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Heart Failure Clinics

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https://www.readbyqxmd.com/read/27886935/robotic-assisted-left-ventricular-lead-placement
#1
REVIEW
Advay G Bhatt, Jonathan S Steinberg
Robot-assisted left ventricular lead implantation for cardiac resynchronization therapy is a feasible and safe technique with superior visualization, dexterity, and precision to target the optimal pacing site. The technique has been associated with clinical response and beneficial reverse remodeling comparable with the conventional approach via the coronary sinus. The lack of clinical superiority and a residual high nonresponder rate suggest that the appropriate clinical role for the technique remains as rescue therapy...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886934/coronary-sinus-lead-positioning
#2
REVIEW
Attila Roka, Rasmus Borgquist, Jagmeet Singh
Although cardiac resynchronization therapy improves morbidity and mortality in patients with cardiomyopathy, heart failure, and electrical dyssynchrony, the rate of nonresponders using standard indications and implant techniques is still high. Optimal coronary sinus lead positioning is important to increase the chance of successful resynchronization. Patient factors such as cause of heart failure, type of dyssynchrony, scar burden, coronary sinus anatomy, and phrenic nerve capture may affect the efficacy of the therapy...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886933/the-role-of-cardiovascular-magnetic-resonance-in-cardiac-resynchronization-therapy
#3
REVIEW
Francisco Leyva
Randomized, controlled trials have shown that cardiac resynchronization therapy (CRT) is beneficial in patients with heart failure, impaired left ventricular (LV) systolic function, and a wide QRS complex. Other studies have shown that targeting the LV pacing site can also improve patient outcomes. Cardiovascular magnetic resonance (CMR) is a radiation-free imaging modality that provides unparalleled spatial resolution. In addition, emerging data suggest that targeted LV lead deployment over viable myocardium improves the outcome of patients undergoing CRT...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886932/newer-echocardiographic-techniques-in-cardiac-resynchronization-therapy
#4
REVIEW
John Gorcsan, Bhupendar Tayal
Echocardiographic imaging plays a major role in patient selection for cardiac resynchronization therapy (CRT). One-third of patients do not respond; there is interest in advanced echocardiographic imaging to improve response. Current guidelines favor CRT for patients with electrocardiographic (ECG) QRS width of 150 milliseconds or greater and left bundle branch block. ECG criteria are imperfect; there is interest in advanced echocardiographic imaging to improve patient selection. This discussion focuses on newer echocardiographic methods to improve patient selection, improve delivery, and identify patients at risk for poor outcomes and serious ventricular arrhythmias...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886931/exploring-the-electrophysiologic-and-hemodynamic-effects-of-cardiac-resynchronization-therapy-from-bench-to-bedside-and-vice-versa
#5
REVIEW
Rick Schreurs, Rob F Wiegerinck, Frits W Prinzen
Cardiac resynchronization therapy (CRT) is an important therapy for heart failure patients with prolonged QRS duration. In patients with left bundle branch block the altered left ventricular electrical activation results in dyssynchronous, inefficient contraction of the left ventricle. CRT aims to reverse these changes and to improve cardiac function. This article explores the electrophysiologic and hemodynamic changes that occur during CRT in patient and animal studies. It also addresses how novel techniques, such as multipoint and endocardial pacing, can further improve the electromechanical response...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886930/cellular-and-molecular-aspects-of-dyssynchrony-and-resynchronization
#6
REVIEW
Jonathan A Kirk, David A Kass
Dyssynchronous contraction of the ventricle significantly worsens morbidity and mortality in patients with heart failure (HF). Approximately one-third of patients with HF have cardiac dyssynchrony and are candidates for cardiac resynchronization therapy (CRT). The initial understanding of dyssynchrony and CRT was in terms of global mechanics and hemodynamics, but lack of clinical benefit in a sizable subgroup of recipients who appear otherwise appropriate has challenged this paradigm. This article reviews current understanding of these cellular and subcellular mechanisms, arguing that these aspects are key to improving CRT use, as well as translating its benefits to a wider HF population...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886929/cardiac-resynchronization-therapy-follow-up-role-of-remote-monitoring
#7
REVIEW
Cecilia Linde, Frieder Braunschweig
Cardiac resynchronization therapy (CRT) is increasingly used in heart failure treatment and management of these patients imposes significant challenges. Remote monitoring is becoming essential for CRT follow-up and allows close surveillance of device function and patient condition. It is helpful to reduce clinic visits, increase device longevity and provide early detection of device failure. Clinical effects include prevention of appropriate and inappropriate shocks and early detection of arrhythmias, such as atrial fibrillation...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886928/cardiac-resynchronization-therapy-how-to-decrease-nonresponders
#8
REVIEW
José María Tolosana, Lluís Mont
Nonresponse to cardiac resynchronization therapy (CRT) is still a major issue in therapy expansion. The description of fast, simple, cost-effective methods to optimize CRT could help in adapting pacing intervals to individual patients. A better understanding of the importance of appropriate patient selection, left ventricular lead placement, and device programming, together with a multidisciplinary approach and an optimal follow-up of the patients, may reduce the percentage of nonresponders.
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886927/what-we-can-learn-from-super-responders
#9
REVIEW
Alessandro Proclemer, Daniele Muser, Domenico Facchin
This review discusses the state of the art of knowledge to help decision making in patients who are candidates for cardiac resynchronization therapy (CRT) and to analyze the long-term total and cardiac mortality, sudden death, and CRT with a defibrillator intervention rate, as well as the evolution of echocardiographic parameters in patients with a left ventricular (LV) ejection fraction of greater than 50% after CRT implantation. Owing to normalization of LV function in super-responders, the need for a persistent defibrillator backup is also considered...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886926/containing-the-cost-of-heart-failure-management-a-focus-on-reducing-readmissions
#10
REVIEW
Dwarakraj Soundarraj, Vini Singh, Vaibhav Satija, Ranjan K Thakur
Heart failure (HF) consumes a large proportion of the total national health care budget. Incidence and prevalence of HF are increasing and may give rise to an unsustainable increase in health care spending. Hospitalizations account for the vast majority of HF-related expenses, and 20% to 25% of patients discharged with a diagnosis of HF are readmitted within 60 days. Thus, efforts to reduce HF readmissions are a reasonable target for reducing overall expenses. It is to be seen if targeting readmission rates will lead to significant cost savings, and more importantly, to improved patient outcomes...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886925/the-role-of-atrioventricular-and-interventricular-optimization-for-cardiac-resynchronization-therapy
#11
REVIEW
Daniel B Cobb, Michael R Gold
Many patients with left ventricular systolic dysfunction may benefit from cardiac resynchronization therapy; however, approximately 30% of patients do not experience significant clinical improvement with this treatment. AV and VV delay optimization techniques have included echocardiography, device-based algorithms, and several other novel noninvasive techniques. Using these techniques to optimize device settings has been shown to improve hemodynamic function acutely; however, the long-term clinical benefit is limited...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886924/how-to-improve-cardiac-resynchronization-therapy-benefit-in-atrial-fibrillation-patients-pulmonary-vein-isolation-and-beyond
#12
REVIEW
Carola Gianni, Luigi Di Biase, Sanghamitra Mohanty, Yalçın Gökoğlan, Mahmut Fatih Güneş, Amin Al-Ahmad, J David Burkhardt, Andrea Natale
Although cardiac resynchronization therapy (CRT) is an important treatment of symptomatic heart failure patients in sinus rhythm with low left ventricular ejection fraction and ventricular dyssynchrony, its role is not well defined in patients with atrial fibrillation (AF). CRT is not as effective in patients with AF because of inadequate biventricular capture and loss of atrioventricular synchrony. Both can be addressed with catheter ablation of AF. It is still unclear if these therapies offer additive benefits in patients with ventricular dyssynchrony...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886923/atrioventricular-node-ablation
#13
REVIEW
Maurizio Gasparini
Cardiac resynchronization therapy (CRT) is a device-based, nonpharmacologic approach that has shown to improve the outcome in patients with heart failure in terms of mortality and morbidity reduction. Large randomized trials have virtually enrolled patients in New York Heart Association class III-IV, with reduced left ventricular ejection fraction, with evidence of electrical dyssynchrony, and receiving optimal medical therapy and who were in sinus rhythm. Guidelines remain imprecise as to defining differentiated approaches according to the forms of atrial fibrillation other than permanent...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886922/atrial-fibrillation-during-cardiac-resynchronization-therapy
#14
REVIEW
Mariëlle Kloosterman, Alexander H Maass, Michiel Rienstra, Isabelle C Van Gelder
The landmark trials on cardiac resynchronization therapy (CRT) have focused on patients with sinus rhythm at inclusion. Little data are available on the efficacy of CRT in patients with atrial fibrillation (AF), while AF has a high prevalence (20-40%) among patients receiving CRT. This review focuses on the detrimental effect of AF on CRT response and discusses management of patients with AF during CRT. Uncertainty remains as to which thresholds of AF burden can lead to a reduced response to CRT and every effort should be made in trying to assess and guarantee successful biventricular pacing in patients with AF...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886921/cardiac-resynchronization-therapy-in-women
#15
REVIEW
Maria Rosa Costanzo
The benefits of cardiac resynchronization therapy (CRT) on the outcomes of patients with heart failure are unquestionable. Women are under-represented in all CRT studies. Most of the available data show that CRT produces a greater clinical benefit in women than men. In several studies, women have left bundle branch block more frequently than men. Women have a remarkably high (90%) CRT response over a wide range of QRS lengths (130-175 milliseconds). Use of a QRS duration of 150 milliseconds as the threshold for CRT prescription may deny a life-saving therapy to many women likely to benefit from CRT...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886920/why-we-have-to-use-cardiac-resynchronization-therapy-pacemaker-more
#16
REVIEW
Jean-Claude Daubert, Raphaël Martins, Christophe Leclercq
Both cardiac resynchronization therapy with a pacemaker (CRT-P) and with a biventricular implantable cardioverter-defibrillator (CRT-D) are electrical treatment modalities validated for the management of chronic heart failure. There is no strong scientific evidence that a CRT-D must be offered to all candidates. Common sense should limit the prescription of these costly and complicated devices. The choice of CRT-P is currently acceptable. A direction to explore could be to downgrade from CRT-D to CRT-P at the time of battery depletion in patients with large reverse remodeling and no ventricular tachycardia and ventricular fibrillation detected...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886919/why-the-authors-use-cardiac-resynchronization-therapy-with-defibrillators
#17
REVIEW
Edward Sze, James P Daubert
Cardiac resynchronization therapy (CRT) improves left ventricular function, especially in patients with left bundle branch block or those receiving chronic right ventricular pacing. CRT is typically accomplished by placing a right ventricular endocardial pacing lead and a left ventricular pacing lead via the coronary sinus to a coronary vein overlying the lateral or posterolateral left ventricle. CRT can be combined with an implantable defibrillator or with a pacemaker. Limited data are available to compare these two versions of CRT head to head...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886918/cardiac-resynchronization-therapy-an-overview-on-guidelines
#18
REVIEW
Giuseppe Boriani, Martina Nesti, Matteo Ziacchi, Luigi Padeletti
Cardiac resynchronization therapy (CRT) is included in international consensus guidelines as a treatment with proven efficacy in well-selected patients on top of optimal medical therapy. Although all the guidelines strongly recommend CRT for LBBB with QRS duration greater than 150 milliseconds, lower strength of recommendation is reported for QRS duration of 120 to 150 milliseconds, especially if not associated with LBBB. CRT is not recommended for a QRS of less than 120 milliseconds. No indication emerges for guiding the implant based on echocardiographic evaluation of dyssynchrony...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886917/coronary-sinus-lead-extraction
#19
REVIEW
Edmond M Cronin, Bruce L Wilkoff
Expanded indications for cardiac resynchronization therapy and the increasing incidence of cardiac implantable electronic device infection have led to an increased need for coronary sinus (CS) lead extraction. The CS presents unique anatomical obstacles to successful lead extraction. Training and facility requirements for CS lead extraction should mirror those for other leads. Here we review the indications, technique, and results of CS lead extraction. Published success rates and complications are similar to those reported for other leads, although multiple techniques may be required...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27886916/understanding-heart-failure
#20
REVIEW
Jeremy A Mazurek, Mariell Jessup
Heart failure (HF) is a growing global health concern that affects more than 20 million people worldwide. With an ever-growing segment of the population over the age of 65, the prevalence of HF and its associated costs are expected to increase exponentially over the next decade. Advances in the understanding of the pathophysiology and treatment of HF have resulted in the ability to enhance both the quantity and the quality of life of patients with HF. This article reviews the current understanding of the pathophysiology, cause, classification, and treatment of HF and describes areas of uncertainty that demand future study...
January 2017: Heart Failure Clinics
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