Biventricular Pacing for Atrioventricular Block and Systolic Dysfunction

Curtis, Anne B.; Worley, Seth J.; Adamson, Philip B.; Chung, Eugene S.; Niazi, Imran Khan; Sherfesee, Lou; Shinn, Timothy; Sutton, Martin St. John

doi:10.1056/nejmoa1210356

Cited by 679 publications

(443 citation statements)

References 16 publications

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“…The US population aged 75 and older grew by ≈600k from 2008 to 2013. Early signs of CRT benefit in patients with atrial fibrillation began to appear in the literature43, 44 before they were established by the BLOCK‐HF trial in 2013 45. In addition, there is increasing recognition of pacing‐related cardiomyopathy, which generally responds well to upgrade to CRT‐P 46.…”

Section: Discussionmentioning

confidence: 99%

Geographic and Temporal Variation in Cardiac Implanted Electric Devices to Treat Heart Failure

Hatfield

Kramer

Volya

et al. 2016

JAHA

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BackgroundCardiac implantable electric devices are commonly used to treat heart failure. Little is known about temporal and geographic variation in use of cardiac resynchronization therapy (CRT) devices in usual care settings.Methods and ResultsWe identified new CRT with pacemaker (CRT‐P) or defibrillator generators (CRT‐D) implanted between 2008 and 2013 in the United States from a commercial claims database. For each implant, we characterized prior medication use, comorbidities, and geography. Among 17 780 patients with CRT devices (median age 69, 31% women), CRT‐Ps were a small and increasing share of CRT devices, growing from 12% to 20% in this study period. Compared to CRT‐D recipients, CRT‐P recipients were older (median age 76 versus 67), and more likely to be female (40% versus 30%). Pre‐implant use of β‐blockers and angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers was low in both CRT‐D (46%) and CRT‐P (31%) patients. The fraction of CRT‐P devices among all new implants varied widely across states. Compared to the increasing national trend, the share of CRT‐P implants was relatively increasing in Kansas and relatively decreasing in Minnesota and Oregon.ConclusionsIn this large, contemporary heart failure population, CRT‐D use dwarfed CRT‐P, though the latter nearly doubled over 6 years. Practice patterns vary substantially across states and over time. Medical therapy appears suboptimal in real‐world practice.

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Section: Discussionmentioning

confidence: 99%

Geographic and Temporal Variation in Cardiac Implanted Electric Devices to Treat Heart Failure

Hatfield

Kramer

Volya

et al. 2016

JAHA

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“…These studies have tested "de novo" CRT implantation in patients with a conventional pacing indication, both with preserved left ventricular systolic function [67][68][69] and with moderate-severe left ventricular dysfunction [70][71][72]. The results suggest that CRT plays a preventive role with regard to HF mortality/hospitalizations only in patients with left ventricular dysfunction (LVEF <40%).…”

Section: Patient Selectionmentioning

confidence: 99%

“…The results suggest that CRT plays a preventive role with regard to HF mortality/hospitalizations only in patients with left ventricular dysfunction (LVEF <40%). Indeed, left ventricular systolic dysfunction has recently been suggested as an independent predictor of the adverse clinical impact of pacing [73,74], even though the preventive impact of CRT on HF in these patients must be carefully evaluated considering the increase in complications due to the greater number of leads implanted (6.5% vs. 18%, conventional pacing vs. CRT in the BLOCK-HF study) [72].…”

Section: Patient Selectionmentioning

confidence: 99%

Six Sigma DMAIC for Shaking Stagnant Construction Cultures – A Conceptual Perspective

A¹

2015

J Civ Eng Environ Sci

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Heart Failure is the result of heterogeneous structural heart diseases, especially ischemic disease, and is becoming increasingly common in all Western countries.Many patients continue to be symptomatic in spite of progress in pharmacological therapy, and the risk of mortality remains high in the most advanced functional classes. Cardiac resynchronization therapy can be used as a therapeutic strategy for alleviating symptoms and reducing mortality in selected patients with heart failure.Cardiac resynchronization therapy provides both immediate and medium/long-term results. The immediate results are the reduced QRS duration, the synchrony restoration between the ventricles and between the lateral and septal walls of the left ventricle, the reduced mitral regurgitation and the increased stroke volume. In the medium/long term, left ventricular reverse remodeling occurs and left ventricular ejection fraction is increased.Several trials have documented both increased functional capacity and improvements in quality of life and New York Heart Association class. Moreover, cardiac resynchronization therapy has been seen to reduce HF hospitalizations and mortality and the total number of days of hospitalization.In order to reduce the percentage of non-responders to cardiac resynchronization therapy, it is necessary to optimize the prognostic stratification of candidates for implantation through multi-parameter evaluations and to ensure correct device programming with periodic updates which are widely recommended but not so often performed.Whether indications should be extended will need to be evaluated in view of the known complications mainly associated with lead implantation. RationaleIt is well known that QRS duration is inversely correlated with survival in HF patients in functional classes II-IV, and patients with QRS ≥200 ms have a 5-fold higher risk of death than those with a narrow QRS [7]. In particular, left bundle branch block (LBBB) usually delays activation of the posterior/lateral wall of the left ventricle, leading to asynchronous contraction between the septum and posterior-lateral wall and reducing the left ventricular ejection fraction (LVEF).CRT can correct this asynchronous contraction through the preexcitation of the posterior-lateral wall of the left ventricle, thereby improving systolic function [8,9]. Indeed, the dyssynchrony due to prolonged QRS duration involves the heterogeneous propagation of electrical activity in the ventricle, which determines various degrees of impaired coordination in filling and contraction [10]. Consequently the contractile efficiency of the heart is compromised and the myocardial oxygen consumption increases, worsening the clinical course of HF.

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“…Pequeños estudios aleatorizados han señalado que los pacientes con disfunción del VI moderada-grave podrían beneficiarse de la TRC en lugar de la estimulación apical del VD convencional (tabla 15) [123][124][125][126][127][128][129][130] . En general, los objetivos primarios de estos estudios se sustituyeron por objetivos hemodinámicos.…”

Section: Estimulación Cardiaca Con Terapia De Resincronización Cardiaunclassified

“…Hubo pocos episodios clínicos, con tendencia a favor de la TRC. En el estudio BLOCK HF 125,126 , se aleatorizó a 691 pacientes con BAV y disfunción sistólica a TRC-M y estimulación del VD con o sin DAI y se les dio un seguimiento medio de 37 meses. El objetivo primario, compuesto de mortalidad y visitas a urgencias por IC o aumento ≥ 15% de la DSVI, mejoró considerablemente entre los aleatorizados a TRC.…”

Section: Estimulación Cardiaca Con Terapia De Resincronización Cardiaunclassified

2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

Brignole

Auricchio

Barón-Esquivias

et al. 2014

Revista Española de Cardiología (English Edition)

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Biventricular Pacing for Atrioventricular Block and Systolic Dysfunction

Abstract: Biventricular pacing was superior to conventional right ventricular pacing in patients with atrioventricular block and left ventricular systolic dysfunction with NYHA class I, II, or III heart failure. (Funded by Medtronic; BLOCK HF ClinicalTrials.gov number, NCT00267098.).

Cited by 679 publications

References 16 publications

Geographic and Temporal Variation in Cardiac Implanted Electric Devices to Treat Heart Failure

Geographic and Temporal Variation in Cardiac Implanted Electric Devices to Treat Heart Failure

Six Sigma DMAIC for Shaking Stagnant Construction Cultures – A Conceptual Perspective

2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

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