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 Cardiac index in atrio- and interventricular delay optimized cardiac resynchronization therapy and cardiac contractility modulation

2015 ◽  
Vol 1 (1) ◽  
pp. 89-91 ◽  
Author(s):  
J. Tumampos ◽  
N. Wulf ◽  
H. Kühnert ◽  
O. Solbrig ◽  
J. Querengässer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Index ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardiac Contractility Modulation ◽  
Heart Failure Patients ◽  
Qrs Duration

AbstractCardiac resynchronization therapy (CRT) is an established therapy for heart failure patients and improves quality of life in patients with sinus rhythm, reduced left ventricular ejection fraction (LVEF), left bundle branch block and wide QRS duration. Since approximately sixty percent of heart failure patients have a normal QRS duration they do not benefit or respond to the CRT. Cardiac contractility modulation (CCM) releases nonexcitatoy impulses during the absolute refractory period in order to enhance the strength of the left ventricular contraction. The aim of the investigation was to evaluate differences in cardiac index between optimized and nonoptimized CRT and CCM devices versus standard values. Impedance cardiography, a noninvasive method was used to measure cardiac index (CI), a useful parameter which describes the blood volume during one minutes heart pumps related to the body surface. CRT patients indicate an increase of 39.74 percent and CCM patients an improvement of 21.89 percent more cardiac index with an optimized device.

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.

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.

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