Evaluation, Management, and Outcomes of Patients Poorly Responsive to Cardiac Resynchronization Device Therapy

Varma, Niraj; Boehmer, John; Bhargava, Kartikeya; Yoo, Dale; Leonelli, Fabio M.; Costanzo, M. R.; Saxena, Anil; Sun, Lin; Gold, Michael R.; Singh, Jagmeet P.; Gill, John B.; Auricchio, Angelo

doi:10.1016/j.jacc.2019.09.043

Cited by 70 publications

(58 citation statements)

References 29 publications

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“…31 Although the trajectory for LVEF after initial CRT cannot be definitively ascertained, most studies assess CRT response at 6 months or 12 months, and the majority of responders usually show improvement at 6 months. 18,19,32 In this study, the mean time from implantation of CRT to initial programming of SyncAV was 17.8 AE 8.5 months, and the results of this study assess echocardiographic parameters before and 6 months after SyncAV optimization. In addition, we used stricter cutoffs for LVEF and LVESV to increase the robustness of our results.…”

Section: Limitationsmentioning

confidence: 93%

Optimization of Chronic Cardiac Resynchronization Therapy Using Fusion Pacing Algorithm Improves Echocardiographic Response

et al. 2020

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Background: Whether reprogramming of cardiac resynchronization therapy (CRT) to increase electrical synchrony translates into echocardiographic improvement remains unclear. SyncAV is an algorithm that allows fusion of intrinsic conduction with biventricular pacing. We aimed to assess whether reprogramming chronically implanted CRT devices with SyncAV is associated with improved echocardiographic parameters. Methods: Patients at a quaternary center with previously implanted CRT devices with a programmable SyncAV algorithm underwent routine electrocardiography-based SyncAV optimization during regular CJC Open 2 (2020) 62e70

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Section: Limitationsmentioning

confidence: 93%

Optimization of Chronic Cardiac Resynchronization Therapy Using Fusion Pacing Algorithm Improves Echocardiographic Response

et al. 2020

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“…CRT plays an important role in the treatment of chronic congestive heart failure [Separham 2019;Hoosain 2017]. It can change the sequence of myocardial activation via left ventricular pacing or biventricular pacing, thereby, improving the LVEF and hemodynamic parameters [Varma 2019;Vereckei 2018]. Many methods have been developed for placing the pacing leads.…”

Section: Discussionmentioning

confidence: 99%

A Hybrid Procedure Combining Mini-Thoracotomy with Interventional Endocardial Lead Implantation for Cardiac Resynchronization Therapy in Patients with Chronic Congestive Heart Failure: A Report of Four Cases

Xiang

Gao

Yang

et al. 2020

HSF

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Background: We describe the application and effectiveness of transthoracic electrode implantation for epicardial left ventricular pacing in cardiac resynchronization therapy (CRT) for patients with chronic congestive heart failure. Methods: We assessed four patients with chronic congestive heart failure for whom implantation of endocardial electrodes was contraindicated. The epicardial electrodes were implanted via a mini-thoracotomy in the fourth or fifth left intercostal space. We analyzed the surgical implantation technique and the short-term effectiveness of the procedure. Results: The epicardial electrodes successfully were implanted in all four patients. The patients’ hemodynamic status, cardiac function, and symptoms significantly improved. Patients I, II, III, and IV were discharged from the hospital on the 8, 11, 4, and 7 days, respectively, after the operation. Follow up lasted for 12 months. None of the patients presented with electrode fractures or surgical wound infections, and the pacing threshold and electrode impedance were normal. In one case, phrenic nerve stimulation occurred due to the low placement position of the electrode. When the electrode was moved slightly inward and upward, the sacral nerve stimulation sign disappeared, and no other complications were noted. One patient developed capsule infection, and the presence of an ectopic pacemaker was noted; therefore, a pacemaker replacement procedure was required. Conclusion: In CRT, the implantation of a left ventricular epicardial electrode through a left-sided small incision is safe, feasible, and effective. This hybrid surgery combining interventional and cardiac techniques can maximize the curative effect of CRT.

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“…This is in contrast with the message from all randomized controlled CRT trials in HFrEF patients with a QRS >130 ms, which consistently show a spectrum of stabilization or improvement of disease progression to even recovery of the disease 10,11 . Moreover, in addition to this ‘failure to refer’, optimization of both the device and the care of the patient following implant is hampered by a lack of integration of cardiological and non‐specialist care, leading to suboptimal and variable post‐implant management 12,13 . As a result, many heart failure patients are not exposed to the full potential benefit of CRT.…”

Section: Introductionmentioning

confidence: 93%

Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care

Mullens

Auricchio

Martens

et al. 2020

European J of Heart Fail

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122

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Cardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure hospitalization rates and all‐cause mortality. Nevertheless, up to two‐thirds of eligible patients are not referred for CRT. Furthermore, post‐implantation follow‐up is often fragmented and suboptimal, hampering the potential maximal treatment effect. This joint position statement from three European Society of Cardiology Associations, Heart Failure Association (HFA), European Heart Rhythm Association (EHRA) and European Association of Cardiovascular Imaging (EACVI), focuses on optimized implementation of CRT. We offer theoretical and practical strategies to achieve more comprehensive CRT referral and post‐procedural care by focusing on four actionable domains: (i) overcoming CRT under‐utilization, (ii) better understanding of pre‐implant characteristics, (iii) abandoning the term ‘non‐response’ and replacing this by the concept of disease modification, and (iv) implementing a dedicated post‐implant CRT care pathway.

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Evaluation, Management, and Outcomes of Patients Poorly Responsive to Cardiac Resynchronization Device Therapy

Cited by 70 publications

References 29 publications

Optimization of Chronic Cardiac Resynchronization Therapy Using Fusion Pacing Algorithm Improves Echocardiographic Response

Optimization of Chronic Cardiac Resynchronization Therapy Using Fusion Pacing Algorithm Improves Echocardiographic Response

A Hybrid Procedure Combining Mini-Thoracotomy with Interventional Endocardial Lead Implantation for Cardiac Resynchronization Therapy in Patients with Chronic Congestive Heart Failure: A Report of Four Cases

Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care

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