Multisite, multipoint pacing

2017 ◽  
Vol 2 (43) ◽  
pp. 9-13
Author(s):  
Przemysław Mitkowski
Keyword(s):  
Nyha Class ◽  
Standard Of Care ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Ventricular Pacing ◽  
Reduced Ejection Fraction ◽  
Clinical Benefits ◽  
Qrs Duration ◽  
Left Ventricular Pacing ◽  
Rv Pacing

Cardiac resynchronization therapy in patients with heart failure, reduced ejection fraction and prolonged QRS duration has become standard of care. Unfortunately, despite improvements in delivery of this treatment still approximately 30% of patients are non-responders. Among causes of this phenomenon one can find an inability to deliver hemodynamically effective left ventricular pacing. There were proposed several solutions to solve the problem, including: multisite RV pacing, multisite LV pacing, multipoint LV pacing. Multisite RV pacing (two RV leads positioned in RV: apex and RVOT), although causes some hemodynamic improvement in LVEF or distance in 6MWT and reduction of LVESD or number of hospitalizations in comparison to no paced patients, but its efficacy is significantly worse than normal CRT. So it should not be considered as an alternative to CRT even to surgically placed LV lead. Multisite LV pacing (two leads iv cardiac veins) gives significant benefits over standard CRT, especially in patients with poor heart vein system, which preclude optimal LV lead placement. Clinical benefits of this mode of therapy were observed in non-responders to classical CRT, and were proved in: higher responder rates, improved EF, VO2, distance in 6MWT, reduction of NYHA class, LVESV, LVEDD and increase of dP/dt. Multipoint LV pacing (different pacing point located on the same LV lead) is encouraging way of CRT delivery and does not require any additional lead. Benefits of MP pacing over classical CRT were proved in numerous trails in acute tests by improvement in dP/dt, increase in maximal strain rate, shortening of total activation time, reduction in QRS duration and after mid- and long term follow-up in reduction of LVESV, increase in EF, reduction of asynchrony and higher percentage of responders. Multipoint left ventricular pacing should be a standard of CRT delivery in first implantations.

scholarly journals Endocardial left ventricular pacing Where are we a systematic review

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
H Santos ◽  
M Santos ◽  
I Almeida ◽  
S Paula ◽  
H Miranda ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Nyha Class ◽  
Left Ventricular ◽  
Systemic Review ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Ventricular Pacing ◽  
Stroke Incidence ◽  
Ventricular Ejection Fraction ◽  
Left Ventricular Pacing

Abstract Funding Acknowledgements Type of funding sources: None. Background Endocardial left ventricular pacing is a technique used in cardiac resynchronization therapy (CRT), when a coronary sinus implant is not possible, conventional CRT was an unsuccess and in CRT nonresponders. We performed a systemic review to evaluate its risks and benefits. Objective Review the evidence regarding the efficacy and safety of endocardial left ventricular pacing. Methods A systemic research on MEDLINE and PUBMED with the term "endocardial left ventricular pacing", "biventricular pacing" or "endocardial left pacing". 1038 results were identified, however, just publish papers (excluding abstract) with more than 16 patients was admitted in these analyses. Comparisons pre and post CRT regard New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF) and QRS width was performed. Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment. Results Eleven studies were selected, including a total of 560 patients. The studies were performed with different techniques, trans-atrial septal technique, trans-ventricular septal technique and transapical technique. Mean age 66.93 years old, 90.54% male, median ejection fraction of 28.86%, NYHA class of 3.03, QRS width 167,50 mseg. Ischemic etiologic in 43.88%, atrial fibrillation in 45.35% and left bundle branch block in 55.20%. Was reported several complications after the procedure, 8 pocket infection (7 studies), 17 transient ischemic attacks (10 papers), 17 ischemic stroke (all), 35 tromboembolic events (all) and 115 deaths, nevertheless, follow up in the different studies was diverse and heterogeneous. Significant improvement was registered in NYHA class (MD 0.64, CI 0.56-0.72, p < 0.00001, I2 = 89%) (reported in 7 studies), LVEF (MD 6.20, CI 5.09-7.32, p = 0.002, I2 = 69%) %) (reported in 8 studies) and QRS width (MD 31.35, CI 26.11-36.60, p < 0.00001, I2 = 89%) %) (reported in 5 studies), (all p < 0.00001). Conclusions Left ventricular endocardial pacing is a feasible alternative to conventional CRT, when the last one is not possible. With clinical, electrocardiogram and echocardiogram improvement in several series. First data regarding this procedure were associated with higher stroke incidence, something contrary to the last study’s results. Nevertheless, at the moment just small series present this technique with heterogenous results and different approaches, being important further investigation.

Abstract 5926: Cardiac Electrical Resynchronization Therapy Combining HIS Bundle and Left Ventricular Pacing is Effective in the Treatment of Severe Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Stanley Tung ◽  
Kesava Rajagopalan ◽  
Andy Ignaszewski ◽  
Jonathan Affolter
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Severe Heart Failure ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Ventricular Pacing ◽  
Resynchronization Therapy ◽  
His Bundle ◽  
Left Ventricular Pacing

Introduction: It is known that Cardiac Resynchronization Therapy (CRT) combining right ventricular (RV) apex pacing and left ventricular pacing (LVP) is ineffective in up to 35% of heart failure (HF) patients. Our hypothesis is that RV apical pacing bypasses the rapidly conducting right bundle and may further impede ventricular activation with LBBB hence a more physiological CRT is via HIS Bundle pacing (HBP) and LVP. We report of our early experience with Cardiac Electrical Resynchronization Therapy (CERT) incorporating HBP with LVP in patients with severe HF. Methods: Patients indicated for CRT were approached for CERT. In addition to an atrial and LV lead, patients also received a HBP lead. An active fixation lead (SelectSecure/Site® Medtronic) was used directly for HIS Bundle mapping and pacing. HBP implant thresholds, procedure and fluoroscopy times, pre and post implant QRS, PR interval, and NYHA class were collected. Student t -test was used for analysis. Results: 15 patients (13 male, mean age 70yrs) referred for CRT underwent successful CERT with mean follow up of 3.5±4.3 months. The mean implant HBP threshold, procedure and fluoroscopy time were 1.6V/0.6ms, 150min, and 26min respectively. All patients had QRS shortening with a mean of 64±21ms (pre CERT 182ms, post CERT 118ms, p<0.0001, figure ) and mean PR shortening of 81±101ms (pre CERT 254ms, post CERT 173ms, p<0.05). 13 patients had improvement of at least one NYHA class. Conclusions: HBP with LVP is effective in achieving electrical resynchronization, and has resulted in early improvement of HF symptoms. Evidence of reverse remodeling is pending. CERT needs to be further validated before considering for wide adoption.

scholarly journals P-162 Transesophageal left ventricular pacing with different pacing mode in heart failure patients with NYHA class III

EP Europace ◽  
2003 ◽  
Vol 4 (Supplement_2) ◽  
pp. B105-B105
Author(s):  
M. Heinke ◽  
H. Kuhnert ◽  
R. Surber ◽  
G. Dannberg ◽  
H.R. Figulla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Left Ventricular ◽  
Ventricular Pacing ◽  
Class Iii ◽  
Heart Failure Patients ◽  
Pacing Mode ◽  
Left Ventricular Pacing

Video-Assisted Implantation of a Left Ventricular Lead and Intrathoracic Tunneling to a Right-Sided CRT-D Device

2011 ◽  
Vol 6 (5) ◽  
pp. 341-343
Author(s):  
Thijs Stoker ◽  
Theo J. Klinkenberg ◽  
Alexander H. Maass ◽  
Massimo A. Mariani
Keyword(s):  
Left Ventricular ◽  
Pleural Space ◽  
Left Ventricular Lead ◽  
Cardiac Resynchronization ◽  
Ventricular Pacing ◽  
Video Assisted ◽  
Ventricular Lead ◽  
Pacing Lead ◽  
Left Ventricular Pacing ◽  
The Right

We describe two cases in which a biventricular implantable cardioverter defibrillator for cardiac resynchronization therapy had to be placed on the right side due to unsuitability of the left subclavian vein. Endocardial implantation of a left ventricular lead through the coronary sinus was previously attempted but was unsuccessful. Implantation of the epicardial left ventricular pacing lead was performed through video-assisted thoracic surgery on the left side. The connector end of the left ventricular pacing lead was tunnelized through the anterior mediastinum into the right pleural space. The right-sided pocket was then opened. A tunnel was created from the pocket to the thoracic wall, and the pleural space was entered over the second rib. The lead was retrieved from the right pleural space and connected with the Cardiac resynchronization therapy-device (CRT-D). Both procedures and postoperative periods were uneventful. Intrathoracic left-to-right tunneling of an epicardial left ventricular lead by video-assisted thoracic surgery is feasible and safe. It provides an alternative to subcutaneous tunneling.

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