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Biventricular Pacing

Andrzej Ząbek, Barbara Małecka, Maciej Dębski, Krzysztof Boczar, Katarzyna Holcman, Mateusz Ulman, Jacek Lelakowski
The electrocardiogram (ECG) interpretation in patients with cardiac resynchronization therapy (CRT) may be challenging. The difficulty increases if not well-known pacemaker algorithm is turned on. We show a T-wave protection algorithm (LVTP) in a patient with CRT. Accelerated sinus rhythm and intermittent oversensing in left ventricular channel resulted in loss of CRT pacing. The restoration of biventricular pacing occurred when atrial rate decreased. We provide detailed descriptions of the electrocardiogram and intracardiac electrogram...
May 2018: Journal of Electrocardiology
Angelo Auricchio, Frits W Prinzen
Cardiac resynchronization therapy (CRT) is an established nonpharmacological treatment for patients with heart failure (HF), reduced left ventricular (LV) ejection fraction, and a wide QRS complex. Although the therapy was developed 30 years ago and approved by the Food and Drug Administration in 2001, attempts to improve it have never stopped. Such improvements have been facilitated by combining knowledge from bench (basic science), bits (computer modeling), and bedside (clinical studies); these issues are addressed in the present review...
November 2017: JACC. Clinical Electrophysiology
Jonathan M Behar, Shahed Islam, Ben Adams, Edward Rowland, Rakesh Uppal, Anthony Chow
No abstract text is available yet for this article.
February 2018: JACC. Clinical Electrophysiology
Milena Leo, David Webster, Tim R Betts
Wireless left ventricular endocardial pacing with the WiSE CRT system has recently become available as alternative to conventional epicardial CRT pacing. We report the first comparison of the acute electrical and hemodynamic response produced by the two CRT pacing modalities in a patient undergoing WiSE CRT implant after a failed conventional CRT procedure. WiSE CRT pacing showed an additive acute benefit compared with conventional CRT. These findings could potentially translate into long-term clinical benefit and introduce the potential for tri-ventricular pacing using both systems simultaneously...
February 2018: Journal of Arrhythmia
Benjamin J Sieniewicz, Jonathan M Behar, Manav Sohal, Justin Gould, Simon Claridge, Bradley Porter, Steve Niederer, James H P Gamble, Tim R Betts, Pierre Jais, Nicolas Derval, David D Spragg, Paul Steendijk, Berry M van Gelder, Frank A Bracke, Christopher A Rinaldi
Aims: The optimal site for biventricular endocardial (BIVENDO) pacing remains undefined. Acute haemodynamic response (AHR) is reproducible marker of left ventricular (LV) contractility, best expressed as the change in the maximum rate of LV pressure (LV-dp/dtmax), from a baseline state. We examined the relationship between factors known to impact LV contractility, whilst delivering BIVENDO pacing at a variety of LV endocardial (LVENDO) locations. Methods and results: We compiled a registry of acute LVENDO pacing studies from five international centres: Johns Hopkins-USA, Bordeaux-France, Eindhoven-The Netherlands, Oxford-United Kingdom, and Guys and St Thomas' NHS Foundation Trust, London-UK...
April 23, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Arndt H Kiessling
OBJECTIVES: Ventricular pacemaker stimulation may cause deterioration of hemodynamics in patients with left-ventricular hypertrophy following aortic valve replacement. Since the diastolic function is often impaired, it remains unclear which heart rate best optimizes cardiac output. Low heart rates are suggested to treat impaired diastolic function chronically, but it is possible that cardiac output may be augmented by increasing the heart rate in patients with a fixed stroke volume (SV)...
March 6, 2018: Heart Surgery Forum
Francesco Zanon, Lina Marcantoni, Enrico Baracca, Gianni Pastore, Giuseppina Giau, Gianluca Rigatelli, Daniela Lanza, Claudio Picariello, Silvio Aggio, Sara Giatti, Marco Zuin, Loris Roncon, Domenico Pacetta, Franco Noventa, Frits W Prinzen
PURPOSE: In order to increase the responder rate to CRT, stimulation of the left ventricular (LV) from multiple sites has been suggested as a promising alternative to standard biventricular pacing (BIV). The aim of the study was to compare, in a group of candidates for CRT, the effects of different pacing configurations-BIV, triple ventricular (TRIV) by means of two LV leads, multipoint (MPP), and multipoint plus a second LV lead (MPP + TRIV) pacing-on both hemodynamics and QRS duration...
April 7, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Fabian Barbieri, Wolfgang Dichtl, Anna Heidbreder, Elisabeth Brandauer, Ambra Stefani, Agne Adukauskaite, Thomas Senoner, Wilfried Schgör, Florian Hintringer, Birgit Högl
BACKGROUND: Sleep disordered breathing is a common but often undiagnosed comorbidity in heart failure patients. Cardiac implantable electronic devices used for cardiac resynchronization therapy (CRT) may detect sleep apnea by use of a transthoracic impedance sensor. Validation of the AP scan® algorithm (Boston Scientific®) was performed by using the diagnostic gold standard polysomnography (PSG). METHODS: Forty-one patients with impaired left ventricular ejection fraction, frequent right ventricular pacing due to atrioventricular block and heart failure symptoms despite optimal medical therapy underwent upgrading to biventricular pacing...
2018: PloS One
Yang Ye, Zuwen Zhang, Xia Sheng, Bei Wang, Shiquan Chen, Yiwen Pan, Jingliang Lan, Yaxun Sun, Yi Luan, Chenyang Jiang, Guosheng Fu
BACKGROUND: Right ventricular pacing (RVP) is associated with an increased incidence of heart failure and may impair cardiac function. Permanent His bundle pacing (HBP) has the potential to physiologically preserve and prevent cardiac dysfunction. This study was to evaluate the feasibility and intermediate follow-up results of upgrade to HBP implantation in patients referred for pulse generator change with long term RVP. METHODS: Twelve of 14 pacing dependent patients who were referred for pulse generator exchange underwent upgrade into HBP successfully in our center...
June 1, 2018: International Journal of Cardiology
David M Tehrani, Sirtaz Adatya, Jonathan Grinstein, Daniel Rodgers, Nitasha Sarswat, Gene H Kim, Jayant Raikhelkar, Gabriel Sayer, Nir Uriel
Cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVADs) are common heart failure therapies; however, little is known regarding the concomitant use of these devices. We aim to evaluate unloading differences in LVAD patients with and without active biventricular pacing. Left ventricular assist device patients with and without CRT prospectively underwent ramp hemodynamic/echocardiographic testing. Patients with >95% biventricular pacing comprised the active CRT pacing group; all others (no device, implantable cardioverter defibrillator only, CRT without biventricular pacing) were categorized into the non-CRT pacing group...
March 28, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Christian Sticherling, Dirk Müller, Beat A Schaer, Silke Krüger, Christof Kolb
Many patients receiving cardiac resynchronization therapy (CRT) suffer from permanent atrial fibrillation (AF). Knowledge of the atrial rhythm is important to direct pharmacological or interventional treatment as well as maintaining AV-synchronous biventricular pacing if sinus rhythm can be restored. A single pass single-coil defibrillator lead with a floating atrial bipole has been shown to obtain reliable information about the atrial rhythm but has never been employed in a CRT-system. The purpose of this study was to assess the feasibility of implanting a single coil right ventricular ICD lead with a floating atrial bipole and the signal quality of atrial electrograms (AEGM) in CRT-defibrillator recipients with permanent AF...
March 26, 2018: Indian Pacing and Electrophysiology Journal
Han Jin, Min Gu, Wei Hua, Xiao-Han Fan, Hong-Xia Niu, Li-Gang Ding, Jing Wang, Cong Xue, Shu Zhang
Background: Super-responders (SRs) are defined as patients who show crucial cardiac function improvement after cardiac resynchronization therapy (CRT). The purpose of this study is to identify and validate predictors of SRs after CRT. Methods: This study enrolled 201 patients who underwent CRT during the period from 2010 to 2014. Clinical and echocardiographic evaluations were conducted before CRT and 6 months after. Patients with a decrease in New York Heart Association (NYHA) functional class ≥ 1, a decrease in left ventricular end-systolic volume (LVESV) ≥ 15%, and a final left ventricular ejection fraction (LVEF) ≥ 45% were classified as SRs...
December 2017: Journal of Geriatric Cardiology: JGC
Nestor O Neto, George C Fonseca, Gustavo G Torres, Luciano P Pinto, Fabio Mastrocola, William Santos R De Oliveira, Maria das Neves Barros
The left bundle-branch block (LBBB) is related to worsening cardiac performance. We describe a case of a patient with an intermittent left bundle-branch block who underwent biventricular pacemaker implantation. We noted a detrimental effect on the performance of her left ventricle with the presence of the LBBB as compared to the performance after she underwent biventricular pacing or after reversal of LBBB (i.e., native rhythm with narrow QRS). Her LBBB was accompanied by increased isovolumetric contraction time, longer pre-ejection period, and increased myocardial performance index (i...
January 20, 2018: Curēus
Mohamed Abdelrahman, Faiz A Subzposh, Dominik Beer, Brendan Durr, Angela Naperkowski, Haiyan Sun, Jess W Oren, Gopi Dandamudi, Pugazhendhi Vijayaraman
BACKGROUND: Right ventricular pacing (RVP) is associated with heart failure and increased mortality. His bundle pacing (HBP) is a physiological alternative to RVP. OBJECTIVES: This study sought to evaluate clinical outcomes of HBP compared to RVP. METHODS: All patients requiring initial pacemaker implantation between October 1, 2013, and December 31, 2016, were included in the study. Permanent HBP was attempted in consecutive patients at 1 hospital and RVP at a sister hospital...
May 22, 2018: Journal of the American College of Cardiology
Alessandro Proclemer, Massimo Zecchin, Antonio D'Onofrio, Giuseppe Boriani, Domenico Facchin, Luca Rebellato, Marco Ghidina, Giulia Bianco, Emanuela Bernardelli, Elsa Pucher, Dario Gregori
BACKGROUND: The pacemaker (PM) and implantable cardioverter-defibrillator (ICD) registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) monitors the main epidemiological data in real-world practice. The survey for the 2016 activity collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers. METHODS: The registry collects prospectively national PM and ICD implantation activity on the basis of European cards...
February 2018: Giornale Italiano di Cardiologia
Abdulcebbar Şipal, Serdar Bozyel, Müjdat Aktaş, Emir Derviş, Tayyar Akbulut, Onur Argan, Umut Çelikyurt, Dilek Ural, Tayfun Şahin, Ayşen Ağır, Ahmet Vural
OBJECTIVE: Failure to select the optimal left ventricular (LV) segment for lead implantation is one of the most important causes of unresponsiveness to the cardiac resynchronization therapy (CRT). In our study, we aimed to investigate the echocardiographic and clinical benefits of LV lead implantation guided by an intraoperative 12-lead surface electrocardiogram (ECG) in patients with multiple target veins. METHODS: We included 80 [42 (62.5%) male] heart failure patients who successfully underwent CRT defibrillator (CRT-D) implantation...
March 2018: Anatolian Journal of Cardiology
Hamza Sunman, Uğur Canpolat, Hikmet Yorgun, Adem Özkan, Muhammet Ulvi Yalçın, Tülin Bayrak, Levent Şahiner, Ergün Barış Kaya, Asuman Özkara, Kudret Aytemir, Ali Oto
OBJECTIVE: Cardiac resynchronization therapy (CRT) induces structural and electrical reverse remodeling of the failing heart. However, the association between native QRS narrowing and cardiac fibrosis markers has not been investigated in patients with an implanted CRT device. METHODS: A total of 41 symptomatic patients diagnosed with systolic heart failure who underwent CRT implantation were included in this study. Electrocardiogram findings and cardiac fibrosis marker levels [galectin-3, growth-differentiation factor-15 (GDF-15) and procollagen III N-terminal propeptide (P3TD)] were collected before and 12 months after initiation of biventricular pacing...
March 2018: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Neal A Chatterjee, E Kevin Heist
Cardiac resynchronization therapy (CRT) is an important therapeutic tool in the management of patients with heart failure and electrical dyssynchrony. In appropriately selected patients, landmark randomized controlled trials have demonstrated morbidity and mortality benefit beyond standard goal-directed medical therapy. Current guidelines emphasize the greatest clinical efficacy of CRT in patients with symptomatic heart failure, left bundle branch block, and wide QRS duration (> 150 ms). Other relevant considerations include the presence of atrial fibrillation, the presence of AV block, the etiology of cardiomyopathy, the presence of masked left-sided conduction delay, and the impact of comorbidities that might predict poor clinical response...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
William A Huang, Maereg A Wassie, Olujimi A Ajijola
His bundle pacing (HBP) has been shown to be a feasible, beneficial, and safe way to achieve cardiac resynchronization therapy (CRT) with recruitment of the heart's physiological conduction system. HBP should be considered for those with unfavorable coronary sinus (CS) anatomy, and nonresponders to biventricular (BiV) pacing. HBP CRT may also help patients with the nonleft bundle branch block form of conduction delay and heart failure (HF). HBP CRT should be considered strongly in preventing right ventricular (RV) pacing-induced cardiomyopathy, especially after atrioventricular nodal ablation given the discrete nature of the block and the low likelihood of distal block...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
Antonio D'Onofrio, Salvatore Ivan Caico, Assunta Iuliano, Paolo Pieragnoli, Valter Bianchi, Daniela Orsida, Antonio Pani, Mario Pasqualini, Francesca Amadori, Ludovico Vasquez, Antonello Talarico, Chiara Minoia, Roberto Ospizio, Greta Merlotti, Maurizio Malacrida, Giuseppe Stabile
PURPOSE: Latency during left ventricle (LV) pacing has been suggested as a potential cause of ineffectual biventricular pacing. We assessed the incidence, predictors, and impact on outcome of increased LV latency in 274 patients undergoing cardiac resynchronization therapy (CRT). METHODS: On implantation, the latency interval was defined as the shortest stimulus-to-QRS onset interval in any lead of the 12-lead ECG. A stimulus-to-QRS onset interval ≥ 40 ms was used to define the presence of increased LV latency...
April 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
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