Canadian Cardiovascular Society Guidelines on the Use of Cardiac Resynchronization Therapy: Implementation

Parkash, Ratika; Philippon, François; Shanks, Miriam; Thibault, Bernard; Cox, Jafna L.; Low, Aaron; Essebag, Vidal; Bashir, Jamil; Moe, Gordon W.; Birnie, David H.; Larose, Éric; Yee, Raymond; Swiggum, Elizabeth; Kaul, Padma; Redfearn, Damián P.; Tang, Anthony; Exner, Derek V.

doi:10.1016/j.cjca.2013.09.009

Cited by 19 publications

(16 citation statements)

References 103 publications

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“…Recent guidelines have recommended evaluation of patients for possible upgrade to CRT at the time of system revision that may be for pulse generator change or other cause. 6,7 Patients with pacemakers who develop pacing-induced ventricular dyssynchrony and HF, and patients with ICDs and HF who subsequently develop a wide QRS represent the majority of patients eligible for upgrade to CRT platforms (CRT defibrillator [CRT-D] or CRT pacemaker). 8 Some centers have reported that 30% of CRT implant procedures represent upgrades from existing CIEDs.…”

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confidence: 99%

Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy

et al. 2019

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Background: Cardiac resynchronization therapy (CRT) is effective in treating advanced heart failure (HF), but data describing benefits and long-term outcomes for upgrades from a preexisting device are limited. This study sought to compare long-term outcomes in de novo CRT implants with those eligible for CRT with a prior device. Methods: This is a retrospective cohort study using data from a provincial registry (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). Patients were included if they had mildmoderate HF, left ventricular ejection fraction 35%, and QRS duration ! 130 ms. Patients were classified as de novo CRT or upgraded to CRT from a prior device. Outcomes were mortality and composite mortality and HF hospitalization. Results: There were 342 patients included in the study. In a multivariate model, patients in the upgraded cohort (n ¼ 233) had a higher 5-year mortality rate (adjusted hazard ratio, 2.86; 95% confidence interval, 1.59-5.15; P ¼ 0.0005) compared with the de novo cohort (n ¼ 109) and higher composite mortality and HF hospitalization (adjusted hazard ratio, 2.60; 95% confidence interval, 1.54-4.37; P ¼ 0.0003). Conclusions: Implantation of de novo CRTs was associated with lower mortality and HF hospitalization compared with upgraded CRTs from preexisting devices. It is unknown whether these differences are due to the timing of CRT implementation or other clinical factors. Further work in this area may be helpful to determine how to improve outcomes for these patients.Randomized trials have demonstrated that among patients with mild to moderate heart failure (HF), reduced ejection fraction, and left bundle branch block, cardiac resynchronization therapy (CRT) significantly reduces mortality and HF CJC Open 1 (2019) 93e99

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confidence: 99%

Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy

et al. 2019

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“…The use of cardiac implantable electronic devices such as pacemakers and defibrillators is increasing as more clinical indications are validated 1 . Advances in device technology and implantation techniques significantly reduce surgical risks, but about 10% of recipients continue to have complications related to device implantation 2 .…”

Section: Discussionmentioning

confidence: 99%

Central venous catheter fracture during pacemaker lead extraction

Rizkallah

Sumner

Sheldon

2016

HeartRhythm Case Reports

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“…The LVEF cutoff of 35% used in this study was based on the guideline-recommended echo criteria for CRT eligibility derived from the studies predominantly using non-contrast 2D echocardiography. [1][2][3] The STICH trial that included >2000 patients with LVEF ≤35% demonstrated that 18.5% of patients had LVEF >35% when the baseline echocardiography data were analyzed by the core laboratory. 26 The authors concluded that the difference in LVEF between the clinical sites and echocardiography core laboratory could be related to different imaging methods, interobserver variability, different timing of imaging, or interpretation error.…”

Section: Coefficient Of Variation (%)mentioning

confidence: 99%

“…For example, reduced left ventricular ejection fraction (LVEF) to ≤35% is one of the main determinant factors in the selection of patients who may benefit from cardiac resynchronization therapy (CRT) as one of the most commonly used device therapies in heart failure patients. [1][2][3] Such a key criterion requires accurate quantification to ensure optimal effectiveness of therapy. Two-dimensional (2D) echocardiography is by far the most commonly used imaging modality for assessment of LVEF given its easy accessibility and relatively low cost compared with other imaging techniques.…”

Section: Introductionmentioning

confidence: 99%

Impact of contrast echocardiography on accurate discrimination of specific degree of left ventricular systolic dysfunction and comparison with cardiac magnetic resonance imaging

et al. 2018

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Aim Limited data exist on the impact of contrast‐enhanced echocardiography on treatment decisions in heart failure patients that require specific left ventricular ejection fraction (LVEF) criteria. This study assessed accuracy of contrast‐enhanced echocardiography in identifying patients with LVEF >35% vs ≤35% with cardiac magnetic resonance (CMR) used as reference method. Methods and results Fifty‐five patients from prospective Alberta HEART cohort with LVEF ≤50% on CMR were included. All patients had echocardiography performed within 2 weeks of CMR. Contrast agent was used when ≥2 contiguous LV endocardial segments were poorly visualized on echocardiography. LVEF was computed by Simpson's biplane method using non‐contrast echocardiography and contrast‐enhanced echocardiography and by outlining the endocardial contours in short‐axis cine CMR images. Strong agreement in LV volumes and LVEF was seen between CMR and echocardiography with and without contrast (intra‐class correlation coefficients >0.8) with less underestimation of LV volumes by contrast‐enhanced echocardiography. Good agreement in LVEF ≤35% vs >35% was seen between CMR and non‐contrast echocardiography with optimal images (κ 0.862) and contrast echocardiography (κ 0.769) while it was moderate for non‐contrast echocardiography with suboptimal images (κ 0.491). The use of LV contrast in patients with suboptimal images (n = 39) resulted in correctly upgrading LVEF from ≤35% to >35% in 5 (13%) patients and downgrading LVEF from >35% to ≤35% in 2 (5%) patients using CMR as reference. Conclusions Contrast‐enhanced echocardiography in heart failure patients with suboptimal images helps to more accurately assess eligibility for specific therapies and avoid need for further testing, therefore should be considered routine part of echocardiographic assessment.

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Canadian Cardiovascular Society Guidelines on the Use of Cardiac Resynchronization Therapy: Implementation

Cited by 19 publications

References 103 publications

Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy

Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy

Central venous catheter fracture during pacemaker lead extraction

Impact of contrast echocardiography on accurate discrimination of specific degree of left ventricular systolic dysfunction and comparison with cardiac magnetic resonance imaging

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