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A cardiovascular simulator tailored for training and clinical uses. J Biomed Inform 2015; 57:100-12. [DOI: 10.1016/j.jbi.2015.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 06/10/2015] [Accepted: 07/06/2015] [Indexed: 11/20/2022]
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Manfredi JA, Al-Khatib SM, Shaw LK, Thomas L, Fogel RI, Padanilam B, Rardon D, Vatthyam R, Gemma LW, Golden K, Prystowsky EN. Association Between Left Ventricular Ejection Fraction Post-Cardiac Resynchronization Treatment and Subsequent Implantable Cardioverter Defibrillator Therapy for Sustained Ventricular Tachyarrhythmias. Circ Arrhythm Electrophysiol 2013; 6:257-64. [DOI: 10.1161/circep.112.000214] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joseph A. Manfredi
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Sana M. Al-Khatib
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Linda K. Shaw
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Laine Thomas
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Richard I. Fogel
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Benzy Padanilam
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - David Rardon
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Rosh Vatthyam
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Lee W. Gemma
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Keith Golden
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Eric N. Prystowsky
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
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BAROLD SSERGE, HERWEG BENGT. Cardiac Resynchronization Therapy: Fusion or No Fusion with the Intrinsic Rhythm? Pacing Clin Electrophysiol 2012; 35:119-22. [DOI: 10.1111/j.1540-8159.2011.03283.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Dzemali O, Monsefi N, Moritz A, Kleine P. Permanent biventricular ICD-implantation in a heart failure second re-do-CABG patient: a case report. CASES JOURNAL 2009; 2:59. [PMID: 19146686 PMCID: PMC2634764 DOI: 10.1186/1757-1626-2-59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 01/15/2009] [Indexed: 11/10/2022]
Abstract
Biventricular pacing has been suggested in end-stage heart failure. We present a 59-year-old patient undergoing second re-do CABG (coronary artery bypass graft) and carotid artery endarterectomy. Ejection fraction was 15%, QRS-width 175 ms. Following the carotid and CABG procedure, an implanted single-chamber ICD (implantable cardioverter defibrillator) was upgraded to permanent biventricular DDD pacing by implantation of one epicardial left ventricular and one epicardial atrial electrode. At follow-up two months postoperatively ejection fraction had significantly improved to 45%, the patient underwent stress test with adequate load and reported a good quality of life.
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Affiliation(s)
- Omer Dzemali
- Department of Thoracic & Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
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Affiliation(s)
- Theodore P Abraham
- Division of Cardiology, Johns Hopkins University, Baltimore, MD 21287, USA.
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Ermis C, Benditt DG. Stent-Stabilization of Left Ventricular Pacing Leads for Cardiac Resynchronization Therapy: A Promising Concept? J Cardiovasc Electrophysiol 2007; 18:308-9. [PMID: 17284283 DOI: 10.1111/j.1540-8167.2006.00748.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dzemali O, Bakhtiary F, Dogan S, Wittlinger T, Moritz A, Kleine P. Perioperative Biventricular Pacing Leads to Improvement of Hemodynamics in Patients with Reduced Left-Ventricular Function?Interim Results. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1341-5. [PMID: 17201840 DOI: 10.1111/j.1540-8159.2006.00545.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has been introduced as a new therapeutic modality in patients with chronic heart failure. However, most studies have investigated the hemodynamic effects in congestive, but not postoperative heart failure. OBJECTIVE The following study investigates hemodynamic effects of perioperative temporary biventricular pacing in patients undergoing open heart surgery. In 54 patients one left and one right ventricular epicardial wire was placed during open heart operations. Hemodynamic parameters were measured immediately after the operation and 6 as well as 24 hours postoperatively. Transesophageal echocardiography was performed 1 hour postoperatively. RESULTS Of the 54 patients (59.2%), 32 responded to biventricular pacing with an increase in cardiac output; in these patients synchronized ventricular contraction could be verified echocardiographically. This hemodynamic benefit persisted 6 hours and 24 hours postoperatively. The remaining 22 patients did not show any hemodynamic improvement from biventricular stimulation. CONCLUSION Biventricular pacing leads to significant rise in cardiac output in approximately 59% of patients with severely reduced left ventricular function and widened QRS complexes. Further studies are necessary to define clearly the clinical characteristics of patients who show remodeling by CRT.
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Affiliation(s)
- Omer Dzemali
- Department of Thoracic and Cardiovascular Surgery, University Hospital, J.W. Goethe University, Frankfurt/Main, Germany.
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Schlosshan D, Barker D, Pepper C, Williams G, Morley C, Tan LB. CRT improves the exercise capacity and functional reserve of the failing heart through enhancing the cardiac flow- and pressure-generating capacity. Eur J Heart Fail 2006; 8:515-21. [PMID: 16377239 DOI: 10.1016/j.ejheart.2005.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2005] [Revised: 09/28/2005] [Accepted: 11/03/2005] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While information on how cardiac resynchronisation therapy (CRT) affects cardiac performance at rest is readily available, the mechanisms whereby CRT alters cardiac function during maximal exercise are unclear. AIMS We examined the medium-term effects of CRT on cardiac and physical functional reserve of patients with severe heart failure (CHF) and prolonged QRS duration. METHODS Seventeen consecutive patients with severe CHF (NYHA III-IV) and widened QRS underwent maximal cardiopulmonary exercise testing with non-invasive central haemodynamic measurements before and 6-8 weeks after CRT pacemaker implantation. RESULTS After CRT there were significant increases in exercise cardiac output by 19.3% (P=0.0048) from 9.5+/-3.4 l min(-1), peak mean arterial blood pressure by 14.1% (P=0.0001) from 91.3+/-13.6 mm Hg, and peak cardiac power output by 37.2% (P=0.0008) from 1.92+/-0.74 W. There were no significant changes in these variables at rest. Exercise duration (+42.3%, P=0.0002), NYHA functional class (P=0.0001) and SF-36 symptom score (P=0.0006) were also significantly improved. Powerful surrogate indicators of prognosis were also significantly improved with CRT: peak O(2) consumption (+20.9%, P=0.0007), VE/VCO(2) slope (-20.0%, P=0.005) and circulatory power (+42.0%, P=0.0012). CONCLUSION In this cohort of patients, post-implant CRT significantly improved the flow-, pressure- and power-generating capacity of the failing hearts. This may be causally related to the improvements observed in exercise capacity, functional class and symptom scores.
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Affiliation(s)
- D Schlosshan
- Molecular Cardiovascular Medicine, University of Leeds, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
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Faber L. Echocardiography-based optimization of cardiac resynchronization therapy in patients with congestive heart failure and conduction disorders. Herzschrittmacherther Elektrophysiol 2006; 17 Suppl 1:I73-9. [PMID: 16598626 DOI: 10.1007/s00399-006-1111-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Resynchronization of segmental left ventricular mechanics as well as re-coordination of both atrio-ventricular and inter-ventricular contraction are potential mechanisms responsible for the clinical benefit observed in patients with advanced congestive heart failure treated by cardiac resynchronization therapy (CRT). Initially electrical conduction problems, in the majority of cases a left bundle branch block (LBBB), were considered the target for CRT. However, growing experience with CRT in different patient populations including those with milder degrees of conduction disturbance, and improved cardiac imaging utilizing the tissue Doppler approach, have shown the complexity of CRT and the usefulness of sophisticated echocardiographic imaging techniques for therapeutic decision making and optimization of CRT device settings.
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Affiliation(s)
- L Faber
- Department of Cardiology, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.
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Ermis C, Seutter R, Zhu AX, Benditt LC, VanHeel L, Sakaguchi S, Lurie KG, Lu F, Benditt DG. Impact of Upgrade to Cardiac Resynchronization Therapy on Ventricular Arrhythmia Frequency in Patients With Implantable Cardioverter-Defibrillators. J Am Coll Cardiol 2005; 46:2258-63. [PMID: 16360055 DOI: 10.1016/j.jacc.2005.04.067] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2005] [Revised: 04/02/2005] [Accepted: 04/13/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study compared cardiac resynchronization therapy's (CRT) impact on ventricular tachyarrhythmia susceptibility in patients who, due to worsening heart failure (HF) symptoms, underwent a replacement of a conventional implantable cardioverter-defibrillator (ICD) with a CRT-ICD. BACKGROUND Cardiac resynchronization therapy is an effective addition to conventional treatment of HF in many patients with left ventricular systolic dysfunction. However, whether CRT-induced improvements in HF status also reduce susceptibility to life-threatening arrhythmias is less certain. METHODS Clinical and ICD electrogram data were evaluated in 18 consecutive ICD patients who underwent an upgrade to CRT-ICD. Pharmacologic HF therapy was not altered during follow-up. The definition of ventricular tachycardia (VT) and ventricular fibrillation (VF) for each patient was as determined by device programming. Statistical comparisons used paired t tests. RESULTS Findings were recorded during two time periods: 47 +/- 21 months (range 24 to 70 months) before and 14 +/- 2 months (range 9 to 18 months) after CRT upgrade. At time of upgrade, patient age was 69 +/- 11 years and ejection fraction was 21 +/- 8%. Before CRT the frequency of VT, VF, and appropriate ICD shocks was 0.31 +/- 1.23, 0.047 +/- 0.083, and 0.048 +/- 0.085 episodes/month/patient, respectively. After CRT-ICD, VT and VF arrhythmia burdens and frequency of shocks were respectively 0.13 +/- 0.56, 0.001 +/- 0.004, and 0.003 +/- 0.016 episodes/month/patient (p = 0.59, 0.03, and 0.05 vs. pre-CRT). CONCLUSIONS Arrhythmia frequency and number of appropriate ICD treatments were reduced after upgrade to CRT-ICD for HF treatment. Thus, apart from hemodynamic benefits, CRT may also ameliorate ventricular tachyarrhythmia susceptibility in HF patients.
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Affiliation(s)
- Cengiz Ermis
- Cardiac Arrhythmia Center, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Ermis C, Lurie KG, Zhu AX, Collins J, Vanheel L, Sakaguchi S, Lu F, Pham S, Benditt DG. Biventricular implantable cardioverter defibrillators improve survival compared with biventricular pacing alone in patients with severe left ventricular dysfunction. J Cardiovasc Electrophysiol 2004; 15:862-6. [PMID: 15333075 DOI: 10.1046/j.1540-8167.2004.04044.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Biventricular cardiac pacemakers provide important hemodynamic benefit in selected patients with heart failure and severe left ventricular (LV) dysfunction. Nevertheless, these patients remain at high mortality risk. To address this issue, we examined mortality outcome in patients with heart failure treated with biventricular pacemakers alone and those treated with biventricular implantable cardioverter defibrillators (ICDs). METHODS AND RESULTS The study population consisted of 126 consecutive patients with LV dysfunction and heart failure who received either a biventricular ICD (n = 62) or a biventricular pacemaker (n = 64) between January 1998 and December 2002. A minimum 12 months of follow-up was obtained in all survivors. ICD indications were conventional in all patients. Kaplan-Meier actuarial method and log rank statistics were used to calculate and compare survival rates in both groups. Comparison of mortality rates utilized Chi-square test. The two groups had similar clinical and demographic features, LV ejection fraction, and medication use. Average follow-up times were 13 +/- 11.8 months (range 4-60) and 18 +/- 13.2 months (range 0.5-53) for biventricular ICD and pacemaker groups, respectively. Overall mortality rate was significantly lower in the biventricular ICD group (13%, 8 deaths) compared to the pacemaker group (41%, 26 deaths) (P = 0.01). Further, the predominant survival benefit for ICD-treated patients becomes evident after the first 12 months of follow-up. CONCLUSION The findings in this study, although necessarily limited in their interpretation by the absence of treatment randomization, suggest that biventricular ICDs offer a survival benefit compared to biventricular pacing alone. Furthermore, this benefit may be most apparent if other clinical factors do not preclude patient survival >1 year postimplant.
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Affiliation(s)
- Cengiz Ermis
- Cardiac Arrhythmia Center, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Peichl P, Kautzner J, Cihák R, Bytesník J. The Spectrum of Inter- and Intraventricular Conduction Abnormalities in Patients Eligible for Cardiac Resynchronization Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1105-12. [PMID: 15305960 DOI: 10.1111/j.1540-8159.2004.00592.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although cardiac resynchronization therapy (CRT) has clearly demonstrated its clinical benefit in patients with congestive heart failure (CHF) and intraventricular conduction abnormalities, selection of eligible patients and/or optimal pacing site are still a matter of debate. The aim of the study was to analyze the spectrum of conduction abnormalities in CRT candidates. A total of 26 patients (mean age 62 +/- 9 years) with CHF and conduction disturbances (QRS > or = 130 ms) were studied. The underlying heart disease was dilated cardiomyopathy (DCM) (n = 12) or coronary artery disease (CAD) (n = 14). High density, left ventricular endocardial activation maps were constructed using an electroanatomic mapping system (CARTO). Based on endocardial activation patterns, left ventricular conduction abnormalities were classified as left bundle branch block (LBBB) (n = 9), nonspecific intraventricular conduction disturbances (n = 10), and the bifascicular block (n = 7). In DCM patients the endocardial activation sequences corresponded with a 12-lead ECG pattern with a homogeneous spread of activation wavefront and the latest activation laterally (LBBB) or anteriorly (bifascicular block), respectively. CAD patients presented with variable activation patterns that reflected the location of the postinfarct scar, and the 12-lead ECG was less predictive. Although there was a trend for longer QRS durations for DCM subjects (170 +/- 23 vs 156 +/- 23 ms, P = NS), left ventricular activation time was significantly longer in the CAD group (115 +/- 21 ms vs 134 +/- 23 ms, P < 0.05). CRT candidates represent a broad spectrum of conduction abnormality patterns with variable inter- and intraventricular activation delays. CAD subjects have more pronounced intraventricular conduction abnormality. The standard ECG is less reliable in the characterization of complex conduction abnormalities.
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Affiliation(s)
- Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Walcott GP, Melnick SB, Killingsworth CR, Smith WM, Ideker RE. Effects of burst stimulation during ventricular fibrillation on cardiac function after defibrillation. Am J Physiol Heart Circ Physiol 2003; 285:H766-74. [PMID: 12702489 DOI: 10.1152/ajpheart.00137.2002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of defibrillation is to rapidly restore blood flow and tissue perfusion following ventricular fibrillation (VF) and shock delivery. We tested the hypotheses that 1) a series of 1-ms pulses of various amplitudes delivered before the defibrillation shock can improve hemodynamics following the shock, and 2) this hemodynamic improvement is due to stimulation of cardiac or thoracic sympathetic nerves. Ten anesthetized pigs received a burst of either 15 or 30 1-ms pulses (0.1-10 A in strength) during VF, after which defibrillation was performed. ECG, arterial blood pressure, and left ventricular (LV) pressure were recorded. Defibrillation shocks and burst pulses were delivered from a right ventricular coil electrode to superior vena cava coil and left chest wall electrodes. Sympathetic blockade was induced with 1 mg/kg timolol and trials were repeated. The first half of this protocol was repeated in two animals that were pretreated with reserpine. Heart rate (HR) after 1-, 2-, 5-, and 10-A pulses was significantly higher than after control shocks without preceding pulse therapy. Mean and peak LV pressure measurements increased 38 and 72%, respectively, following shocks preceded by 5- and 10-A pulses compared with shocks preceded by no burst pulses. Mean and peak arterial pressures increased 36 and 43%, respectively, following shocks preceded by 5- and 10-A pulses compared with shocks preceded by no burst pulses. After beta-blockade, HR, mean and peak arterial pressures, and mean LV pressure were not significantly different after pulses of any strength compared with control shocks. LV peak pressure following the 10-A pulses was significantly higher than with no burst pulses but was significantly lower than the response to the 10-A pulses delivered without beta-blockade. HR, mean and peak arterial pressures, and mean and peak LV pressure responses after 15 or 30 5- or 10-A pulses were similar to the responses to the same pulses after beta-blockade. We conclude that a burst of 15-30 1-ms pulses delivered during VF can increase HR, arterial pressure, and LV pressure following defibrillation. beta-Blockade or reserpine pretreatment prevents most of this postshock increase in HR, arterial pressure, and LV pressure.
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Affiliation(s)
- Gregory P Walcott
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama, 1670 University Blvd., Birmingham, AL 35294, USA.
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Kleine P, Doss M, Aybek T, Wimmer-Greinecker G, Moritz A. Biventricular pacing for weaning from extracorporeal circulation in heart failure. Ann Thorac Surg 2002; 73:960-2. [PMID: 11899211 DOI: 10.1016/s0003-4975(01)03118-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Resynchronization of the intra- and interventricular conduction by biventricular pacing has been suggested in patients with end-stage heart failure. We present a case in which extracorporeal circulation could only be weaned after placement of an additional left ventricular pacing wire. Biventricular stimulation led to normal motion of the anterior wall and a previously bulging interventricular septum; this improved the hemodynamic situation significantly.
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Affiliation(s)
- Peter Kleine
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
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Blanck Z, Georgakopoulos ND, Berger M, Cooley R, Dhala A, Sra J, Deshpande S, Akhtar M. Electrical therapy in patients with congestive heart failure introduction. Curr Probl Cardiol 2002; 27:45-93. [PMID: 11893983 DOI: 10.1067/mcn.2002.121818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Zalmen Blanck
- University of Wisconsin Medical School-Milwaukee Clinical Campus, St. Luke's and Sinai Samaritan Medical Centers, Milwaukee, Wisconsin, USA
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Leclercq C, Kass DA. Retiming the failing heart: principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol 2002; 39:194-201. [PMID: 11788207 DOI: 10.1016/s0735-1097(01)01747-8] [Citation(s) in RCA: 368] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Left or biventricular (BiV) pacing, or cardiac resynchronization therapy, was proposed nearly 10 years ago as an adjunctive treatment for patients with advanced heart failure (HF) complicated by discoordinate contraction due to intraventricular conduction delay. Since then, both short-term and a growing number of long-term clinical trials have reported on the mechanisms and short- and mid-term efficacy of this approach, with encouraging results. Therapy is implemented with novel pacing systems incorporating an endocardial lead to stimulate the lateral free wall via a cardiac vein, and often a right ventricular (RV) apex lead to provide BiV stimulation. A third atrial sensing lead monitors intrinsic rhythm and provides timing data to ensure ventricular pre-excitation. Modulation of the electronic atrial-ventricular (AV) time delay can optimize contractile synchrony, enhance the contribution of atrial systole, and reduce mitral regurgitation. Individuals with advanced HF, a wide QRS complex often with an AV time delay, and evidence of contraction dyssynchrony in viable myocardium represent the target patient group. Short-term studies reveal systolic augmentation and chamber efficiency from pacing resynchronization that can be substantial. Long-term studies reveal improved symptoms and exercise capacity, and some report reversal of chronic cardiac dilation. However, important questions regarding long-term efficacy and mortality impact, optimal mode for pacing stimulation, and role of combined pacing/cardioverter/defibrillation devices remain unresolved. Here we review pathophysiologic mechanisms, short- and long-term clinical results, and future directions of this new and promising therapy.
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Affiliation(s)
- Christophe Leclercq
- Departement de Cardiologie et Maladies Vasculaires, Centre Cardio-Pneumologique, Centre Hospitalier Universitaire, Rennes, France
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Breithardt OA, Stellbrink C, Franke A, Balta O, Diem BH, Bakker P, Sack S, Auricchio A, Pochet T, Salo R. Acute effects of cardiac resynchronization therapy on left ventricular Doppler indices in patients with congestive heart failure. Am Heart J 2002; 143:34-44. [PMID: 11773910 DOI: 10.1067/mhj.2002.119616] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with heart failure frequently exhibit intraventricular conduction delays, which contribute to asynchronous contraction patterns and impaired hemodynamic performance. Cardiac resynchronization therapy (CRT) with biventricular (BV) and left ventricular (LV) pacing has been shown to improve both hemodynamic and clinical performance. This study investigated the effects of CRT on LV Doppler indices in these patients. METHODS AND RESULTS Thirty-two patients with advanced heart failure (New York Heart Association class > or =III, QRS >120 milliseconds, PR interval >150 milliseconds) were studied 4 weeks after implantation of a CRT system. Doppler echocardiography was conducted in 3 separate CRT modes, right ventricular, LV, and BV stimulation at 3 different atrioventricular delays. CRT resulted in significant improvement of Doppler parameters such as filling time (FT, 313 +/- 111 milliseconds at baseline --> 363 +/- 154 milliseconds [BV], P <.05), aortic velocity time integral (AO(VTI) 23.2 +/- 7.4 cm at baseline --> 26.8 +/- 8.8 cm [LV], P <.05), and the myocardial performance index (MPI, 1.21 +/- 0.51 at baseline --> 0.85 +/- 0.34 [BV], P <.05). The most improvement was observed with LV and BV stimulation at short and intermediate atrioventricular delays (80-120 milliseconds), independent of ischemic or idiopathic origin. CONCLUSIONS CRT improves hemodynamic performance in patients with heart failure with intraventricular conduction delays. Doppler echocardiography allows noninvasive evaluation of acute CRT effects in patients with heart failure. In particular, FT, AO(VTI), and MPI are useful parameters for noninvasive follow-up and optimization of pacing parameters.
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MESH Headings
- Analysis of Variance
- Atrioventricular Node/physiopathology
- Cardiac Pacing, Artificial/methods
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnostic imaging
- Cross-Over Studies
- Echocardiography, Doppler
- Female
- Heart Failure/diagnostic imaging
- Heart Failure/physiopathology
- Heart Failure/therapy
- Humans
- Male
- Middle Aged
- Myocardial Contraction/physiology
- Pacemaker, Artificial
- Single-Blind Method
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/therapy
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Dysfunction, Right/therapy
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Affiliation(s)
- Ole-A Breithardt
- Department of Cardiology, RWTH University of Technology, Aachen, Germany
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18
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Abstract
Cardiac resynchronization refers to pacing techniques that change the degree of atrial and ventricular electromechanical asynchrony in patients with major atrial and ventricular conduction disorders. Atrial and ventricular resynchronization is usually accomplished by pacing from more than one site in an electrical chamber--atrium or ventricle--and occasionally by stimulation at a single unconventional site. Resynchronization produces beneficial hemodynamic and antiarrhythmic effects by providing a more physiologic pattern of depolarization. Atrial resynchronization may prevent atrial fibrillation in selected patients with underlying bradycardia or interatrial block. Its antiarrhythmic effect in the absence of bradycardia is unclear. Ventricular resynchronization is of far greater clinical value than atrial resynchronization. Biventricular (or single-chamber left ventricular) pacing is beneficial for patients with congestive heart failure, severe left ventricular systolic dysfunction, dilated cardiomyopathy (either ischemic or idiopathic), and a major left-sided intraventricular conduction disorder, such as left bundle branch block. The change in electrical activation from resynchronization, which has no positive inotropic effect as such, is translated into mechanical improvement with a more coordinated left ventricular contraction. Several recent randomized trials and a number of observational studies have demonstrated the long-term effectiveness of ventricular resynchronization in the above group of patients. The high incidence of sudden death among these patients has encouraged ongoing clinical trials to evaluate the benefit of a system that combines biventricular pacing and cardioversion-defibrillation into a single implantable device.
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Affiliation(s)
- S S Barold
- Broward General Hospital, Fort Lauderdale, Florida, USA
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19
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Slotwiner DJ, Stein KM, Markowitz SM, Mittal S, Iwai S, Das M, Lerman BB. Emerging indications for cardiac pacing. HEART DISEASE (HAGERSTOWN, MD.) 2001; 3:224-30. [PMID: 11975798 DOI: 10.1097/00132580-200107000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Substantial data have been accumulated and indications have been well delineated for pacemaker implantation in the treatment of sinus node dysfunction and heart block. However, many other indications have been proposed for pacemaker implantation. In this review, the authors examine available data regarding pacemaker implantation for new indications: neurally mediated syncope, hypertrophic obstructive cardiomyopathy, congestive heart failure, prevention of atrial fibrillation, and the relative merits of single-chamber and dual-chamber pacemakers.
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Affiliation(s)
- D J Slotwiner
- Department of Medicine, Division of Cardiology, New York Hospital-Cornell University Medical College, New York, New York 10021, USA
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