Impact of Cardiac Resynchronization Therapy on Heart Failure Patients: Experience from One Center

Elzoghby, Ibrahim Abd Elhakam; Attia, I.; Azab, Abdo El; Hammouda, Mohammed

doi:10.21767/1989-5216.1000232

Cited by 3 publications

(6 citation statements)

References 15 publications

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“…In our study, the optimal QRSd obtained after CRT application supposed a 20% reduction of the QRSd. This result is in agreement with the study of Elhakam Elzoghby et al (2017), where 180 patients under heart failure conditions and LBBB were studied, and similar reductions were obtained. Other studies obtained lower QRS reduction values, namely 17 and 12%, for CRT responders in Molhoek et al (2004) and Pitzalis et al (2002) studies, respectively.…”

Section: Discussionsupporting

confidence: 93%

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Optimization of Lead Placement in the Right Ventricle During Cardiac Resynchronization Therapy. A Simulation Study

et al. 2019

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Patients suffering from heart failure and left bundle branch block show electrical ventricular dyssynchrony causing an abnormal blood pumping. Cardiac resynchronization therapy (CRT) is recommended for these patients. Patients with positive therapy response normally present QRS shortening and an increased left ventricle (LV) ejection fraction. However, around one third do not respond favorably. Therefore, optimal location of pacing leads, timing delays between leads and/or choosing related biomarkers is crucial to achieve the best possible degree of ventricular synchrony during CRT application. In this study, computational modeling is used to predict the optimal location and delay of pacing leads to improve CRT response. We use a 3D electrophysiological computational model of the heart and torso to get insight into the changes in the activation patterns obtained when the heart is paced from different regions and for different atrioventricular and interventricular delays. The model represents a heart with left bundle branch block and heart failure, and allows a detailed and accurate analysis of the electrical changes observed simultaneously in the myocardium and in the QRS complex computed in the precordial leads. Computational simulations were performed using a modified version of the O'Hara et al. action potential model, the most recent mathematical model developed for human ventricular electrophysiology. The optimal location for the pacing leads was determined by QRS maximal reduction. Additionally, the influence of Purkinje system on CRT response was assessed and correlation analysis between several parameters of the QRS was made. Simulation results showed that the right ventricle (RV) upper septum near the outflow tract is an alternative location to the RV apical lead. Furthermore, LV endocardial pacing provided better results as compared to epicardial stimulation. Finally, the time to reach the 90% of the QRS area was a good predictor of the instant at which 90% of the ventricular tissue was activated. Thus, the time to reach the 90% of the QRS area is suggested as an additional index to assess CRT effectiveness to improve biventricular synchrony.

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Section: Discussionsupporting

confidence: 93%

“…In clinical practice, a shorter QRSd is one of the standard criteria used to evaluate CRT response. However, both non-responder and responder patients show a reduction in QRSd after CRT application (Molhoek et al, 2004; Elhakam Elzoghby et al, 2017). Therefore, an additional indicator would be useful for a better perception of CRT benefit.…”

Section: Resultsmentioning

confidence: 99%

Optimization of Lead Placement in the Right Ventricle During Cardiac Resynchronization Therapy. A Simulation Study

et al. 2019

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“…In our study, the optimal QRSd obtained after CRT application supposed a 20% reduction of the QRSd. This result is in agreement with the study of Elhakam et al [187], where 180 patients under heart failure conditions and LBBB were studied, and similar reductions were obtained. Other studies obtained lower QRS reduction values, namely 17% and 12%, for CRT responders in Molhoek et al [188] and Pitzalis et al [214] studies, respectively.…”

Section: Indicators To Evaluate Crt Outcomesupporting

confidence: 93%

“…In clinical practice, a shorter QRSd is one of the standard criteria used to evaluate CRT response. However, both non-responder and responder patients show a reduction in QRSd after CRT application [187], [188]. Therefore, an additional indicator would be useful for a better perception of CRT benefit.…”

Section: Ventricular Activation Time During Crtmentioning

confidence: 99%

Contribution to the improvement of electrical therapies and to the comprehension of electrophysiological mechanisms in heart failure and acute ischemia using computational simulation

Garay¹,

Fernando²

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A better understanding of the mechanisms underlying ventricular arrhythmias, as well as an improvement of the associated electrical and pharmacological therapies, are a key factor to prevent sudden cardiac death in patients with structural and electrical heart diseases. An important cardiomyopathy that can lead to life-threatening ventricular arrhythmias is heart failure (HF). Patients with HF also often suffer from left bundle branch block (LBBB), which worsens their condition. Currently, the most effective treatment to these patients is cardiac resynchronization therapy (CRT). However, many patients are non-responders, so further studies are needed to improve this treatment.

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“…Quality of life and reverse remodeling do not always align, as patients may experience improvement in one parameter without the other. Therefore, clinical parameters should not be disregarded, as an increase in quality of life or improvement in NYHA class can be just as significant as patient survival [3].…”

Section: Introductionmentioning

confidence: 99%

Clinical, electrical, and functional changes following CRT-P implantation: short-term results in patients with non-ischaemic cardiomyopathy

Mostafa,

Abdelmoneim,

Ramadan

et al. 2024

Racionalʹnaâ farmakoterapiâ v kardiologii

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Aim. Assessment of the correlation between cardiac remodeling, functional status and electrical remodeling after cardiac resynchronisation therapy (CRT) in patients with non-ischaemic cardiomyopathy.Material and methods. A single center, prospective, observational study included 50 patients with non-ischaemic cardiomyopathy who were candidate for CRT implantation. All patients prior to CRT and then 3 months after implantation had standard 12-lead surface ECGs to assess QRSd for assessment electrical response, for assessment of left ventricular ejection fraction (LVEF) and volumes (left ventricular end diastolic and systolic volume, LVEDV and LVESV), mitral regurgitation (degree of mitral regurgitation), pulmonary artery systolic pressure (for diagnosis of pulmonary hypertension), NYHA class and 6 minute walk test (6MWT) to assess patient’s functional capacity.Results. 50 patients with CRT were included (35 males and 15 females, mean age 54.88±7.48 years). All patients were in sinus rhythm with QRS duration (QRSd) ≥120 ms, EF<35% and left bundle branch block. After 3 months; there was significant improvement in QRSd in 82% of the cases (145.3±16.3 ms vs 133.3±17.2 ms, p<0.001). NYHA class improved at least one class in 78% and 6 min walk test improved in 80% (168.5 [131.0; 181.0] m vs 280.0 [237.0; 297.0] m, p<0.001). LVEF increased significantly in 74% of study cases (28.6±2.7 vs 34.5±3.1, p value 0.001) also there were statistically significant improvement in LVEDV (267.0±45.7 to 221.8±41.9 ml, p=0.002) and LVESV (137.43±47.19 to 105.03±42.7 ml, p=0.003). There was statistically significant correlation between QRSd and NYHA class (r=0.392, p=0.005), QRSd and 6MWT (r=0.323, p=0.022) and QRSd with LVEF (r=0.672 with p<0.001). Only seven patients showed improvement in the 3 parameters: LVESV, QRS duration and 6 min walk test.Conclusion. The CRT-pacemaker implantation was associated with significant improvement in QRSd, NYHA class, 6MWT and LV volumes in the short-term period. QRSd improvement was significantly correlated with functional status and LV EF.

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Impact of Cardiac Resynchronization Therapy on Heart Failure Patients: Experience from One Center

Cited by 3 publications

References 15 publications

Optimization of Lead Placement in the Right Ventricle During Cardiac Resynchronization Therapy. A Simulation Study

Optimization of Lead Placement in the Right Ventricle During Cardiac Resynchronization Therapy. A Simulation Study

Contribution to the improvement of electrical therapies and to the comprehension of electrophysiological mechanisms in heart failure and acute ischemia using computational simulation

Clinical, electrical, and functional changes following CRT-P implantation: short-term results in patients with non-ischaemic cardiomyopathy

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