Acute Evaluation of Programmer‐Guided AV/PV and VV Delay Optimization Comparing an IEGM Method and Echocardiogram for Cardiac Resynchronization Therapy in Heart Failure Patients and Dual‐Chamber ICD Implants

Baker, James H.; McKenzie, John P.; Beau, Scott L.; Greer, G. Stephen; Porterfield, James G.; Fedor, Matthew; Greenberg, Steven M.; Daoud, Emile G.; Corbisiero, Raffaele; Bailey, J. Russell; Porterfield, Linda M.

doi:10.1111/j.1540-8167.2006.00671.x

Cited by 96 publications

(88 citation statements)

References 26 publications

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“…These three points are all necessary to guarantee a tailored therapy and to decrease the rate of non responders, especially in the field of electrophysiology where engineering tools could be very useful to support clinical practice and innovation [4,7,10,11,14,15,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…• QuickOpt® of the St.Jude Medical™, where the AV is set to maximize ventricular filling and allow for proper timing of mitral valve closure, while the ventricular sense, right ventricular pace, and the LV pace tests are used to calculate VV to time the pacing stimuli so that the resultant ventricular contractions meet near the ventricular septum [10,11].…”

Section: Molfetta Et Al: Towards a Personalized And Dynamic Crt-dmentioning

confidence: 99%

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Towards a Personalized and Dynamic CRT-D

Molfetta

Santini²,

Forleo³

et al. 2012

Methods Inf Med

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SummaryBackground: In spite of cardiac resynchronization therapy (CRT) benefits, 25 -30% of patients are still non responders. One of the possible reasons could be the non optimal atrioventricular (AV) and interventricular (VV) intervals settings. Our aim was to exploit a numerical model of cardiovascular system for AV and VV intervals optimization in CRT. Methods: A numerical model of the cardiovascular system CRT-dedicated was previously developed. Echocardiographic parameters, Systemic aortic pressure and ECG were collected in 20 consecutive patients before and after CRT. Patient data were simulated by the model that was used to optimize and set into the device the intervals at the baseline and at the follow up. The optimal AV and VV intervals were chosen to optimize the simulated selected variable/s on the base of both echocardiographic and electrocardiographic parameters. Results: Intervals were different for each patient and in most cases, they changed at follow up. The model can well reproduce clinical data as verified with Bland Altman analysis and T-test (p > 0.05). Left ventricular remodeling was 38.7% and left ventricular ejection fraction increasing was 11% against the 15% and 6% reported in literature, respectively. Conclusions: The developed numerical model could reproduce patients conditions at the baseline and at the follow up including the CRT effects. The model could be used to optimize AV and VV intervals at the baseline and at the follow up realizing a personalized and dynamic CRT. A patient tailored CRT could improve patients outcome in comparison to literature data.

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Section: Discussionmentioning

confidence: 99%

Section: Molfetta Et Al: Towards a Personalized And Dynamic Crt-dmentioning

confidence: 99%

Towards a Personalized and Dynamic CRT-D

Molfetta

Santini²,

Forleo³

et al. 2012

Methods Inf Med

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“…34 This method (now incorporated into commercial devices) was shown to have a close correlation with stroke volume (derived from aortic VTi on echocardiography).…”

Section: Other Methods Of Ventricular Optimizationmentioning

confidence: 99%

Ventricular optimization of biventricular pacing: a systematic review

2008

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Biventricular pacing has been shown to improve the overall clinical outcomes in patients with systolic heart failure and ventricular conduction delay on electrocardiogram. As correction of ventricular dyssynchrony is the putative mechanism of benefit, biventricular pacing is also termed as cardiac resynchronization therapy. The development of separate programmability of right and left ventricular output has led to a growing number of reports on the potential benefit of optimization of cardiac resynchronization by sequential biventricular pacing with different techniques and endpoints. This systematic review summarizes the current data for the optimization of sequential (V-V delay) compared with (default) simultaneous biventricular pacing in heart failure.

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“…This has been shown to correlate with echo-based optimization and takes only a few minutes to perform. 71 The treatment of nonresponders should first focus on whether the patient is receiving CRT. The device function should be evaluated to ensure appropriate sensing and capture of all leads.…”

Section: Follow-up and Response To Therapymentioning

confidence: 99%

Interventional Electrophysiology and Cardiac Resynchronization Therapy

Burkhardt

Wilkoff

2007

Circulation

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Abstract-Implantable devices have become a readily available option for patients with heart failure. Not only do these patients develop bradycardia and ventricular tachycardia, but their ventricular dysfunction can often improve with cardiac resynchronization therapy. However, this is a complex and rapidly developing clinical science for which the physician chooses techniques and selects patients on the basis of the results of clinical trials, clinical experience, and rapidly evolving tools. The results depend on the interplay of these complex variables. Placement of the left ventricular lead has forced the device physician to develop new skills and/or interdisciplinary relationships with physicians with vascular intervention, imaging, and surgical skills. Familiarity with the cardiac venous anatomy, occlusive venography, venoplasty, guide wire tools, guiding catheters, stenting, and new intracardiac visualization and magnetic intracardiac lead positioning tools are examples of just a few of the novel skills that are useful in the delivery of cardiac resynchronization therapy. Beyond implantation, these patients and devices require specialized follow-up with continued medical therapy and echo-guided adjustments of device programming. Finally, there are ongoing controversies and many as yet unanswered questions that are the subject of ongoing and planned clinical trials. (Circulation. 2007;115:2208-2220.)Key Words: electrical stimulation Ⅲ heart failure Ⅲ pacemakers Ⅲ defibrillators, implantable P atients with advanced congestive heart failure (CHF) on maximal medical therapy have had very limited options until recently. The advent of cardiac resynchronization therapy (CRT) has revolutionized the treatment of these patients. Many patients with advanced CHF demonstrate dyssynchrony by evidence of a widened QRS complex on the EKG. Most frequently this takes the form of a left bundle-branch block morphology, but right bundle-branch block morphology and intraventricular conduction delay are also less frequently present. 1,2 Electrical dyssynchrony usually implies that different portions of the ventricle contract at different times, unlike that of a normal heart in which contraction of all segments is nearly simultaneous. The presence of a widened QRS itself in the presence of CHF symptoms is associated with increased mortality. 3,4 Dyssynchrony on EKG, particularly of the left bundle-branch type, is associated with delayed activation of the left lateral wall, mitral regurgitation, impaired left ventricular filling, and reduced measures of cardiac contractility. 5-8 CRT operates on the premise that attempts to normalize the timing of activation of the left and right ventricle or lateral wall and septum may improve the consequences of this impaired activation. 9 Multiple trials have shown that CRT improves heart failure symptoms in the majority of recipients. 10 -14 These trials include the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) trial, which studied 453 patients. All patients had a CRT device impla...

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Acute Evaluation of Programmer‐Guided AV/PV and VV Delay Optimization Comparing an IEGM Method and Echocardiogram for Cardiac Resynchronization Therapy in Heart Failure Patients and Dual‐Chamber ICD Implants

Abstract: The automated programmer-based IEGM method provides a reliable and simpler alternative to standard techniques for the optimization of AV/PV and VV delay settings in patients with CRT-D devices and dual-chamber ICDs.

Cited by 96 publications

References 26 publications

Towards a Personalized and Dynamic CRT-D

Towards a Personalized and Dynamic CRT-D

Ventricular optimization of biventricular pacing: a systematic review

Interventional Electrophysiology and Cardiac Resynchronization Therapy

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