Heart Failure Decompensation and All-Cause Mortality in Relation to Percent Biventricular Pacing in Patients With Heart Failure (original) (raw)
Related papers
2010
The goal of this analysis was to determine the appropriate biventricular pacing target in patients with heart failure (HF). Background Cardiac resynchronization therapy (CRT) decreases the risk of death and HF hospitalization. However, the appropriate amount of biventricular pacing is ill-defined. Methods Mortality and HF hospitalization data from patients undergoing CRT in 2 trials (CRT RENEWAL [Cardiac Resynchronization Therapy Registry Evaluating Patient Response with RENEWAL Family Devices] and REFLEx [ENDOTAK RELIANCE G Evaluation of Handling and Electrical Performance Study]; n ϭ 1,812) were analyzed in a post-hoc fashion. Subjects were grouped based on percent biventricular pacing quartiles with the use of Kaplan-Meier survival analysis.
Journal of Cardiovascular Electrophysiology, 2008
was not yet performed, leaving clinicians to question whether CRT-P alone is enough to protect congestive heart failure (CHF) patients from sudden cardiac death and whether CRT-D should be implanted to all CHF patients indicated for biventricular pacing. This study attempts to make this type of comparison in a large CHF population and seeks to identify predictors of death in patients with different comorbidities.
European Heart Journal
Background and Aims De novo implanted cardiac resynchronisation therapy with defibrillator (CRT-D) reduces the risk of morbidity and mortality in patients with left bundle branch block, heart failure and reduced ejection fraction (HFrEF). However, among HFrEF patients with right ventricular pacing (RVP), the efficacy of CRT-D upgrade is uncertain. Methods In this multicentre, randomised, controlled trial, 360 symptomatic (New York Heart Association class II-IVa) HFrEF patients with a pacemaker or implantable cardioverter defibrillator (ICD), high RVP burden ≥20%, and a wide, paced QRS complex duration ≥150 ms were randomly assigned to receive CRT-D upgrade (n = 215) or ICD (n = 145) in a 3:2 ratio. The primary outcome was the composite of all-cause mortality, heart failure hospitalisation or <15% reduction of left ventricular end-systolic volume assessed at 12 months. Secondary outcomes included all-cause mortality or heart failure hospitalisation. Results Over a median follow-up...
Cardiac resynchronization therapy in congestive heart failure: Ready for prime time?
Heart Rhythm, 2004
OBJECTIVES/BACKGROUND The aim of this article is to critically review the data accumulated to date on the application of cardiac resynchronization therapy (CRT) via biventricular pacing techniques to manage patients with advanced heart failure. The data from studies evaluating the effects of long-term right ventricular (RV) pacing are also briefly reviewed. METHODS MEDLINE and selective journal searches of English-language reports and a search of references of relevant papers were conducted. RESULTS Cardiac dyssynchrony as reflected by a prolonged QRS complex, often in the form of left bundle branch block, is encountered in about 30% of patients with moderate-to-advanced heart failure. Among these patients, 10% to 15% are candidates for CRT via biventricular pacing. Accumulated evidence from randomized controlled studies over the last few years has indicated a significant hemodynamic and clinical improvement conferred by CRT to class III or IV heart failure patients with idiopathic or ischemic dilated cardiomyopathy having a low left ventricular ejection fraction (Յ35%) and a wide QRS complex (Ն120 -150 ms). Newer data suggest a significant reduction in overall mortality and heart failure hospitalization, particularly when CRT is combined with automatic defibrillator backup. Technical advances with percutaneous methods accessing the tributaries of the cardiac veins have raised the success rate of implantation of left ventricular leads to Ͼ90%. Further confirmation from ongoing trials is awaited, and more data from cost-effectiveness studies are needed before CRT is considered for prime time therapy in the heart failure population. If the data confirm a survival benefit from CRT, use of this electrical therapy at earlier stages of heart failure might be contemplated. New evidence from recent studies suggests a deleterious effect of the long-standing practice of producing an iatrogenic left bundle branch block by conventional RV apical pacing in patients receiving permanent pacemakers. Thus, having already become poignantly aware of the harmful effects of spontaneous left bundle branch block, this emerging new evidence about RV apical pacing would dictate a change of attitude and direct our attention to alternate sites of pacing, such as the left ventricle and/or the RV outflow tract, if not for all patients then at least for those with left ventricular dysfunction. CONCLUSIONS CRT offers hemodynamic and clinical improvement to patients with moderate-toadvanced heart failure, and it might significantly prolong survival in selected patients, particularly if devices with defibrillation backup are used. Further confirmatory data from randomized mortality trials are needed, and issues of cost efficacy must be resolved before this vital therapeutic alternative is ready for prime time therapy of heart failure patients.
Resynchronisation therapy in patients with heart failure: Our results
Srpski arhiv za celokupno lekarstvo, 2005
INTRODUCTION. Resynchronisation therapy with biventricular permanent pacing stimulation is one method of treating patients with systolic heart failure, with echocardiograph signs of ventricular asynchrony and a prolonged QRS of longer than 120 milliseconds. This method has been accepted in most medical centers around the world and was instigated in our Pacemaker Centre in December 2001, 3 months after FDA approval for human use. OBJECTIVE. The aim of the study was to present this new procedure and the results obtained from our own group of patients. METHOD. A multi-site, biventricular pacemaker, with a special electrode for left-half heart stimulation was implanted in the coronary sinus of 17 patients who had suffered systolic heart failure (12 male and 5 female, average age 59.9 years). For all of them, the duration of the QRS interval was longer than 120 ms, with left bundle branch morphology, and an ejection fraction below 30%. All the patients were NYHA class II or III. Prior to...
Pace-pacing and Clinical Electrophysiology, 2007
There are few studies on cardiac resynchronization therapy (CRT) in heart failure (HF) patients with preexisting right ventricular (RV) pacing. The purpose of this study was to determine the efficacy of CRT upgrading in RV-paced patients and the predictivity of electromechanical dyssynchrony parameters (EDP) evaluated by standard echocardiography (ECHO) and tissue Doppler imaging (TDI). Methods: Thirty-eight consecutive patients with HF [New York Heart Association (NYHA) class III or IV, LVEF < 35%], prior continuous RV pacing, and absence of atrial fibrillation were enrolled in the presence of a paced QRS ≥ 150 ms and evaluated by ECHO and TDI. A responder was defined as a patient with a favorable change in NYHA class and neither HF hospitalization nor death, plus an absolute increase of LVEF ≥ 10 units. Results: At six-months follow-up, the whole study population had significant improvement in symptoms, systolic function, and QRS duration (P < 0.001); 32 (84%) patients had a favorable clinical outcome, 25 (66%) were considered responders according to the previous definition. Postimplant QRS was similarly reduced in both responders and nonresponders, whereas EDP had a significant improvement only in responders (P < 0.05). Using EDP, 23 (79%) patients were responders compared with 2 (22%) patients without mechanical dyssynchrony (P = 0.002). Conclusions: In HF patients with previous RV pacing, CRT is effective to improve clinical, functional outcome, and LV performance and to reduce electromechanical dyssynchrony in a large proportion of patients. Dyssynchrony evaluated by standard and TDI ECHO can be useful for CRT selection of paced patients. (PACE 2007; 30:1096-1104 heart failure, ventricular dyssynchrony, cardiac resynchronization therapy, biventricular upgrading
European Heart Journal, 2021
Introduction A history of preoperative atrial fibrillation (AF) has been found to be associated with unfavorable outcomes, higher risks of non-response to cardiac resynchronization therapy (CRT) and loss of biventricular pacing (BivP). We aimed to assess the impact of AF and BivP on long-term outcomes in heart failure patients treated with CRT. Methods We retrospectively enrolled 227 patients undergoing CRT implantation between 2013 and 2020 according to the current guidelines. 118 patients were included in our analysis, from whom all data were available. Clinical, electrocardiographic and echocardiographic parameters were evaluated at baseline and 6 months after CRT. Response to CRT was defined as an increase in left ventricular ejection fraction (LVEF) >10%. We considered an effective delivery of BivP >98%. The primary endpoint was the composite endpoint of hospitalization due to HF or death for any cause. Results 118 patients were included (mean age 69±11 years, 66.1% males...
His Corrective Pacing or Biventricular Pacing for Cardiac Resynchronization in Heart Failure
Journal of the American College of Cardiology, 2019
Boston Scientific, and Medtronic; he also has a patent pending for a His delivery tool. Dr. Hemal Nayak has been a speaker for Medtronic, Biotronik, and Boston Scientific. Dr. Nishant Verma has been a speaker for Biotronik and Medtronic. Dr. Gopi Dandamudi has been a speaker and consultant for Medtronic and serves on the advisory board for Biotronik. Dr. Parikshit Sharma has been a speaker for Medtronic and has been a consultant for Abbott and Biotronik. Dr. Moeen Saleem has been a consultant for Medtronic, Boston Scientific, and Abbott. Dr. Roderick Tung has been on the advisory board for Abbott and Boston Scientific. Dr. John Mandrola and Dr. Davide Genovese report no relevant disclosures. Northwestern University receives institutional support for the training of fellows from Abbott, Biosense Webster, Biotronik, Boston Scientific, and Medtronic. The University of Chicago Medicine receives institutional support for the training of fellows from Abbott, Biotronik, Boston Scientific, and Medtronic. Acknowledgements: The authors thank Dalise Shatz, BA, and Stephanie Besser, MSAS, for data management and statistical support.
2014
INTRODUCTION Long-term pacing from the right ventricle (RV) has been shown to induce a deleterious effect on left ventricular function. Cardiac resynchronization therapy (CRT) is an established treatment for heart failure (HF) patients. The purpose of this study was to assess the benefit from upgrading to CRT in chronically RV-paced patients with a low left ventricular ejection fraction (LVEF<35%). METHODS Thirty-seven HF patients (age 71.4 ± 7.7, 26 male), who fulfilled CRT indications, were included. Study subjects had undergone VVI or DDD pacemaker implantation 6.1 ± 5.7 years earlier and were referred to our centre because of worsened clinical condition or a depleted battery. Patients were assessed at baseline and six months after CRT. Evaluation included NYHA classification, functional capacity assessed by six-minute walk test (6 MWT), hospitalization rate and echocardiographic assessment. RESULTS Biventricular pacing was possible in 34 of the 37 cases (91.7%) who had their ...