Mitral-Aortic Flow Reversal in Cardiac Resynchronization Therapy

Muñoz, Daniel; Mur, José Luis Moya; Moreno, Javier; Fernández-Golfín, Covadonga; Franco, Eduardo; Berlot, B; Monteagudo, J M; Francés, Roberto Matía; Hernández‐Madrid, Antonio; Zamorano, José Luís

doi:10.1161/circep.116.004927

Cited by 4 publications

(3 citation statements)

References 24 publications

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“…Rodríguez Muñoz et al 39 described the use of echocardiography to optimize AV delay in cardiac resynchronization therapy using analysis of flow dynamics of blood entering the mitral inflow getting immediately redirected to the outflow tract without reaching the LV apex, that is, the mitral-aortic flow reversal. Optimal AV delay achieves perfect coupling between the inflow and outflow patterns, whereas long AV delays desynchronize the 2 flows and short AV delays reduce the flow reversal.…”

Section: Cardiac Resynchronization Therapymentioning

confidence: 99%

Year in Review in Cardiac Electrophysiology

Tzou

Hussein

Madhavan

et al. 2018

Circ: Arrhythmia and Electrophysiology

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1 In the past year, there have been key advances in our understanding of arrhythmia mechanisms and diagnosis and important new therapies. We have seen advances in basic cardiac electrophysiology with demonstration of optogenetic targeting of atrial fibrillation (AF) rotors, induced pluripotent stem cell-based biological pacemakers, small-conductance Ca 2+ -activated K + (SK) channels as targets for AF treatment, and reductions in inward rectifier potassium current in promoting ventricular fibrillation. Hand-held ECG devices and implantable loop recorders have been shown to detect subclinical AF. Catheter ablation of AF in patients with left ventricular dysfunction improves outcomes compared with medical therapy. Both hybrid thoracoscopic surgical and catheter ablation procedures and off-pump surgery for AF have demonstrated efficacy. Anticoagulation with uninterrupted dabigatran had a lower major bleeding rate compared with uninterrupted warfarin after AF ablation. Studies have examined optimizing access to automatic external defibrillators by identifying optimal locations for placement and possibility of using a drone delivery network. In long-QT syndrome, there are advances in understanding of ECG predictors of arrhythmic events, the role of the role of gene variants in conferring arrhythmic risk, and effect of age and sex on QTc interval. There are numerous advances in the treatment of ventricular tachycardia, including noninvasive cardiac radiation. Catheter ablation and implantable devices continue to demonstrate effectiveness in patients with congenital heart disease.In the past year, there have been numerous ground-breaking discoveries and observations that illustrate the vibrancy and promise of our field. In this review, we have tried to capture articles published in the year 2017 of particular interest to cardiac electrophysiologists. Although we have focused on articles from our journal, we have captured many of the most impactful articles in numerous other journals. We apologize for omitting a large number of other important articles that cannot be included in this review because of space limitations. We have placed some of these in our Data Supplement. BASIC ELECTROPHYSIOLOGY BradyarrhythmiasThe search for new biological therapies for bradycardia met with recent progress as human keratinocytes genetically reprogrammed into electrically unstable cardiomyocytes were shown to persist and provide continued catecholaminergic-responsive pacing for 13 weeks after subepicardial injection into immunosuppressed dogs at the time of atrioventricular (AV) node ablation.1 Although only 40% to 80% of the beats matched the site of cell injection, this is first study to test a human induced pluripotent stem cell-based biological pacemaker in a large animal model of heart block and represents an important step forward in biological pacing.

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Section: Cardiac Resynchronization Therapymentioning

confidence: 99%

Year in Review in Cardiac Electrophysiology

Tzou

Hussein

Madhavan

et al. 2018

Circ: Arrhythmia and Electrophysiology

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“…Alternative techniques to optimize AV delay consist of impedance cardiography, finger photoplethysmography, hemodynamic optimization using noninvasive blood pressure measurements, acoustic cardiography, or peak endocardial acceleration [ 24 , 25 , 26 ]. Moreover, a flow pattern in the LV outflow tract in which there is coupling between mitral-aortic flow reversal and ejection flow has also been described as a way for determining optimal AV delay [ 27 ]. Additionally, there are multiple IEGM-based algorithms available, including QuickOpt (Abbott ® ), SmartDelay (Boston Scientific ® ), Adaptive-CRT (Medtronic ® ), and SonR (Microport ® ).…”

Section: Discussionmentioning

confidence: 99%

“…Despite the neutral randomized studies in optimizing AV delays, experimental physiological and pathophysiological research supports the rationale to optimize AV delays [ 11 , 12 , 13 , 14 , 27 ]. Adequate patient selection, as well as the best method for optimizing, measuring, and assessing the effects of AV optimization, remains to be defined to establish clinical benefit.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Resynchronization Therapy beyond Nominal Settings: An IEGM-Based Approach for Paced and Sensed Atrioventricular Delay Offset Optimization in Daily Clinical Practice

Kloosterman

Daniëls

Roseboom

et al. 2023

JCM

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Optimization of the atrioventricular (AV) delay has been performed in several landmark trials in cardiac resynchronization therapy (CRT), although it is often not performed in daily practice. Our aim was to study optimal AV delays and investigate a simple intracardiac electrogram (IEGM)-based optimization approach. 328 CRT patients with paired IEGM and echocardiography optimization data were included in our single-center observational study. Sensed (sAV) and paced (pAV) AV delays were optimized using an iterative echocardiography method. The offset between sAV and pAV delays was calculated using the IEGM method. The mean age of the patients was 69 ± 12 years; 64% were men, 48% had ischemic etiology of heart failure. During echocardiographic optimization, an offset of 73 ± 18 ms was found, differing from nominal AV settings (p < 0.001). Based on the IEGM method, the optimal offset was 75 ± 25 ms. The echocardiographic and IEGM-generated AV offset delays showed good correlation (R2 = 0.62, p < 0.001) and good agreement according to Bland-Altman plot analysis. CRT responders had a near zero offset difference between IEGM and echo optimization (−0.2 ± 17 ms), while non-responders had an offset difference of 6 ± 17 ms, p = 0.006. In conclusion, optimal AV delays are patient-specific and differ from nominal settings. pAV delay can easily be calculated from IEGM after sAV delay optimization.

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