fluoroscopy times, reduction of LV volumes (EDV 127 (86 – 150) ml vs. 146 (121 – 190) ml, P = 0.101; ESV 64 (46 – 81) ml vs. 90 (75 – 123) ml, P = 0.008) and increase in LVEF (46 (41 – 55) % vs. 38 (35 – 42) %, P = 0.005). However, improvement of the New York Heart Association class was similar in both groups.Conclusions In ventricular rate refractory AF patients with moderately reduced EF and narrow QRS undergoing AVNA, HBP could be a conceivable alternative to BiV pacing. Further prospective studies are warranted to address the outcomes between both “ablate and pace” strategies.

Abstract 216: Left Ventricular Enlargement and Heart Failure Events: Is Bigger Better?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Farbod Raiszadeh ◽  
Neeraja Yedlapati ◽  
Ileana L Piña ◽  
Daniel M Spevack
Keyword(s):  
Heart Failure ◽  
New York ◽  
Cox Regression ◽  
Systolic Heart Failure ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Volumes ◽  
End Diastolic Volume ◽  
New York Heart Association ◽  
The Individual

Background: Since stroke volume (SV) is a function of ejection fraction (EF) and end-diastolic volume (EDV) (SV = EF x EDV), we hypothesized that increased EDV may be advantageous in systolic heart failure (HF), allowing the left ventricle to supply increased cardiac output. Methods: Echocardiograms from 968 consecutive patients seen in our hospital’s HF clinic were reviewed. Left ventricular volumes were measured both at end systole and end diastole using the bi-plane Simpson’s method and were indexed to body surface area. EF was calculated using (EDV-ESV)/EDV. Dates of subsequent HF events (death or admission for HF exacerbation) were obtained from our database. Results: Systolic HF (EF < 50%) was found in 649 of the study subjects. Increased SV index was associated with increased EDV index. The strength of this association varied with EF, Figure. In a bivariate Cox regression model, lower SV index and higher EDV index were each independent predictors of HF events. Increase in EDV by 50 cc was associated with a 20% increase in HF events, p<0.001. Decrease in SVI by 5 cc was associated with 5% increase in HF events, p<0.001. These associations were limited to those with systolic HF. The associations between both EDVI and SVI and HF events were not confounded by patient age, sex and New York Heart Association Class. Conclusion: Increased EDV index was independently associated with increased HF events, indicating that LV enlargement in HF is not favorable. These findings underscore the individual contributions of the components of EF (SV and EDV) in predicting HF outcomes.

An Early Canadian Experience with the Correx Automated Coring and Apical Connector Device for Aortic Valve Bypass

2016 ◽  
Vol 11 (6) ◽  
pp. 434-438
Author(s):  
Hussein A. Al-Amodi ◽  
Christopher L. Tarola ◽  
Hamad F. Alhabib ◽  
Corey Adams ◽  
Linrui Ray Guo ◽  
...  
Keyword(s):  
New York ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
New York Heart Association ◽  
Apical Connector ◽  
Aortic Valve Bypass

Objective Aortic valve replacement is the standard of care for severe, symptomatic aortic valve stenosis (AS); however, anatomy or preexisting comorbidities may preclude conventional or alternative transcatheter approaches. Aortic valve bypass (AVB) may be performed as a salvage procedure for the relief of symptomatic aortic stenosis in patients who are not suitable candidates for aortic valve replacement. Methods At our institution, seven patients underwent AVB using the Correx automated coring and apical connector system. All patients had severe AS with New York Heart Association functional class 3 symptoms and were not candidates for conventional or transcatheter approaches. Via a left anterolateral thoracotomy to access the descending aorta and left ventricular apex, we used the Correx system (Correx, Waltham, MA USA) to anastomose a valve conduit to the left ventricular apex proximally and the descending aorta distally. Three patients required cardiopulmonary bypass. Results In all seven patients, the automated coring and apical connector was successfully deployed. There were two in-hospital deaths in this series. Immediately postoperatively and at 3 months, there was a significant reduction in mean and peak valve gradients, and all surviving patients performed at New York Heart Association functional class 1. Conclusions Aortic valve bypass seems to be an acceptable alternative for the treatment of severe AS in high-risk patients who are not candidates for aortic valve replacement. The Correx automated system may improve the clinical applicability and surgical repro-ducibility of AVB in appropriately selected patients in which conventional or transcatheter aortic valve replacement is not a feasible options.

Real-Time Three-Dimensional Echocardiographic Study of Left Ventricular Function After Infarct Exclusion Surgery for Ischemic Cardiomyopathy

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Jian Xin Qin ◽  
Takahiro Shiota ◽  
Patrick M. McCarthy ◽  
Michael S. Firstenberg ◽  
Neil L. Greenberg ◽  
...  
Keyword(s):  
New York ◽  
Ischemic Cardiomyopathy ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Before And After ◽  
Infarct Exclusion ◽  
New York Heart Association ◽  
Lv Volume

Background —Infarct exclusion (IE) surgery, a technique of left ventricular (LV) reconstruction for dyskinetic or akinetic LV segments in patients with ischemic cardiomyopathy, requires accurate volume quantification to determine the impact of surgery due to complicated geometric changes. Methods and Results —Thirty patients who underwent IE (mean age 61±8 years, 73% men) had epicardial real-time 3-dimensional echocardiographic (RT3DE) studies performed before and after IE. RT3DE follow-up was performed transthoracically 42±67 days after surgery in 22 patients. Repeated measures ANOVA was used to compare the values before and after IE surgery and at follow-up. Significant decreases in LV end-diastolic (EDVI) and end-systolic (ESVI) volume indices were apparent immediately after IE and in follow-up (EDVI 99±40, 67±26, and 71±31 mL/m 2 , respectively; ESVI 72±37, 40±21, and 42±22 mL/m 2 , respectively; P <0.05). LV ejection fraction increased significantly and remained higher (0.29±0.11, 0.43±0.13, and 0.42±0.09, respectively, P <0.05). Forward stroke volume in 16 patients with preoperative mitral regurgitation significantly improved after IE and in follow-up (22±12, 53±24, and 58±21 mL, respectively, P <0.005). New York Heart Association functional class at an average 285±144 days of clinical follow-up significantly improved from 3.0±0.8 to 1.8±0.8 ( P <0.0001). Smaller end-diastolic and end-systolic volumes measured with RT3DE immediately after IE were closely related to improvement in New York Heart Association functional class at clinical follow-up (Spearman’s ρ=0.58 and 0.60, respectively). Conclusions —RT3DE can be used to quantitatively assess changes in LV volume and function after complicated LV reconstruction. Decreased LV volume and increased ejection fraction imply a reduction in LV wall stress after IE surgery and are predictive of symptomatic improvement.

scholarly journals Impact of Left Ventricular Function and Heart Failure Symptoms on Outcomes Post Ablation of Atrial Fibrillation in Heart Failure

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Christian Sohns ◽  
Konstantin Zintl ◽  
Yan Zhao ◽  
Lilas Dagher ◽  
Dietrich Andresen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
New York ◽  
Ventricular Dysfunction ◽  
Heart Association ◽  
Left Ventricular ◽  
Pharmacological Therapy ◽  
York Heart Association Class ◽  
Association Class ◽  
New York Heart Association

Background: Recent data demonstrate promising effects on left ventricular dysfunction and left ventricular ejection fraction (LVEF) improvement following ablation for atrial fibrillation (AF) in patients with heart failure. We sought to study the relationship between LVEF, New York Heart Association class on presentation, and the end points of mortality and heart failure admissions in the CASTLE-AF study (Catheter Ablation for Atrial Fibrillation With Heart Failure) population. Furthermore, predictors for LVEF improvement were examined. Methods: The CASTLE-AF patients with coexisting heart failure and AF (n=363) were randomized in a multicenter prospective controlled fashion to ablation (n=179) versus pharmacological therapy (n=184). Left ventricular function and New York Heart Association class were assessed at baseline (after randomization) and at each follow-up visit. Results: In the ablation arm, a significantly higher number of patients experienced an improvement in their LVEF to >35% at the end of the study (odds ratio, 2.17; P <0.001). Compared with the pharmacological therapy arm, both ablation patient groups with severe (<20%) or moderate/severe (≥20% and <35%) baseline LVEF had a significantly lower number of composite end points (hazard ratio [HR], 0.60; P =0.006), all-cause mortality (HR, 0.54; P =0.019), and cardiovascular hospitalizations (HR, 0.66; P =0.017). In the ablation group, New York Heart Association I/II patients at the time of treatment had the strongest improvement in clinical outcomes (primary end point: HR, 0.43; P <0.001; mortality: HR, 0.30; P =0.001). Conclusions: Compared with pharmacological treatment, AF ablation was associated with a significant improvement in LVEF, independent from the severity of left ventricular dysfunction. AF ablation should be performed at early stages of the patient’s heart failure symptoms.

scholarly journals Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: A prospective cohort study

2019 ◽  
Vol 19 (4) ◽  
pp. 310-319 ◽  
Author(s):  
Shining Cai ◽  
Jos M Latour ◽  
Ying Lin ◽  
Wenyan Pan ◽  
Jili Zheng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiac Function ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Classification ◽  
New York Heart Association

Background: Delirium is a common postoperative complication after cardiac surgery. The relationship between delirium and cardiac function has not been fully elucidated. Aims: The aim of this study was to identify the association between preoperative cardiac function and delirium among patients after cardiac surgery. Methods: We prospectively recruited 635 cardiac surgery patients with a planned cardiac intensive care unit admission. Postoperative delirium was diagnosed using the confusion assessment method for the intensive care unit. Preoperative cardiac function was assessed using N-terminal prohormone of brain natriuretic peptide (NT-proBNP), New York Heart Association functional classification and left ventricular ejection fraction. Results: Delirium developed in 73 patients (11.5%) during intensive care unit stay. NT-proBNP level (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01–1.52) and New York Heart Association functional classification (OR 2.34, 95% CI 1.27–4.31) were both independently associated with the occurrence of delirium after adjusting for various confounders. The OR of delirium increased with increasing NT-proBNP levels after the turning point of 7.8 (log-transformed pg/ml). The adjusted regression coefficients were 1.19 (95% CI 0.95–1.49, P=0.134) for NT-proBNP less than 7.8 (log-transformed pg/ml) and 2.78 (95% CI 1.09–7.12, P=0.033) for NT-proBNP greater than 7.8 (log-transformed pg/ml). No association was found between left ventricular ejection fraction and postoperative delirium. Conclusion: Preoperative cardiac function parameters including NT-proBNP and New York Heart Association functional classification can predict the incidence of delirium following cardiac surgery. We suggest incorporating an early determination of preoperative cardiac function as a readily available risk assessment for delirium prior to cardiac surgery.

scholarly journals A Pregnancy with Severe Hypertrophic Obstructive Cardiomyopathy after Surgery for an Implantable Cardioverter Defibrillator: A Case Report and Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Takashi Mitsui ◽  
Hisashi Masuyama ◽  
Kentaro Ejiri ◽  
Kei Hayata ◽  
Hiroshi Ito ◽  
...  
Keyword(s):  
New York ◽  
Heart Association ◽  
Ventricular Myocardium ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Peripheral Oxygen Saturation ◽  
Left Ventricular Outflow ◽  
New York Heart Association ◽  
Sudden Decrease

Hypertrophic obstructive cardiomyopathy (HOCM) is cardiac hypertrophy of ventricular myocardium with left ventricular outflow tract obstruction. We report a pregnancy with HOCM after defibrillator implantation surgery. The patient was a 33-year-old nulligravida and was categorized as New York Heart Association class II. Her brain natriuretic peptide (BNP) level was 724.6 pg/dL at preconception. She received careful pregnancy management. However, because frequent uterine contractions were observed at 25 weeks and 6 days of pregnancy, she was hospitalized, and magnesium sulfate was started as a tocolytic agent. At 27 weeks and 5 days of pregnancy, she had respiratory discomfort and orthopnea with a sudden decrease in peripheral oxygen saturation. Cardiac ultrasonography showed a worsened condition of HOCM and her BNP level was 1418.0 pg/mL. We performed an emergent cesarean section and she delivered a boy weighing 999 g. The Apgar score was 8 and 9 points at 1 and 5 minutes, respectively. The mother’s heart failure quickly improved after birth and she was discharged at 10 days postoperatively. Fluctuations in circulatory dynamics during pregnancy may sometimes exacerbate heart disease. Therefore, the risks should be fully explained and careful assessment of cardiac function should be performed during pregnancy in patients with severe HOCM.

Cardiac resynchronization therapy for ischemic myopathy

2016 ◽  
Vol 25 (5) ◽  
pp. 383-385
Author(s):  
Shinichiro Ikeda ◽  
Hideo Yoshida ◽  
Keiji Yunoki ◽  
Kunikazu Hisamochi
Keyword(s):  
New York ◽  
Cardiac Resynchronization Therapy ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Mitral Valve Plasty ◽  
New York Heart Association ◽  
The Right

We performed coronary artery grafting, mitral valve plasty, and tricuspid plasty in a 75-year-old man who had double-vessel coronary disease and moderate mitral and tricuspid insufficiency. Preoperative transthoracic echocardiography revealed an ejection fraction of 34% and dyssynchronous wall motion of the septum and free wall. We placed pacing leads on the right ventricular outlet and posterior left ventricular wall for cardiac resynchronization therapy. The dyssynchrony disappeared postoperatively and the New York Heart Association functional class improved from IV to I.

scholarly journals The Use of a Novel Heart Failure Agent in the Treatment of Pregnancy-Associated Cardiomyopathy

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Vamsi C. Gaddipati ◽  
Aarti A. Patel ◽  
Adam J. Cohen
Keyword(s):  
Heart Failure ◽  
New York ◽  
Heart Association ◽  
Standard Of Care ◽  
Left Ventricular ◽  
The Novel ◽  
Current Standard ◽  
Association Class ◽  
New York Heart Association ◽  
Caucasian Female

Peripartum cardiomyopathy is an uncommon, pregnancy-related form of dilated cardiomyopathy that is associated with development of new-onset left ventricular dysfunction. Its etiology is presently unknown, but current standard of care involves the use of typical drug therapy for the treatment of heart failure. Pregnancy-associated cardiomyopathy (PACM) is a similar condition that refers to patients who develop such symptoms prior to the last month of pregnancy. We report the case of a nulliparous Caucasian female who develops early, severe PACM during her first pregnancy with postpartum persistence of New York Heart Association class II-III symptoms despite medical therapy. The use of the novel heart failure agent, sacubitril/valsartan (Entresto), is initiated with near-complete resolution of her symptoms.

Unusual Left Ventricular Function and Survival in Peripartum Cardiomyopathy

2000 ◽  
Vol 8 (2) ◽  
pp. 155-157
Author(s):  
Mandeep Bhargava ◽  
Mandeep Singh ◽  
Pujar Venkateshacharya Suresh ◽  
Rajneesh Juneja ◽  
Harinder Kumar Bali ◽  
...  
Keyword(s):  
New York ◽  
Enzyme Inhibitors ◽  
Heart Association ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Left Ventricular ◽  
Functional Class ◽  
Peripartum Cardiomyopathy ◽  
Class Iii ◽  
Converting Enzyme Inhibitors ◽  
New York Heart Association

A 34-year-old woman presented with congestive heart failure 3 months after her third pregnancy. She was stabilized in New York Heart Association functional class II with digoxin and diuretics for 21 years. She was readmitted with worsening symptoms and found to have a regional contraction abnormality. With the addition of angiotensin-converting enzyme inhibitors to her medication, she has been maintained in functional class III for a further 4 years.

Cardiac recovery following left ventricular assist device therapy: experience of complete device explantation including ventricular patch plasty

2020 ◽  
Author(s):  
Takayuki Gyoten ◽  
Sebastian V Rojas ◽  
Henrik Fox ◽  
Masatoshi Hata ◽  
Marcus-André Deutsch ◽  
...  
Keyword(s):  
New York ◽  
Ventricular Assist Device ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Myocardial Recovery ◽  
Assist Device ◽  
Ventricular Assist ◽  
New York Heart Association ◽  
Patch Plasty

Abstract   OBJECTIVES Myocardial recovery is a rare phenomenon in left ventricular assist device (LVAD) therapy. Surgical LVAD removal is associated with the risk of cardiac failure, and the individual evaluation of sufficient myocardial recovery is crucial. Thus, complete device explantation is not consistently performed to minimize perioperative risk. However, the remaining ventricular assist device components bear significant risks of infection or thrombosis. Therefore, we developed this study to evaluate a complete LVAD explantation protocol. METHODS All patients in our institution who had an LVAD explanted were enrolled in the study. Explant surgery involved removal of the driveline, pump housing, sewing ring and outflow graft. The ventricular wall was reconstructed by double patch plasty. Our analysis focused on surgical and postoperative outcome parameters, including all-cause mortality and major adverse cardiac and cerebrovascular events. RESULTS A total of 12 patients (HVAD, n = 5; HeartMate II, n = 3; HeartMate 3, n = 4) had myocardial recovery and qualified for our LVAD explantation study protocol [median age: 40 years, interquartile range (IQR) 33–52 years; 50% men]. Primary heart failure aetiology: myocarditis (n = 5), dilated cardiomyopathy (n = 4), toxic cardiomyopathy (n = 2) and valvular heart failure (n = 1). The median average duration on LVAD was 10 months (25–75%: IQR 8.5–30 months). The median left ventricular ejection fraction was 15% (IQR 13–18%) at LVAD implantation and 50% (IQR 45–50%) before LVAD explantation (P = 0.0025).The 30-day survival was 100%. The 1-year survival was 91.7%. All patients were discharged after a median 13 days (IQR 10–18 days) postoperatively. No patient had major adverse cardiac and cerebrovascular events. The New York Heart Association functional class remained consistent during the follow-up period (median New York Heart Association functional class: II, IQR II–II class) including preservation of ventricular function. CONCLUSIONS Complete LVAD explantation with ventricular patch plasty is feasible and has consistent long-term results.

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