1
|
Noheria A, Sodhi S, Orme GJ. The Evolving Role of Electrocardiography in Cardiac Resynchronization Therapy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:91. [DOI: 10.1007/s11936-019-0784-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
2
|
Pujol-López M, San Antonio R, Mont L, Trucco E, Tolosana JM, Arbelo E, Guasch E, Heist EK, Singh JP. Electrocardiographic optimization techniques in resynchronization therapy. Europace 2019; 21:1286-1296. [DOI: 10.1093/europace/euz126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/05/2019] [Indexed: 12/22/2022] Open
Abstract
Abstract
Cardiac resynchronization therapy (CRT) is a cornerstone of therapy for patients with heart failure, reduced left ventricular (LV) ejection fraction, and a wide QRS complex. However, not all patients respond to CRT: 30% of CRT implanted patients are currently considered clinical non-responders and up to 40% do not achieve LV reverse remodelling. In order to achieve the best CRT response, appropriate patient selection, device implantation, and programming are important factors. Optimization of CRT pacing intervals may improve results, increasing the number of responders, and the magnitude of the response. Echocardiography is considered the reference method for atrioventricular and interventricular (VV) intervals optimization but it is time-consuming, complex and it has a large interobserver and intraobserver variability. Previous studies have linked QRS shortening to clinical response, echocardiographic improvement and favourable prognosis. In this review, we describe the electrocardiographic optimization methods available: 12-lead electrocardiogram; fusion-optimized intervals (FOI); intracardiac electrogram-based algorithms; and electrocardiographic imaging. Fusion-optimized intervals is an electrocardiographic method of optimizing CRT based on QRS duration that combines fusion with intrinsic conduction. The FOI method is feasible and fast, further reduces QRS duration, can be performed during implant, improves acute haemodynamic response, and achieves greater LV remodelling compared with nominal programming of CRT.
Collapse
Affiliation(s)
- Margarida Pujol-López
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Rodolfo San Antonio
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Lluís Mont
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Emilce Trucco
- Department of Cardiology, Hospital Universitari Doctor Josep Trueta, Girona, Catalonia, Spain
| | - José María Tolosana
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Elena Arbelo
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Edwin Kevin Heist
- Cardiology Division, Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jagmeet P Singh
- Cardiology Division, Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Cardiogoniometry can predict positive response to cardiac resynchronization therapy - A proof of concept study. Indian Heart J 2019; 70 Suppl 3:S60-S63. [PMID: 30595322 PMCID: PMC6309150 DOI: 10.1016/j.ihj.2018.05.009] [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: 09/10/2017] [Revised: 04/29/2018] [Accepted: 05/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background According to American Heart Association guidelines, QRS duration and morphology are used to select patients for cardiac resynchronization therapy (CRT). But still there are some patients who are not responding to this device. We investigated whether the Cardiogoniometry (CGM) as a three-dimensional vectorcardiogram method can improve patient selection. Methods Echocardiography and CGM were performed for 25 consecutive patients with Left bundle branch morphology who were candidate for CRT implantation and were in sinus rhythm. Patients re-evaluated by echocardiography after 6 months post CRT implantation. Results The mean age of the patients was 63 ± 13 years and 17 (68%) were males. The mean LVEF was 19.4 ± 7.4% and 24.2 ± 11.5% before and after CRT implantation respectively. Median of the duration of the R loop before the R maximum demonstrated a negative correlation with the increase in LVEF, (r = −0.36, P = 0.07) and mean of maximal spatial velocity of the T-loop for all measured showed a positive correlation (r = 0.39, p = 0.04). Other parameters didn't show any significant differences. Conclusions Three-dimensional vectorcardiogram parameters can be helpful to predict the CRT response. Shorter duration of the R loop before the maximum R and smaller R loop area are predictors for responder patients.
Collapse
|
4
|
Brown OI, Nikolaidou T, Beddoes G, Hoye A, Clark AL. The HF-CGM Study: An Analysis of Cardiogoniometric Axes in Patients With Cardiac Resynchronization Therapy. IEEE Trans Biomed Eng 2018; 65:1711-1716. [PMID: 29989935 DOI: 10.1109/tbme.2017.2769060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
GOAL The HF-CGM is a proof-of-principle study to investigate whether cardiogoniometry (CGM), a three-dimensional electrocardiographic method, can differentiate between pacing modes in patients with cardiac resynchronization therapy (CRT). METHODS At a tertiary cardiology center, CGM recordings were performed using four pacing modes: no pacing; right ventricular (RV) pacing; left ventricular (LV) pacing, and biventricular (BIV) pacing. Three orthogonal CGM planes orientated to the long axis (XY), the frontal plane (YZ), and the short axis (XZ) of the heart were constructed, and the direction of the QRS-axis was calculated for each pacing mode in each plane. During BIV pacing, the direction of CGM QRS-axis was compared between patients with optimal and nonoptimal 12-lead pacing variables. RESULTS Twenty-two participants (aged 71.5 ± 10.8; 77.3% male, LVEF 29 ± 7%) were consecutively recruited. Only QRS-axis measured in the XY plane could significantly distinguish between all three pacing modes versus no pacing. Mean QRS-axis in the XY plane with pacing off and during RV pacing was leftward and basal; LV pacing was apical; and BIV pacing was rightward and basal. There was a statistically significant difference in the direction of the QRS-axis between patients with optimal versus nonoptimal paced QRS morphology in the XY plane (rightward and basal versus inconsistent). SIGNIFICANCE CGM recorded in the XY plane can accurately detect differences between ventricular pacing sites. It may also be able to identify patients with a CRT device in situ who have optimal response.
Collapse
|
5
|
Engels EB, Strik M, van Middendorp LB, Kuiper M, Vernooy K, Prinzen FW. Prediction of optimal cardiac resynchronization by vectors extracted from electrograms in dyssynchronous canine hearts. J Cardiovasc Electrophysiol 2017; 28:944-951. [PMID: 28467647 DOI: 10.1111/jce.13241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Proper optimization of atrioventricular (AV) and interventricular (VV) intervals can improve the response to cardiac resynchronization therapy (CRT). It has been demonstrated that the area of the QRS complex (QRSarea) extracted from the vectorcardiogram can be used as a predictor of optimal CRT-device settings. We explored the possibility of extracting vectors from the electrograms (EGMs) obtained from pacing electrodes and of using these EGM-based vectors (EGMVs) to individually optimize acute hemodynamic CRT response. METHODS AND RESULTS Biventricular pacing was performed in 13 dogs with left bundle branch block (LBBB) of which five also had myocardial infarction (MI), using 100 randomized AV- and VV-settings. Settings providing an acute increase in LV dP/dtmax ≥ 90% of the highest achieved value were defined as optimal. The prediction capability of QRSarea derived from the EGMV (EGMV-QRSarea) was compared with that of QRS duration. EGMV-QRSarea strongly correlated to the change in LV dP/dtmax (R = -0.73 ± 0.19 [LBBB] and -0.66 ± 0.14 [LBBB + MI]), while QRS duration was more poorly related to LV dP/dtmax changes (R = -0.33 ± 0.25 [LBBB] and -0.47 ± 0.39 [LBBB + MI]). This resulted in a better prediction of optimal CRT-device settings by EGMV-QRSarea than by QRS duration (LBBB: AUC = 0.89 [0.86-0.93] vs. 0.76 [0.69-0.83], P < 0.01; LBBB + MI: AUC = 0.91 [0.84-0.99] vs. 0.82 [0.59-1.00], P = 0.20, respectively). CONCLUSION In canine hearts with chronic LBBB with or without MI, the EGMV-QRSarea predicts acute hemodynamic CRT response and identifies optimal AV and VV settings accurately. These data support the potency of EGM-based vectors as a noninvasive, easy and patient-tailored tool to optimize CRT-device settings.
Collapse
Affiliation(s)
- Elien B Engels
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Marc Strik
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Lars B van Middendorp
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Marion Kuiper
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
6
|
Daubert C, Mabo P, Leclercq C. Do novel noninvasive ECG techniques improve patient selection for CRT? Heart Rhythm 2017; 14:400-401. [DOI: 10.1016/j.hrthm.2016.12.019] [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: 11/24/2016] [Indexed: 10/20/2022]
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Seifert M, Butter C. Evaluation of wireless stimulation of the endocardium, WiSE, technology for treatment heart failure. Expert Rev Med Devices 2016; 13:523-31. [DOI: 10.1080/17434440.2016.1187559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Engels EB, Alshehri S, van Deursen CJ, Wecke L, Bergfeldt L, Vernooy K, Prinzen FW. The synthesized vectorcardiogram resembles the measured vectorcardiogram in patients with dyssynchronous heart failure. J Electrocardiol 2015; 48:586-92. [DOI: 10.1016/j.jelectrocard.2015.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Indexed: 10/23/2022]
|
11
|
van Deursen CJM, Wecke L, van Everdingen WM, Ståhlberg M, Janssen MHG, Braunschweig F, Bergfeldt L, Crijns HJGM, Vernooy K, Prinzen FW. Vectorcardiography for optimization of stimulation intervals in cardiac resynchronization therapy. J Cardiovasc Transl Res 2015; 8:128-37. [PMID: 25743446 PMCID: PMC4382533 DOI: 10.1007/s12265-015-9615-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/12/2015] [Indexed: 11/26/2022]
Abstract
Current optimization of atrioventricular (AV) and interventricular (VV) intervals in cardiac resynchronization therapy (CRT) is time consuming and subject to noise. We aimed to prove the principle that the best hemodynamic effect of CRT is achieved by cancelation of opposing electrical forces, detectable from the QRS morphology in the 3D vectorcardiogram (VCG). Different degrees of left (LV) and right ventricular (RV) pre-excitation were induced, using variation in AV intervals during LV pacing in 20 patients with left bundle branch block (LBBB) and variation in VV intervals during biventricular pacing in 18 patients with complete AV block or atrial fibrillation. The smallest QRS vector area identified stimulation intervals with minimal systolic stretch (median difference [IQR] 20 ms [−20, 20 ms] and maximal hemodynamic response (10 ms [−20, 40 ms]). Reliability of VCG measurements was superior to hemodynamic measurements. This study proves the principle that VCG analysis may allow easy and reliable optimization of stimulation intervals in CRT patients.
Collapse
Affiliation(s)
- Caroline J M van Deursen
- Departments of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
|
13
|
Sagara K. Ventriculoventricular delay optimization of a cardiac resynchronization device. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
|
14
|
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: 61] [Impact Index Per Article: 5.5] [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.
Collapse
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
| |
Collapse
|
15
|
van Deursen CJ, Blaauw Y, Witjens MI, Debie L, Wecke L, Crijns HJ, Prinzen FW, Vernooy K. The value of the 12-lead ECG for evaluation and optimization of cardiac resynchronization therapy in daily clinical practice. J Electrocardiol 2014; 47:202-11. [DOI: 10.1016/j.jelectrocard.2014.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Indexed: 01/30/2023]
|
16
|
van Middendorp LB, Strik M, Houthuizen P, Kuiper M, Maessen JG, Auricchio A, Prinzen FW. Electrophysiological and haemodynamic effects of vernakalant and flecainide in dyssynchronous canine hearts. Europace 2014; 16:1249-56. [DOI: 10.1093/europace/eut429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
17
|
Electrophysiological and Hemodynamic Effects of Vernakalant and Flecainide During Cardiac Resynchronization in Dyssynchronous Canine Hearts. J Cardiovasc Pharmacol 2014; 63:25-32. [DOI: 10.1097/fjc.0000000000000020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Sohaib SMA, Whinnett ZI, Ellenbogen KA, Stellbrink C, Quinn TA, Bogaard MD, Bordachar P, van Gelder BM, van Geldorp IE, Linde C, Meine M, Prinzen FW, Turcott RG, Spotnitz HM, Wichterle D, Francis DP. Cardiac resynchronisation therapy optimisation strategies: systematic classification, detailed analysis, minimum standards and a roadmap for development and testing. Int J Cardiol 2013; 170:118-31. [PMID: 24239155 DOI: 10.1016/j.ijcard.2013.10.069] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/19/2013] [Accepted: 10/19/2013] [Indexed: 01/23/2023]
Abstract
In this article an international group of CRT specialists presents a comprehensive classification system for present and future schemes for optimising CRT. This system is neutral to the measurement technology used, but focuses on little-discussed quantitative physiological requirements. We then present a rational roadmap for reliable cost-effective development and evaluation of schemes. A widely recommended approach for AV optimisation is to visually select the ideal pattern of transmitral Doppler flow. Alternatively, one could measure a variable (such as Doppler velocity time integral) and "pick the highest". More complex would be to make measurements across a range of settings and "fit a curve". In this report we provide clinicians with a critical approach to address any recommendations presented to them, as they may be many, indistinct and conflicting. We present a neutral scientific analysis of each scheme, and equip the reader with simple tools for critical evaluation. Optimisation protocols should deliver: (a) singularity, with only one region of optimality rather than several; (b) blinded test-retest reproducibility; (c) plausibility; (d) concordance between independent methods; and (e) transparency, with all steps open to scrutiny. This simple information is still not available for many optimisation schemes. Clinicians developing the habit of asking about each property in turn will find it easier to win now down the broad range of protocols currently promoted. Expectation of a sophisticated enquiry from the clinical community will encourage optimisation protocol-designers to focus on testing early (and cheaply) the basic properties that are vital for any chance of long term efficacy.
Collapse
Affiliation(s)
-
- National Heart & Lung Institute, Imperial College London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Strik M, van Deursen CJ, van Middendorp LB, van Hunnik A, Kuiper M, Auricchio A, Prinzen FW. Transseptal Conduction as an Important Determinant for Cardiac Resynchronization Therapy, as Revealed by Extensive Electrical Mapping in the Dyssynchronous Canine Heart. Circ Arrhythm Electrophysiol 2013; 6:682-9. [DOI: 10.1161/circep.111.000028] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marc Strik
- From the Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands (M.S., C.J.M.v.D., L.B.v.M., A.v.H., M.K., F.W.P.); and Department of Cardiology, Fondazione, Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Caroline J.M. van Deursen
- From the Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands (M.S., C.J.M.v.D., L.B.v.M., A.v.H., M.K., F.W.P.); and Department of Cardiology, Fondazione, Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Lars B. van Middendorp
- From the Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands (M.S., C.J.M.v.D., L.B.v.M., A.v.H., M.K., F.W.P.); and Department of Cardiology, Fondazione, Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Arne van Hunnik
- From the Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands (M.S., C.J.M.v.D., L.B.v.M., A.v.H., M.K., F.W.P.); and Department of Cardiology, Fondazione, Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Marion Kuiper
- From the Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands (M.S., C.J.M.v.D., L.B.v.M., A.v.H., M.K., F.W.P.); and Department of Cardiology, Fondazione, Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Angelo Auricchio
- From the Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands (M.S., C.J.M.v.D., L.B.v.M., A.v.H., M.K., F.W.P.); and Department of Cardiology, Fondazione, Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Frits W. Prinzen
- From the Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands (M.S., C.J.M.v.D., L.B.v.M., A.v.H., M.K., F.W.P.); and Department of Cardiology, Fondazione, Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| |
Collapse
|