Cardiac resynchronization therapy beyond nominal settings: who needs individual programming of the atrioventricular and interventricular delay?

Bogaard, Margot D.; Meine, Mathias; Tuinenburg, Anton E.; Maskara, Barun; Loh, Peter; Doevendans, Pieter A.

doi:10.1093/europace/eus170

Cited by 42 publications

(40 citation statements)

References 21 publications

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“…The present study shows that the largest hemodynamic improvement is achieved during optimal interventricular resynchronziation, coinciding with LV preexcitation, which agrees with earlier observation in our canine model and clinical studies. 4,12,24 …”

Section: Slow Transseptal Conductionmentioning

confidence: 99%

Transseptal Conduction as an Important Determinant for Cardiac Resynchronization Therapy, as Revealed by Extensive Electrical Mapping in the Dyssynchronous Canine Heart

Strik

Deursen

Middendorp

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background-Simple conceptual ideas about cardiac resynchronization therapy assume that biventricular (BiV) pacing results in collision of right and left ventricular (LV) pacing-derived wavefronts. However, this concept is contradicted by the minor reduction in QRS duration usually observed. We investigated the electric mechanisms of cardiac resynchronization therapy by performing detailed electric mapping during extensive pacing protocols in dyssynchronous canine hearts. Methods and Results-Studies were performed in anesthetized dogs with acute left bundle-branch block (LBBB, n=10) and chronic LBBB with tachypacing-induced heart failure (LBBB+HF, n=6). Activation times (AT) were measured using LV endocardial contact and noncontact mapping and epicardial contact mapping. BiV pacing reduced QRS duration by 21±10% in LBBB but only by 5±12% in LBBB+HF hearts. Transseptal impulse conduction was significantly slower in LBBB+HF than in LBBB hearts (67±9 versus 44±16 ms, respectively), and in both groups significantly slower than transmural LV conduction (≈30 ms). In both groups QRS duration and vector and the epicardial AT vector amplitude and angle were significantly different between LV and BiV pacing, whereas the endocardial AT vector was similar. During variation of atrioventricular delay while LV pacing, and ventriculo-ventricular delay while BiV pacing, the optimal hemodynamic effect was achieved when epicardial AT and QRS vectors were minimal and endocardial AT vector indicated LV preexcitation. Conclusions-Due

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Section: Slow Transseptal Conductionmentioning

confidence: 99%

Transseptal Conduction as an Important Determinant for Cardiac Resynchronization Therapy, as Revealed by Extensive Electrical Mapping in the Dyssynchronous Canine Heart

Strik

Deursen

Middendorp

et al. 2013

Circ: Arrhythmia and Electrophysiology

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“…However, the echocardiographic methods include complex adjustments that require expertise and are time consuming; thus, they are not routinely performed. Other groups have also used invasive hemodynamic measurements …”

Section: Introductionmentioning

confidence: 99%

Fusion‐Optimized Intervals (FOI): A New Method to Achieve the Narrowest QRS for Optimization of the AV and VV Intervals in Patients Undergoing Cardiac Resynchronization Therapy

Arbelo

Tolosana

Trucco

et al. 2013

Cardiovasc electrophysiol

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“…This would need measurements of the effect of biventricular pacing on individual patients that have narrow withinindividual error bars. Symptoms or outcomes assessed in the conventional way are not suitable, but quantitative physiological measurements could be developed to deliver this (33)(34)(35). Wider implications for cardiologic research.…”

Section: Implications For Research Into Mechanical Dyssynchronymentioning

confidence: 99%

The Limit of Plausibility for Predictors of Response: Application to Biventricular Pacing

Nijjer¹,

Pabari²,

Stegemann³

et al. 2012

JACC: Cardiovascular Imaging

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Reports of R(2) > 0.2 in response prediction arose exclusively from studies without formally documented enrollment and blinding. The HSSCS approach overestimates R(2) values, frequently breaching the mathematical ceiling on sustainably observable R(2), which is far below 1.0, and can easily be calculated by readers using formulas presented here. Community awareness of this low ceiling may help resist future claims. Reliable individualized response prediction, using methods originally designed for group-mean effects, may never be possible because it has 2 currently unavailable and perhaps impossible prerequisites: 1) excellent blinded test-retest reproducibility of dyssynchrony; and 2) response markers reproducible over time within nonintervened individuals. Dispassionate evaluation, and improvement, of test-retest reproducibility is required before any further claims of strong prediction. Prediction studies should be designed to resist bias.

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Cardiac resynchronization therapy beyond nominal settings: who needs individual programming of the atrioventricular and interventricular delay?

Cited by 42 publications

References 21 publications

Transseptal Conduction as an Important Determinant for Cardiac Resynchronization Therapy, as Revealed by Extensive Electrical Mapping in the Dyssynchronous Canine Heart

Transseptal Conduction as an Important Determinant for Cardiac Resynchronization Therapy, as Revealed by Extensive Electrical Mapping in the Dyssynchronous Canine Heart

Fusion‐Optimized Intervals (FOI): A New Method to Achieve the Narrowest QRS for Optimization of the AV and VV Intervals in Patients Undergoing Cardiac Resynchronization Therapy

The Limit of Plausibility for Predictors of Response: Application to Biventricular Pacing

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