scholarly journals New opportunities for assessing the optimal positioning of a multipolar left ventricular electrode for resynchronization therapy

2019 ◽  
Vol 23 (4) ◽  
pp. 84 ◽  
Author(s):  
A. B. Romanov ◽  
E. A. Morzhanaev ◽  
I. L. Mikheenko ◽  
A. V. Ponomarenko ◽  
A. G. Filippenko ◽  
...  
Keyword(s):  
Heart Failure ◽  
Myocardial Perfusion ◽  
Conflict Of Interest ◽  
Myocardial Perfusion Scintigraphy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Perfusion Scintigraphy ◽  
Bundle Branch Block ◽  
Optimal Position

<p>Heart failure and left bundle branch block is a common disease in the modern world. Cardiac resynchronization therapy is used to correct this condition, but some patients have no positive clinical effect from its use. One of the reasons for the lack of response to therapy is not the optimal position of the left ventricular electrode. In this clinical case we presented the experience of using myocardial perfusion scintigraphy to determine the optimal position of the left ventricular electrode.<br />A 60-year-old patient, who was admitted to the center with symptoms of heart failure and signs of complete left bundle branch block, underwent an implantation of the cardiac resynchronization system. Both intraoperative data and the data of preliminary myocardial scintigraphy were used to select the site of implantation of the left ventricular electrode. A significant improvement in the patient’s condition, evaluated after 6 months after the implantation of the device, allowed us to conclude that the use of myocardial perfusion scintigraphy with standard methods of ultrasound diagnosis can increase the efficiency of implantation of cardiac resynchronization devices and a response to the therapy.</p><p>Received 2 October 2019. Revised 20 December 2019. Accepted 23 December 2019.</p><p><strong>Funding:</strong> The work is supported by a grant of the President of the Russian Federation for young scientists No. МД-2893.2018.7.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

scholarly journals The comparison of left ventricular mechanical dyssynchrony obtained by myocardial perfusion scintigraphy and gated blood pool SPECT to predict the result of the cardiac resynchronization therapy

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
A Mishkina ◽  
K Zavadovsky ◽  
V Shipulin ◽  
V Saushkin ◽  
YU Lishmanov
Keyword(s):  
Myocardial Perfusion ◽  
Myocardial Perfusion Scintigraphy ◽  
Blood Pool ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Perfusion Scintigraphy ◽  
Left Ventricular Mechanical Dyssynchrony ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction The assessment of left ventricular mechanical dyssynchrony (LV MD) is essential in identifying patients who may benefit from cardiac resynchronization therapy (CRT). Both gated myocardial perfusion scintigraphy (MPS) and gated blood pool SPECT (GBPS) are widely used to LV MD assessment [1,2]. Lack of data is available regarding the comparison of left ventricular MD parameters obtained by MPS and GBPS on cadmium-zinc-telluride (CZT) gamma-cameras and their prognostic value. Purpose to compare two scintigraphic methods – MPS and GBPS in LV MD assessment and to assess the capability of these methods to predict CRT response. Methods This study included 30 heart failure patients referred for CRT. Before CRT all patients underwent rest gated MPS and GBPS with LV MD evaluation on CZT cardiac gamma. Based on the phase analysis, the following indexes were estimated: phase standard deviation (SD) and phase histogram bandwidth (HBW). One year after CRT patients were divided to responders and non-responders. The response criteria were defined as LV end systolic volume decreased by ≥ 15% or LV ejection fraction increase by ≥ 5%, based on echocardiography. Results The correlation between gated MPI indexes and GBPS indexes was suboptimal: SD r = 0.39, p &lt; 0.05; HBW r = 0.48, p &lt; 0.05. Based on Mann-Whitney statistics significant differences between LV MD indexes, assessed by both MPS and GBPS were found: SD LV 56.1 (IQR 50.6 – 64) deg. vs 50.6 (37 - 61) deg., p &lt; 0.05 and HBW LV 188.64 (176 - 213) deg. vs 201.68 (180 - 240) deg., p = 0.03, respectively. The Bland-Altman analysis showed poor agreement between gated MPS and GBPS for SD assessment (p = 0.02) with mean difference value 7.02 (96% CI 1.11 to 12.9). However both MPS and GBPS were comparable in terms of HBW estimation (p = 0.18), with mean difference value of -12.5 (96% CI -31.5 to 6.3).MD indexes derived by MPS differed significantly between CRT responders and non-responders: SD 53.56 (47 – 63.4) deg. vs 62.4 (56-71) deg., p &lt; 0.05; HBW 182.1 (166 - 211) deg. vs 204.3 (179 - 225) deg., p &lt; 0.05. MD indexes obtained by GBPS did not show significant difference in CRT responders and non-responders: SD 51.2 (37 – 62) deg. vs 49.4 (40 – 58) deg., p = 0.92 and HBW 203.4 (186 - 237) deg. vs 198.5 (174 - 240) deg., p = 073. Univariate logistic regression analysis showed that SD and HBW assessed by gated MPS were independent predictors of CRT response: SD (OR = 0.91; 95% CI 0.85-0.97; p &lt; 0.05) and HBW (OR = 0.98; 95% CI 0.96-0.99; p =0.03). However MD indexes obtained by GBPS, did not show statistically significance in prediction of CRT response. Conclusion Gated MPS and GBPS are not interchangeable in terms of left ventricular MD assessment. Left ventricular SD and HBW obtained by gated MPI on CZT gamma-camera showed prognostic significance to predict CRT response.

scholarly journals His-optimized cardiac resynchronization therapy in a patient with heart failure and right bundle branch block: a case report

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Dmytro Volkov ◽  
Dmytro Lopin ◽  
Stanislav Rybchynskyi ◽  
Dmytro Skoryi
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Right Bundle Branch Block ◽  
Clinical Status ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction

Abstract Background  Cardiac resynchronization therapy (CRT) is an option for treatment for chronic heart failure (HF) associated with left bundle branch block (LBBB). Patients with HF and right bundle branch block (RBBB) have potentially worse outcomes in comparison to LBBB. Traditional CRT in RBBB can increase mortality and HF deterioration rates over native disease progression. His bundle pacing may improve the results of CRT in those patients. Furthermore, atrioventricular node ablation (AVNA) for rate control in atrial fibrillation (AF) can be challenging in patients with previously implanted leads in His region. Case summary  We report the case of 74-year-old gentleman with a 5-year history of HF, permanent AF with a rapid ventricular response, and RBBB. He was admitted to the hospital with complaints of severe weakness and shortness of breath. Left ventricular ejection fraction (LVEF) was decreased (41%), right ventricle (RV) was dilated (41 mm), and QRS was prolonged (200 ms) with RBBB morphology. The patient underwent His-optimized CRT with further left-sided AVNA. As a result, LVEF increased to 51%, RV dimensions decreased to 35 mm with an improvement of the clinical status during a 6-month follow-up. Discussion  Patients with AF, RBBB, and HF represent the least evaluated clinical subgroup of individuals with less beneficial clinical outcomes according to CRT studies. Achieving the most effective resynchronization could require pacing fusion from sites beyond traditional with the intention to recruit intrinsic conduction pathways. This approach can be favourable for reducing RV dilatation, improving LVEF, and maximizing electrical resynchronization.

Abstract 1647: Can Left Ventricular Dyssynchrony as evaluated by Phase Analysis on Gated Myocardial Perfusion SPECT predict Response to Cardiac Resynchronization Therapy?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Maureen M Henneman ◽  
Ji Chen ◽  
Petra Dibbets-Schneider ◽  
Marcel P Stokkel ◽  
Gabe B Bleeker ◽  
...  
Keyword(s):  
Heart Failure ◽  
Myocardial Perfusion ◽  
Cardiac Resynchronization Therapy ◽  
Phase Analysis ◽  
Clinical Status ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cutoff Value ◽  
Lv Dyssynchrony

Purpose: Cardiac resynchronization therapy (CRT) is now a well established therapeutic option for patients with end-stage heart failure. However, not all patients respond to CRT, and therefore preimplantation identification of responders is desirable. The purpose of the present study was to investigate whether the degree of left ventricular (LV) dyssynchrony as assessed with phase analysis from gated myocardial perfusion single photon emission computed tomography (GMPS), can predict which patients will respond to CRT. Methods: Forty-two patients with severe heart failure, depressed LV ejection fraction and wide QRS complex, were prospectively included for implantation of a CRT device and underwent GMPS and 2D echocardiography as part of clinical protocol. Clinical status was evaluated using New York Heart Association (NYHA) classification, 6-minute walk test and quality-of-life score. The histogram bandwidth and phase standard deviation (SD) (parameters indicating LV dyssynchrony) were assessed from GMPS, and clinical status and echocardiographic variables were re-assessed at 6 months follow-up. Results: Responders (71%) and non-responders (29%) had comparable baseline characteristics, except for histogram bandwidth (175±63° vs 117±51°, P <0.01) and phase SD (56.3±19.9° vs 37.1±14.4°, P <0.01) which were significantly larger in responders as compared to non-responders. Moreover, receiver-operator characteristic curve analysis demonstrated an optimal cutoff value of 135° for histogram bandwidth (sensitivity and specificity of 70%) and of 43° for phase SD (sensitivity and specificity of 74%) for the prediction of response to CRT. Conclusion: Response to CRT is related to the presence of LV dyssynchrony assessed by phase analysis with GMPS. A cutoff value of 135° for histogram bandwidth and of 43° for phase SD could be used to predict response to CRT. Larger prospective studies are warranted to confirm the present findings.

Left ventricular endocardial or triventricular pacing to optimize cardiac resynchronization therapy in a chronic canine model of ischemic heart failure

2012 ◽  
Vol 303 (2) ◽  
pp. H207-H215 ◽  
Author(s):  
Pierre Bordachar ◽  
Nathan Grenz ◽  
Pierre Jais ◽  
Philippe Ritter ◽  
Christophe Leclercq ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Canine Model ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Endocardial Lead ◽  
Endocardial Pacing ◽  
Optimal Site

Cardiac resynchronization therapy (CRT) is a proven treatment for heart failure but ∼30% of patients appear to not benefit from the therapy. Left ventricular (LV) endocardial and multisite epicardial [triventricular (TriV)] pacing have been proposed as alternatives to traditional LV transvenous epicardial pacing, but no study has directly compared the hemodynamic effects of these approaches. Left bundle branch block ablation and repeated microembolizations were performed in dogs to induce electrical dysynchrony and to reduce LV ejection fraction to <35%. LVdP/d tmax and other hemodynamic indexes were measured with a conductance catheter during LV epicardial, LV endocardial, biventricular (BiV) epicardial, BiV endocardial, and TriV pacing performed at three atrioventricular delays. LV endocardial pacing was obtained with a clinically available pacing system. The optimal site was defined as the site that increased dP/d tmax by the largest percentage. Implantation of the endocardial lead was feasible in all canines ( n = 8) without increased mitral regurgitation seen with transesophageal echocardiography and with full access to the different LV endocardial pacing sites. BiV endocardial pacing increased dP/d tmax more than BiV epicardial and TriV pacing on average ( P < 0.01) and at the optimal site ( P < 0.01). There were no significant differences between BiV epicardial and TriV pacing. BiV endocardial pacing was superior to BiV epicardial and to TriV pacing in terms of acute hemodynamic response. Further investigation is needed to confirm the chronic benefit of this approach in humans.

scholarly journals Mechanical Dyssynchrony for Prediction of the Cardiac Resynchronization Therapy Response in Patients with Dilated Cardiomyopathy

Kardiologiia ◽  
2021 ◽  
Vol 61 (7) ◽  
pp. 14-21
Author(s):  
K. V. Zavadovskij ◽  
V. V. Saushkin ◽  
Yu. V. Varlamova ◽  
A. I. Mishkina ◽  
V. V. Shipulin ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Myocardial Perfusion Scintigraphy ◽  
Positive Response ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Defect Size ◽  
Resynchronization Therapy ◽  
Perfusion Scintigraphy ◽  
End Diastolic Volume

Aim      To evaluate the predictive value of indexes of left ventricular mechanical dyssynchrony (MD) as determined by data of electrocardiogram (ECG)-gated myocardial perfusion scintigraphy (ECG-MPS) for prediction of the efficacy of resynchronization therapy (RT) in patients with chronic heart failure (CHF).Material and methods  This prospective study included 32 patients with nonischemic CHF and standard indications for RT. All patients underwent complete clinical an instrumental examination, including 24-h ECG monitoring and echocardiography (EchoCG). In order to evaluate the left ventricular (LV) myocardial perfusion, contractile function, and MD, myocardial perfusion scintigraphy was performed for all patients at rest prior to RT. In addition to the perfusion defect size at rest and hemodynamic parameters, LV MD was determined. The following indexes were used for analysis of dyssynchronization: phase standard deviation (PSD), phase histogram bandwidth (HBW), and phase histogram asymmetry and steepness. The treatment efficacy was evaluated by the clinical status of patients (clinical condition evaluation scale for CHF patient) and EchoCG at 6 months following RT. The criteria for a positive response to RT were an increase in LV ejection fraction (EF) by 5% and/or a decrease in the LV end-diastolic volume by 15% compared to preoperative values.Results According to ECG-MPS findings, all patients had scintigraphic signs of severe CHF with dilated LV cavity (end-diastolic volume, EDV 246 [217; 269] ml) and also of pronounced mechanical and electrical dyssynchrony. The values of mechanical dyssynchrony were PSD 53 [41; 61], HBW 176 [136; 202], asymmetry 1.62 [1.21; 1.89], and steepness 2.81 [1.21; 3.49]. The QRS duration was 165 [155; 175] msec. Furthermore, the LV perfusion was moderately impaired (perfusion defect size 4 [3; 10] %). Mean follow-up duration after implantation of the resynchronizing device was 6±1.7 mos. According to the selected criteria, 20 (63 %) patients were considered as responders and 12 (37 %) patients as non-responders. Before implantation of the cardiac synchronizing device, responders and non-responders differed only in LV MD (PSD 44 [35; 54] vs. 63 [58; 72]; p=0.0001); HBW 158 [118; 179] vs. 205 [199; 249]; p=0.0001; asymmetry 1.77 [1.62; 2.02] vs. 1.21 [0.93; 1.31]; p=0.0001; steepness 3.03 [2.60; 3.58] vs. 1.21 [0.19; 1.46]; p=0.0001), respectively. A one-factor logistic regression analysis showed that MD values were statistically significant predictors of a positive response to RT. A multi-factor logistic analysis of phase histogram steepness (odds ratio, OR 1.196; 95 % confidence interval, CI 1.04–1.37) and PSD (OR 0.67; 95 % CI 0.47–0.97) were identified as independent predictors for the response to RT. According to results of the ROC analysis, a PSD <55 and a phase histogram steepness >1.54 may predict the effectiveness of RT (AUC= 0.92; р=0.0001).Conclusion      LV MD parameters determined with ECG-MPS allow predicting the effectiveness of RT in patients with nonischemic CHF. In this patient group, high values of standard deviation and low values of phase histogram steepness were independent predictors for the absence of response to RT after 6 mos. of follow-up.

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