scholarly journals Cardiac Resynchronization Therapy Using Left-bundle-branch Area Pacing and Coronary Sinus Pacing

2021 ◽  
Author(s):  
Xiang-Fei Feng ◽  
Rui Zhang ◽  
Yi-Chi Yu ◽  
Bo Liu ◽  
Ya-Qin Han ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Coronary Sinus ◽  
Biventricular Pacing ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Resynchronization Therapy ◽  
Group 4 ◽  
Qrs Duration ◽  
A New Technique

Abstract Background: Cardiac resynchronization therapy via biventricular pacing (BVP) is an established therapy for patients with heart failure. Recently, it has been shown that left bundle branch area pacing (LBBAP) is feasible and may also improve clinical outcomes. In this article, we describe a new technique (sequential LBBAP followed by coronary sinus pacing, designated LOT-CRT) and assess the feasibility of LOT-CRT.Methods: The database of all patients with adaptive CRT from single centre was reviewed retrospectively. The eligible patients were divided into two groups, LOT-CRT and BV-CRT. The LBBAP lead implanted using our methods. The QRS duration (QRSd) was measured at baseline and during LBBAP, BVP, and LOT-CRT.Results: The study enrolled 17 consecutive heart failure patients with LBBB. LBBAP failed in 1 patient, succeed in 8 patients, while CS leads were implanted successfully in all patients. At baseline, the two groups (8 cases in LOT-CRT group, 9 cases in BV-CRT group) were matched for QRSd and ischemic cardiomyopathy (ICM, 5 cases in LOT-CRT group, 4 cases in BV-CRT group). In LOT-CRT group, BVP resulted in significant reduction of the QRSd from 158.0 ± 13.0 ms at baseline to 132.0 ± 4.5 ms (P=0.019). Compared with BVP, unipolar LBBAP resulted in further reduction of the QRSd to 123.0 ± 5.7 ms (P < 0.01). However, LOT-CRT with adaptive algorithm resulted in a significantly greater reduction of the QRSd to 117.0 ± 6.7 ms (P < 0.01). In BV-CRT group, BVP resulted in significant reduction of the QRSd from 176.7 ±19.7 ms at baseline to 143.3 ±8.2 ms (P=0.011). However, compared with LOT-CRT, BVP has no any advantage in reducing QRSd (P >0.05). As compared to the baseline after 3 months of LBBAP, patients in LOT-CRT group showed significant improvement in LVEF and NT-proBNP levels (P < 0.01), while patients in BV-CRT group showed non-significant changes in these parameters (P >0.05).Conclusions: The study demonstrates that LOT-CRT is clinically feasible in patients with systolic HF and LBBB. LOT-CRT was associated with significant narrowing of the QRSd and improvement in LV function, especially in patients with ICM.

scholarly journals Cardiac Resynchronization Therapy Using Left-bundle-branch Area Pacing and Coronary Sinus Pacing

2021 ◽  
Author(s):  
Xiang-Fei Feng ◽  
Rui Zhang ◽  
Yi-Chi Yu ◽  
Bo Liu ◽  
Ya-Qin Han ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Coronary Sinus ◽  
Biventricular Pacing ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Resynchronization Therapy ◽  
Group 2 ◽  
A New Technique ◽  
Group 1

Abstract Background: Cardiac resynchronization therapy via biventricular pacing (BVP) is an established therapy for patients with heart failure. Recently, it has been shown that left bundle branch area pacing (LBBAP) is feasible and may also improve clinical outcomes. In this article, we describe a new technique (sequential LBBAP followed by coronary sinus pacing, designated LOT-CRT) and assess the feasibility of LOT-CRT.Methods: The database of all patients from single centre was reviewed retrospectively. The eligible patients were divided into two groups randomly, LOT-CRT and BV-CRT. The LBBAP lead implanted using our methods. The QRS duration (QRSd) was measured at baseline and during LBBAP, BVP, and LOT-CRT.Results: The study enrolled 11 consecutive heart failure patients with LBBB. LBBAP failed in 1 patient, succeed in 5 patients, while CS leads were implanted successfully in all patients. At baseline, the two groups (5 LOT-CRT cases in group 1, 6 BV-CRT cases in group 2) were matched for QRSd and ischemic cardiomyopathy (ICM, 3 cases in group 1, 2 cases in group 2). In group 1, BVP resulted in significant reduction of the QRSd from 158.0 ± 13.0 ms at baseline to 132.0 ± 4.5 ms (P=0.019). Compared with BVP, unipolar LBBAP resulted in further reduction of the QRSd to 123.0 ± 5.7 ms (P < 0.01). However, LOT-CRT resulted in a significantly greater reduction of the QRSd to 117.0 ± 6.7 ms (P < 0.01). In group 2, BVP resulted in significant reduction of the QRSd from 176.7 ±19.7 ms at baseline to 143.3 ±8.2 ms (P=0.011). However, compared with LBBAP, BVP resulted in increase of the QRSd (P >0.05). As compared to the baseline after 3 months of LBBAP, patients in group 1 showed significant improvement in LVEF and NT-proBNP levels (P < 0.01), while patients in group 2 showed non-significant changes in these parameters (P >0.05).Conclusions: The study demonstrates that LOT-CRT is clinically feasible in patients with systolic HF and LBBB. LOT-CRT was associated with significant narrowing of the QRSd and improvement in LV function, especially in patients with ICM.

Abstract 12717: Improvement of Longitudinal Function is Closely Related to Reverse Remodeling in Cardiac Resynchronization Therapy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Nina E Hasselberg ◽  
Kristina H Haugaa ◽  
Anne Bernard-Brunet ◽  
Erik Kongsgård ◽  
Erwan Donal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Lv Function ◽  
Resynchronization Therapy ◽  
Heart Failure Patients ◽  
Longitudinal Function

Introduction: Response to cardiac resynchronization therapy (CRT) is often defined as reverse remodeling as a reduction in left ventricular (LV) end systolic volume (ESV). How myocardial mechanics are affected by biventricular pacing is not fully clarified. We tested the hypothesis that longitudinal and circumferential function are affected differently by biventricular pacing. Methods: Echocardiography (two dimensional) was performed before and 6 months after CRT implantation in heart failure patients with LV ejection fraction (EF) ≤ 35% and QRS ≥ 120 ms. LV function was assessed by EF and by global longitudinal (GLS) and global circumferential (GCS) strain from 16 LV segments by speckle tracking technique. CRT responders were defined as patients with reverse remodeling with a reduction in ESV ≥ 15% at 6 months. Results: We included 138 heart failure patients (65±10 years, 22% women, NYHA functional class 2.8±0.4, 48% ischemic cardiomyopathy). In the total population, GLS did not change (-8.5±3.9% to -8.9±4.7%, p=0.31) after 6 months with biventricular pacing, while GCS (-11.3±3.3% to -14.2±4.5%, p<0.001) and EF (27±9% to 36±12%, p<0.001) improved. Analyzing CRT responders (62%) and non-responders separately, GLS improved in responders (-8.4±3.8% to -9.5±3.8%, p=0.02) but not in non-responders (-8.7±4.1% to -7.9±4.5%, p=0.30) (Figure). GCS improved in both groups (-11.3±3.0% to -15.0±4.3%, p<0.001 and -11.4±3.8% to 13.0±4.7%, p=0.01). ΔGLS was a predictor of CRT response (OR 0.84 (0.75-0.95), p=0.009) and of ΔESV (1.62 (0.45-2.79), p=0.007) independently of ΔGCS. Conclusions: Biventricular pacing by CRT generally induced less changes in GLS than in GCS and EF. Importantly, GLS improved only in CRT responders with reverse remodeling. We suggest that reverse remodeling is more dependent on improved longitudinal function than circumferential function.

scholarly journals Effects of Adaptive Cardiac Resynchronization Therapy With Left-Bundle-Branch Area Pacing and Coronary Sinus Pacing

2021 ◽  
Author(s):  
Xiang-Fei Feng ◽  
Ren-Hua Chen ◽  
Rui Zhang ◽  
Yi-Chi Yu ◽  
Bo Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Statistical Significance ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Resynchronization Therapy ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients ◽  
Av Conduction ◽  
Qrs Duration

Abstract Adaptive cardiac resynchronization therapy (aCRT) is associated with improved clinical outcomes. Left bundle branch area pacing (LBBAP) has shown encouraging results as an alternative option for CRT. In this study, we observed the clinical and echocardiographic outcome of LBB-optimized aCRT in combination with synchronized LV pacing (LOT-aCRT) in heart failure patients with reduced ejection fraction and LBBB. Heart failure patients with preserved AV conduction and LBBB morphology, who underwent aCRT from February 1, 2019, to September 30, 2020 were included. The eligible patients with or without LBBAP were divided into LOT-aCRT group or BV-CRT group. In LOT-aCRT group, the CS lead was connected to the pace-sensing portion of the RV port, and the LBBAP lead was connected to the LV port. Seventeen patients were enrolled in this study (8 cases in LOT-aCRT group, 9 cases in BV-CRT group). Patients were matched for ischemic cardiomyopathy (ICM) at baseline (5 cases vs. 4 cases). QRS duration (QRSd) via BVP was narrowed from 158.0 ± 13.0 ms at baseline to 132.0 ± 4.5 ms in LOT-aCRT group (P=0.019), and further narrowed to 123.0 ± 5.7 ms (P < 0.01) via LBBAP. However, LOT-aCRT resulted in further reduction of the QRSd (121.0 ± 3.8 ms), but no statistical significance (P > 0.05). In BV-CRT group, BVP resulted in significant reduction of the QRSd from 176.7 ±19.7 ms at baseline to 143.3 ±8.2 ms (P=0.011). However, compared with LOT-aCRT, BVP has no any advantage in reducing QRSd (P > 0.05). During follow-up, patients in LOT-aCRT group showed significant improvement in LVEF and NT-proBNP levels (P < 0.01), while patients in BV-CRT group showed non-significant changes in these parameters (P >0.05). The study demonstrates that LOT-aCRT is clinically feasible in patients with systolic HF and LBBB. LOT-aCRT was associated with significant narrowing of the QRSd and improvement in LV function, especially in patients with ICM.

scholarly journals A case report of advanced heart failure refractory to pharmacological therapy who was successfully recovered by combinatory usage of cardiac resynchronizing therapy, Impella and MitraClip

2020 ◽  
Author(s):  
Mitsuo Sobajima ◽  
Nobuyuki Fukuda ◽  
Hiroshi Ueno ◽  
Koichiro Kinugawa
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Therapeutic Option ◽  
Bed Rest ◽  
Pharmacological Therapy ◽  
Advanced Heart Failure ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Resynchronization Therapy ◽  
Qrs Duration

Abstract Background  The safety and efficacy of MitraClip for advanced heart failure (HF) patients who are inotrope-dependent or mechanically supported are unknown. Case summary  The patient was a 71-year-old man diagnosed as dilated cardiomyopathy in 2003. He was admitted due to worsening HF in January 2019 and became dependent upon intravenous infusion of inotropes. During the 8-month hospitalization, his haemodynamics were relatively static with bed rest and continuous inotropes, but he was definitely dependent on them. Our multidisciplinary team decided to perform both cardiac resynchronization therapy (CRT) and MitraClip under Impella support. First, Impella was inserted from left subclavian artery. After a week, CRT was implanted from right subclavian vein, and the QRS duration of electrocardiogram became remarkably narrow. MitraClip was performed 2 weeks after Impella, and functional mitral regurgitation improved from severe to mild, and Impella was removed on the same day. Inotropes could be ceased, and he was discharged 2 months after MitraClip. Discussion  During inotrope-dependent status, there was a risk that HF would worsen with haemodynamic collapse when performing CRT implantation, and we firstly supported his haemodynamics by Impella. Cardiac resynchronization therapy implantation before MitraClip seemed to be crucial. In fact, the mitral valve morphology before Impella insertion had very poor coaptation of the anterior and posterior leaflets that was not optimal for MitraClip procedure. But the Impella support and correction of dyssynchrony by CRT markedly improved the coaptation of those leaflets. The combination therapy of CRT and MitraClip unloading with Impella maybe a new therapeutic option for advanced HF.

45Improving the optimization of cardiac resynchronization therapy: Does multipoint left ventricular pacing shorten the paced-QRS duration compared to the fusion-optimized intervals method?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R San Antonio ◽  
M Pujol-Lopez ◽  
R Jimenez-Arjona ◽  
A Doltra ◽  
F Alarcon ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Prospective Clinical Study ◽  
Battery Life ◽  
Resynchronization Therapy ◽  
Qrs Duration ◽  
Phrenic Stimulation

Abstract Funding Acknowledgements Cardiac Pacing Scholarship from the Spanish Society of Cardiology (SEC) Background Electrocardiogram-based optimization of cardiac resynchronization therapy (CRT) using the fusion-optimized intervals (FOI) method has demonstrated to improve both acute hemodynamic response and left ventricle (LV) reverse remodeling compared to nominal programming of CRT. FOI optimizes the atrioventricular (AV) and ventriculo-ventricular (VV) intervals to achieve the shortest paced-QRS duration. The recent development of multipoint pacing (MPP) enables the activation of the LV from 2 locations, also shortening the QRS duration compared to conventional biventricular pacing. Purpose To determine if MPP reduces the paced-QRS duration compared to FOI optimization.  Methods This prospective clinical study included 25 consecutive patients who successfully received a CRT with MPP pacing capability. All patients were in sinus rhythm and had an PR interval below 250 ms. The QRS duration was measured with a 12-lead digital electrocardiography (screen speed of 200 mm/s) at baseline and using 3 different configurations: MPP, FOI and a combined FOI-MPP strategy. In MPP, the intervals were (based on previous studies): 1) AV 130 ms, 2) Right ventricular (RV)-LV2 (Δ1) 5 ms, and 3) LV1-LV2 (Δ2) 5 ms. In FOI, AV and VV intervals were optimized to achieve fusion between intrinsic conduction and biventricular pacing. In FOI-MPP, the Δ2 was set at 5 ms, while AV and Δ1 intervals were optimized using the FOI method. The CRT device was programmed with the configuration that achieved a greater paced-QRS shortening. After 45 days, battery life was estimated. Results   Mean age was 65 ± 10 years, 20 were men (80%) and baseline QRS duration was 177 ± 17 ms. The FOI method bested nominal MPP (QRS shortened by 58 ± 16 ms vs 43 ± 16 ms, respectively, p = 0.002). Adding MPP to the narrowest QRS by FOI did not result in further shortening (FOI: 58 ± 16 ms vs FOI-MPP: 59 ± 13 ms, p = 0.81). The final configuration was FOI method alone in most cases (n = 16, 64%) and FOI-MPP in all others (n = 9, 36%; figure). In total, 10 out of 25 patients (40%) were not candidates to MPP due to: 1) pacing thresholds exceeding 3.5 V/0.4 ms at the distal or proximal electrode (8, 32%), and 2) phrenic stimulation (2, 8%). Estimated battery longevity was longer in patients receiving FOI as compared to MPP (8.3 ± 2.1 years vs. 6.2 ± 2.2 years, p = 0.04). Conclusion In CRT, the FOI method is not improved by coupling with MPP.  Up to 40% of patients are not candidates for MPP due to high thresholds or phrenic stimulation. The use of MPP in unselected patients would result in a decrease of battery longevity, without any additional benefit over FOI. Abstract Figure.

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