Haemodynamic evaluation of alternative left ventricular endocardial pacing sites in clinical non-responders to cardiac resynchronisation therapy

Gelder, Berry M. van; Nathoe, Roy; Bracke, Frank

doi:10.1007/s12471-015-0773-7

Cited by 10 publications

(5 citation statements)

References 19 publications

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“…Crucially, in 96.8% of patients, the optimal hemodynamic performance was associated with delivering pacing therapy at the site exhibiting the LEA. A similar figure (85%) was observed by van Gelder et al in their evaluation of the effects of LV endocardial pacing amongst a cohort of non-responders to epicardial CRT [102]. The small discrepancy may be attributed to the larger cohort of ischemic patients in this study.…”

Section: Identifying the Site Of Latest Electrical Activation (Lea)supporting

confidence: 86%

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

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Introduction: Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment.Areas covered: This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT.Expert commentary: Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.

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Section: Identifying the Site Of Latest Electrical Activation (Lea)supporting

confidence: 86%

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

View full text Add to dashboard Cite

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“…The percentage of nonresponders (8.5%) included in the series that we initiated in April 2011 is much lower than what was observed in ALSYNC study (23%) because we began to include previous nonresponders in late 2015. This clinical decision was initially based on a case report published by Bracke et al, then strengthened by the good results obtained in nonresponders by ALSYNC investigators and first reported at Heart Rhythm 2014; additional evidence was provided by Van Gelder in 2016 …”

Section: Discussionmentioning

confidence: 99%

“…Bracke et al published a successful protocol (using dP/dTmax measurements) to assess the acute hemodynamic (AHR) response of alternative LV endocardial pacing sites, as compared to the implanted CS‐epicardial system, in one nonresponder patient . The same team studied 24 clinical nonresponders using improvements in dP/dTmax and the Q‐LV interval to measure the AHR of different LV endocardial sites . Behar et al combined magnetic resonance imaging, electroanatomic contact mapping, and AHR studies, reporting the superiority of endocardial pacing over epicardial venous pacing when both were optimized using AHR.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular endocardial pacing in the real world: Five years of experience at a single center

Guerrero

Castañeda

Calatrava

et al. 2019

Pacing Clinical Electrophis

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Background A left ventricular (LV) endocardial lead implant to achieve cardiac resynchronization therapy (CRT) is feasible when a conventional implant failed due to anatomical or technical issues or when the venous implant was performed but the patient did not respond to the therapy. Methods Data about the implantation procedure (age, sex, clinical characteristics, anticoagulant use, and previous devices), patient characteristics (indication, technique used, lead model, complications), and follow‐up (clinical and echocardiographic outcome, LV lead electrical measurements) were analyzed for all CRT systems implanted using LV endocardial lead, due to failed conventional implant or nonresponse, between April 2011 and November 2016. Results Thirty‐five patients were implanted with an active fixation LV endocardial lead during the study period, without significant complications. There were no dislodgements or severe complications related to the implant procedure in the follow‐up period (36 ± 20 months) and a high percentage of patients responded to therapy, as assessed by several indicators. Conclusions An LV endocardial lead implant was feasible when the conventional technique had previously failed or was not effective. A high rate of response was achieved without any significant complications.

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“…This underlines that QRS absolute width itself may not reflect the real pattern of conduction delay to the LV, which instead may be measured by the Q-LV interval. The Q-LV interval is defined as the interval from the onset of the intrinsic QRS on 12-lead surface ECG to the first large positive or negative peak of the LV EGM [18].…”

Section: Pacing Timing In Crtmentioning

confidence: 99%

ECG optimisation for CRT systems in the era of automatic algorithms: a comprehensive review

et al. 2022

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Cardiac resynchronisation therapy (CRT) may fail in up to one third of patients, mainly due to anatomical and procedural issues. In the daily practice, ECG optimisation is largely used to address CRT delivery. Ineffective CRT can be related to non-optimal pacing timing as well as inadequate pacing-capture. A rate-competitive atrial fibrillation (AF) or a high daily burden of premature ventricular contractions (PVC) may also affect CRT by means of fusion or pseudo-fusion captures. Growing observations suggest that in a subset of patients with typical left bundle branch block (LBBB), selected LV pacing may be more effective, producing a complete fusion between the left pacing and the intrinsic right bundle activation. The His-ventricular (HV) interval is an invasive measurement (derived from electrophysiological study), which mainly reflects the RV activation (and its contribution to QRS timing) and has been proposed by some authors when addressing LV-paced–RV-sensed fusion. In sinus rhythm CRT patients, with baseline typical LBBB criteria and preserved AV conduction, the “dromotropic” management to achieve RV intrinsic activation with LV fusion is also “AV delay dependent”. In this regard, the RV intrinsic activation (detected by RV sensing) and the A (paced/sensed)-RV (sensed) interval are also influenced by the RV lead position within the RV. The current families of CRT devices have implemented automatic algorithms to optimise AV and VV timing intervals. The proof of principle is again the evidence that fusion of an LV-paced beat with intrinsic rhythm may be more beneficial than standard biventricular pacing, provided a preserved AV conduction. In the present review, all the above issues are discussed.

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Haemodynamic evaluation of alternative left ventricular endocardial pacing sites in clinical non-responders to cardiac resynchronisation therapy

Cited by 10 publications

References 19 publications

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Left ventricular endocardial pacing in the real world: Five years of experience at a single center

ECG optimisation for CRT systems in the era of automatic algorithms: a comprehensive review

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