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Cardiac Resynchronization Therapy

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https://www.readbyqxmd.com/read/27909498/shock-lead-dislodgement-related-to-its-small-hair-pin-curve-in-a-pocket-a-case-of-ratchet-syndrome
#1
Yuka Taguchi, Kohei Matsushita, Toshiyuki Ishikawa, Yutaka Ogino, Hirooki Matsushita, Junya Hosoda, Katsumi Matsumoto, Satoshi Umemura
There have been few reports about ratchet syndrome. We report a case of ratchet syndrome caused by small hair-pin curve of lead that triggered the lead retract itself. A 69-year-old man with a past history of inferior wall myocardial infarction, presented with progressive congestive heart failure. He underwent implantation of cardiac resynchronization therapy with an implantable cardiac defibrillator (CRTD) at our hospital. At 33 days after implantation, shock lead dislodgement was revealed. X-ray showed that the lead tip was in left subclavian vein, leaving its screw out, and a large part of the proximal portion of the lead was retracted into the pocket, while the other two leads remained in appropriate positions and the device had not rotated...
April 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909481/ice-guided-crt-is-there-evidence-of-reverse-remodeling
#2
REVIEW
Antonio Rossillo Md, Angelo B Ramondo Md
Cardiac resynchronization therapy (CRT) is an accepted treatment for patients with heart failure (HF), impaired left ventricular (LV) function, and a wide QRS complex. However, more than 30% of eligible patients fail to benefit from CRT. It is clearly necessary to define the characteristics of the best candidates for this therapy. To this end, surface ECG and echocardiography have been tested. Unfortunately, however, neither of these examinations has proved sufficiently able to identify the best patients. A tailored approach based on the evaluation of both electrical and mechanical delay to guide LV lead placement seems to be the most reasonable strategy in order to increase the efficacy of CRT therapy...
February 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909478/cardiac-resynchronization-therapy-in-non-ischemic-cardiomyopathy
#3
REVIEW
Miriam Shanks Md PhD, Victoria Delgado Md PhD, Jeroen J Bax Md PhD
Cardiac resynchronization therapy (CRT) is an established therapy for heart failure patients who remain symptomatic despite optimal medical therapy, have reduced left ventricular ejection fraction (<35%) and wide QRS duration (>120 ms), preferably with left bundle branch block morphology. The response to CRT depends on the cardiac substrate: presence of correctable left ventricular mechanical dyssynchrony, presence of myocardial fibrosis (scar) and position of the left ventricular pacing lead. Patients with non-ischemic cardiomyopathy have shown higher response rates to CRT compared with patients with ischemic cardiomyopathy...
February 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27906653/longer-left-ventricular-electric-delay-reduces-mitral-regurgitation-after-cardiac-resynchronization-therapy-mechanistic-insights-from-the-smart-av-study-smartdelay-determined-av-optimization-a-comparison-to-other-av-delay-methods-used-in-cardiac-resynchronization
#4
Neal A Chatterjee, Michael R Gold, Alan D Waggoner, Michael H Picard, Kenneth M Stein, Yinghong Yu, Timothy E Meyer, Nicholas Wold, Kenneth A Ellenbogen, Jagmeet P Singh
BACKGROUND: Mitral regurgitation (MR) is associated with worse survival in those undergoing cardiac resynchronization therapy (CRT). Left ventricular (LV) lead position in CRT may ameliorate mechanisms of MR. We examine the association between a longer LV electric delay (QLV) at the LV stimulation site and MR reduction after CRT. METHODS AND RESULTS: QLV was assessed retrospectively in 426 patients enrolled in the SMART-AV study (SmartDelay Determined AV Optimization: A Comparison to Other AV Delay Methods Used in CRT)...
November 2016: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/27905927/characteristics-and-outcomes-of-diabetic-patients-with-an-implantable-cardioverter-defibrillator-in-a-real-world-setting-results-from-the-israeli-icd-registry
#5
Hillel Steiner, Michael Geist, Ilan Goldenberg, Mahmoud Suleiman, Michael Glikson, Alexander Tenenbaum, Moshe Swissa, Enrique Z Fisman, Gregory Golovchiner, Boris Strasberg, Alon Barsheshet
AIMS: There are limited data regarding the effect of diabetes mellitus (DM) on the risks of both appropriate and inappropriate implantable cardioverter defibrillator (ICD) therapy. The present study was designed to compare the outcome of appropriate and inappropriate ICD therapy in patients with or without DM. METHODS AND RESULTS: The risk of a first appropriate ICD therapy for ventricular tachyarrhythmias (including anti tachycardia pacing and shock) was compared between 764 DM and 1346 non-DM patients enrolled in the national Israeli ICD registry...
December 1, 2016: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/27903393/-a-multi-center-study-on-the-long-term-mortality-and-related-risk-factors-in-patients-with-chronic-heart-failure-receiving-resynchronization-therapy
#6
S Y Qi, D M Wang, H B Yu, C Ding, F L Tian, L S Ru, J Li, B Zhang, Y L Han
Objective: To analyze long-term mortality and patients characteristics of cardiac resynchronization therapy (CRT) for patients with chronic heart failure. Methods: In-patients with chronic heart failure who received CRT in the three medical centers(Bethune International Peace Hospital, General Hospital of Shenyang Military Command of Chinese People's Liberation Army, and 251 Hospital of People's Liberation Army)from March 2001 to June 2013 were included.Mortality and related causes, echocardiographic parameters were analyzed...
November 24, 2016: Zhonghua Xin Xue Guan Bing za Zhi
https://www.readbyqxmd.com/read/27903028/-cardiovascular-morbidity-and-mortality-in-patients-with-kidney-disease
#7
Ivo Quack, Ralf Westenfeld
Patients with kidney disease have a significantly increased cardiovascular morbidity and mortality. Especially diabetics have an increased risk to develop renal insufficiency and cardiovascular events. Two recent studies show that the SGLT2 inhibitor Empagliflozin and the GLP1 agonist Liraglutid are able to lower the cardiovascular risk of type2 diabetics with renal insufficiency. Recent observations suggest that bradycardia and asystole are main triggers for sudden cardiac death in patients with chronic kidney disease...
November 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27898337/complications-and-1-year-benefit-of-cardiac-resynchronization-therapy-in-patients-over-75-years-of-age-insights-from-the-german-device-registry
#8
Julia Köbe, Dietrich Andresen, Sebastian Maier, Christoph Stellbrink, Thomas Kleemann, Bernd-Dieter Gonska, Sebastian Reif, Matthias Hochadel, Jochen Senges, Lars Eckardt
OBJECTIVE: Evidence on cardiac resynchronization therapy (CRT) in older patients is scarce and conflicting. Nevertheless, CRT in the elderly is of major practical relevance as heart failure prevalence increases with age. METHODS: The German Device Registry (DEVICE) is a nationwide, prospective registry with a longitudinal follow-up design investigating device implantations in 60 German centres. The present analysis of DEVICE focussed on perioperative complication rates and 1-year outcome of patients ≥75years (n=320) compared to younger patients (n=879) receiving a CRT device...
November 10, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27890282/selective-versus-non-selective-his-bundle-pacing-for-cardiac-resynchronization-therapy
#9
REVIEW
Gaurav A Upadhyay, Roderick Tung
Cardiac resynchronization therapy (CRT) has an established role in the device-based therapy for patients with systolic dysfunction and intraventricular conduction delay, particularly left bundle branch block (LBBB). Recently, His bundle pacing (HBP) has emerged as a viable alternative for resynchronization which can successfully narrow surface QRS and improve mechanical dyssynchrony. The role of selective (i.e., an isoelectric His-paced to QRS interval similar to native HV interval) versus non-selective capture (i...
October 18, 2016: Journal of Electrocardiology
https://www.readbyqxmd.com/read/27886935/robotic-assisted-left-ventricular-lead-placement
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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/27886925/the-role-of-atrioventricular-and-interventricular-optimization-for-cardiac-resynchronization-therapy
#19
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
#20
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
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