Acute Hemodynamic Effects of Cardiac Resynchronization Therapy Versus Alternative Pacing Strategies in Patients With Left Ventricular Assist Devices

Tomashitis, Brett; Baicu, Catalin F.; Butschek, Ross A.; Jackson, Gregory R.; Winterfield, Jeffrey; Tedford, Ryan J.; Zile, Michael R.; Gold, Michael R.; Houston, Brian A.

doi:10.1161/jaha.120.018127

Cited by 7 publications

(7 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prior studies have shown that turning off LV leads following insertion of continuous flow LVADs can preserve battery, decreasing the need for generator changes 20 . A recent study by Tomashitis et al 24 also investigated the hemodynamic effects of different pacing modes in patients with CRT and LVAD. They found that biventricular pacing and RV pacing only showed improved load‐independent RV contractility.…”

Section: Discussionmentioning

confidence: 99%

Association between biventricular pacing and incidence of ventricular arrhythmias in the early post‐operative period after left ventricular assist device implantation

Chou

Larson

Deshmukh

et al. 2022

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction: Cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVAD) improve outcomes in heart failure patients. Early ventricular arrhythmias (VA) are common after LVAD and are associated with increased mortality. The association between left ventricular pacing (LVP) with CRT and VAs in the early post-LVAD period remains unclear. Methods: This was a retrospective study of all patients undergoing LVAD implantation from 1/2016 to 12/2019. Patients were divided into those with CRT and active LVP (CRT-LVP) immediately post-LVAD implant versus those without CRT-LVP. Implantable cardiac defibrillator electrograms were reviewed and early VAs were defined as sustained ventricular tachycardia (VT)/ventricular fibrillation occurring within 30 days of LVAD implantation.Results: Of 186 included patients (mean age 53 years, 75% male, mean body mass index 28), 72 had CRT devices, 63 of whom had LV pacing enabled after LVAD implant (CRT-LVP group). Patients with CRT-LVP were more likely to have VA in the early postoperative period (21% vs. 4%; p = .0001). All 9 patients with CRT in whom LVP was disabled had no early VA. Among those with early VA, patients with CRT-LVP were more likely to have monomorphic VT (77% vs. 40%; p = .07). In multiple logistic regression, CRT-LVP pacing remained an independent predictor of early VA after adjustment for history of VA and AF.Conclusions: Patients with CRT-LVP after LVAD implant had a higher incidence of early VA (specifically monomorphic VT). Epicardial LV pacing may be proarrhythmic in the early postoperative period after LVAD.

show abstract

Section: Discussionmentioning

confidence: 99%

Association between biventricular pacing and incidence of ventricular arrhythmias in the early post‐operative period after left ventricular assist device implantation

Chou

Larson

Deshmukh

et al. 2022

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…Tomashitis et al 50 reported that the biventricular pacing acutely improves load-independent right ventricular contractility in patients with left ventricular assist devices, including pacing nonresponders.…”

Section: Ventricular Arrhythmias and Sudden Cardiac Deathmentioning

confidence: 99%

Advances in Cardiac Electrophysiology

Piccini

Russo

Sharma

et al. 2022

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

Despite the global COVID-19 pandemic, during the past 2 years, there have been numerous advances in our understanding of arrhythmia mechanisms and diagnosis and in new therapies. We increased our understanding of risk factors and mechanisms of atrial arrhythmias, the prediction of atrial arrhythmias, response to treatment, and outcomes using machine learning and artificial intelligence. There have been new technologies and techniques for atrial fibrillation ablation, including pulsed field ablation. There have been new randomized trials in atrial fibrillation ablation, giving insight about rhythm control, and long-term outcomes. There have been advances in our understanding of treatment of inherited disorders such as catecholaminergic polymorphic ventricular tachycardia. We have gained new insights into the recurrence of ventricular arrhythmias in the setting of various conditions such as myocarditis and inherited cardiomyopathic disorders. Novel computational approaches may help predict occurrence of ventricular arrhythmias and localize arrhythmias to guide ablation. There are further advances in our understanding of noninvasive radiotherapy. We have increased our understanding of the role of His bundle pacing and left bundle branch area pacing to maintain synchronous ventricular activation. There have also been significant advances in the defibrillators, cardiac resynchronization therapy, remote monitoring, and infection prevention. There have been advances in our understanding of the pathways and mechanisms involved in atrial and ventricular arrhythmogenesis.

show abstract

“…Similarly, there are no differences between pacing modes in LV unloading during invasive ramp tests ( 271 ). Although some patients may benefit from CRT to improve RV contractility ( 272 ), frequent pack changes, reduced exercise capacity and quality of life with biventricular pacing suggests that turning off the LV-lead is advisable for most patients after LVAD ( 266 , 273 , 274 ).…”

Section: Early and Acute Right Ventricular Failurementioning

confidence: 99%

Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

Ródenas-Alesina

Brahmbhatt

Rao

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Left ventricular assist devices (LVADs) are increasingly common across the heart failure population. Right ventricular failure (RVF) is a feared complication that can occur in the early post-operative phase or during the outpatient follow-up. Multiple tools are available to the clinician to carefully estimate the individual risk of developing RVF after LVAD implantation. This review will provide a comprehensive overview of available tools for RVF prognostication, including patient-specific and right ventricle (RV)-specific echocardiographic and hemodynamic parameters, to provide guidance in patient selection during LVAD candidacy. We also offer a multidisciplinary approach to the management of early RVF, including indications and management of right ventricular assist devices in this setting to provide tools that help managing the failing RV.

show abstract

Acute Hemodynamic Effects of Cardiac Resynchronization Therapy Versus Alternative Pacing Strategies in Patients With Left Ventricular Assist Devices

Cited by 7 publications

References 35 publications

Association between biventricular pacing and incidence of ventricular arrhythmias in the early post‐operative period after left ventricular assist device implantation

Association between biventricular pacing and incidence of ventricular arrhythmias in the early post‐operative period after left ventricular assist device implantation

Advances in Cardiac Electrophysiology

Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

Contact Info

Product

Resources

About