A Pilot Study Assessing ECG versus ECHO Ventriculoventricular Optimization in Pediatric Resynchronization Patients

Punn, Rajesh; Hanisch, Debra; Motonaga, Kara S.; Rosenthal, David N.; Ceresnak, Scott R.; Dubin, Anne M.

doi:10.1111/jce.12863

Cited by 16 publications

(4 citation statements)

References 25 publications

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“…Several echocardiographic methods have been clinically utilized for the quantification of mechanical (contractile) myocardial dyssynchrony, including M-mode echocardiography, Doppler tissue imaging, Doppler-derived strain, and strain rate analysis or, more recently, STE. Each of these methods has limitations leading to modest accuracy to predict CRT response [ 22 , 23 ]. Lower reproducibility and temporal resolution over 10 ms are the main drawbacks.…”

Section: Discussionmentioning

confidence: 99%

Ventricular dyssynchrony assessment using ultra-high frequency ECG technique

Jurák

Halámek

Meluzı́n

et al. 2017

J Interv Card Electrophysiol

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PurposeThe aim of this proof-of-concept study is to introduce new high-dynamic ECG technique with potential to detect temporal-spatial distribution of ventricular electrical depolarization and to assess the level of ventricular dyssynchrony.Methods5-kHz 12-lead ECG data was collected. The amplitude envelopes of the QRS were computed in an ultra-high frequency band of 500–1000 Hz and were averaged (UHFQRS). UHFQRS V lead maps were compiled, and numerical descriptor identifying ventricular dyssynchrony (UHFDYS) was detected.ResultsAn electrical UHFQRS maps describe the ventricular dyssynchrony distribution in resolution of milliseconds and correlate with strain rate results obtained by speckle tracking echocardiography. The effect of biventricular stimulation is demonstrated by the UHFQRS morphology and by the UHFDYS descriptor in selected examples.ConclusionsUHFQRS offers a new and simple technique for assessing electrical activation patterns in ventricular dyssynchrony with a temporal-spatial resolution that cannot be obtained by processing standard surface ECG. The main clinical potential of UHFQRS lies in the identification of differences in electrical activation among CRT candidates and detection of improvements in electrical synchrony in patients with biventricular pacing.Electronic supplementary materialThe online version of this article (doi:10.1007/s10840-017-0268-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Ventricular dyssynchrony assessment using ultra-high frequency ECG technique

Jurák

Halámek

Meluzı́n

et al. 2017

J Interv Card Electrophysiol

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“…According to the authors, echocardiography optimization of synchrony was not superior to ECG optimization. ECG optimization required less time and cost [ 40 , 41 ].…”

Section: Resultsmentioning

confidence: 99%

The Role of Echocardiography in the Optimization of Cardiac Resynchronization Therapy: Current Evidence and Future Perspectives

Spartalis¹,

Tzatzaki²,

Spartalis³

et al. 2017

TOCMJ

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Background:Cardiac resynchronization therapy (CRT) has become a mainstay in the management of heart failure. Up to one-third of patients who received resynchronization devices do not experience the full benefits of CRT. The clinical factors influencing the likelihood to respond to the therapy are wide QRS complex, left bundle branch block, female gender, non-ischaemic cardiomyopathy (highest responders), male gender, ischaemic cardiomyopathy (moderate responders) and narrow QRS complex, non-left bundle branch block (lowest, non-responders). Objective:This review provides a conceptual description of the role of echocardiography in the optimization of CRT. Method:A literature survey was performed using PubMed database search to gather information regarding CRT and echocardiography. Results:A total of 70 studies met selection criteria for inclusion in the review. Echocardiography helps in the initial selection of the patients with dyssynchrony, which will benefit the most from optimal biventricular pacing and provides a guide to left ventricular (LV) lead placement during implantation. Different echocardiographic parameters have shown promise and can offer the possibility of patient selection, response prediction, lead placement optimization strategies and optimization of device configurations. Conclusion:LV ejection fraction along with specific electrocardiographic criteria remains the cornerstone of CRT patient selection. Echocardiography is a non-invasive, cost-effective, highly reproducible method with certain limitations and accuracy that is affected by measurement errors. Echocardiography can assist with the identification of the appropriate electromechanical substrate of CRT response and LV lead placement. The targeted approach can improve the haemodynamic response, as also the patient-specific parameters estimation.

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“…Due to dynamic changes in cardiac physiology and anatomy, whether it be positive (in responders) or negative (in nonresponders), the optimal pacing location and device timings may change dynamically. Optimizing pacing location and timings as the heart remodels over time may therefore offer a strategy for maximizing CRT response . Dynamically optimizing timing delays during the course of CRT treatment remains controversial, with some studies showing improvement, while others finding no improvements in clinical outcome with optimization after 3–6 months of CRT .…”

Section: Introductionmentioning

confidence: 99%

“…Optimizing pacing location and timings as the heart remodels over time may therefore offer a strategy for maximizing CRT response. 13,14 Dynamically optimizing timing delays during the course of CRT treatment remains controversial, with some studies showing improvement, 15,16 while others finding no improvements in clinical outcome with optimization after 3-6 months of CRT. 7,17 Recent advances in multisite LV stimulation from multipolar leads in a single vein or multivein pacing now offer the potential to noninvasively and dynamically optimize both the timing and location of pacing following device implantation to maximize patient response.…”

Section: Introductionmentioning

confidence: 99%

Biophysical Modeling to Determine the Optimization of Left Ventricular Pacing Site and AV/VV Delays in the Acute and Chronic Phase of Cardiac Resynchronization Therapy

Lee

Crozier

Hyde

et al. 2017

Cardiovasc electrophysiol

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Device Optimization for Acute and Chronic CRTBackgroundCardiac anatomy and function adapt in response to chronic cardiac resynchronization therapy (CRT). The effects of these changes on the optimal left ventricle (LV) lead location and timing delay settings have yet to be fully explored.ObjectiveTo predict the effects of chronic CRT on the optimal LV lead location and device timing settings over time.MethodsBiophysical computational cardiac models were generated for 3 patients, immediately post‐implant (ACUTE) and after at least 6 months of CRT (CHRONIC). Optimal LV pacing area and device settings were predicted by pacing the ACUTE and CHRONIC models across the LV epicardium (49 sites each) with a range of 9 pacing settings and simulating the acute hemodynamic response (AHR) of the heart.ResultsThere were statistically significant differences between the distribution of the AHR in the ACUTE and CHRONIC models (P < 0.0005 in all cases). The site delivering the maximal AHR shifted location between the ACUTE and CHRONIC models but provided a negligible improvement (<2%). The majority of the acute optimal LV pacing regions (76–100%) and device settings (76–91%) remained optimal chronically.ConclusionOptimization of the LV pacing location and device settings were important at the time of implant, with a reduced benefit over time, where the majority of the acute optimal LV pacing region and device settings remained optimal with chronic CRT.

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A Pilot Study Assessing ECG versus ECHO Ventriculoventricular Optimization in Pediatric Resynchronization Patients

Abstract: ECHO optimization of synchrony was not superior to ECG optimization in this pilot study. ECG optimization required less time and cost than ECHO optimization.

Cited by 16 publications

References 25 publications

Ventricular dyssynchrony assessment using ultra-high frequency ECG technique

Ventricular dyssynchrony assessment using ultra-high frequency ECG technique

The Role of Echocardiography in the Optimization of Cardiac Resynchronization Therapy: Current Evidence and Future Perspectives

Biophysical Modeling to Determine the Optimization of Left Ventricular Pacing Site and AV/VV Delays in the Acute and Chronic Phase of Cardiac Resynchronization Therapy

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