Concurrent optimization of timing delays and electrode positioning in biventricular pacing based on a computer heart model assuming 17 left ventricular segments

2009 ◽  
Vol 54 (2) ◽  
pp. 55-65 ◽  
Author(s):  
Raz Miri ◽  
Matthias Reumann ◽  
Dimitry Farina ◽  
Olaf Dössel
Keyword(s):  
Biventricular Pacing ◽  
Left Ventricular ◽  
Heart Model ◽  
Concurrent Optimization ◽  
Electrode Positioning

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.

scholarly journals Three dimensional echocardiography documents haemodynamic improvement by biventricular pacing in patients with severe heart failure

Heart ◽  
2001 ◽  
Vol 85 (5) ◽  
pp. 514-520
Author(s):  
W Y Kim ◽  
P Søgaard ◽  
P T Mortensen ◽  
H Kjærulf Jensen ◽  
A Kirstein Pedersen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Biventricular Pacing ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Walking Distance ◽  
Short Term ◽  
Bundle Branch Block ◽  
Patients With Heart Failure ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography

OBJECTIVESTo quantify the short term haemodynamic effects of biventricular pacing in patients with heart failure and left bundle branch block by using three dimensional echocardiography.DESIGNThree dimensional echocardiography was performed in 15 consecutive heart failure patients (New York Heart Association functional class III or IV) with an implanted biventricular pacing system. Six minute walk tests were performed to investigate the effect of biventricular pacing on exercise capacity. Data were acquired at sinus rhythm and after short term (2–7 days) biventricular pacing.RESULTSCompared with baseline values, biventricular pacing significantly reduced left ventricular end diastolic volume (EDV) by mean (SD) 4.0 (5.1)% (p < 0.01) and end systolic volume (ESV) by 5.6 (6.4)% (p < 0.02). Mitral regurgitant fraction was significantly reduced by 11 (12.1)% (p < 0.003) and forward stroke volume (FSV) increased by 13.9 (18.6)% (p < 0.02). Exercise capacity was significantly improved with biventricular pacing by 48.4 (43.3)% (p < 0.00001). Regression analyses showed that the percentage increase in FSV independently predicted percentage improvement in walking distance (r2 = 0.73, p < 0.0002). Both basal QRS duration and QRS narrowing predicted pacing efficacy, showing a significant correlation with %ΔEDV, %ΔESV, and %ΔFSV.CONCLUSIONSIn five of 15 consecutive patients with heart failure and left bundle branch block, biventricular pacing induced a more than 15% increase in FSV, which predicted a more than 25% increase in walking distance and was accompanied by an immediate reduction in left ventricular chamber size and mitral regurgitation.

Dobutamine responsiveness, PET mismatch, and lack of necrosis in low-flow ischemia: is this hibernation in the isolated rat heart?

2003 ◽  
Vol 285 (1) ◽  
pp. H316-H324 ◽  
Author(s):  
Richard Southworth ◽  
Pamela B. Garlick
Keyword(s):  
Rat Heart ◽  
Recovery Of Function ◽  
Electron Microscopic Examination ◽  
Left Ventricular ◽  
Isolated Rat Heart ◽  
Low Flow ◽  
Hibernating Myocardium ◽  
Heart Model ◽  
Electron Microscopic ◽  
Isolated Rat

The clinical hallmarks of hibernating myocardium include hypocontractility while retaining an inotropic reserve (using dobutamine echocardiography), having normal or increased [18F]fluoro-2-deoxyglucose-6-phosphate (18FDG6P) accumulation associated with decreased coronary flow [flow-metabolism mismatch by positron emission tomography (PET)], and recovering completely postrevascularization. In this study, we investigated an isolated rat heart model of hibernation using experimental equivalents of these clinical techniques. Rat hearts ( n = 5 hearts/group) were perfused with Krebs-Henseleit buffer for 40 min at 100% flow and 3 h at 10% flow and reperfused at 100% flow for 30 min (paced at 300 beats/min throughout). Left ventricular developed pressure fell to 30 ± 8% during 10% flow and recovered to 90 ± 7% after reperfusion. In an additional group, this recovery of function was found to be preserved over 2 h of reperfusion. Electron microscopic examination of hearts fixed at the end of the hibernation period demonstrated a lack of ischemic injury and an accumulation of glycogen granules, a phenomenon observed clinically. In a further group, hearts were challenged with dobutamine during the low-flow period. Hearts demonstrated an inotropic reserve at the expense of increased lactate leakage, with no appreciable creatine kinase release. PET studies used the same basic protocol in both dual- and globally perfused hearts (with 250MBq18FDG in Krebs buffer ± 0.4 mmol/l oleate). PET data showed flow-metabolism “mismatch;” whether regional or global,18FDG6P accumulation in ischemic tissue was the same as (glucose only) or significantly higher than (glucose + oleate) control tissue (0.023 ± 0.002 vs. 0.011 ± 0.002 normalized counts · s-1· g-1· min-1, P < 0.05) despite receiving 10% of the flow. This isolated rat heart model of acute hibernation exhibits many of the same characteristics demonstrated clinically in hibernating myocardium.

Left ventricular pacing should be considered when biventricular pacing worsens heart failure: left ventricular pacing instead of biventricular pacing?

2011 ◽  
Vol 33 (1) ◽  
pp. 37-41
Author(s):  
Syed Y. Ahsan ◽  
Matthew W. Fittall ◽  
Aerakondal B. Gopalamurugan ◽  
James W. McCready ◽  
Laurence Nunn ◽  
...  
Keyword(s):  
Heart Failure ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
Ventricular Pacing ◽  
Left Ventricular Pacing
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