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Cardiac Resynchronization Therapy - Europe PMC

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Last Updated: 10 September 2022

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Treatment of cardiac resynchronization therapy non-responders: current approaches and new frontiers.

Introduction Cardiac resynchronization therapy has progressed into a very safe procedure for patients with reduced systolic function and has greatly enhanced patient care. This paper explores the main factors that are affecting CRT response, from patient selection to LV lead position, to a structured follow-up in CRT clinics. In second, common causes and solutions for CRT non-responsiveness are explored. Patient care in interdisciplinary teams, including heart failure, imaging, and cardiac arrhythmia specialists, is vital, as complexity is increasing and CRT non-response is often a multifactorial issue.

Source link: https://europepmc.org/article/MED/35997539


A new Electromechanical Wave Imaging dispersion metric for the characterization of ventricular activation in different Cardiac Resynchronization Therapy pacing schemes.

Heart failure patients are mainly treated with conventional biventricular rhythm synchronization therapy. Multiple novel CRT pacing techniques for optimal treatment success have been tested recently, including His-Bundle pacing, as alternate pacing strategies for optimal treatment success. To better characterize ventricular activation, this proof-of-concept study introduces a new EWI-based dispersion metric. Four volunteers in normal sinus rhythm were photographed with patients with His-Bundle device implantation, left-bundle branch block, right-ventricular pacing, or BiV pacing. The ventricular stimulation resulting from His-Bundle pacing was precisely tracked by EWI. In addition, very similar activation patterns were found in the NSR subjects, demonstrating a revival of physiological activity with His pacing. According to both novel His-Bundle pacing and more conventional BiV pacing methods, the initial findings published herein show that EWI and its new dispersion metric can be a valuable resynchronization measurement clinical tool in CRT patients.

Source link: https://europepmc.org/article/MED/36049009


The MADIT-ICD benefit score helps to select implantable cardioverter-defibrillator candidates in cardiac resynchronization therapy.

According to a multidisciplinary expert center approach, the aim of this research is to determine whether the MADIT-ICD benefit score can tell who receives the most from the introduction of implantable cardioverter-defibrillator to cardiac resynchronization therapy in real-world patients with heart failure with reduced ejection fractions and compare this to selection. Methods and findings Consecutive HFrEF patients who underwent a CRT for a guideline indication at a tertiary care hospital between October 2008 and September 2016 were retrospectively reviewed. For non-arrhythmic mortality, Uno's C-statistic 0. 69 vs. 0. 60 for VT/VF and 0. 60 for non-arrhythmic mortality were similar to expert multidisciplinary assessment and the MADIT-ICD benefit score: The prediction power for ICD health was similar between expert multidisciplinary report and the MADIT-ICD's benefit score: 1. 69 vs. 0. 69 for VT/VF and 0. 68 vs. 0. 60 for non-deva Conclusion The MADIT-ICD's benefit score can tell who gains the most from CRT-D and is comparable with multidisciplinary decisions in a CRT specialist center.

Source link: https://europepmc.org/article/MED/35352116


Tricuspid regurgitation after cardiac resynchronization therapy: evolution and prognostic significance.

This review looked at the effects of cardiac synchronization therapy on TR risk and long-term outcomes. Patients were divided into four groups: no or mild TR without progression; no or mild TR with increase in no or mild TR; and severe TR with change to no or mild TR; and significant TR without change without change. Patients with significant TR show improvement at follow-up had higher outcomes than those who did not show improvement. Significant TR with improvement at follow-up was not reflected on multivariable analysis, with no or mild TR progressing to significant TR with significant change [hazard ratio 1. 745; 95% confidence interval : 2. 287-2. 366; P 0. 001] and significant TR without change [not analyzed]. Conclusion In a significant proportion of patients, significant TR after CRT has been observed, showing the potential benefits of CRT for patients with significant TR.

Source link: https://europepmc.org/article/MED/35348656


The role of cardiac magnetic resonance in identifying appropriate candidates for cardiac resynchronization therapy - a systematic review of the literature.

This systematic review aims to present the latest scientific evidence about the role of cardiac magnetic resonance in identifying patients who are likely to respond quickly to the CRT. For at least three months, we considered eligible observational studies or randomized clinical trials that enrolled patients over 18 years old with heart failure of ischaemic or non-ischaemic aetiology and collected evidence on the relationship of baseline CMR variables with clinical or echocardiographic response to CRT. In addition, new reports have shown that scar location can be correlated with CRT response rates. CMR results can be used to refine the position of the left ventricular lead during the CRT implantation procedure. Specifically, placing the left ventricular lead in a branch of the coronary sinus that feeds an area of transmural scarcity was associated with slower response to CRT.

Source link: https://europepmc.org/article/MED/36045189


Electrical dyssynchrony mapping and cardiac resynchronization therapy.

Purpose of the Original Purpose There is no such instrument for measuring or displaying electrical dyssynchrony in patients receiving cardiac synchronization therapy. Methods A coronary resynchronization index was determined at several device settings in 90 patients. Electrical dyssynchrony maps were created for each patient to display CRI at any combination of AVD and VVD. Native wavefront offsets were estimated for right ventricular paced fusion, left ventricular tempo, and native wavefront offsets. In patients with high-grade heart block, there was an OSL similar to the simultaneous biventricular pacing line with leftward shift across all AVDs. In all patients with intact AV node conduction, patients with intact AV node conduction had an OSL parallel to BiVP V-SIM's Biv-SIM line, with leftward shift at short AVDs, curvilinear at intermediate AVDs, and vertical at long AVDs in all patients, except for those with poor LV lead positions.

Source link: https://europepmc.org/article/MED/36055070


Differences in Mode of Death between Men and Women Receiving Implantable Cardioverter Defibrillators or Cardiac Resynchronization Therapy in the MADIT Trials.

In the MADIT trials, we investigated whether sex influenced death or device effectiveness in ICD and CRT-D participants. Methods The combined MADIT cohort was made up of 3038 men and 1000 women with ischemic or non-ischemic cardiomyopathy, LVEF u2264 percent; NYHA Class I-III heart failure and CRT-D; and non-cardiac causes were classified into cardiac and non-cardiac causes, interpreted by independent adjudication committees; NYHA Class I-III heart failure reported by independent adjudication committees; NYHA Class I-III heart failure Non-arrhythmic cardiac death in males was the most common cause of death, as well as non-cardiac death in women. With ICM, male vs. women were 1. 5 to 2. 0 fold higher, but the NICM was relatively similar, despite adjusting for covariates. CRT-D was more effective at reducing all-cause and cardiac deaths in women than in men than women. In men with ICM, heart death is higher than in women, but not so with NICM.

Source link: https://europepmc.org/article/MED/36007729


Prediction of Cardiac Resynchronization Therapy Response Using a Lead Placement Score Derived From 4-Dimensional Computed Tomography.

Background Cardiac resynchronization therapy is an appropriate treatment for patients with heart disease; however, 30 percent of patients do not respond to the therapy. We wanted to create patient-specific left ventricle maps of lead placement scores that highlight target pacing lead sites for a higher rate of CRT response. Each subject was given a linear combination of the support vector machine feature weights and the subject's own feature vector, which was an LPS map over the left ventricle. Subjects with an LPSu2264Q1's posttest probability of responding by 14%, but those with an LPSu2265 Q 3 had a posttest likelihood of responding by 90%. Subjects with Q1 – LPS – Q3 had a posttest likelihood of responding that was virtually unchanged from the pretest likelihood. Responders with an LPS threshold were identified in 87% of the area under the curve of the receiver operating characteristic curve for identifying responders with an LPS threshold.

Source link: https://europepmc.org/article/MED/35973012


Complications of Cardiac Resynchronization Therapy: Comparison of Safety Outcomes from Real-world Studies and Clinical Trials.

Cardiac resynchronization therapy is a vital step in heart disease prevention. We wanted to compare procedural risk between major RCTs of CRT with "real-world" complication rates reported in registry and administrative claims database analyses in order to compare rates of procedural error between simulated and administrative claims database studies. To find all relevant publications on CRT and group them into RCTs and registry studies, we ran a PubMed search. In RCTs, the overall rates of procedural difficulties with CRT were significantly higher than those in the real world. In conclusion, real-world procedural complication rates of CRT seem to be significantly lower than those reported in RCTs.

Source link: https://europepmc.org/article/MED/36072440

* Please keep in mind that all text is summarized by machine, we do not bear any responsibility, and you should always check original source before taking any actions

* Please keep in mind that all text is summarized by machine, we do not bear any responsibility, and you should always check original source before taking any actions