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Chronic Resynchronization Therapy

Daniel J Friedman, Haikun Bao, Erica S Spatz, Jeptha P Curtis, James P Daubert, Sana M Al-Khatib
BACKGROUND: -A prolonged PR interval is common among cardiac resynchronization therapy (CRT) candidates; however, the association between PR interval and outcomes is unclear, and data are conflicting. METHODS: -We conducted inverse probability weighted (IPW) analyses of 26,451 CRT eligible (EF≤35, QRS≥120ms) patients from the National Cardiovascular Data Registry ICD Registry to assess the association between a prolonged PR interval (≥230ms), receipt of CRT with defibrillator (CRT-D) versus implantable cardioverter defibrillator (ICD), and outcomes...
October 19, 2016: Circulation
Ana Abreu, Helena Santa Clara
Cardiac resynchronization therapy (CRT) is an established treatment for patients with moderate-to-severe chronic heart failure (CHF) and intraventricular conduction delay, which is identified by a QRS interval of 120msec or more on a 12-lead electrocardiogram (ECG). CRT improved functional capacity, reduced hospitalizations for worsening CHF and increased survival. However, about 30-40% of patients who underwent CRT were non-responders with no clinical or echocardiographic improvement. Imaging parameters for prediction of CRT response have been reviewed...
October 14, 2016: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Usama A Daimee, Yitschak Biton, Arthur J Moss, Wojciech Zareba, David Cannom, Helmut Klein, Scott Solomon, Martin H Ruwald, Scott McNitt, Bronislava Polonsky, Paul J Wang, Ilan Goldenberg, Valentina Kutyifa
BACKGROUND: The effect of chronic kidney disease (CKD) on benefit from cardiac resynchronization therapy with defibrillator (CRT-D) in reducing ventricular tachyarrhythmia (VTA) risk among mild heart failure (HF) patients is not well understood. METHODS: We evaluated the impact of baseline renal function on VTAs in 1274 left bundle branch block (LBBB) patients enrolled in MADIT-CRT. Two prespecified subgroups were created based on estimated glomerular filtration rate (GFR): GFR <60 (n = 413) and GFR ≥60 ml/min/1...
September 15, 2016: Annals of Noninvasive Electrocardiology
Cong Xue, Wei Hua, Chi Cai, Li-Gang Ding, Zhi-Min Liu, Xiao-Han Fan, Yun-Zi Zhao, Shu Zhang
BACKGROUND: Prolongation of the Tpeak-Tend (TpTe) interval as a measurement of transmural dispersion of repolarization (TDR) is an independent risk factor for chronic heart failure mortality. However, the cardiac resynchronization therapy's (CRT) effect on TDR is controversial. Therefore, this study aimed to evaluate CRTs acute and chronic effects on repolarization dispersion. Furthermore, we aimed to investigate the relationship between TpTe changes and ventricular arrhythmia. METHODS: The study group consisted of 101 patients treated with CRT-defibrillator (CRT-D)...
2016: Chinese Medical Journal
Thais S Nobre, Ligia M Antunes-Correa, Raphaela V Groehs, Maria-Janieire N N Alves, Adriana O Sarmento, Aline Villa Nova Bacurau, Ursula Urias, Guilherme Barreto Alves, Maria Urbana P B Rondon, Patricia C Brum, Martino Martinelli, Holly R Middlekauff, Carlos E Negrao
Heart failure(HF) is characterized by decreased exercise capacity, attributable to neurocirculatory and skeletal muscle factors. Cardiac resynchronization therapy(CRT) and exercise training have each been shown to decrease muscle sympathetic nerve activity(MSNA) and increase exercise capacity in patients with HF. We hypothesized that exercise training in the setting of CRT would further reduce MSNA and vasoconstriction and would increase Ca(2+) handling gene expression in skeletal muscle in chronic systolic HF patients...
September 2, 2016: American Journal of Physiology. Heart and Circulatory Physiology
Girish Ganesha Babu, Matthew Webber, Rui Providencia, Sanjeev Kumar, Aerakondal Gopalamurugan, Dominic P Rogers, Holly Louise Daw, Syed Ahsan, Fakhar Khan, Anthony Chow, Martin Lowe, Edward Rowland, Pier Lambiase, Oliver R Segal
BACKGROUND: Chronic kidney disease (CKD) is a risk factor for arrhythmias in patients with heart failure (HF). However, the effects of CKD on ventricular arrhythmia (VA) burden in patients with cardiac resynchronization therapy and defibrillator (CRT-D) devices in a primary prevention setting are unknown. OBJECTIVE: To determine whether baseline CKD is associated with increased risk of VA in patients implanted with primary prevention CRT-D devices. METHODS AND RESULTS: In this retrospective study, 199 consecutive primary prevention CRT-D recipients (2005-2010) were stratified by estimated glomerular filtration rate (eGFR) levels prior to device implantation with 106 (53...
October 6, 2016: Journal of Cardiovascular Electrophysiology
Hiroko Beck, Anne B Curtis
The use of cardiac resynchronization therapy (CRT) is well accepted as an important option for the treatment of patients with systolic heart failure and prolonged QRS duration. CRT for patients with narrow QRS complexes is reserved for patients who are undergoing implantation of new or replacement pacemakers or implantable cardioverter defibrillators with an anticipated significant requirement for ventricular pacing. The Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK HF) Trial examined the role of CRT in heart failure patients with atrioventricular block and demonstrated significantly better outcomes with CRT compared to right ventricular pacing...
August 23, 2016: Current Heart Failure Reports
Gábor Széplaki, András Mihály Boros, Szabolcs Szilágyi, István Osztheimer, Zsigmond Jenei, Annamária Kosztin, Klaudia Vivien Nagy, Júlia Karády, Levente Molnár, Tamás Tahin, Endre Zima, László Gellér, Zoltán Prohászka, Béla Merkely
BACKGROUND: The chronic inflammation plays an important role in heart failure and complement components might be useful markers of the prognosis. We set out to evaluate their predictive value in the clinical outcomes of patients with cardiac resynchronization therapy (CRT). METHODS: We determined the complement levels C3, C3a, sC5b-9 and also the N-terminus of the prohormone brain natriuretic peptide (NT-proBNP) of 126 heart failure patients in a prospective, single-center observational study before and 6 months after CRT implantation...
August 4, 2016: Inflammation Research: Official Journal of the European Histamine Research Society ... [et Al.]
Salah A M Said, Rogier Nijhuis, Anita Derks, Herman Droste
BACKGROUND Cardiac resynchronization therapy (CRT) has been demonstrated to reduce morbidity and mortality in patients with advanced, drug-refractory heart failure. Procedure-related mortality is less than 1% in larger studies. Approximately10% of CRT patients have to undergo surgical revision because of infections, dislocations, or unacceptable electrical behavior manifested as high threshold, unstable sensing, or unwanted phrenic nerve stimulation. CASE REPORT A 70-year-old man with symptomatic congestive heart failure underwent implantation of a biventricular pacemaker on the left anterior chest wall in 2003 and pulse generator exchange in August 2009...
2016: American Journal of Case Reports
Luka Lipar, Komandoor Srivathsan, Luis Roberto Scott
BACKGROUND: Cardiac resynchronization therapy (CRT) is considered as a standard adjunct therapy in symptomatic patients with congestive heart failure (CHF) who have a prolonged QRS. There is an increasing number of patients who do not receive de novo CRT devices but are upgraded from right ventricular (RV) pacing to biventricular stimulation. We wanted to evaluate the benefit of CRT in patients with chronic RV pacing in comparison to previously non-paced heart failure patients. METHODS: One hundred and sixty-five patients who had their device newly implanted (group I) and 116 who were upgraded from previously implanted RV pacing systems (group II) at Mayo Clinic Hospital were retrospectively analyzed...
September 15, 2016: International Journal of Cardiology
M Marcinkiewicz-Siemion, M Ciborowski, A Kretowski, W J Musial, K A Kaminski
Heart failure (HF) is a complex syndrome representing a final stage of various cardiovascular diseases. Despite significant improvement in the diagnosis and treatment (e.g. ACE-inhibitors, β-blockers, aldosterone antagonists, cardiac resynchronization therapy) of the disease, prognosis of optimally treated patients remains very serious and HF mortality is still unacceptably high. Therefore there is a strong need for further exploration of novel analytical methods, predictive and prognostic biomarkers and more personalized treatment...
September 15, 2016: International Journal of Cardiology
Bożena Urbanek, Jan Ruta, Krzysztof Kudryński, Paweł Ptaszyński, Artur Klimczak, Jerzy Krzysztof Wranicz
BACKGROUND The aim of the study was to explore the relationship between changes in pulse pressure (PP) and frequency domain heart rate variability (HRV) components caused by left ventricular pacing in patients with implanted cardiac resynchronization therapy (CRT). MATERIAL AND METHODS Forty patients (mean age 63±8.5 years) with chronic heart failure (CHF) and implanted CRT were enrolled in the study. The simultaneous 5-minute recording of beat-to-beat arterial systolic and diastolic blood pressure (SBP and DBP) by Finometer and standard electrocardiogram with CRT switched off (CRT/0) and left ventricular pacing (CRT/LV) was performed...
2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Michael R Bristow, Leslie A Saxon, Arthur M Feldman, Chaoqun Mei, Susan A Anderson, David L DeMets
COMPANION (Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure), the first cardiac resynchronization therapy (CRT)-heart failure mortality and morbidity controlled clinical trial planned, conducted, and reported, was a randomized, 3-arm study that compared CRT delivered by a biventricular pacemaker (CRT-P) or a CRT defibrillator device (CRT-D) with optimal pharmacological therapy alone. The patient population had advanced chronic heart failure with QRS interval prolongation ≥120 ms and reduced left ventricular ejection fraction (heart failure with reduced ejection fraction)...
July 2016: JACC. Heart Failure
João Fernandes Serôdio, Mário Martins Oliveira, Sérgio Matoso Laranjo, Cristiano Tavares, Pedro Silva Cunha, Ana Abreu, Luísa Branco, Sandra Alves, Isabel Rocha, Rui Cruz Ferreira
INTRODUCTION: Baroreflex function is an independent marker of prognosis in heart failure (HF). However, little is known about its relation to response to cardiac resynchronization therapy (CRT). The aim of this study is to assess arterial baroreflex function in HF patients who are candidates for CRT. METHODS: The study population consisted of 25 patients with indication for CRT, aged 65±10 years, NYHA functional class ≥III in 52%, QRS width 159±15 ms, left ventricular ejection fraction (LVEF) 29±5%, left ventricular end-systolic volume (LVESV) 150±48 ml, B-type natriuretic peptide (BNP) 357±270 pg/ml, and peak oxygen consumption (peak VO2) 18...
June 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Yuanyuan Tang, Zhen Chen, Xiaofeng Hou, Quanpeng Wang, Feng Zhang, Jiangang Zou
OBJECTIVE: To study the effects of cardiac resynchronization therapy (CRT) with different pacing rates and modes on MTWA.
 METHODS: From March, 2012 to October, 2014, 43 patients who received CRT or CRT-D implantation in the first affiliated hospital, Nanjing Medical University were studied. Time-domain MTWA test were assessed following CRT implantation. MTWA was measured at 90 min(-1) and 110 min(-1) by treadmill exercise test with GE CASE 8000 during CRT-on (BIV biventricular) and CRT-off (RA right atrial) pacing modes...
April 2016: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
David D Daly, Anbukarasi Maran, J Madison Hyer, Frederick Funke, Ashley Waring, Frank A Cuoco, J Lacy Sturdivant, Robert B Leman, Michael R Gold
BACKGROUND: Cardiac resynchronization therapy (CRT) improves functional status, reduces heart failure hospitalizations, and decreases mortality. Several comorbidities including renal function affect outcomes with CRT. However, moderate to severe chronic kidney disease (CKD) was an exclusion criterion in the large randomized control trials. OBJECTIVE: To evaluate the association of renal function on survival following CRT implantation. METHODS: This was a retrospective analysis of 432 consecutive patients implanted with an implantable cardioverter defibrillator with CRT (CRT-D)...
August 2016: Pacing and Clinical Electrophysiology: PACE
Kamila Lachowska, Marcin Gruchała, Krzysztof Narkiewicz, Dagmara Hering
Heart failure (HF) is a major and growing public health problem. This condition is associated with poor prognosis, a high rate of mortality, frequent hospitalization and increasing costs to health care systems. Pharmacological approaches aimed at reducing morbidity and mortality in HF have primarily focused on inhibition of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS), both of which have been associated with disease development, progression and adverse cardiovascular (CV) outcomes...
July 2016: Current Hypertension Reports
Jiarui Mi, Zhimin Liu, Shengwen Yang, Wei Hua, Keping Chen, Ligang Ding, Shu Zhang
OBJECTIVE: To explore the prognostic role of free triiodothyronine (FT3) on all-cause mortality and heart failure (HF) hospitalization in patients receiving cardiac resynchronization therapy (CRT). METHODS: In this single-center retrospective cohort study, a total of 202 chronic heart failure (CHF) patients who had CRT implantation from January 2010 to December 2014 were enrolled. Clinical outcomes were defined as all-cause mortality (including heart transplantation) and new heart failure (HF) hospitalization...
December 19, 2015: Zhonghua Yi Xue za Zhi [Chinese medical journal]
C W Israel, Y H Lee-Barkey
Sudden cardiac death (SCD) represents one of the most frequent causes of death in patients with diabetes. In contrast to patients without diabetes it has not been significantly reduced despite improvements in the treatment of acute myocardial infarction and long-term treatment of cardiovascular diseases as well as diabetes mellitus. Several mechanisms can be responsible for the high incidence of SCD in diabetics: 1. arrhythmogenic effects mediated via cardiac autonomic neuropathy, repolarization disturbances or sympathetic tone activation (hypoglycemia), 2...
May 2016: Herz
Isabella Rosa, Claudia Marini, Stefano Stella, Francesco Ancona, Marco Spartera, Alberto Margonato, Eustachio Agricola
Chronic functional mitral regurgitation (FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy (DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in FMR, such as annular dilatation and dysfunction, left ventricle (LV) remodeling, dysfunction and dyssynchrony, papillary muscles displacement and dyssynchrony. The best therapeutic choice for FMR is still debated. When optimal medical treatment has already been set, a further option for cardiac resynchronization therapy (CRT) and/or surgical correction should be considered...
February 26, 2016: World Journal of Cardiology
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