Non-invasive hemodynamic determination of patient-specific optimal pacing mode in cardiac resynchronization therapy

Ferchaud, Virginie; Garcia, Rodrigue; Bidegain, Nicolas; Degand, Bruno; Milliez, Paul; Pezel, Théo; Moubarak, Ghassan

doi:10.1007/s10840-020-00908-6

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…In addition to the underling cardiac disease, the perioperative risk may be affected significantly by the device itself, because ICDs and pacemakers implanted for CRT represent the most complex type of CIEDs. The software encloses a large variety of different sensors, automatic algorithms, and programming features, and it may differ depending on the manufacturer [8][9][10]. The biventricular hardware configuration with a third lead wedged in an epicardial coronary sinus side branch is associated with higher complication rates in the long term compared with conventional devices [11][12][13][14].…”

Section: Methodsmentioning

confidence: 99%

Perioperative Sensor and Algorithm Programming in Patients with Implanted ICDs and Pacemakers for Cardiac Resynchronization Therapy

Niedermeier

Vitali-Serdoz²,

Fischlein

et al. 2021

Sensors

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Background: ICDs and pacemakers for cardiac resynchronization therapy (CRT) are complex devices with different sensors and automatic algorithms implanted in patients with advanced cardiac diseases. Data on the perioperative management and outcome of CRT carriers undergoing surgery unrelated to the device are scarce. Methods: Data from 198 CRT device carriers (100 with active rate responsive sensor) were evaluated regarding perioperative adverse (device-related) events (A(D)E) and lead parameter changes. Results: Thirty-nine adverse observations were documented in 180 patients during preoperative interrogation, which were most often related to the left-ventricular lead and requiring intervention/reprogramming in 22 cases (12%). Anesthesia-related events occurred in 69 patients. There was no ADE for non-cardiac surgery and in pacemaker-dependent patients not programmed to an asynchronous pacing mode. Post-operative device interrogation showed significant lead parameter changes in 64/179 patients (36%) requiring reprogramming in 29 cases (16%). Conclusion: The left-ventricular pacing lead represents the most vulnerable system component. Comprehensive pre and post-interventional device interrogation is mandatory to ensure proper system function. The type of ICD function suspension has no impact on each patient’s outcome. Precautionary activity sensor deactivation is not required for non-cardiac interventions. Routine prophylactic device reprogramming to asynchronous pacing appears inessential. Most of the CRT pacemakers do not require surgery-related reprogramming.

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Section: Methodsmentioning

confidence: 99%

Perioperative Sensor and Algorithm Programming in Patients with Implanted ICDs and Pacemakers for Cardiac Resynchronization Therapy

Niedermeier

Vitali-Serdoz²,

Fischlein

et al. 2021

Sensors

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“…[ 64 ] The impact of SyncAV programming on acute haemodynamic response has also been assessed non-invasively using aortic velocity time integral (VTI) and systolic blood pressure response, with augmentation of response seen using personalised SyncAV offsets. [ 65 , 66 ]…”

Section: Electrogram Algorithm-basedprogramming Optimisationmentioning

confidence: 99%

Fusion Pacing with Biventricular, Left Ventricular-only and Multipoint Pacing in Cardiac Resynchronisation Therapy: Latest Evidence and Strategies for Use

Lambiase

Muthumala

Rowland

et al. 2021

Arrhythm Electrophysiol Rev

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Despite advances in the field of cardiac resynchronisation therapy (CRT), response rates and durability of therapy remain relatively static. Optimising device timing intervals may be the most common modifiable factor influencing CRT efficacy after implantation. This review addresses the concept of fusion pacing as a method for improving patient outcomes with CRT. Fusion pacing describes the delivery of CRT pacing with a programming strategy to preserve intrinsic atrioventricular (AV) conduction and ventricular activation via the right bundle branch. Several methods have been assessed to achieve fusion pacing. QRS complex duration (QRSd) shortening with CRT is associated with improved clinical response. Dynamic algorithm-based optimisation targeting narrowest QRSd in patients with intact AV conduction has shown promise in people with heart failure with left bundle branch block. Individualised dynamic programming achieving fusion may achieve the greatest magnitude of electrical synchrony, measured by QRSd narrowing.

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“…Small observational studies have demonstrated acute hemodynamic benefits of optimizing AV delays during CRT. [28][29][30] Although the use of echocardiography-based AV optimization was not shown to provide clinical benefit over empirical AV delays in a large randomized trial, 31 studies using dynamic device-based algorithms to optimize AV delays have shown more promise. 32,33 Interestingly, in a recently reported mechanistic study of 19 patients undergoing temporary His bundle pacing at the time of CRT implant, the majority of the hemodynamic benefit derived from CRT was found to be secondary to shortening of the AV delay, rather than ventricular resynchronization.…”

Section: Suboptimal Biventricular Pacingmentioning

confidence: 99%

Atrial fibrillation in cardiac resynchronization therapy

et al. 2021

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Patients with atrial fibrillation (AF) were largely excluded from the major clinical trials of cardiac resynchronization therapy (CRT), despite the presence of AF in up to 40% of patients receiving CRT in clinical practice. AF appears to attenuate the response to CRT, by the combination of a reduction in biventricular pacing and the loss of atrioventricular synchrony. In addition, remodeling secondary to CRT may influence the progression of AF. Management options for patients with AF and CRT include rate control, with drugs or atrioventricular node ablation, or rhythm control, with electrical cardioversion and antiarrhythmic therapy, or AF catheter ablation. The evidence for these therapies in patients with CRT is largely limited to observational studies or inferred from randomized studies in the general heart failure population. In this review, we explore the complex interaction between AF, heart failure, and CRT and discuss the evidence for the treatment options in this difficult patient cohort.

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Non-invasive hemodynamic determination of patient-specific optimal pacing mode in cardiac resynchronization therapy

Cited by 4 publications

References 27 publications

Perioperative Sensor and Algorithm Programming in Patients with Implanted ICDs and Pacemakers for Cardiac Resynchronization Therapy

Perioperative Sensor and Algorithm Programming in Patients with Implanted ICDs and Pacemakers for Cardiac Resynchronization Therapy

Fusion Pacing with Biventricular, Left Ventricular-only and Multipoint Pacing in Cardiac Resynchronisation Therapy: Latest Evidence and Strategies for Use

Atrial fibrillation in cardiac resynchronization therapy

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