scholarly journals The Relationship between the Reverse Left Ventricular Remodelling Developing After Cardiac Resynchronisation Therapy and the Postimplantation Changes in QRS Duration and Presence of Fragmented QRS

2013 ◽  
Vol 62 (18) ◽  
pp. C8
Author(s):  
Neslihan Özlem Al ◽  
Ahmet Vural ◽  
Umut Yengi Çelikyurt ◽  
Erhan Saraçoğlu ◽  
Hakan Çakmak ◽  
...  
Keyword(s):  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Ventricular Remodelling ◽  
Left Ventricular Remodelling ◽  
Fragmented Qrs ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Qrs Duration ◽  
The Relationship

scholarly journals Use of Cardiac Resynchronisation Therapy – Change of Clinical Settings

2014 ◽  
Vol 3 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Khang-Li Looi ◽  
Anthony SL Tang ◽  
Sharad Agarwal
Keyword(s):  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Severe Left Ventricular Dysfunction ◽  
Surface Ecg ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Qrs Duration

Current guidelines recommend cardiac resynchronisation therapy (CRT) for patients with severe left ventricular dysfunction (left ventricular ejection fraction [LVEF] ≤35 %), QRS duration of ≥120–150 ms (Class IA and IB indications) on surface electrocardiogram (ECG) and New York Heart Association (NYHA) class III or IV heart failure (HF) symptoms. Ongoing studies aim to expand the use of CRT in patients with asymptomatic or minimal symptoms left ventricular dysfunction. There have been studies that have shown benefit of CRT extended to this group of patients. There have also been different implications of the role of CRT in patients with atrial fibrillation (AF), patients with narrow QRS duration or with right bundle branch block (RBBB) on surface ECG, as well as patients with end-stage renal failure on dialysis therapy. This article aims to review the current body of evidence of expanding use of CRT in these populations.

scholarly journals Cardiac Resynchronisation Therapy and Heart Failure: Persepctive from 5P Medicine

2015 ◽  
Vol 1 (1) ◽  
pp. 35 ◽  
Author(s):  
Fang Fang ◽  
Zhou Yu Jie ◽  
Luo Xiu Xia ◽  
Liu Ming ◽  
Ma Zhan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Qrs Duration

Chronic heart failure is still a major challenge for healthcare. Currently, cardiac resynchronisation therapy (CRT) has been incorporated into the updated guideline for patients with heart failure, left ventricular ejection fraction ≤35 % and prolonged QRS duration. With 20 years of development, the concept of ‘from bench to bedside’ has been illustrated in the field of CRT. Given the fact that the indications of CRT keep evolving, the role of CRT is not limited to the curative method for heart failure. We therefore summarise with the perspective of 5P medicine – preventive, personalised, predictive, participatory, promotive, to review the benefit of CRT in the prevention of heart failure in those with conventional pacemaker indications, the individualised assessment of patient’s selection, the predictor of responders of CRT, and the obstacles hindering the more application of CRT and the future development of this device therapy.

scholarly journals Determinants of LV dP/dtmax and QRS duration with different fusion strategies in cardiac resynchronisation therapy

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001615
Author(s):  
Hans Henrik Odland ◽  
Torbjørn Holm ◽  
Lars Ove Gammelsrud ◽  
Richard Cornelussen ◽  
Erik Kongsgaard
Keyword(s):  
Biventricular Pacing ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Acute Effects ◽  
Haemodynamic Change ◽  
Main Determinant ◽  
Cardiac Resynchronisation ◽  
Pacing Strategies ◽  
Resynchronisation Therapy ◽  
Qrs Duration

BackgroundWe designed this study to assess the acute effects of different fusion strategies and left ventricular (LV) pre-excitation/post-excitation on LV dP/dtmax and QRS duration (QRSd).MethodsWe measured LV dP/dtmax and QRSd in 19 patients having cardiac resynchronisation therapy (CRT). Two groups of biventricular pacing were compared: pacing the left ventricle (LV) with FUSION with intrinsic right ventricle (RV) activation (FUSION), and pacing the LV and RV with NO FUSION with intrinsic RV activation. In the NO FUSION group, the RV was paced before the expected QRS onset. A quadripolar LV lead enabled distal, proximal and multipoint pacing (MPP). The LV was stimulated relative in time to either RV pace or QRS-onset in four pre-excitation/post-excitation classes (PCs). We analysed the interactions of two groups (FUSION/NO FUSION) with three different electrode configurations, each paced with four different degrees of LV pre-excitation (PC1–4) in a statistical model.ResultsLV dP/dtmax was higher with NO FUSION than with FUSION (769±46 mm Hg/s vs 746±46 mm Hg/s, p<0.01), while there was no difference in QRSd (NO FUSION 156±2 ms and FUSION 155±2 ms). LV dP/dtmax and QRSd increased with LV pre-excitation compared with pacing timed to QRS/RV pace-onset regardless of electrode configuration. Overall, pacing LV close to QRS-onset (FUSION) with MPP shortened QRSd the most, while LV dP/dtmax increased the most with LV pre-excitation.ConclusionWe show how a beneficial change in QRSd dissociates from the haemodynamic change in LV dP/dtmax with different biventricular pacing strategies. In this study, LV pre-excitation was the main determinant of LV dP/dtmax, while QRSd shortens with optimal resynchronisation.

Optimisation of Cardiac Resynchronisation Therapy with MultiPoint™ Pacing

2015 ◽  
Vol 4 (3) ◽  
pp. 3
Author(s):  
Antonio Curnis ◽  
David O’Donnell ◽  
Axel Kloppe ◽  
Žarko Calovic ◽  
◽  
...  
Keyword(s):  
Systolic Function ◽  
Biventricular Pacing ◽  
Heart Rhythm ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Optimal Placement ◽  
Jude Medical ◽  
Number Of Patients ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Cardiac resynchronisation therapy (CRT) using biventricular pacing is an established therapy for impairment of left ventricular (LV) systolic function in patients with heart failure (HF). Although technological advances have improved outcomes in patients undergoing biventricular pacing, the optimal placement of pacing leads remains challenging, and approximately one third of patients have no response to CRT. This may be due to patient selection and lead placement. Electrical mapping can greatly improve outcomes in CRT and increase the number of patients who derive benefit from the procedure. MultiPoint™ pacing (St Jude Medical, St Paul, MN, US) using a quadripolar lead increases the possibility of finding the best pacing site. In clinical studies, use of MultiPoint pacing in HF patients undergoing CRT has been associated with haemodynamic and clinical benefits compared with conventional biventricular pacing, and these benefits have been sustained at 12 months. This article describes the proceedings of a satellite symposium held at the European Heart Rhythm Association (EHRA) Europace conference held in Milan, Italy, in June 2015.

Cardiac Resynchronisation Therapy – Evolving Strategies to Enhance Response

2010 ◽  
Vol 6 (1) ◽  
pp. 83
Author(s):  
Jagmeet P Singh ◽  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Patient Specific ◽  
Cardiac Resynchronisation ◽  
Clinical Benefits ◽  
Pacing Lead ◽  
Resynchronisation Therapy ◽  
Physiological Impact

Cardiac resynchronisation therapy (CRT) has gained widespread acceptance as a safe and effective therapeutic strategy for congestive heart failure (CHF) refractory to optimal medical therapy. The use of implantable devices has substantially altered the natural history of systolic heart failure. These devices exert their physiological impact through ventricular remodelling, associated with a reduction in left ventricular (LV) volumes and an improvement in ejection fraction (EF). Several prospective randomised studies have shown that this in turn translates into long-term clinical benefits such as improved quality of life, increased functional capacity and reduction in hospitalisation for heart failure and overall mortality. Despite these obvious benefits, there remain more than a few unresolved concerns, the most important being that up to one-third of patients treated with CRT do not derive any detectable benefit. There are several determinants of successful delivery and response to CRT, including selecting the appropriate patient, patient-specific optimal LV pacing lead placement and appropriate post-implant device care and follow-up. This article highlights the importance of collectively working on all of these aspects of CRT to enhance and maximise response.

Emerging Cardiac Resynchronisation Therapy Indications

2011 ◽  
Vol 7 (1) ◽  
pp. 29
Author(s):  
Charlotte Eitel ◽  
Gerhard Hindricks ◽  
Christopher Piorkowski ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Current Evidence ◽  
Class Iii ◽  
Ventricular Ejection Fraction ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Cardiac resynchronisation therapy (CRT) is an efficacious and cost-effective therapy in patients with highly symptomatic systolic heart failure and delayed ventricular conduction. Current guidelines recommend CRT as a class I indication for patients with sinus rhythm, New York Heart Association (NYHA) functional class III or ambulatory class IV, a QRS duration ≥120ms, and left ventricular ejection fraction (LVEF) ≤35%, despite optimal pharmacological therapy. Recent trials resulted in an extension of current recommendations to patients with mild heart failure, patients with atrial fibrillation, and patients with an indication for permanent right ventricular pacing with the aim of morbidity reduction. The effectiveness of CRT in patients with narrow QRS, patients with end-stage heart failure and cardiogenic shock, and patients with an LVEF >35% still needs to be proved. This article reviews current evidence and clinical applications of CRT in heart failure and provides an outlook on future developments.

scholarly journals Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

2021 ◽  
Author(s):  
Philippe C. Wouters ◽  
Geert E. Leenders ◽  
Maarten J. Cramer ◽  
Mathias Meine ◽  
Frits W. Prinzen ◽  
...  
Keyword(s):  
Systolic Function ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Lv Function ◽  
Peak Strain ◽  
Cardiac Resynchronisation ◽  
Reverse Remodelling ◽  
Resynchronisation Therapy ◽  
Lv Systolic Function

AbstractPurpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.

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