scholarly journals Cardiac Resynchronization Therapy using Left-Bundle-Branch Area and Left Ventricular Pacing

2020 ◽  
Author(s):  
Xiang-Fei Feng ◽  
Ling-Chao Yang ◽  
Rui Zhang ◽  
Yi Yu ◽  
Bo Liu ◽  
...  
Keyword(s):  
New York ◽  
Cardiac Resynchronization Therapy ◽  
Biventricular Pacing ◽  
Operation Time ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Resynchronization Therapy

Introduction: Cardiac resynchronization therapy via biventricular pacing is an established therapy for patients with heart failure. However, high nonresponder rates and inability to predict response remains a challenge. Recently left bundle branch area pacing (LBBAP) has been shown to be feasible and may also improve clinical outcomes. In this article we describe sequential LBBAP followed by left ventricular (LV) pacing (LOT-CRT) and assess the feasibility of LOT-CRT. Methods: The RV implantation site was positioned and the LBBAP lead was implanted using our methods. The QRS duration (QRSd) at baseline, during LBBAP, biventricular pacing, and LOT-CRT was measured. Results: LOT-CRT was successful in 5 patients (age 71.8 ± 5.1 years, men 3, ischemic 3). The QRSd at baseline was 158.0 ± 13.0 ms and significantly narrowed to 117.0 ± 6.7 ms during LOT-CRT (P < 0.01). During 3-month follow-up, LV ejection fraction improved from 32.8 ± 5.2 % to 45.0 ± 5.1% (P < 0.01), and New York Heart Association functional class changed from 3.25 ± 0.5 to 2.5 ± 0.6 (P < 0.05). A decrease in left ventricular end-diastolic dimension was observed, with widening from (68.2 ± 12.3) mm at baseline to (62.2 ± 11.3) mm at pacing (P < 0.05). The length of operation time was (152.0 ± 31.1) min. 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 QRSd and improvement in LV function, especially in patients with ischemic cardiomyopathy.

scholarly journals Cardiac Resynchronization Therapy using Left-Bundle-Branch Area and Left Ventricular Pacing

2020 ◽  
Author(s):  
Xiang-Fei Feng ◽  
Ling-Chao Yang ◽  
Rui Zhang ◽  
Mei Yang ◽  
Bo Liu ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Biventricular Pacing ◽  
Operation Time ◽  
Left Ventricular ◽  
Functional Class ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Ventricular Pacing ◽  
Resynchronization Therapy ◽  
Left Ventricular Pacing

Abstract Background: Cardiac resynchronization therapy via biventricular pacing is an established therapy for patients with heart failure. However, high nonresponder rates and inability to predict response remains a challenge. Recently left bundle branch area pacing (LBBAP) has been shown to be feasible and may also improve clinical outcomes. In this article we describe the new technique (sequential LBBAP followed by left ventricular pacing, LOT-CRT) and assess the feasibility of LOT-CRT.Methods: The RV implantation site was positioned and the LBBAP lead was implanted using our methods. The QRS duration (QRSd) at baseline, during LBBAP, biventricular pacing, and LOT-CRT was measured. Results: LOT-CRT was successful in 5 patients (age 71.8 ± 5.1 years, men 3, ischemic 3). The QRSd at baseline was 158.0 ± 13.0 ms and significantly narrowed to 117.0 ± 6.7 ms during LOT-CRT (P < 0.01). During 3-month follow-up, LV ejection fraction improved from 32.8 ± 5.2 % to 45.0 ± 5.1% (P < 0.01), and New York Heart Association functional class changed from 3.25 ± 0.5 to 2.5 ± 0.6 (P < 0.05). A decrease in left ventricular end-diastolic dimension was observed, with widening from (68.2 ± 12.3) mm at baseline to (62.2 ± 11.3) mm at pacing (P < 0.05). The length of operation time was (152.0 ± 31.1) min. 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 QRSd and improvement in LV function, especially in patients with ischemic cardiomyopathy.

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 Left cardiac atrioventricular delay and inter-ventricular delay in cardiac resynchronization therapy responder and non-responder

2016 ◽  
Vol 2 (1) ◽  
pp. 247-250 ◽  
Author(s):  
Matthias Heinke ◽  
Helmut Kühnert ◽  
Tobias Heinke ◽  
Jonas Tumampos ◽  
Gudrun Dannberg
Keyword(s):  
New York ◽  
Cardiac Resynchronization Therapy ◽  
Biventricular Pacing ◽  
Heart Association ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Atrioventricular Delay ◽  
Surface Ecg ◽  
New York Heart Association

AbstractCardiac resynchronization therapy is an established therapy for heart failure patients. The aim of the study was to evaluate electrical left cardiac atrioventricular delay and interventricular desynchronization in sinus rhythm cardiac resynchronization therapy responder and non-responder. Cardiac electrical desynchronization were measured by surface ECG and focused transesophageal bipolar left atrial and left ventricular ECG before implantation of cardiac resynchronization therapy defibrillators. Preoperative electrical cardiac desynchronization was 195.7 ± 46.7 ms left cardiac atrioventricular delay and 74.8 ± 24.5 ms interventricular delay in cardiac resynchronization therapy responder. Cardiac resynchronization therapy responder New York Heart Association class improved during long term biventricular pacing. Transesophageal left cardiac atrioventricular delay and interventricular delay may be additional useful parameters to improve patient selection for cardiac resynchronization therapy.

Effect of Cardiac Resynchronization Therapy in Patients With New York Heart Association Functional Class IV Heart Failure

2010 ◽  
Vol 106 (8) ◽  
pp. 1146-1151 ◽  
Author(s):  
Rutger J. van Bommel ◽  
Eva van Rijnsoever ◽  
C. Jan Willem Borleffs ◽  
Victoria Delgado ◽  
Nina Ajmone Marsan ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Cardiac Resynchronization Therapy ◽  
Heart Association ◽  
Functional Class ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
New York Heart Association ◽  
Class Iv

Results of the randomized studies on cardiac resynchronization therapy and the reevaluation of the cardiac ventricular activation in left bundle branch block

2013 ◽  
Vol 154 (18) ◽  
pp. 688-693 ◽  
Author(s):  
István Préda
Keyword(s):  
New York ◽  
Cardiac Resynchronization Therapy ◽  
Left Bundle Branch Block ◽  
Heart Association ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
New York Heart Association

If New York Heart Association Class II–IV heart failure is present, and ejection fraction ≤35%, electrocardiographic QRS width ≥ 120 ms in the presence of left bundle branch block, cardiac resynchronization therapy is indicated. Reevaluation of the data of cardiac resynchronization trials and electrophysiologic findings in left bundle branch block provided evidence that “true” left bundle branch block requires a QRS width of ≥130 ms (in woman) and ≥140 ms (in man). In “true” left bundle branch block, after the 40th ms of the QRS notched/slurred R waves are characteristic in minimum two of I, aVL, V1, V2, V5 and V6 leads, in addition to a ≥40 ms increase of the QRS complex, as compared to the original QRS complex. In contrast, slowly and continuously widened “left bundle branch block like” QRS patterns are mostly occur in left ventricular hypertrophy or in a metabolic/infiltrative disease. Orv. Hetil., 2013, 154, 688–693.

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 Duration of the preejection phase is less preload dependent and therefore a better marker of acute response to cardiac resynchronization therapy than maximum pressure rise

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Villegas-Martinez ◽  
HH Odland ◽  
OJ Sletten ◽  
F Khan ◽  
A Wajdan ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Biventricular Pacing ◽  
Linear Regression Analysis ◽  
Pressure Rise ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Maximum Pressure ◽  
Resynchronization Therapy ◽  
Acute Response

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie Background There is no consensus on which haemodynamic marker should be used to quantify acute response to cardiac resynchronization therapy (CRT) during implantation of the device. CRT has been shown to acutely reduce left ventricular (LV) end systolic as well as end-diastolic volume (EDV), precluding the use of preload dependent markers such as LV maximum pressure rise (dP/dtmax). Purpose As resynchronization will abolish the uncoordinated regional early systolic contractions of the LV, it will shorten the time to maximal pressure rise and aortic valve opening. For this reason, the purpose of this study was to investigate if duration from the time-point of ventricular pacing to dP/dtmax is less preload dependent and a better marker of acute response to CRT than dP/dtmax by comparing how the 2 markers reflected LV function during different CRT configurations. Methods LV pressure by micromanometer and volume by sonomicrometry were measured in 6 anaesthetized canines with left bundle branch block. Transient caval constrictions were performed to vary preload. Preload dependency of the 2 markers was compared by normalizing their values and calculating their relations to EDV. In 4 of the animals, biventricular pacing was performed at 3 different pacing sites with variations in atrioventricular delays that provided a range of response to CRT. To correct for acute changes in preload by CRT, stroke volume (SV) at identical EDV found from transient caval constrictions, were assessed and used as reference to grade improved LV function. Linear regression analysis was used to assess the correlation of both the duration of the preejection phase and dP/dtmax with SV. Results The duration of the preejection phase varied less with changes in preload compared to dP/dtmax: the slopes of their relation to EDV were -0.6 ± 0.7 %/ml and 4.8 ± 2.1 %/ml (p = 0.004), respectively. Turning CRT on, acutely reduced EDV from 74 ± 16 to 69 ± 17 ml (p &lt; 0.001) at the best pacing configuration. For the different pacing sites and settings, there was a consistent relation in all animals where the preejection phase shortened as SV increased (average r2 = 0.75) (Figure A). dP/dtmax showed no clear relation to SV (average r2 = 0.22) and included cases with both negative and positive slopes (Figure B). Conclusions The duration of the preejection phase correlated with changes in LV function induced by CRT while dP/dtmax performed poorly as preload was changed. Hence, the novel timing parameter was less preload dependent and may be a better marker for assessing acute response to CRT. Abstract Figure.

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