Abstract:Introduction: Left ventricular (LV) lead optimal positioning is one of the most important determinants of cardiac resynchronization therapy (CRT) success. LV quadripolar active fixation (QAF) leads have been designed to ensure stable LV pacing in the target area and reduce the likelihood of phrenic nerve stimulation (PNS). The aim of this analysis is to compare performances, safety, and clinical outcomes of QAF with those of quadripolar passive fixation leads (QPL) and bipolar active fixation (BAF) leads in a … Show more
“…Over the past 20 years of widespread clinical use, CRT has led to a reduction in mortality and heart failure hospitalizations in a substantial number of patients 3–5 . CRT implantation tools have significantly improved in recent years, making the implantation procedure simpler and safer 6–8 . Italy is one of the world's countries in which the highest number of CRT implantations is performed in relation to patient population 9 .…”
Section: Introductionmentioning
confidence: 99%
“…3 -5 CRT implantation tools have significantly improved in recent years, making the implantation procedure simpler and safer. [6][7][8] Italy is one of the world's countries in which the highest number of CRT implantations is performed in relation to patient population. 9 However, despite the annual number of CRT implantations having remained stable in our country, a slight decrease in CRT indication has been observed in Europe and USA.…”
Background
Cardiac resynchronization therapy (CRT) represents an effective heart failure treatment, associated with reduction in mortality and heart failure hospitalizations. This Italian survey aimed to address relevant CRT issues.
Methods
An online survey was administered to AIAC members.
Results
One hundred and five electrophysiologists participated, with a median of 40 (23–70) CRT implantations/year (33% in high-volume centres). Forty-five percent of respondents (especially working in high-volume centres) reported an increase in CRT implantations in the last 2 years, in 16% a decrease, and in 38% CRT remained stable. Seventy-five percent of respondents implanted CRT only in patients with European Heart Rhythm Association (EHRA) class I indications. All operators collected ECG and echocardiography before implantation. Eighty-five percent of respondents selected coronary sinus target vein empirically, whereas 10% used mechanical and/or electrical delay techniques. Physicians working in high-volume centres reported a lower failure rate compared with others (16 vs. 34%; P = 0.03). If the coronary sinus lead could not be positioned in the target branch, 80% placed it in another vein, whereas 16% opted for a surgical approach or for conduction system pacing (CSP). Eighty percent accomplished CRT optimization in all patients, 17% only in nonresponders. Regarding anticoagulation, high agreement with EHRA guidelines emerged.
Conclusion
CRT represents a valid therapeutic option in heart failure treatment. Nowadays, CRT implantations remain stable and are mainly performed in patients with class I indications. ECG remains the preferred tool for patient selection, whereas imaging is increasingly used to determine the left pacing target area. In most patients, the left ventricular lead can be successfully positioned in the target vein, but in some cases, the result can be unsatisfactory; however, the decision to explore alternative resynchronization approaches is rarely pursued.
“…Over the past 20 years of widespread clinical use, CRT has led to a reduction in mortality and heart failure hospitalizations in a substantial number of patients 3–5 . CRT implantation tools have significantly improved in recent years, making the implantation procedure simpler and safer 6–8 . Italy is one of the world's countries in which the highest number of CRT implantations is performed in relation to patient population 9 .…”
Section: Introductionmentioning
confidence: 99%
“…3 -5 CRT implantation tools have significantly improved in recent years, making the implantation procedure simpler and safer. [6][7][8] Italy is one of the world's countries in which the highest number of CRT implantations is performed in relation to patient population. 9 However, despite the annual number of CRT implantations having remained stable in our country, a slight decrease in CRT indication has been observed in Europe and USA.…”
Background
Cardiac resynchronization therapy (CRT) represents an effective heart failure treatment, associated with reduction in mortality and heart failure hospitalizations. This Italian survey aimed to address relevant CRT issues.
Methods
An online survey was administered to AIAC members.
Results
One hundred and five electrophysiologists participated, with a median of 40 (23–70) CRT implantations/year (33% in high-volume centres). Forty-five percent of respondents (especially working in high-volume centres) reported an increase in CRT implantations in the last 2 years, in 16% a decrease, and in 38% CRT remained stable. Seventy-five percent of respondents implanted CRT only in patients with European Heart Rhythm Association (EHRA) class I indications. All operators collected ECG and echocardiography before implantation. Eighty-five percent of respondents selected coronary sinus target vein empirically, whereas 10% used mechanical and/or electrical delay techniques. Physicians working in high-volume centres reported a lower failure rate compared with others (16 vs. 34%; P = 0.03). If the coronary sinus lead could not be positioned in the target branch, 80% placed it in another vein, whereas 16% opted for a surgical approach or for conduction system pacing (CSP). Eighty percent accomplished CRT optimization in all patients, 17% only in nonresponders. Regarding anticoagulation, high agreement with EHRA guidelines emerged.
Conclusion
CRT represents a valid therapeutic option in heart failure treatment. Nowadays, CRT implantations remain stable and are mainly performed in patients with class I indications. ECG remains the preferred tool for patient selection, whereas imaging is increasingly used to determine the left pacing target area. In most patients, the left ventricular lead can be successfully positioned in the target vein, but in some cases, the result can be unsatisfactory; however, the decision to explore alternative resynchronization approaches is rarely pursued.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.