Effect of Echocardiography-Guided Left Ventricular Lead Placement for Cardiac Resynchronization Therapy on Mortality and Risk of Defibrillator Therapy for Ventricular Arrhythmias in Heart Failure Patients (from the Speckle Tracking Assisted Resynchronization Therapy for Electrode Region [STARTER] Trial)

Adelstein, Evan; Alam, Mian Bilal; Schwartzman, David; Jain, Sandeep; Marek, Josef; Gorcsan, John; Saba, Samir

doi:10.1016/j.amjcard.2014.01.431

Cited by 42 publications

(33 citation statements)

References 14 publications

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“…Our study is the first report about the impact on reverse LV remodeling, which is related to patient outcome . Our study showed similar CRT response rates as compared to historical reports in the literature . However, the proportion of super responders seen with the quadripolar lead in our study exceeded that seen in prior CRT studies with older generation unipolar or bipolar leads .…”

Section: Discussionsupporting

confidence: 78%

“…Given the heterogeneity of these methods, the TPS was defined as an area spanning 2 cm in length and width around the target pacing point declared by the implanter on the 30° right anterior oblique (RAO) view before taking the coronary angiogram (preoperative TPS selection) or after Q‐LV measurements (intraoperative TPS selection). Such an area is broader than a target segment as evaluated by strain analysis, and covers the optimal site plus an adjacent site, as defined in the TARGET (Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy) and STARTER (Speckle Tracking Assisted Resynchronization Therapy for Electrode Region) trials . Its length is 2 cm, and corresponds to the LV1‐LV2 and LV3‐LV4 spacing of the Performa leads, thus enabling the assessment of the electrode/s being at the TPS on fluoroscopy.…”

Section: Methodsmentioning

confidence: 99%

“…Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure, though 30% of implanted patients fail to reach clinical improvement and reverse left ventricular (LV) remodeling, factors that are closely linked to survival . Careful patient selection and LV lead placement are key for clinically successful CRT, with coronary vein anatomy, lead movement in the target vein, and phrenic nerve stimulation (PNS) being the major challenges to achieve targeted LV stimulation . Taken together, these issues may account for failure to deliver CRT in up to 12% of patients when unipolar or bipolar LV leads are employed .…”

Section: Introductionmentioning

confidence: 99%

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Left Ventricular Reverse Remodeling Elicited by a Quadripolar Lead: Results from the Multicenter Per4mer Study

Ziacchi

Saporito

Zardini

et al. 2016

Pacing Clinical Electrophis

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Section: Discussionsupporting

confidence: 78%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Left Ventricular Reverse Remodeling Elicited by a Quadripolar Lead: Results from the Multicenter Per4mer Study

Ziacchi

Saporito

Zardini

et al. 2016

Pacing Clinical Electrophis

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“…Speckle tracking echocardiography has been used in several studies to measure scar area, the area of latest mechanical activation, prognosis of lead placement, survival rate free from defibrillator therapy, and its correlates with CMR . Because the RA is the source of such electrical phenomena, it would be worthwhile to focus on it through STE to elucidate the novel mechanistic insights of electrical activation.…”

Section: Methods To Measure Strainmentioning

confidence: 99%

Speckle Tracking Echocardiography of the Right Atrium: The Neglected Chamber

Sultan

Lima

Munir

et al. 2015

Clinical Cardiology

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The right atrium (RA) plays a pivotal role in electromechanical and endocrine regulation of the heart. Its peculiar anatomical features and phasic mechanical function make it distinct from ventricles. Various invasive and noninvasive techniques have been used to elucidate RA structure and function. Of these modalities, echocardiography has distinct advantages over others. Several conventional measures of RA function through echocardiography have been described in the literature, but they are load dependent. A relatively new technique is speckle tracking-derived strain, which is relatively less dependent on loading conditions. Speckle tracking echocardiography tracks acoustic scatters (speckles) of myocardium frame-by-frame to calculate strain or deformation of the myocardium. Speckle tracking echocardiography has been used extensively for strain assessment of the right and left ventricle to detect subtle disease pathology, to gain mechanistic insight, as a marker of ischemic metabolic memory, as an endpoint in clinical trials, and as a functional assessment tool. The RA is a relatively neglected chamber, as it is mostly studied for assessment of atrial mass lesions, for electrophysiological studies, and in animal models for physiological assessment. However, its role in the systolic and diastolic function of the right heart, pulmonary vascular pathology, congenital heart diseases, and combined electromechanical activation phenomena has been less explored or unexplored. Speckle tracking echocardiography is an ideal tool for the assessment of the RA because of its regional and global functional characterization, angle independence, and high temporal resolution. IntroductionThe right atrium (RA) is located on the anterosuperior aspect of the heart and lies anterior to the left atrium (LA), which forms the most posterior chamber of the heart. The interatrial septum is oblique (at 65 degrees) to the cardiac axis and the tricuspid and mitral valves are located at different levels; therefore, the RA lies anterior and inferior to the LA.

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“…The optimal site of pacing was defined as the latest radial strain peak with amplitude of strain ≥10%. Using this approach, good results were reported for the echo‐guided CRT implant in terms of overall survival and survival free of defibrillator shocks and heart failure …”

Section: Integrating Myocardial Dyssynchrony and Viabilitymentioning

confidence: 99%

Echocardiographic evaluation of cardiac dyssynchrony: Does it still matter?

et al. 2018

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Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. For many years, cardiac mechanical dyssynchrony assessed by echocardiography has been considered as a key evaluation to characterize CRT candidates and predict CRT response. In current guidelines, however, CRT implant indications rely only on electrical dyssynchrony. The aim of this article was to clarify whether and how the evaluation of cardiac mechanical dyssynchrony should be performed today by echocardiography.

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Cited by 42 publications

References 14 publications

Left Ventricular Reverse Remodeling Elicited by a Quadripolar Lead: Results from the Multicenter Per4mer Study

Left Ventricular Reverse Remodeling Elicited by a Quadripolar Lead: Results from the Multicenter Per4mer Study

Speckle Tracking Echocardiography of the Right Atrium: The Neglected Chamber

Echocardiographic evaluation of cardiac dyssynchrony: Does it still matter?

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