2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management

Daubert, Jean‐Claude; Saxon, Leslie A.; Adamson, Philip B.; Auricchio, Angelo; Berger, Ronald D.; Beshai, John F.; Breithard, Ole; Brignole, Michele; Cleland, John G.F.; Delurgio, David B.; Dickstein, Kenneth; Exner, Derek V.; Gold, Michael R.; Grimm, Richard A.; Hayes, David L.; Israel, Carsten W.; Leclercq, Christophe; Linde, Cecilia; Lindenfeld, JoAnn; Merkely, Béla; Mont, Lluı́s; Murgatroyd, Francis; Prinzen, Frits W.; Saba, Samir; Shinbane, Jerold S.; Singh, Jagmeet P.; Tang, Anthony; Vardas, Panos; Wilkoff, Bruce L.; Zamorano, José Luís

doi:10.1016/j.hrthm.2012.07.025

Cited by 336 publications

(230 citation statements)

References 339 publications

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“…Cardiac CT offers a potential benefit over CMR due to the fact that approximately 28% of patients undergoing CRT implantation have already received an implantable cardiac device rendering them unsuitable to undergo CMR scanning [96]. Cardiac CT is associated with submillimeter spatial resolution and can assess regional and global LV dyssynchrony by calculating the stretch of the endocardial surface throughout the cardiac cycle (stretch quantifier for endocardial engraved zones [SQUEEZ]) [97].…”

Section: Dyssynchrony Assessment and Identification Of The Site Of Lamentioning

confidence: 99%

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: Dyssynchrony Assessment and Identification Of The Site Of Lamentioning

confidence: 99%

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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“…Patient follow up was standardised as per the European Heart Rhythm Association (EHRA) recommendations [15] with a minimum of 3-6 monthly remote and at least 12 monthly ICD clinics follow ups. Follow up was complete in all patients except one, who relocated, and who has subsequently been excluded from our analysis.…”

Section: Device Implantation Programming and Follow Upmentioning

confidence: 99%

Shock rates in an unselected real world cohort of patients with medtronic protecta implantable cardioverter defibrillators

Av¹,

Barker²,

Mj³

et al. 2017

Cardiovasc Disord Med

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Objective: To investigate rates of inappropriate shocks in patients with a Medtronic Protecta implantable cardioverter defibrillator device (Medtronic Inc., Minneapolis, MN, USA). Methods:Consecutive patients implanted with Protecta defibrillators at a single centre between April 2010 and July 2012 were studied retrospectively.Results: Follow-up data was available for 599 patients(84% male; age 64 ± 14 years, range 16-92; 49% secondary prevention indication; 42% cardiac resynchronisation therapy, 24% single chamber, and 34% dual chamber defibrillator devices). Mean follow-up was 19 ± 7 months. 57 patients (9.5%) received a shock: 8 patients(1.3%) had inappropriate shocks; 50 patients(8.3%) had appropriate shocks. Of the 10 inappropriate shocks, seven were for supraventricular tachycardia; one for T-wave oversensing; one due to lead displacement; and one occurred after an appropriate shock for ventricular tachycardia. Conclusions:Our reported inappropriate shock rate over a 20-month follow-up period is lower than previously reported.

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“…2 All patients considered for CRT are recommended to undergo careful pre-implant screening including comorbidities, routine labs, functional assessment, qualityof-life measurement, echocardiogram for quantification of LVEF and cardiac size, and electrocardiogram (ECG) to document QRS duration and morphology. Additionally, optimal medical therapy per current guidelines should be instituted and stable.…”

Section: Guidelinesmentioning

confidence: 99%

Developments in Cardiac Resynchronisation Therapy

Lewis

Gold

2015

Arrhythmia &Amp; Electrophysiology Review

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Since the introduction of CRT more than 20 years ago, its role in mild to severe systolic heart failure has become well established.CRT has been shown to decrease mortality, reduce heart failure hospitalisations and improve functional status in patients with NYHA class II-IV heart failure and QRS prolongation, most commonly with LBBB pattern.1 One of the major limitations of CRT implementation is the significant number of 'appropriate' candidates, as determined by guidelines, who fail to respond with clinical, functional or structural endpoints. The rate of non-responders has been estimated between 20 % and 40 %.2 Efforts to predict those patients who will respond to CRT and to optimise the magnitude of response have been important areas of focus with regard to the future of CRT. This article will present recent considerations and advances, both technical and theoretical, in CRT. 3 This trial examined 67 patients with LV ejection fraction (LVEF) ≤35 %, NYHA class III heart failure symptoms, sinus rhythm and QRS duration >150 ms who had biventricular pacemakers placed. The devices were initially programmed to ventricular back-up pacing for rates <40 beats per minute for a period of 3 months followed by reprogramming to encourage biventricular pacing. CRT resulted in significant improvement in 6-minute walk distance, quality of life and peak oxygen uptake as well as decreased hospitalisations. Eighty-five per cent of the study patients reported that they felt better during the period with biventricular pacing programmed on. BackgroundThe Multicentre InSync Randomised Clinical Evaluation (MIRACLE) trial evaluated a similar but much larger patient population. 4 There were 453 patients with NYHA class III-IV heart failure, LVEF ≤35 % and QRS duration ≥130 ms randomised to biventricular or no pacing. Over 6 months of follow-up, significant improvements were noted in 6-minute walk distance, NYHA class and quality of life. Additionally, CRT was an effective adjunct to optimal medical therapy in reducing the secondary combined endpoint of heart failure hospitalisation or death. Although the results of MUSTIC and MIRACLE were encouraging in terms of the clinical benefits of CRT, reduced mortality had not yet been proved. The Comparison of Medical Therapy, Pacing and Defibrillation(COMPANION) trial used a combined primary endpoint of hospitalisation or death from any cause.5 Enrolling 1,520 patients with LVEF ≤35 %, NYHA class III-IV heart failure and QRS duration >120 ms, this trial randomised subjects to optimal medical therapy, medical therapy with a CRT pacemaker (CRT-P) or medical therapy with a CRT defibrillator (CRT-D). At 1 year of follow-up, the CRT-D group showed significant reduction in overall mortality versus medical therapy alone, and the CRT-P group had showed a strong trend for reduced mortality (p=0.059).These results suggested a mortality benefit from CRT even in the absence of defibrillator capabilities.Several studies have since examined the effects of biventricular pacing alone (i.e. CRT-P) on heart fa...

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2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management

Cited by 336 publications

References 339 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

Shock rates in an unselected real world cohort of patients with medtronic protecta implantable cardioverter defibrillators

Developments in Cardiac Resynchronisation Therapy

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