Effect of Resynchronization Therapy Stimulation Site on the Systolic Function of Heart Failure Patients

Butter, Christian; Auricchio, Angelo; Stellbrink, Christoph; Fleck, Eckart; Ding, Jiang; Yu, Yinghong; Huvelle, Etienne; Spinelli, Julio

doi:10.1161/hc5001.102229

Cited by 586 publications

(352 citation statements)

References 12 publications

(10 reference statements)

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“…Early CRT studies showed that a lateral or posterolateral LV lead position was associated with a superior hemodynamic benefit than anterior positions 14. Other clinical studies, however, have not been consistent.…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Outcomes of Cardiac Resynchronization Therapy Using Apical Versus Nonapical Left Ventricular Pacing

Leyva

Zegard

Taylor

et al. 2018

JAHA

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BackgroundExperimental evidence indicates that left ventricular (LV) apical pacing is hemodynamically superior to nonapical LV pacing. Some studies have shown that an LV apical lead position is unfavorable in cardiac resynchronization therapy. We sought to determine whether an apical LV lead position influences cardiac mortality after cardiac resynchronization therapy.Methods and ResultsIn this retrospective observational study, the primary end point of cardiac mortality was assessed in relation to longitudinal (basal, midventricular, or apical) and circumferential (anterior, lateral, or posterior) LV lead positions, as well as right ventricular (apical or septal), assigned using fluoroscopy. Lead positions were assessed in 1189 patients undergoing cardiac resynchronization therapy implantation over 15 years. After a median follow‐up of 6.0 years (interquartile range: 4.4–7.7 years), an apical LV lead position was associated with lower cardiac mortality than a nonapical position (adjusted hazard ratio: 0.74; 95% confidence interval, 0.56–0.99) after covariate adjustment. There were no differences in total mortality or heart failure hospitalization. Death from pump failure was lower with apical than nonapical positions (adjusted hazard ratio: 0.69; 95% confidence interval, 0.51–0.94). Compared with a basal position, an apical LV position was also associated with lower risk of sudden cardiac death (adjusted hazard ratio: 0.34; 95% confidence interval, 0.13–0.93). No differences emerged between circumferential LV lead positions or right ventricular positions with respect to any end point.ConclusionsIn recipients of cardiac resynchronization therapy, an apical LV lead position was associated with better long‐term cardiac survival than a nonapical position. This effect was due to a lower risk of pump failure and sudden cardiac death.

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Section: Discussionmentioning

confidence: 99%

Long‐Term Outcomes of Cardiac Resynchronization Therapy Using Apical Versus Nonapical Left Ventricular Pacing

Leyva

Zegard

Taylor

et al. 2018

JAHA

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“…Butter et al compared the acute effects of LV pacing site (anterior vs. free wall) on net change in global systolic function. He found that LV free wall pacing consistently resulted in greater increases in dP/dtmax and aortic pulse pressure than did anterior pacing (35). Accordingly, CS pacing leads are typically placed in midlateral wall positions, frequently over a guideword directed into the selected tributary3.In a study by Gasparini et al the effects of differential pacing sites were evaluated in CRT treated patients, the results were not in favor of lateral wall pacing.…”

Section: Where To Pace; Bi -Ventricular or LV Anterior Or Free Wall?mentioning

confidence: 99%

Cardiac Resynchronisation Therapy in Heart Failure

Wahab¹,

Alvi²,

Panwar³

et al. 2011

Int Cardiovasc Res J

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This review is intended for those managing patients of heart failure and aims to provide the recent advances and emerging role of CRT implantation in heart failure management.Cardiac resynchronization therapy (CRT) represents one of the recent advances in heart failure (HF) management. It implies an attempt to establish left ventricular synchronous contraction in order to improve left ventricular hemodynamics; thereby improving functional class, and quality of life. CRT has come a long way from an incidental treatment modality to an accepted and indicated treatment strategy for patients suffering from severe and chronic heart failure. With its ever increasing use, it is important that we become conversant with its role in the management of heart failure. This article aims to review the evidence for CRT, how CRT benefits patients of heart failure and reveals the indications of CRT implantation in HF patients.

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“…Some authors stress the placement of left ventricle electrode into the lateral wall of the left ventricle, for reason of better hemodynamic response than other walls of the left ventricle 16 . Stimulation of the left ventricle anterior wall can lead to deterioration of cardiac failure and mitral regurgitation 17 .…”

Section: % Of Cases Does the Resynchronization Therapy Lead To Reducmentioning

confidence: 99%

Does the Resynchronization Therapy Lead to Reduction of Symptoms and to Improvement of Left Ventricular Functions in Patients With Chronic Heart Failure?

Ozábalová¹,

Novák²,

Krejčí³

et al. 2010

BIOMED PAP

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Aim.To evaluate the therapeutic effect of resynchronization in patients with chronic heart failure who are symptomatic despite adequate pharmacological medication.Sample and methodology. 118 patients with chronic heart failure, mostly dilated cardiomyopathy and ischaemic heart disease, with depressed systolic function, decreased left ventricular ejection fraction (LVEF) and left bundle branch block wide QRS complex, underwent implantation of the biventricular system between the years 2000-2006. We assessed changes in the NYHA functional class, hemodynamic parameters acquired during right heart catheterization, the maximum oxygen consumption during stress spiroergometric examination, as well as echocardiographic parameters.Results. A statistically significant improvement was found in the NYHA functional class (from 2.8 ± 0.4 to 2.3 ± 0.5 after 3m, p < 0,001 and to 2.5 ± 0.6 after 12m, p < 0,01 respectively), as well as an increase in the maximum oxygen consumption during spiroergometric examination (VO2 max from 14.1 ± 3.1ml/kg/min to 15.3 ± 3.1 ml/kg/ min, p < 0,001 and to 15.3 ± 2.5 ml/kg/min, p = NS respectively). In regard to hemodynamic parameters, there were increases in cardiac output and cardiac index after three months. After 12 months the change was not statistically significant (CO from 3.9 ± 1 l/min to 4.2 ± 0.9 l/min, p < 0,05, and to 4.1 ± 0.9 l/min, p = NS, CI from 2 ± 0.5l/kg/min to 2.2 ± 0.4l/kg/min, p < 0,05, and to 2.1 ± 0.4 l/kg/min, p = NS). Mean pulmonary artery pressure, as well as pulmonary capillary wedge pressure was reduced after 3, as well as after 12 months to a statistically significant degree (MPA from 29.1 ± 11.5 mm Hg to 23.9 ± 10.3 mm Hg, p< 0,001, and to 24.9 ± 11.8 mm Hg, p < 0,01 respectively, and PCWP from 19.9 ± 9.5 mm Hg to 15.2 ± 9.2 mm Hg, p < 0,01, and to 15.6 ± 9 mm Hg, p < 0,01 respectively). In regard to echocardiographic parameters, there was an increase in LVEF, a reduction in the end-diastolic diameter of the left ventricle, as well as a statistically significant reduction in severity of mitral regurgitation after 3, as well as 12 months (LVEF from 20.5 ± 5.3%, to 23 ± 6.5%, p < 0,001, and to 24.5 ± 8%, p < 0,001, LVEDD from 69 ± 9 mm to 68 ± 9 mm, p < 0.01 and to 65 ± 12 mm, p< 0.01 respectively, mitral regurgitation from 2.2 ± 0.8 to 1.9 ± 0.8, p< 0.001, and to 2 ± 0.8, p < 0.001.Conclusions. In patients with chronic heart failure, resynchronization therapy leads to reduced symptoms, reduction in dyspnea and to improvements in cardiac performance due to increase in the systolic function of the left ventricle and hemodynamic changes.

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Effect of Resynchronization Therapy Stimulation Site on the Systolic Function of Heart Failure Patients

Cited by 586 publications

References 12 publications

Long‐Term Outcomes of Cardiac Resynchronization Therapy Using Apical Versus Nonapical Left Ventricular Pacing

Long‐Term Outcomes of Cardiac Resynchronization Therapy Using Apical Versus Nonapical Left Ventricular Pacing

Cardiac Resynchronisation Therapy in Heart Failure

Does the Resynchronization Therapy Lead to Reduction of Symptoms and to Improvement of Left Ventricular Functions in Patients With Chronic Heart Failure?

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