The relationship between ventricular electrical delay and left ventricular remodelling with cardiac resynchronization therapy
Michael R. Gold,Ulrika Birgersdotter-Green,Jagmeet P. Singh,Kenneth A. Ellenbogen,Yinghong Yu,Timothy E. Meyer,Milan Seth,Patrick J. Tchou +7 more
TLDR
Electrical dyssynchrony, as measured by QLV, was strongly and independently associated with reverse remodelling and QOL with CRT, and acute measurements of QLV may be useful to guide LV lead placement.Abstract:
Aims The aim of the present study was to evaluate the relationship between left ventricular (LV) electrical delay, as measured by the QLV interval, and outcomes in a prospectively designed substudy of the SMART-AV Trial.
Methods and results This was a multicentre study of patients with advanced heart failure undergoing cardiac resynchronization therapy (CRT) defibrillator implantation. In 426 subjects, QLV was measured as the interval from the onset of the QRS from the surface ECG to the first large peak of the LV electrogram. Left ventricular volumes were measured by echocardiography at baseline and after 6 months of CRT by a blinded core laboratory. Quality of life (QOL) was assessed by a standardized questionnaire. When separated by quartiles based on QLV duration, reverse remodelling response rates (>15% reduction in LV end systolic volume) increased progressively from 38.7 to 68.4% and QOL response rate (>10 points reduction) increased from 50 to 72%. Patients in the highest quartile of QLV had a 3.21-fold increase (1.58–6.50, P = 0.001) in their odds of a reverse remodelling response after correcting for QRS duration, bundle branch block type, and clinical characteristics by multivariate logistic regression analysis.
Conclusion Electrical dyssynchrony, as measured by QLV, was strongly and independently associated with reverse remodelling and QOL with CRT. Acute measurements of QLV may be useful to guide LV lead placement.read more
Citations
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Journal ArticleDOI
2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure : implant and follow-up recommendations and management
Jean-Claude Daubert,Leslie A. Saxon,Philip B. Adamson,Angelo Auricchio,Ronald D. Berger,John F. Beshai,Ole Breithard,Michele Brignole,John G.F. Cleland,David B. Delurgio,Kenneth Dickstein,Derek V. Exner,Michael S. Gold,Richard A. Grimm,David L. Hayes,Carsten W. Israel,Christophe Leclercq,Cecilia Linde,JoAnn Lindenfeld,Béla Merkely,Lluís Mont,Francis Murgatroyd,Frits W. Prinzen,Samir Saba,Jerold S. Shinbane,Jagmeet P. Singh,Anthony S.L. Tang,Panos E. Vardas,Bruce L. Wilkoff,José Luis Zamorano +29 more
TL;DR: 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure : implant and follow-up recommendations and management.
Journal ArticleDOI
Avoiding non-responders to cardiac resynchronization therapy: a practical guide
Claude Daubert,Claude Daubert,Nathalie Behar,Raphaël P. Martins,Raphaël P. Martins,Philippe Mabo,Philippe Mabo,Christophe Leclercq,Christophe Leclercq +8 more
TL;DR: The prevention of NR to CRT is essential to improve the overall performance of this treatment and lower its risk-benefit ratio, and precise recommendations are offered regarding the optimal device programming, use of telemonitoring and optimization of management of HF.
Journal ArticleDOI
Cardiac resynchronization therapy: state-of-the-art of current applications, guidelines, ongoing trials, and areas of controversy.
TL;DR: The main findings were that REVERSE showed significant reverse remodeling, MADIT-CRT showed less hospitalization, and RAFT also showed significant reduction in mortality in the CRT arm.
Journal ArticleDOI
Impact of Mechanical Activation, Scar, and Electrical Timing on Cardiac Resynchronization Therapy Response and Clinical Outcomes
Kenneth C. Bilchick,Sujith Kuruvilla,Yasmin S Hamirani,Raghav Ramachandran,Samantha Clarke,Katherine M. Parker,George J. Stukenborg,Pamela K. Mason,John D. Ferguson,J. Randall Moorman,Rohit Malhotra,J. Michael Mangrum,Andrew E. Darby,John P. DiMarco,Jeffrey W. Holmes,Michael Salerno,Christopher M. Kramer,Frederick H. Epstein +17 more
TL;DR: Mechanical, electrical, and scar properties at the LVLP together with CMR mechanical dyssynchrony are strongly associated with echocardiographic CRT response and clinical events after CRT, and modeling these findings holds promise for improving CRT outcomes.
Journal ArticleDOI
Impact of QRS Morphology and Duration on Outcomes After Cardiac Resynchronization Therapy Results From the Resynchronization–Defibrillation for Ambulatory Heart Failure Trial (RAFT)
David H. Birnie,Andrew C.T. Ha,Lyall Higginson,Kiran Sidhu,Martin S. Green,François Philippon,Bernard Thibault,George A. Wells,Anthony Tang +8 more
TL;DR: The data do not support the use of implantable cardioverter defibrillator-CRT in patients with non-LBBB, especially when the QRS duration is <160 ms, but there may be some delayed benefit when theQRS is ≥160ms, but this needs further investigation.
References
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The effect of cardiac resynchronization on morbidity and mortality in heart failure
John G.F. Cleland,Jean-Claude Daubert,Erland Erdmann,Nick Freemantle,Daniel Gras,Lukas Kappenberger,Luigi Tavazzi +6 more
TL;DR: Cardiac resynchronization has been shown to reduce symptoms and improve left ventricular function in patients with heart failure due to systolic dysfunction and cardiac dyssynchrony.
Journal ArticleDOI
Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure.
Michael R. Bristow,Leslie A. Saxon,John P. Boehmer,Steven K. Krueger,David A. Kass,Teresa De Marco,Peter E. Carson,Lorenzo DiCarlo,David L. DeMets,Bill G. White,Dale W DeVries,Arthur M. Feldman +11 more
TL;DR: In this paper, the authors tested the hypothesis that prophylactic cardiac-resynchronization therapy in the form of biventricular stimulation with a pacemaker with or without a defibrillator would reduce the risk of death and hospitalization among patients with advanced chronic heart failure and intraventricular conduction delays.
Journal ArticleDOI
Cardiac Resynchronization in Chronic Heart Failure
William T. Abraham,Westby G. Fisher,Andrew L. Smith,David B. Delurgio,Angel R. Leon,Evan Loh,Dusan Z. Kocovic,Milton Packer,Alfredo L. Clavell,David L. Hayes,Myrvin H. Ellestad,Robin J. Trupp,Jackie Underwood,Faith Pickering,Cindy Truex,Peggy McAtee,John C. Messenger +16 more
TL;DR: Cardiac resynchronization results in significant clinical improvement in patients who have moderate-to-severe heart failure and an intraventricular conduction delay.
Journal ArticleDOI
Cardiac-resynchronization therapy for the prevention of heart-failure events.
TL;DR: CRT combined with ICD decreased the risk of heart-failure events in relatively asymptomatic patients with a low ejection fraction and wide QRS complex and was associated with a significant reduction in left ventricular volumes and improvement in the ejectedion fraction.
Journal ArticleDOI
Effects of Multisite Biventricular Pacing in Patients with Heart Failure and Intraventricular Conduction Delay
Serge Cazeau,Christophe Leclercq,Thomas Lavergne,S Walker,Varma C,Cecilia Linde,Stéphane Garrigue,Lukas Kappenberger,G A Haywood,Massimo Santini,Bailleul C,Jean-Claude Daubert,Multisite Stimulation in Cardiomyopathies (Mustic) Study Investigators +12 more
TL;DR: In this article, transvenous atriobiventricular pacemakers (with leads in one atrium and each ventricle) were used to reduce ventricular asynchrony.
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