Dual intraventricular response after cardiac resynchronization (original) (raw)
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Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2014
Alternative forms of cardiac resynchronization therapy (CRT), including biventricular endocardial (BV-Endo) and multisite epicardial pacing (MSP), have been developed to improve response. It is unclear which form of stimulation is optimal. We aimed to compare the acute haemodynamic response (AHR) and electrophysiological effects of BV-Endo with MSP via two separate coronary sinus (CS) leads or a single-quadripolar CS lead.
Cardiac resynchronization therapy: evaluation of ventricular dysynchrony and patient selection
Archivos De Cardiologia De Mexico, 2010
Cardiac resynchronization therapy (CRT) is an established treatment modality for systolic heart failure. Aimed to produce simultaneous biventricular stimulation and correct the lack of ventricular synchrony in selected patients with congestive heart failure, CRT has shown to improve mortality and reduce hospital admissions when compared to medical treatment. At present, the indication criteria for the implantation of a CRT device include an ejection fraction of less than 35%, heart failure symptoms consistent with NYHA functional class III-IV and a QRS complex duration equal or longer than 120 milliseconds. It has been reported that 30% of patients who meet those criteria still may not derive clinical benefit from CRT. Due to the existing diversity of imaging modalities and resources for their process and analysis, a great expectation in terms of more accurate diagnosis of ventricular dyssynchrony has been raised. Reliable identification of dyssynchrony could allow us to better predict the favorable response of an individual patient to CRT and therefore offer this procedure to those individuals most likely to benefit. We review the available techniques for the study of ventricular dyssynchrony for CRT patient selection and the results of its application in clinical trials. Despite tremendous progress in the imaging technology available for the assessment and diagnosis of ventricular dyssynchrony, an ideal method has not been identified and the duration of the QRS complex in the surface ECG remains the accepted criteria of dyssynchrony in the selection of patients for CRT.
Bifocal Right Ventricular Resynchronization for the Failing Right Ventricle
Pacing and Clinical Electrophysiology, 2011
The present case illustrates that in patients with right ventricular (RV) failure and right bundle branch block it is possible to resynchronize the RV without further worsening RV or left ventricular (LV) pump function, even in cases with various degrees of atrioventricular block. The acute response to different pacing configurations was analyzed in terms of dP/dt variations. Bifocal RV pacing (His bundle plus RV outflow tract pacing) achieved the best acute results and was chosen for permanent pacing. This pacing configuration was associated to clinical and echocardiographic improvement. (PACE 2011; 34: e78-e81) cardiac resynchronization, right ventricle, heart failure
Wide complex tachycardia in a patient with a dual chamber pacemaker
Europace, 2008
An 81-year-old patient was admitted to the coronary care unit due to unstable angina and respiratory distress after urgent eye surgery for retinal detachment. He had a medical history of hypertension, diabetes mellitus, coronary artery disease, and valvular heart disease. He underwent coronary artery bypass grafting and aortic valve replacement in 1998 and received a dual chamber pacemaker (Pulsar Max DR Guidant/Boston Scientific Natick, MA, USA) for third-degree heart block in 1999. The diagnosis of myocardial infarction complicated by acute pulmonary oedema was withheld, in view of a rise in troponin I level to a maximum of 14.66 mg/L (normal value ,0.14 mg/L). ST-segment elevation could not be assessed because of ventricular pacing ( . He developed respiratory failure for which mechanical ventilation was initiated. His echocardiography showed a depressed left ventricular function with an ejection fraction of 30% due to a large antero-lateral myocardial infarction. An urgent coronary angiography showed a critical stenosis of the left coronary artery, and a percutaneous coronary intervention of the native left anterior descending and circumflex artery was performed.
Mapping and Ablation of Frequent Post‐Infarction Premature Ventricular Complexes
Journal of …, 2010
Mapping of Post-Infarction PVCs. Introduction: Premature ventricular complexes (PVCs) occur frequently in patients with heart disease. The sites of origin of PVCs in patients with prior myocardial infarction and the response to catheter ablation have not been systematically assessed. Methods and Results: In 28 consecutive patients (24 men, age 60 ± 10, ejection fraction [EF] 0.37 ± 0.14) with remote myocardial infarction referred for catheter ablation of symptomatic refractory PVCs, the PVCs were mapped by activation mapping or pace mapping using an irrigated-tip catheter in conjunction with an electroanatomic mapping system. The site of origin (SOO) was classified as being within low-voltage (scar) tissue (amplitude ≤1.5 mV) or tissue with preserved voltage (>1.5 mV). The SOO was confined to endocardial scar tissue in 24/28 patients (86%). The SOO was outside of scar in 3 patients and could not be identified in 1 patient. At the SOO, local endocardial activation preceded the PVC by 46 ± 19 ms, and the electrogram amplitude during sinus rhythm was 0.48 ± 0.34 mV. The PVCs were effectively ablated in 25/28 patients (89%), resulting in a decrease in PVC burden on a 24-hour Holter monitor from 15.6 ± 12.3% to 2.4 ± 4.2% (P < 0.001). The SOO most often was confined to scar tissue located in the left ventricular septum and the papillary muscles. Conclusion: Similar to post-infarction ventricular tachycardia, PVCs after remote myocardial infarction most often originate within scar tissue. Catheter ablation of these PVCs has a high-success rate.
Heart Rhythm, 2010
A 56-year-old man with a long history of congestive heart failure due to ischemic cardiomyopathy was admitted to our clinic for evaluation of asymptomatic fixed high heart rate detected during routine automatic blood pressure measurement. The patient had undergone placement of a biventricular pacemaker and defibrillator (Atlas ϩ HF V-341, St. Jude Medical, St. Paul, MN, USA) 1 year prior to admission because of syncopal ventricular tachycardia. On admission, the patient was tachycardic with only intermittent (2:1) biventricular pacing ). Programmed parameters were as follows: base rate 60 bpm, max track rate 130 bpm, paced/sensed AV delay 160 ms/ 110 ms, rate-responsive AV delay off, interventricular delay 15 ms (left ventricle first), pace refractoriness postventricular atrial refractory period (PVARP) 280 ms/V 250 ms, rate-responsive PVARP off, atrial sensitivity automatic (maximum 0.3 mV), and ventricular sensitivity automatic (maximum 0.3 mV). P-and R-wave amplitudes were 1.9 and 9.7 mV, respectively. Atrial, right, and left ventricular pacing thresholds were 0.75, 1, and 1.25 V at 0.5 ms, respectively. Atrial, right, and left ventricular pacing lead impedances were 435, 475, and 520 ⍀, respectively. The detection rates for ventricular tachycardia (VT-1 and VT-2) and ventricular fibrillation were programmed at 350 ms (171 bpm), 310 ms (194 bpm), and 260 ms (231 bpm), respectively. What is the cardiac rhythm? What is the mechanism for intermittent failure of biventricular pacing? Is the device functioning appropriately?
Atrioventricular Cross-talk in Biventricular Pacing: A Potential Cause of Ventricular Standstill
Pacing and Clinical Electrophysiology, 2002
Pacing system malfunction is a known cause of sudden death in pacemaker dependent patients. In cardiac resynchronization by biventricular stimulation, a method recently confirmed to improve cardiac function, 1 the left ventricle is usually paced via a tributary of the coronary sinus (CS). Spontaneous sensing of left atrial (LA) signals may occur in some ventricular lead positions, though this phenomenon has not been studied in detail in chronic left ventricular (LV) pacing. This study examined the risk of ventricular pacing inhibition by atrioventricular (AV) cross-talk on spontaneous LA electrogram (AVCSA) due to sensing of the LA by the LV lead, and risk of asys-tole from AVCSA in pacemaker dependent patients. Patients and Methods A cardiac resynchronization pacing system was implanted in 17 patients (mean age 67.5 6 9.5 years) with congestive heart failure, in sinus rhythm associated with abnormal intraventricular conduction. In six patients, SSI (n 5 2) and DDD (n 5 4) conventional pacing systems were already in place. All patients had the following clinical characteristics: (1) New York Heart Association (NYHA) heart failure functional Class III or IV despite optimal medical management; (2) irreversible ischemic, valvular, or idiopathic dilated cardiomyopathy; (3) QRS duration $ 120 ms, and interventricular delay $ 30 ms by Doppler echocardiographic measurements; (4) echocardiographic LV ejection fraction , 0.35, and LV enddiastolic diameter $ 55 mm. Informed consent was obtained from each patient. An Attain lead model 2187 (Medtronic Inc.