Improvement of Reverse Remodeling Using Electrocardiogram Fusion-Optimized Intervals in Cardiac Resynchronization Therapy

Trucco, Emilce; Tolosana, José Marı́a; Arbelo, Elena; Doltra, Adelina; Castel, María Ángeles; Benito, Eva; Borràs, Roger; Guasch, Eduard; Vidorreta, S.; Vidal, Bárbara; Montserrat, Sílvia; Sitges, Marta; Berruezo, Antonio; Brugada, Josép; Mont, Lluı́s

doi:10.1016/j.jacep.2017.11.020

Cited by 74 publications

(89 citation statements)

References 34 publications

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“…None of the patients had QRS widening or worsening in the LVEF or MR at 6 months after continuous CRT optimization using the SyncAV algorithm. Trucco et al 21 showed that baseline manual optimization of the AV and ventriculo-ventricular delays, to achieve biventricular fusion pacing, immediately postimplantation leads to a greater proportion of patients achieving both electrical synchrony and LV reverse remodelling at 12 months. Our study validates the long-term effect of an automated continuously optimized biventricular fusion-pacing algorithm.…”

Section: Discussionmentioning

confidence: 99%

“…22 Even in studies that used an ECG-based optimization, the ECG analyses were performed with a paper speed between 50 and 300 mm/s, used computerized recording systems, and required experienced observers for QRS width measurement. 12,21 In contrast, we used the standard 12-lead surface ECG at a regular speed of 25 mm/s with automated measurements, which are faster, accurate, and easily reproducible.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Narrowing of the QRS complex after CRT reflects the improvement in electrical synchrony. A reduction in QRS duration after CRT has been shown to acutely improve hemodynamics and as well as left ventricular reverse remodeling . In addition, narrowing of the QRS has been associated with a reduction in functional mitral regurgitation as well as a reduction in cardiovascular hospitalizations and mortality .…”

Section: Discussionmentioning

confidence: 99%

Predicting response to cardiac resynchronization therapy: Use of strict left bundle branch block criteria

Hadjis

AlTurki

Proietti

et al. 2019

Pacing Clinical Electrophis

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Background Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). CRT efficacy is greater in left bundle branch block (LBBB). This study aimed to determine if strict LBBB criteria predict an improved QRS duration and left ventricular ejection fraction (LVEF) response after CRT. Methods HFrEF patients who received a CRT device at a single quaternary center were included. Patients were divided into three groups based on baseline QRS morphology. Group 1 consisted of patients with strict LBBB. Group 2 had conventional LBBB, and group 3 had non‐LBBB morphology. Outcomes assessed included change in QRS duration after CRT, change in LVEF, and all‐cause mortality. Results In 231 patients, 56% of patients were in group 1, 29% were in group 2, and 15% were in group 3. Patients with strict LBBB had a significant reduction in QRS duration (–20.9 ± 12.4 ms) compared to conventional LBBB (6.7 ± 19.4 ms; P < 0.0001) and non‐LBBB (3.9 ± 29.3 ms; P < 0.0001). Patients with strict LBBB had a significant increase in LVEF (19.5 ± 10.2) compared to conventional LBBB (5.3 ± 12.6; P < 0.0001) and non‐LBBB (–1.3 ± 10.9; P < 0.0001). There was moderate negative correlation between changes in QRS duration and LVEF (correlation coefficient = –0.63, P < 0.0001). Strict LBBB criteria were associated with a significant reduction in mortality compared to conventional LBBB (odds ratio 0.49, 95% confidence interval 0.24 to 0.99; P = 0.046). Conclusions Strict LBBB predicted a reduction in QRS duration and an increase in LVEF compared to conventional LBBB and non‐LBBB morphology in patients with HFrEF who received CRT.

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“…Therefore, symptomatic heart failure patients with reduced ejection fraction (HF r EF) with prolonged QRS duration is indicated for cardiac resynchronization therapy (CRT) based on various international guideline . CRT reduces mortality and HF hospitalizations in selected patients with left ventricular (LV) systolic dysfunction and prolonged QRS duration …”

Section: Introductionmentioning

confidence: 99%

Endocardial biventricular pacing for chronic heart failure patients: Effect on transmural dispersion of repolarization

Yamin

Yuniadi

Alwi

et al. 2019

Journal of Arrhythmia

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Background and Aim Conventional epicardial cardiac resynchronization therapy (CRT) can cause fatal arrhythmia associated with increased transmural dispersion of repolarization (TDR). It is unknown whether endocardial biventricular pacing in various locations will decrease TDR and hence the occurrence of fatal arrhythmia. This study aimed to find out the most effective location of endocardial biventricular pacing resulting in the shortest homogenous TDR. Methods A before‐and‐after study on adult chronic heart failure (CHF) patients undergoing endocardial biventricular pacing in several defined locations. The changes in TDR from baseline were compared among various pacing locations. Results Fourteen subjects were included with age ranged 36‐74 years old, of which 10 were males. Location revealed the highest post biventricular pacing TDR (113.4 (SD 13.8) ms) was the outlet septum of right ventricle in combination with lateral wall of left ventricle (RVOTseptum‐LVlateral) while the lowest one (106.1 (SD 11.6) ms) was of the right ventricular apex and posterolateral left ventricle (RVapex‐LVposterolateral). Two CRT locations resulted in the most homogenous TDR, that is the right ventricular apex ‐ left ventricular lateral wall (RVapex‐LVlateral, mean difference −9.43; 95% CI (−19.72;0.87) ms, P = 0.07) and right ventricular apex ‐ left ventricle posterolateral wall (RVapex‐LVposterolateral, mean difference −6.85; 95% CI (−13.93;0.22) ms, P = 0.056). Conclusion Endocardial biventricular pacing on right ventricular apex and left ventricular lateral/posterolateral walls results in the most homogenous TDR.

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Improvement of Reverse Remodeling Using Electrocardiogram Fusion-Optimized Intervals in Cardiac Resynchronization Therapy

Abstract: Device optimization based on FOI achieves greater LV remodeling, compared with nominal settings. (ECG Optimization of CRT: Evaluation of Mid-Term Response [BEST]; NCT01439529).

Cited by 74 publications

References 34 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

Predicting response to cardiac resynchronization therapy: Use of strict left bundle branch block criteria

Endocardial biventricular pacing for chronic heart failure patients: Effect on transmural dispersion of repolarization

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