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Sisti N, Cardona A, Baldi E, Sciaccaluga C, Notaristefano F, Santoro A, Mandoli GE, Cameli M. Multimodality Imaging for Selecting Candidates for CRT: Do We Have a Single Alley to Increase Responders? Curr Probl Cardiol 2024; 49:102150. [PMID: 37863462 DOI: 10.1016/j.cpcardiol.2023.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
Cardiac resynchronization therapy has evolved in recent years to provide a reduction of morbidity and mortality for many patients with heart failure. Its application and optimization is an evolving field and its use requires a multidisciplinary approach for patient and device selection, technical preprocedural planning, and optimization. While echocardiography has always been considered the first line for the evaluation of patients, additional imaging techniques have gained increasing evidence in recent years. Today different details about heart anatomy, function, dissynchrony can be investigated by magnetic resonance, cardiac computed tomography, nuclear imaging, and more, with the aim of obtaining clues to reach a maximal response from the electrical therapy. The purpose of this review is to provide a practical analysis of the single and combined use of different imaging techniques in the preoperative and perioperative phases of cardiac resynchronization therapy, underlining their main advantages, limitations, and information provided.
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Affiliation(s)
- Nicolò Sisti
- Department of Cardiology, Hospital of Gubbio, Gubbio, Italy.
| | - Andrea Cardona
- Division of Advanced Cardiovascular Diagnostics, Regional Healthcare Unit, Todi Hospital, Todi, Italy
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | | | - Amato Santoro
- Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
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2
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Radu AD, Zlibut A, Scarlatescu A, Cojocaru C, Bogdan S, Scafa-Udriște A, Dorobantu M. Cardiac Resynchronization Therapy and Left Atrial Remodeling: A Novel Insight? Biomedicines 2023; 11:1156. [PMID: 37189774 PMCID: PMC10136256 DOI: 10.3390/biomedicines11041156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) restores ventricular dyssynchrony, improving left ventricle (LV) systolic function, symptoms, and outcome in patients with heart failure, systolic dysfunction, and prolonged QRS interval. The left atrium (LA) plays tremendous roles in maintaining cardiac function, being often inflicted in various cardiovascular diseases. LA remodeling implies structural-dilation, functional-altered phasic functions, and strain and electrical-atrial fibrillation remodeling. Until now, several important studies have approached the relationship between LA and CRT. LA volumes can predict responsiveness to CRT, being also associated with improved outcome in these patients. LA function and strain parameters have been shown to improve after CRT, especially in those who were positive responders to it. Further studies still need to be conducted to comprehensively characterize the impact of CRT on LA phasic function and strain, and, also, in conjunction with its impact on functional mitral regurgitation and LV diastolic dysfunction. The aim of this review was to provide an overview of current available data regarding the relation between CRT and LA remodeling.
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Affiliation(s)
- Andrei Dan Radu
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Alexandru Zlibut
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Alina Scarlatescu
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cosmin Cojocaru
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Stefan Bogdan
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Cardiology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Alexandru Scafa-Udriște
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Maria Dorobantu
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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3
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Waddingham PH, Mangual JO, Orini M, Badie N, Muthumala A, Sporton S, McSpadden LC, Lambiase PD, Chow AWC. Electrocardiographic imaging demonstrates electrical synchrony improvement by dynamic atrioventricular delays in patients with left bundle branch block and preserved atrioventricular conduction. Europace 2023; 25:536-545. [PMID: 36480445 PMCID: PMC9935053 DOI: 10.1093/europace/euac224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022] Open
Abstract
AIMS Cardiac resynchronization therapy programmed to dynamically fuse pacing with intrinsic conduction using atrioventricular (AV) timing algorithms (e.g. SyncAV) has shown promise; however, mechanistic data are lacking. This study assessed the impact of SyncAV on electrical dyssynchrony across various pacing modalities using non-invasive epicardial electrocardiographic imaging (ECGi). METHODS AND RESULTS Twenty-five patients with left bundle-branch block (median QRS duration (QRSd) 162.7 ms) and intact AV conduction (PR interval 174.0 ms) were prospectively enrolled. ECGi was performed acutely during biventricular pacing with fixed nominal AV delays (BiV) and using SyncAV (optimized for the narrowest QRSd) during: BiV + SyncAV, LV-only single-site (LVSS + SyncAV), MultiPoint pacing (MPP + SyncAV), and LV-only MPP (LVMPP + SyncAV). Dyssynchrony was quantified via ECGi (LV activation time, LVAT; RV activation time, RVAT; LV electrical dispersion index, LVEDi; ventricular electrical uncoupling index, VEU; and biventricular total activation time, VVtat). Intrinsic conduction LVAT (124 ms) was significantly reduced by BiV pacing (109 ms) (P = 0.001) and further reduced by LVSS + SyncAV (103 ms), BiV + SyncAV (103 ms), LVMPP + SyncAV (95 ms), and MPP + SyncAV (90 ms). Intrinsic RVAT (93 ms), VVtat (130 ms), LVEDi (36 ms), VEU (50 ms), and QRSd (163 ms) were reduced by SyncAV across all pacing modes. More patients exhibited minimal LVAT, VVtat, LVEDi, and QRSd with MPP + SyncAV than any other modality. CONCLUSION Dynamic AV delay programming targeting fusion with intrinsic conduction significantly reduced dyssynchrony, as quantified by ECGi and QRSd for all evaluated pacing modes. MPP + SyncAV achieved the greatest synchrony overall but not for all patients, highlighting the value of pacing mode individualization during fusion optimization.
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Affiliation(s)
- Peter H Waddingham
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.,William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London EC1M 6BQ, UK
| | | | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Amal Muthumala
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | | | - Pier D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.,Institute of Cardiovascular Science, University College London, London, UK
| | - Anthony W C Chow
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.,William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London EC1M 6BQ, UK
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4
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Waddingham PH, Mangual J, Orini M, Badie N, McSpadden L, Lambiase PD, Chow AW. Noninvasive electrocardiographic imaging of dynamic atrioventricular delay programming in a patient with left bundle branch block. HeartRhythm Case Rep 2021; 7:849-853. [PMID: 34987974 PMCID: PMC8695252 DOI: 10.1016/j.hrcr.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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5
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Sedova K, Repin K, Donin G, Dam PV, Kautzner J. Clinical Utility of Body Surface Potential Mapping in CRT Patients. Arrhythm Electrophysiol Rev 2021; 10:113-119. [PMID: 34401184 PMCID: PMC8335851 DOI: 10.15420/aer.2021.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
This paper reviews the current status of the knowledge on body surface potential mapping (BSPM) and ECG imaging (ECGI) methods for patient selection, left ventricular (LV) lead positioning, and optimisation of CRT programming, to indicate the major trends and future perspectives for the application of these methods in CRT patients. A systematic literature review using PubMed, Scopus, and Web of Science was conducted to evaluate the available clinical evidence regarding the usage of BSPM and ECGI methods in CRT patients. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement was used as a basis for this review. BSPM and ECGI methods applied in CRT patients were assessed, and quantitative parameters of ventricular depolarisation delivered from BSPM and ECGI were extracted and summarised. BSPM and ECGI methods can be used in CRT in several ways, namely in predicting CRT outcome, in individualised optimisation of CRT device programming, and the guiding of LV electrode placement, however, further prospective or randomised trials are necessary to verify the utility of BSPM for routine clinical practice.
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Affiliation(s)
- Ksenia Sedova
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Kirill Repin
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Gleb Donin
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Peter Van Dam
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Waddingham PH, Lambiase P, Muthumala A, Rowland E, Chow AW. Fusion Pacing with Biventricular, Left Ventricular-only and Multipoint Pacing in Cardiac Resynchronisation Therapy: Latest Evidence and Strategies for Use. Arrhythm Electrophysiol Rev 2021; 10:91-100. [PMID: 34401181 PMCID: PMC8335856 DOI: 10.15420/aer.2020.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 12/11/2022] Open
Abstract
Despite advances in the field of cardiac resynchronisation therapy (CRT), response rates and durability of therapy remain relatively static. Optimising device timing intervals may be the most common modifiable factor influencing CRT efficacy after implantation. This review addresses the concept of fusion pacing as a method for improving patient outcomes with CRT. Fusion pacing describes the delivery of CRT pacing with a programming strategy to preserve intrinsic atrioventricular (AV) conduction and ventricular activation via the right bundle branch. Several methods have been assessed to achieve fusion pacing. QRS complex duration (QRSd) shortening with CRT is associated with improved clinical response. Dynamic algorithm-based optimisation targeting narrowest QRSd in patients with intact AV conduction has shown promise in people with heart failure with left bundle branch block. Individualised dynamic programming achieving fusion may achieve the greatest magnitude of electrical synchrony, measured by QRSd narrowing.
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Affiliation(s)
- Peter H Waddingham
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Pier Lambiase
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,UCL Institute of Cardiovascular Science University College London, London, UK
| | - Amal Muthumala
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Edward Rowland
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anthony Wc Chow
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
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Anselme F, Albatat M, Marquié C, Leclercq C, Ritter P, Ollivier JF, Shan N, Ziglio F, Feuerstein D. Exploring a New Systematic Route for Left Ventricular Pacing in Cardiac Resynchronization Therapy. Circ J 2021; 85:283-290. [PMID: 33504741 DOI: 10.1253/circj.cj-20-0266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Frequency and distribution of left ventricular (LV) venous collaterals were studied in vivo to evaluate the ease and feasibility of implanting a new ultra-thin LV quadripolar microlead for cardiac resynchronization therapy (CRT).Methods and Results:Evaluable venograms were analyzed to define the prevalence of venous collaterals (>0.5 mm diameter) between: (1) different LV segments; and (2) different major LV veins in: unselected patients who underwent CRT from 2008 to 2012 at Rouen Hospital, France (retrospective); and CRT patients from the Axone Acute pilot study in 2018 (prospective). In prospective patients with evaluable venograms, LV microlead implantation was attempted. Thirty-six (21/65 retrospective, 15/20 prospective) patients had evaluable venograms with ≥1 visible venous collaterals. Collaterals were found between LV veins in all CRT patients with evaluable venograms. Regionally, prevalence was highest between: the apical inferior and apical lateral (42%); and mid inferior and mid inferolateral (42%) segments. Collateral connections were most prevalent between: the inferior interventricular vein (IIV) and lateral vein (64% [23/36]); and IIV and infero-lateral vein (36% [13/36]). Cross-vein microlead implantation was possible in 18 patients (90%), and single-vein implantation was conducted in the other 2 patients (10%). CONCLUSIONS Venous collaterals were found in vivo between LV veins in all CRT patients with evaluable venograms, making this network an option for accessing multiple LV sites using a single LV microlead.
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8
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Left Axis Deviation in Brugada Syndrome: Vectorcardiographic Evaluation during Ajmaline Provocation Testing Reveals Additional Depolarization Abnormalities. Int J Mol Sci 2021; 22:ijms22020484. [PMID: 33418933 PMCID: PMC7825029 DOI: 10.3390/ijms22020484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 11/17/2022] Open
Abstract
Patients with Brugada syndrome (BrS) can show a leftward deviation of the frontal QRS-axis upon provocation with sodium channel blockers. The cause of this axis change is unclear. In this study, we aimed to determine (1) the prevalence of this left axis deviation and (2) to evaluate its cause, using the insights that could be derived from vectorcardiograms. Hence, from a large cohort of patients who underwent ajmaline provocation testing (n = 1430), we selected patients in whom a type-1 BrS-ECG was evoked (n = 345). Depolarization and repolarization parameters were analyzed for reconstructed vectorcardiograms and were compared between patients with and without a >30° leftward axis shift. We found (1) that the prevalence of a left axis deviation during provocation testing was 18% and (2) that this left axis deviation was not explained by terminal conduction slowing in the right ventricular outflow tract (4th QRS-loop quartile: +17 ± 14 ms versus +13 ± 15 ms, nonsignificant) but was associated with a more proximal conduction slowing (1st QRS-loop quartile: +12[8;18] ms versus +8[4;12] ms, p < 0.001 and 3rd QRS-loop quartile: +12 ± 10 ms versus +5 ± 7 ms, p < 0.001). There was no important heterogeneity of the action potential morphology (no difference in the ventricular gradient), but a left axis deviation did result in a discordant repolarization (spatial QRS-T angle: 122[59;147]° versus 44[25;91]°, p < 0.001). Thus, although the development of the type-1 BrS-ECG is characterized by a terminal conduction delay in the right ventricle, BrS-patients with a left axis deviation upon sodium channel blocker provocation have an additional proximal conduction slowing, which is associated with a subsequent discordant repolarization. Whether this has implications for risk stratification is still undetermined.
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Hajek P, Safarikova I, Baxa J. Image-guided left ventricular lead placement in cardiac resynchronization therapy: focused on image fusion methods. J Appl Biomed 2019; 17:199-208. [PMID: 34907722 DOI: 10.32725/jab.2019.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/30/2019] [Indexed: 11/05/2022] Open
Abstract
Cardiac resynchronization therapy is an effective and widely accessible treatment for patients with advanced, drug-refractory heart failure. It has been shown to reverse maladaptive ventricular remodeling, increase exercise capacity, and lower hospitalization and mortality rates. However, there still exists a considerable proportion of patients who do not respond favorably to the therapy. Tailored left ventricular (LV) lead positioning instead of empiric implantation is thought to have the greatest potential to increase response rates. In our paper, we focus on the rationale for guided LV lead implantation and provide a review of the non-invasive imaging modalities applicable for navigation during LV lead implantation, with special attention to the latest achievements in the field of multimodality imaging and image fusion techniques. Current limitations and future perspectives of the concept are discussed as well.
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Affiliation(s)
- Premysl Hajek
- Ceske Budejovice Hospital, Department of Cardiology, Ceske Budejovice, Czech Republic
| | - Iva Safarikova
- Ceske Budejovice Hospital, Department of Cardiology, Ceske Budejovice, Czech Republic.,University of South Bohemia in Ceske Budejovice, Faculty of Health and Social Sciences, Budejovice, Czech Republic
| | - Jan Baxa
- Charles University in Prague, University Hospital and Faculty of Medicine in Pilsen, Department of Imaging Methods, Pilsen, Czech Republic
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10
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Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices. Ann Biomed Eng 2019; 48:26-46. [DOI: 10.1007/s10439-019-02376-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/25/2019] [Indexed: 01/29/2023]
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11
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Defining left bundle branch block-Is this a roadblock to CRT delivery? Int J Cardiol 2019; 286:78-80. [PMID: 30928259 DOI: 10.1016/j.ijcard.2019.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 11/20/2022]
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12
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Tao N, Qiu Y, Tang H, Qian Z, Wu H, Zhu R, Wang Y, Hou X, Zhou W, Zou J. Assessment of left ventricular contraction patterns using gated SPECT MPI to predict cardiac resynchronization therapy response. J Nucl Cardiol 2018; 25:2029-2038. [PMID: 28608184 DOI: 10.1007/s12350-017-0949-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/24/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The U-shaped left ventricular (LV) contraction pattern, identified by MRI or echocardiography, is associated with improved CRT response. Gated SPECT MPI can measure both myocardial viability and mechanical dyssynchrony in a single scan. The aim of this study is to examine the relationship of the LV contraction pattern and the response of CRT in patients with left bundle branch block (LBBB). METHODS Fifty-eight patients who met CRT guidelines and who had pre-CRT MPI were enrolled. Myocardial segments with tracer uptake < 50% of maximum were considered as scar. The LV contraction pattern was considered as U-shaped or non-U-shaped (U-shaped has a block line in the direction of contraction propagation). CRT response was defined as an increase in left ventricular ejection fraction ≥ 5% after 6-month follow-up. RESULTS Twenty-eight patients (48%) had a U-shaped contraction pattern and thirty patients (52%) had a non-U-shaped contraction pattern. The U-shaped group showed a significantly higher response rate than the non-U-shaped group (90% vs. 57%; P = 0.005). By univariate and multivariate logistic regression analysis, the U-shaped pattern was an independent predictor of CRT response. CONCLUSION Non-invasive gated SPECT MPI can characterize LV mechanical contraction patterns. A U-shaped contraction pattern identified is associated with improved CRT response. This may prove useful for improved patient selection for CRT.
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Affiliation(s)
- Ningchao Tao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Yuanhao Qiu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Haipeng Tang
- School of Computing, University of Southern Mississippi, Long Beach, MS, 39560, USA
| | - Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Hongping Wu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Rui Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, 39560, USA.
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China.
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Albatat M, King DR, Unger LA, Arevalo H, Wall S, Sundnes J, Bergsland J, Balasingham I. Electromechanical Model to Predict Cardiac Resynchronization Therapy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:5446-5459. [PMID: 30441569 DOI: 10.1109/embc.2018.8513539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac resynchronization therapy (CRT) can substantially improve dyssynchronous heart failure and reduce mortality. However, one-third of the CRT patients derive no measurable benefit from CRT, due to suboptimal placement of the left ventricular (LV) lead. We introduce a pipeline for improved CRT-therapy by creating an electromechanical model using patient-specific geometric parameters allowing individualization of therapy. The model successfully mimics expected changes when variables for tension, stiffness, and conduction are entered. Changing LV pacing site had a notable effect on maximum pressure gradient (dP/dtmax) in the presence of cardiac scarring, causing non-uniform excitation propagation through the LV. Tailoring CRT to the individual requires simulations with patient-specific biventricular meshes including cardiac geometry and conductivity properties.
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14
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Sieniewicz BJ, Gould J, Porter B, Sidhu BS, Behar JM, Claridge S, Niederer S, Rinaldi CA. Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy. Expert Rev Med Devices 2018; 15:555-570. [PMID: 30019954 PMCID: PMC6178093 DOI: 10.1080/17434440.2018.1502084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/12/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment. AREAS COVERED This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT. EXPERT COMMENTARY Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.
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Affiliation(s)
- Benjamin J. Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Baldeep S Sidhu
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Behar
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon Claridge
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steve Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
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15
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Okada JI, Washio T, Nakagawa M, Watanabe M, Kadooka Y, Kariya T, Yamashita H, Yamada Y, Momomura SI, Nagai R, Hisada T, Sugiura S. Absence of Rapid Propagation through the Purkinje Network as a Potential Cause of Line Block in the Human Heart with Left Bundle Branch Block. Front Physiol 2018; 9:56. [PMID: 29467667 PMCID: PMC5808183 DOI: 10.3389/fphys.2018.00056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/17/2018] [Indexed: 01/31/2023] Open
Abstract
Background: Cardiac resynchronization therapy is an effective device therapy for heart failure patients with conduction block. However, a problem with this invasive technique is the nearly 30% of non-responders. A number of studies have reported a functional line of block of cardiac excitation propagation in responders. However, this can only be detected using non-contact endocardial mapping. Further, although the line of block is considered a sign of responders to therapy, the mechanism remains unclear. Methods: Herein, we created two patient-specific heart models with conduction block and simulated the propagation of excitation based on a cellmodel of electrophysiology. In one model with a relatively narrow QRS width (176 ms), we modeled the Purkinje network using a thin endocardial layer with rapid conduction. To reproduce a wider QRS complex (200 ms) in the second model, we eliminated the Purkinje network, and we simulated the endocardial mapping by solving the inverse problem according to the actual mapping system. Results: We successfully observed the line of block using non-contact mapping in the model without the rapid propagation of excitation through the Purkinje network, although the excitation in the wall propagated smoothly. This model of slow conduction also reproduced the characteristic properties of the line of block, including dense isochronal lines and fractionated local electrocardiograms. Further, simulation of ventricular pacing from the lateral wall shifted the location of the line of block. By contrast, in the model with the Purkinje network, propagation of excitation in the endocardial map faithfully followed the actual propagation in the wall, without showing the line of block. Finally, switching the mode of propagation between the two models completely reversed these findings. Conclusions: Our simulation data suggest that the absence of rapid propagation of excitation through the Purkinje network is the major cause of the functional line of block recorded by non-contact endocardial mapping. The line of block can be used to identify responders as these patients loose rapid propagation through the Purkinje network.
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Affiliation(s)
- Jun-Ichi Okada
- Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
| | - Takumi Washio
- Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
| | | | | | | | - Taro Kariya
- Department of Cardiovascular Medicine, School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Yamashita
- Department of Cardiovascular Medicine, School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoko Yamada
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shin-Ichi Momomura
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Ryozo Nagai
- Department of Cardiovascular Medicine, School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Hisada
- Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
| | - Seiryo Sugiura
- Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
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16
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Papageorgiou N, Providência R, Lambiase PD, Tousoulis D, Lloyd G, Bhattacharyya S. Does presence of left ventricular contractile reserve improve response to cardiac resynchronization therapy? An updated meta-analysis. Int J Cardiol 2018; 252:224-228. [DOI: 10.1016/j.ijcard.2017.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/26/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
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17
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Bertaglia E, Migliore F, Baritussio A, De Simone A, Reggiani A, Pecora D, D'Onofrio A, Rapacciuolo A, Savarese G, Pierantozzi A, Marenna B, Ruffa F, Campari M, Malacrida M, Stabile G. Stricter criteria for left bundle branch block diagnosis do not improve response to CRT. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:850-856. [PMID: 28543265 DOI: 10.1111/pace.13104] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/20/2017] [Accepted: 04/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has proved to be effective in patients with heart failure and left bundle branch block (LBBB). Recently, new electrocardiography criteria have been proposed for the diagnosis of LBBB. These criteria are stricter than the current American Heart Association (AHA) criteria. We assessed the rate of echocardiographic response to CRT in patients with traditional LBBB versus patients who met the new criteria (strict LBBB). METHODS Consecutive patients undergoing CRT were enrolled in the CRT MORE registry. Patients with no-LBBB QRS morphology according to AHA criteria, atrial fibrillation, right bundle branch block, and right ventricular pacing were excluded. Strict LBBB was defined as: QRS ≥ 140 ms for men and ≥130 ms for women, QS or rS in V1-V2, mid-QRS notching or slurring in ≥2 contiguous leads. Patients showing a relative decrease of ≥15% in left ventricular end-systolic volume (LVESV) at 12 months were defined as responders. RESULTS Among 335 patients with LBBB, 131 (39%) had strict LBBB. Patients with and without strict LBBB showed comparable baseline characteristics, except for QRS duration (166 ± 20 ms vs 152 ± 25 ms, P < 0.001). On 12-month evaluation, 205 patients (61%) were responders; 85 of 131 (65%) had strict LBBB and 120 of 204 (59%) had traditional LBBB (P = 0.267). On multivariate analysis, a history of atrial fibrillation, larger LVESV, and the presence of mid-QRS notching in ≥1 lead (odds ratio 2.099; 95% confidence interval 1.061-4.152, P = 0.033) were independently associated with echocardiographic response. CONCLUSION Stricter definition of LBBB did not improve response to CRT in comparison to the current AHA definition.
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Affiliation(s)
- Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Anna Baritussio
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | | | | | | | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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18
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Derval N, Duchateau J, Mahida S, Eschalier R, Sacher F, Lumens J, Cochet H, Denis A, Pillois X, Yamashita S, Komatsu Y, Ploux S, Amraoui S, Zemmoura A, Ritter P, Hocini M, Haissaguerre M, Jaïs P, Bordachar P. Distinctive Left Ventricular Activations Associated With ECG Pattern in Heart Failure Patients. Circ Arrhythm Electrophysiol 2017. [DOI: 10.1161/circep.117.005073] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In contrast to patients with left bundle branch block (LBBB), heart failure patients with narrow QRS and nonspecific intraventricular conduction delay (NICD) display a relatively limited response to cardiac resynchronization therapy. We sought to compare left ventricular (LV) activation patterns in heart failure patients with narrow QRS and NICD to patients with LBBB using high-density electroanatomic activation maps.
Methods and Results—
Fifty-two heart failure patients (narrow QRS [n=18], LBBB [n=11], NICD [n=23]) underwent 3-dimensional electroanatomic mapping with a high density of mapping points (387±349 LV). Adjunctive scar imaging was available in 37 (71%) patients and was analyzed in relation to activation maps. LBBB patients typically demonstrated (1) a single LV breakthrough at the septum (38±15 ms post-QRS onset); (2) prolonged right-to-left transseptal activation with absence of direct LV Purkinje activity; (3) homogeneous propagation within the LV cavity; and (4) latest activation at the basal lateral LV. In comparison, both NICD and narrow QRS patients demonstrated (1) multiple LV breakthroughs along the posterior or anterior fascicles: narrow QRS versus LBBB, 5±2 versus 1±1;
P
=0.0004; NICD versus LBBB, 4±2 versus 1±1;
P
=0.001); (2) evidence of early/pre-QRS LV electrograms with Purkinje potentials; (3) rapid propagation in narrow QRS patients and more heterogeneous propagation in NICD patients; and (4) presence of limited areas of late activation associated with LV scar with high interindividual heterogeneity.
Conclusions—
In contrast to LBBB patients, narrow QRS and NICD patients are characterized by distinct mechanisms of LV activation, which may predict poor response to cardiac resynchronization therapy.
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Affiliation(s)
- Nicolas Derval
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Josselin Duchateau
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Saagar Mahida
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Romain Eschalier
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Frederic Sacher
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Joost Lumens
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Hubert Cochet
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Arnaud Denis
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Xavier Pillois
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Seigo Yamashita
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Yuki Komatsu
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Sylvain Ploux
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Sana Amraoui
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Adlane Zemmoura
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Philippe Ritter
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Mélèze Hocini
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Michel Haissaguerre
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Pierre Jaïs
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Pierre Bordachar
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
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19
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Providencia R, Rogers D, Papageorgiou N, Ioannou A, James A, Babu G, Cobb V, Ahsan S, Segal OR, Rowland E, Lowe M, Lambiase PD, Chow AW. Long-Term Results of Triventricular Versus Biventricular Pacing in Heart Failure. JACC Clin Electrophysiol 2016; 2:825-835. [DOI: 10.1016/j.jacep.2016.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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20
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Schreurs R, Wiegerinck RF, Prinzen FW. Exploring the Electrophysiologic and Hemodynamic Effects of Cardiac Resynchronization Therapy: From Bench to Bedside and Vice Versa. Heart Fail Clin 2016; 13:43-52. [PMID: 27886931 DOI: 10.1016/j.hfc.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an important therapy for heart failure patients with prolonged QRS duration. In patients with left bundle branch block the altered left ventricular electrical activation results in dyssynchronous, inefficient contraction of the left ventricle. CRT aims to reverse these changes and to improve cardiac function. This article explores the electrophysiologic and hemodynamic changes that occur during CRT in patient and animal studies. It also addresses how novel techniques, such as multipoint and endocardial pacing, can further improve the electromechanical response.
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Affiliation(s)
- Rick Schreurs
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Rob F Wiegerinck
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
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21
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Sadeghian H, Kousari A, Majidi S, Rezvanfard M, Kazemisaeid A, Moezzi SA, Vasheghani Farahani A, Abdar Esfahani M, Sahebjam M, Zoroufian A, Sadeghian A. Association between Latest Activated Sites in the Left Ventricle and Akinetic Segments in Patients with Ischemic Cardiomyopathy. J Tehran Heart Cent 2016; 11:115-122. [PMID: 27956911 PMCID: PMC5148814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: It is not clear whether the latest activation sites in the left ventricle (LV) are matched with infracted regions in patients with ischemic cardiomyopathy (ICM). We aimed to investigate whether the latest activation sites in the LV are in agreement with the region of akinesia in patients with ICM. Methods: Data were analyzed in 106 patients (age = 60.5 ± 12.1 y, male = 88.7%) with ICM (ejection fraction ≤ 35%) who were refractory to pharmacological therapy and were referred to the echocardiography department for an evaluation of the feasibility of cardiac resynchronization therapy. Wall motion abnormalities, time to peak systolic myocardial velocity (Ts) of 6 basal and 6 mid-portion segments of the LV, and 4 frequently used dyssynchrony indices were measured using 2-dimensional echocardiography and tissue Doppler imaging (TDI). To evaluate the influence of the electrocardiographic pattern, we categorized the patients into 2 groups: patients with QRS ≤ 120 ms and those with QRS >120 ms. Results: A total of 1 272 segments were studied. The latest activation sites (with longest Ts) were most frequently located in the mid-anterior (n = 32, 30.2%) and basal-anterior segments (n = 29, 27.4%), while the most common sites of akinesia were the mid-anteroseptal (n = 65, 61.3%) and mid-septal (n = 51, 48.1%) segments. Generally, no significant concordance was found between the latest activated segments and akinesia either in all the patients or in the QRS groups. Detailed analysis within the segments indicated a good agreement between akinesia and delayed activation in the basal-lateral segment solely in the patients with QRS duration ≤ 120 ms (Φ = 0.707; p value ≤ 0.001). Conclusion: The akinetic segment on 2-dimensional echocardiogram was not matched with the latest activation sites in the LV determined by TDI in patients with ICM.
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Affiliation(s)
- Hakimeh Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Hakimeh Sadeghian, Associate Professor of Cardiology, Tehran Heart Center, North Kargar Street, Tehran, Iran. 1411713138. Tel: +98 21 88029257. Fax: +98 21 88029256.
| | - Aliasghar Kousari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Shahla Majidi
- Emam Khomeini Hospital, Ahvaz University of Medical Sciences, Ahvaz, Iran.
| | - Mehrnaz Rezvanfard
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Kazemisaeid
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Ali Moezzi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | | | | | - Mohammad Sahebjam
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Arezoo Zoroufian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
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22
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Hyde ER, Behar JM, Crozier A, Claridge S, Jackson T, Sohal M, Gill JS, O'Neill MD, Razavi R, Niederer SA, Rinaldi CA. Improvement of Right Ventricular Hemodynamics with Left Ventricular Endocardial Pacing during Cardiac Resynchronization Therapy. Pacing Clin Electrophysiol 2016; 39:531-41. [PMID: 27001004 PMCID: PMC4913734 DOI: 10.1111/pace.12854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/22/2016] [Accepted: 03/13/2016] [Indexed: 11/30/2022]
Abstract
Background Cardiac resynchronization therapy (CRT) with biventricular epicardial (BV‐CS) or endocardial left ventricular (LV) stimulation (BV‐EN) improves LV hemodynamics. The effect of CRT on right ventricular function is less clear, particularly for BV‐EN. Our objective was to compare the simultaneous acute hemodynamic response (AHR) of the right and left ventricles (RV and LV) with BV‐CS and BV‐EN in order to determine the optimal mode of CRT delivery. Methods Nine patients with previously implanted CRT devices successfully underwent a temporary pacing study. Pressure wires measured the simultaneous AHR in both ventricles during different pacing protocols. Conventional epicardial CRT was delivered in LV‐only (LV‐CS) and BV‐CS configurations and compared with BV‐EN pacing in multiple locations using a roving decapolar catheter. Results Best BV‐EN (optimal AHR of all LV endocardial pacing sites) produced a significantly greater RV AHR compared with LV‐CS and BV‐CS pacing (P < 0.05). RV AHR had a significantly increased standard deviation compared to LV AHR (P < 0.05) with a weak correlation between RV and LV AHR (Spearman rs = −0.06). Compromised biventricular optimization, whereby RV AHR was increased at the expense of a smaller decrease in LV AHR, was achieved in 56% of cases, all with BV‐EN pacing. Conclusions BV‐EN pacing produces significant increases in both LV and RV AHR, above that achievable with conventional epicardial pacing. RV AHR cannot be used as a surrogate for optimizing LV AHR; however, compromised biventricular optimization is possible. The beneficial effect of endocardial LV pacing on RV function may have important clinical benefits beyond conventional CRT.
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Affiliation(s)
- Eoin R Hyde
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Jonathan M Behar
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Andrew Crozier
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Simon Claridge
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Tom Jackson
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Manav Sohal
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Jaswinder S Gill
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Mark D O'Neill
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Steven A Niederer
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Christopher A Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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Schreurs R, Wiegerinck RF, Prinzen FW. Exploring the Electrophysiologic and Hemodynamic Effects of Cardiac Resynchronization Therapy: From Bench to Bedside and Vice Versa. Card Electrophysiol Clin 2015; 7:599-608. [PMID: 26596805 DOI: 10.1016/j.ccep.2015.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an important therapy for heart failure patients with prolonged QRS duration. In patients with left bundle branch block the altered left ventricular electrical activation results in dyssynchronous, inefficient contraction of the left ventricle. CRT aims to reverse these changes and to improve cardiac function. This article explores the electrophysiologic and hemodynamic changes that occur during CRT in patient and animal studies. It also addresses how novel techniques, such as multipoint and endocardial pacing, can further improve the electromechanical response.
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Affiliation(s)
- Rick Schreurs
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Rob F Wiegerinck
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
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Lumens J, Tayal B, Walmsley J, Delgado-Montero A, Huntjens PR, Schwartzman D, Althouse AD, Delhaas T, Prinzen FW, Gorcsan J. Differentiating Electromechanical From Non-Electrical Substrates of Mechanical Discoordination to Identify Responders to Cardiac Resynchronization Therapy. Circ Cardiovasc Imaging 2015; 8:e003744. [PMID: 26338877 DOI: 10.1161/circimaging.115.003744] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular (LV) mechanical discoordination, often referred to as dyssynchrony, is often observed in patients with heart failure regardless of QRS duration. We hypothesized that different myocardial substrates for LV mechanical discoordination exist from (1) electromechanical activation delay, (2) regional differences in contractility, or (3) regional scar and that we could differentiate electromechanical substrates responsive to cardiac resynchronization therapy (CRT) from unresponsive non-electrical substrates. METHODS AND RESULTS First, we used computer simulations to characterize mechanical discoordination patterns arising from electromechanical and non-electrical substrates and accordingly devise the novel systolic stretch index (SSI), as the sum of posterolateral systolic prestretch and septal systolic rebound stretch. Second, 191 patients with heart failure (QRS duration ≥120 ms; LV ejection fraction ≤35%) had baseline SSI quantified by automated echocardiographic radial strain analysis. Patients with SSI≥9.7% had significantly less heart failure hospitalizations or deaths 2 years after CRT (hazard ratio, 0.32; 95% confidence interval, 0.19-0.53; P<0.001) and less deaths, transplants, or LV assist devices (hazard ratio, 0.28; 95% confidence interval, 0.15-0.55; P<0.001). Furthermore, in a subgroup of 113 patients with intermediate electrocardiographic criteria (QRS duration of 120-149 ms or non-left bundle branch block), SSI≥9.7% was independently associated with significantly less heart failure hospitalizations or deaths (hazard ratio, 0.41; 95% confidence interval, 0.23-0.79; P=0.004) and less deaths, transplants, or LV assist devices (hazard ratio, 0.27; 95% confidence interval, 0.12-0.60; P=0.001). CONCLUSIONS Computer simulations differentiated patterns of LV mechanical discoordination caused by electromechanical substrates responsive to CRT from those related to regional hypocontractility or scar unresponsive to CRT. The novel SSI identified patients who benefited more favorably from CRT, including those with intermediate electrocardiographic criteria, where CRT response is less certain by ECG alone.
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Affiliation(s)
- Joost Lumens
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.).
| | - Bhupendar Tayal
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - John Walmsley
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Antonia Delgado-Montero
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Peter R Huntjens
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - David Schwartzman
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Andrew D Althouse
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Tammo Delhaas
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Frits W Prinzen
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - John Gorcsan
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
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Abstract
Cardiac resynchronisation therapy (CRT) is an effective intervention for appropriately selected patients with heart failure, but exactly how it works is uncertain. Recent data suggest that much, or perhaps most, of the benefits of CRT are not delivered by re-coordinating left ventricular dyssynchrony. Atrio-ventricular resynchronization, reduction in mitral regurgitation and prevention of bradycardia are other potential mechanisms of benefit that will vary from one patient to the next and over time. Because there is no single therapeutic target, it is unlikely that any single measure will accurately predict benefit. The only clinical characteristic that appears to be a useful predictor of the benefits of CRT is a QRS duration of >140 ms. Many new approaches are being developed to try to improve the effectiveness of and extend the indications for CRT. These include smart pacing algorithms, better pacing-site targeting, new sensors, multipoint pacing, remote device monitoring and leadless endocardial pacing. Whether CRT is effective in patients with atrial fibrillation or whether adding a defibrillator function to CRT improves prognosis awaits further evidence.
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Niazi IK, Sperzel J, Heist EK, Rosenberg SP, Ryu K, Yang M, D'Avila A, Singh JP. Three-Dimensional Cardiac Mapping Characterizes Ventricular Contractile Patterns during Cardiac Resynchronization Therapy Implant: A Feasibility Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1091-8. [PMID: 26096125 DOI: 10.1111/pace.12674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 05/04/2015] [Accepted: 06/01/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electroanatomic mapping systems track the position of electrodes in the heart. We assessed the feasibility of characterizing left ventricular (LV) performance during cardiac resynchronization therapy (CRT) implant utilizing an electroanatomic mapping system to track the motion of CRT lead electrodes, thus deriving ventricular contractility surrogates. METHODS During CRT implant, atrial, right ventricular (RV), and LV leads were connected to the EnSite NavX™ mapping system (St. Jude Medical Inc., St. Paul, MN, USA). The relative displacement of electrodes was averaged over 10 cardiac cycles during RV, LV, and biventricular (BiV) pacing in DOO mode. Three contractility surrogates indicative of ventricular performance were extracted from the RV-LV distance waveform: systolic slope (SS), time to peak systolic contraction (TPSC), and fractional shortening (FS). RESULTS In the 20 patients included, there were detectable differences in each of the three contractility surrogates responding to the different pacing configurations. Median SS varied 42%, median TPSC varied 35%, and median FS varied 19% across RV, LV, and BiV pacing interventions. The RV-LV distance waveform showed subtle sensitivity to varying pacing timing cycles when measured in a subset of patients. For all pacing configurations, RV-LV distance waveforms were stable during 2-minute recordings. CONCLUSIONS Tracking the motion of CRT pacing electrodes with a mapping system to derive contractility surrogates during implant is feasible.
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Affiliation(s)
- Imran K Niazi
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | | | | | | | | | | | - Andre D'Avila
- Massachusetts General Hospital, Boston, Massachusetts
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Lopez-Perez A, Sebastian R, Ferrero JM. Three-dimensional cardiac computational modelling: methods, features and applications. Biomed Eng Online 2015; 14:35. [PMID: 25928297 PMCID: PMC4424572 DOI: 10.1186/s12938-015-0033-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 04/02/2015] [Indexed: 01/19/2023] Open
Abstract
The combination of computational models and biophysical simulations can help to interpret an array of experimental data and contribute to the understanding, diagnosis and treatment of complex diseases such as cardiac arrhythmias. For this reason, three-dimensional (3D) cardiac computational modelling is currently a rising field of research. The advance of medical imaging technology over the last decades has allowed the evolution from generic to patient-specific 3D cardiac models that faithfully represent the anatomy and different cardiac features of a given alive subject. Here we analyse sixty representative 3D cardiac computational models developed and published during the last fifty years, describing their information sources, features, development methods and online availability. This paper also reviews the necessary components to build a 3D computational model of the heart aimed at biophysical simulation, paying especial attention to cardiac electrophysiology (EP), and the existing approaches to incorporate those components. We assess the challenges associated to the different steps of the building process, from the processing of raw clinical or biological data to the final application, including image segmentation, inclusion of substructures and meshing among others. We briefly outline the personalisation approaches that are currently available in 3D cardiac computational modelling. Finally, we present examples of several specific applications, mainly related to cardiac EP simulation and model-based image analysis, showing the potential usefulness of 3D cardiac computational modelling into clinical environments as a tool to aid in the prevention, diagnosis and treatment of cardiac diseases.
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Affiliation(s)
- Alejandro Lopez-Perez
- Centre for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, València, Spain.
| | - Rafael Sebastian
- Computational Multiscale Physiology Lab (CoMMLab), Universitat de València, València, Spain.
| | - Jose M Ferrero
- Centre for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, València, Spain.
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Varma N, Ploux S, Ritter P, Wilkoff B, Eschalier R, Bordachar P. Noninvasive mapping of electrical dyssynchrony in heart failure and cardiac resynchronization therapy. Card Electrophysiol Clin 2015; 7:125-134. [PMID: 25784029 DOI: 10.1016/j.ccep.2014.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Causes for diverse effects of cardiac resynchronization therapy (CRT) are poorly understood. Because CRT is an electrical therapy, it may be best understood by detailed characterization of electrical substrate and its interaction with pacing. Electrocardiogram (ECG) features affect CRT outcomes. However, the surface ECG reports rudimentary electrical data. In contrast, noninvasive electrocardiographic imaging provides high-resolution single-beat ventricular mapping. Several complex characteristics of electrical substrate, not decipherable from the 12-lead ECG, are linked to CRT effect. CRT response may be improved by candidate selection and left ventricular lead placement directed by more precise electrical evaluation, on an individual patient basis.
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Affiliation(s)
- Niraj Varma
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Sylvain Ploux
- CHU Bordeaux, Liryc Institute Bordeaux, Université de Bordeaux, France
| | - Philippe Ritter
- CHU Bordeaux, Liryc Institute Bordeaux, Université de Bordeaux, France
| | - Bruce Wilkoff
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Romain Eschalier
- CHU Bordeaux, Liryc Institute Bordeaux, Université de Bordeaux, France
| | - Pierre Bordachar
- CHU Bordeaux, Liryc Institute Bordeaux, Université de Bordeaux, France
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Varma N. Left ventricular electrical activation during right ventricular pacing in heart failure patients with LBBB: Visualization by electrocardiographic imaging and implications for cardiac resynchronization therapy. J Electrocardiol 2015; 48:53-61. [DOI: 10.1016/j.jelectrocard.2014.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Indexed: 11/16/2022]
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Huntjens PR, Walmsley J, Ploux S, Bordachar P, Prinzen FW, Delhaas T, Lumens J. Influence of left ventricular lead position relative to scar location on response to cardiac resynchronization therapy: a model study. Europace 2014; 16 Suppl 4:iv62-iv68. [DOI: 10.1093/europace/euu231] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Silva E, Bijnens B, Berruezo A, Mont L, Doltra A, Andreu D, Brugada J, Sitges M. Integración de la imagen mecánica, estructural y eléctrica para entender la respuesta a la terapia de resincronización cardiaca. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Silva E, Bijnens B, Berruezo A, Mont L, Doltra A, Andreu D, Brugada J, Sitges M. Integration of mechanical, structural and electrical imaging to understand response to cardiac resynchronization therapy. ACTA ACUST UNITED AC 2014; 67:813-21. [PMID: 25262127 DOI: 10.1016/j.rec.2013.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is extensive controversy exists on whether cardiac resynchronization therapy corrects electrical or mechanical asynchrony. The aim of this study was to determine if there is a correlation between electrical and mechanical sequences and if myocardial scar has any relevant impact. METHODS Six patients with normal left ventricular function and 12 patients with left ventricular dysfunction and left bundle branch block, treated with cardiac resynchronization therapy, were studied. Real-time three-dimensional echocardiography and electroanatomical mapping were performed in all patients and, where applicable, before and after therapy. Magnetic resonance was performed for evaluation of myocardial scar. Images were postprocessed and mechanical and electrical activation sequences were defined and time differences between the first and last ventricular segment to be activated were determined. Response to therapy was defined as a reduction in left ventricular end-systolic volume ≥ 15% after 12 months of follow-up. RESULTS Good correlation between electrical and mechanical timings was found in patients with normal left ventricular function (r(2) = 0.88; P = .005) but not in those with left ventricular dysfunction (r(2) = 0.02; P = not significant). After therapy, both timings and sequences were modified and improved, except in those with myocardial scar. CONCLUSIONS Despite a close electromechanical relationship in normal left ventricular function, there is no significant correlation in patients with dysfunction. Although resynchronization therapy improves this correlation, the changes in electrical activation may not yield similar changes in left ventricular mechanics particularly depending on the underlying myocardial substrate.
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Affiliation(s)
- Etelvino Silva
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Bart Bijnens
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antonio Berruezo
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Lluis Mont
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Adelina Doltra
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - David Andreu
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Josep Brugada
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Marta Sitges
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
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Dynamic conduction and repolarisation changes in early arrhythmogenic right ventricular cardiomyopathy versus benign outflow tract ectopy demonstrated by high density mapping & paced surface ECG analysis. PLoS One 2014; 9:e99125. [PMID: 25014132 PMCID: PMC4094482 DOI: 10.1371/journal.pone.0099125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 05/09/2014] [Indexed: 11/26/2022] Open
Abstract
Aims The concealed phase of arrhythmogenic right ventricular cardiomyopathy (ARVC) may initially manifest electrophysiologically. No studies have examined dynamic conduction/repolarization kinetics to distinguish benign right ventricular outflow tract ectopy (RVOT ectopy) from ARVC's early phase. We investigated dynamic endocardial electrophysiological changes that differentiate early ARVC disease expression from RVOT ectopy. Methods 22 ARVC (12 definite based upon family history and mutation carrier status, 10 probable) patients without right ventricular structural anomalies underwent high-density non-contact mapping of the right ventricle. These were compared to data from 14 RVOT ectopy and 12 patients with supraventricular tachycardias and normal hearts. Endocardial & surface ECG conduction and repolarization parameters were assessed during a standard S1-S2 restitution protocol. Results Definite ARVC without RV structural disease could not be clearly distinguished from RVOT ectopy during sinus rhythm or during steady state pacing. Delay in Activation Times at coupling intervals just above the ventricular effective refractory period (VERP) increased in definite ARVC (43±20 ms) more than RVOT ectopy patients (36±14 ms, p = 0.03) or Normals (25±16 ms, p = 0.008) and a progressive separation of the repolarisation time curves between groups existed. Repolarization time increases in the RVOT were also greatest in ARVC (definite ARVC: 18±20 ms; RVOT ectopy: 5±14, Normal: 1±18, p<0.05). Surface ECG correlates of these intracardiac measurements demonstrated an increase of greater than 48 ms in stimulus to surface ECG J-point pre-ERP versus steady state, with an 88% specificity and 68% sensitivity in distinguishing definite ARVC from the other groups. This technique could not distinguish patients with genetic predisposition to ARVC only (probable ARVC) from controls. Conclusions Significant changes in dynamic conduction and repolarization are apparent in early ARVC before detectable RV structural abnormalities, and were present to a lesser degree in probable ARVC patients. Investigation of dynamic electrophysiological parameters may be useful to identify concealed ARVC in patients without disease pedigrees by using endocardial electrogram or paced ECG parameters.
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Three-dimensional electroanatomic mapping of the coronary veins during cardiac resynchronization therapy implant: feasibility and possible applications. J Interv Card Electrophysiol 2014; 41:147-53. [DOI: 10.1007/s10840-014-9932-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
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36
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Sade LE, Saba S, Marek JJ, Onishi T, Schwartzman D, Adelstein EC, Soman P, Gorcsan J. The Association of Left Ventricular Lead Position Related to Regional Scar by Speckle-Tracking Echocardiography with Clinical Outcomes in Patients Receiving Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2014; 27:648-56. [DOI: 10.1016/j.echo.2014.01.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Indexed: 10/25/2022]
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Vernooy K, van Deursen CJM, Strik M, Prinzen FW. Strategies to improve cardiac resynchronization therapy. Nat Rev Cardiol 2014; 11:481-93. [PMID: 24839977 DOI: 10.1038/nrcardio.2014.67] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiac resynchronization therapy (CRT) emerged 2 decades ago as a useful form of device therapy for heart failure associated with abnormal ventricular conduction, indicated by a wide QRS complex. In this Review, we present insights into how to achieve the greatest benefits with this pacemaker therapy. Outcomes from CRT can be improved by appropriate patient selection, careful positioning of right and left ventricular pacing electrodes, and optimal timing of electrode stimulation. Left bundle branch block (LBBB), which can be detected on an electrocardiogram, is the predominant substrate for CRT, and patients with this conduction abnormality yield the most benefit. However, other features, such as QRS morphology, mechanical dyssynchrony, myocardial scarring, and the aetiology of heart failure, might also determine the benefit of CRT. No single left ventricular pacing site suits all patients, but a late-activated site, during either the intrinsic LBBB rhythm or right ventricular pacing, should be selected. Positioning the lead inside a scarred region substantially impairs outcomes. Optimization of stimulation intervals improves cardiac pump function in the short term, but CRT procedures must become easier and more reliable, perhaps with the use of electrocardiographic measures, to improve long-term outcomes.
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Affiliation(s)
- Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, Netherlands
| | | | - Marc Strik
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, Netherlands
| | - Frits W Prinzen
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands
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Seger M, Hanser F, Dichtl W, Stuehlinger M, Hintringer F, Trieb T, Pfeifer B, Berger T. Non-invasive imaging of cardiac electrophysiology in a cardiac resynchronization therapy defibrillator patient with a quadripolar left ventricular lead. Europace 2014; 16:743-9. [DOI: 10.1093/europace/euu045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rogers DP, Lambiase PD, Lowe MD, Chow AW. A randomized double-blind crossover trial of triventricular versus biventricular pacing in heart failure. Eur J Heart Fail 2014; 14:495-505. [DOI: 10.1093/eurjhf/hfs004] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Dominic P.S. Rogers
- The Heart Hospital; Institute of Cardiovascular Medicine, UCLH; London W1G 8PH UK
| | - Pier D. Lambiase
- The Heart Hospital; Institute of Cardiovascular Medicine, UCLH; London W1G 8PH UK
| | - Martin D. Lowe
- The Heart Hospital; Institute of Cardiovascular Medicine, UCLH; London W1G 8PH UK
| | - Anthony W.C. Chow
- The Heart Hospital; Institute of Cardiovascular Medicine, UCLH; London W1G 8PH UK
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Spotnitz HM. Invited commentary. Ann Thorac Surg 2014; 97:609. [PMID: 24484799 DOI: 10.1016/j.athoracsur.2013.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 10/01/2013] [Accepted: 10/11/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Henry M Spotnitz
- Department of Surgery, Columbia University Medical Center, 622 W 168th St, 10th Flr, Vanderbilt Clinic, Rm 1010, New York, NY10032.
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Masarone D, Limongelli G, Ammendola E, Del Giorno G, Colimodio F, D’Andrea A, Pacileo G, Santangelo L, Lambiase PD. Cardiac resynchronization therapy in cardiomyopathies. J Cardiovasc Med (Hagerstown) 2014; 15:92-9. [DOI: 10.2459/jcm.0b013e3283637ff2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Varma N. Variegated left ventricular electrical activation in response to a novel quadripolar electrode: Visualization by non-invasive electrocardiographic imaging. J Electrocardiol 2014; 47:66-74. [DOI: 10.1016/j.jelectrocard.2013.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Indexed: 10/26/2022]
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MIHALCZ ATTILA, KASSAI IMRE, GELLER LASZLO, SZILI-TÖRÖK TAMAS. Alternative Techniques for Left Ventricular Pacing in Cardiac Resynchronization Therapy. Pacing Clin Electrophysiol 2013; 37:255-61. [DOI: 10.1111/pace.12320] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 09/26/2013] [Accepted: 10/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - IMRE KASSAI
- Hungarian National Institute of Cardiology; Budapest Hungary
| | - LASZLO GELLER
- Heart Center; Semmelweis University; Budapest Hungary
| | - TAMAS SZILI-TÖRÖK
- Department of Clinical Cardiac Electrophysiology; Thorax Centre; Rotterdam the Netherlands
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Affiliation(s)
- Frits W. Prinzen
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Kevin Vernooy
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Angelo Auricchio
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
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Sohal M, Shetty A, Duckett S, Chen Z, Sammut E, Amraoui S, Carr-White G, Razavi R, Rinaldi CA. Noninvasive Assessment of LV Contraction Patterns Using CMR to Identify Responders to CRT. JACC Cardiovasc Imaging 2013; 6:864-73. [DOI: 10.1016/j.jcmg.2012.11.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/15/2012] [Indexed: 10/26/2022]
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Kydd AC, McCormick LM, Dutka DP. Optimizing benefit from CRT: role of speckle tracking echocardiography, the importance of LV lead position and scar. Expert Rev Med Devices 2013; 9:521-36. [PMID: 23116079 DOI: 10.1586/erd.12.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac resynchronization therapy is demonstrated to be effective in patients with advanced heart failure. Correcting mechanical dyssynchrony is proposed as the predominant mechanism of response. Achieving optimum left ventricular lead position, at the site of maximal mechanical dyssynchrony but away from transmural scar, is identified as one of the main determinants of both symptomatic and prognostic benefit. Strategies employing multimodality cardiac imaging techniques have been used to identify this optimal pacing site, in addition to any potential anatomical limitations to successful implantation. Speckle tracking echocardiography offers prospective lead targeting, incorporating pathophysiological determinants of cardiac resynchronization therapy response. This review considers the key factors in defining optimum left ventricular lead location, emphasizing the role of myocardial scar. The use of speckle tracking echocardiography and the potential for this technique to be incorporated into routine practice to guide the implant strategy in an individual patient is discussed.
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Affiliation(s)
- Anna C Kydd
- Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, UK
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Auricchio A, Delnoy PP, Regoli F, Seifert M, Markou T, Butter C. First-in-man implantation of leadless ultrasound-based cardiac stimulation pacing system: novel endocardial left ventricular resynchronization therapy in heart failure patients. Europace 2013; 15:1191-7. [DOI: 10.1093/europace/eut124] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kandala J, Upadhyay GA, Altman RK, Parks KA, Orencole M, Mela T, Kevin Heist E, Singh JP. QRS morphology, left ventricular lead location, and clinical outcome in patients receiving cardiac resynchronization therapy. Eur Heart J 2013; 34:2252-62. [DOI: 10.1093/eurheartj/eht123] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Ginks MR, Shetty AK, Lambiase PD, Duckett SG, Bostock J, Peacock JL, Rhode KS, Bucknall C, Gill J, Taggart P, Leclercq C, Carr-White GS, Razavi R, Rinaldi CA. Benefits of Endocardial and Multisite Pacing Are Dependent on the Type of Left Ventricular Electric Activation Pattern and Presence of Ischemic Heart Disease. Circ Arrhythm Electrophysiol 2012; 5:889-97. [DOI: 10.1161/circep.111.967505] [Citation(s) in RCA: 61] [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)
- Matthew R. Ginks
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Anoop K. Shetty
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Pier D. Lambiase
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Simon G. Duckett
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Julian Bostock
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Janet L. Peacock
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Kawal S. Rhode
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Cliff Bucknall
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Jaswinder Gill
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Peter Taggart
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Christophe Leclercq
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Gerald S. Carr-White
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Reza Razavi
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - C. Aldo Rinaldi
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
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An image-based model of the whole human heart with detailed anatomical structure and fiber orientation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2012; 2012:891070. [PMID: 22952559 PMCID: PMC3431151 DOI: 10.1155/2012/891070] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 07/20/2012] [Indexed: 12/14/2022]
Abstract
Many heart anatomy models have been developed to study the electrophysiological properties of the human heart. However, none of them includes the geometry of the whole human heart. In this study, an anatomically detailed mathematical model of the human heart was firstly reconstructed from the computed tomography images. In the reconstructed model, the atria consisted of atrial muscles, sinoatrial node, crista terminalis, pectinate muscles, Bachmann's bundle, intercaval bundles, and limbus of the fossa ovalis. The atrioventricular junction included the atrioventricular node and atrioventricular ring, and the ventricles had ventricular muscles, His bundle, bundle branches, and Purkinje network. The epicardial and endocardial myofiber orientations of the ventricles and one layer of atrial myofiber orientation were then measured. They were calculated using linear interpolation technique and minimum distance algorithm, respectively. To the best of our knowledge, this is the first anatomically-detailed human heart model with corresponding experimentally measured fibers orientation. In addition, the whole heart excitation propagation was simulated using a monodomain model. The simulated normal activation sequence agreed well with the published experimental findings.
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