Non-Responders to Cardiac Resynchronization Therapy  - The Magnitude of the Problem and the Issues -

Auricchio, Angelo; Prinzen, Frits W.

doi:10.1253/circj.cj-10-1268

Cited by 201 publications

(76 citation statements)

References 42 publications

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“…Recently, CRT-D therapy was shown to be equally effective in Japanese as in Western patients, 19 even if pre-identification of CRT responders still represents a significant challenge. 20, 21 The growing use of implantable cardiovascular electronic devices translates into an increasingly heavy workload for physicians in charge of regular follow-up. Remote follow-up option is becoming increasingly attractive as a substitute for clinic visits, despite some unsolved safety, legal, and reimbursement issues.…”

Section: Discussionmentioning

confidence: 99%

Reliability of Implantable Cardioverter Defibrillator Home Monitoring in Forecasting the Need for Regular Office Visits, and Patient Perspective

Watanabe

Kasai

Fujii

et al. 2013

Circ J

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Section: Discussionmentioning

confidence: 99%

Reliability of Implantable Cardioverter Defibrillator Home Monitoring in Forecasting the Need for Regular Office Visits, and Patient Perspective

Watanabe

Kasai

Fujii

et al. 2013

Circ J

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“…Being a stretch-derived measurement, septum rebound stretch reflects "dyscoordination" rather than "dyssynchrony". 22 Whether this or other dyscoordination indices are useful in common practice has yet to be proven in multiple centers.…”

Section: Recent Focus On the Mechanical Substratementioning

confidence: 99%

Cardiac Resynchronization Therapy - Refocus on the Electrical Substrate -

Strik

Ploux

Vernooy

et al. 2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp s its name suggests, cardiac resynchronization therapy (CRT) aims to treat the electrical substrate in symptomatic heart failure (HF) patients with reduced LV ejection fraction (EF) and wide QRS complex. A recent metaanalysis pooled more than 3,000 CRT patients from 6 trials and reported a reduction in all-cause mortality of 29% and a reduction in the number of new hospitalizations for worsening HF of 37%. 1 Nevertheless, a QRS duration >120 ms has proven to be a moderate predictor of CRT efficacy, as 30-50% of implanted patients do not respond to the therapy. This has sparked major efforts into identifying patients who benefit from CRT by investigating mechanical dyssynchrony. However, the relatively slow improvement in CRT efficacy in recent years has renewed interest in the electrical substrate. It has become increasingly clear that left bundle branch block (LBBB) is the hallmark conduction disease that is treatable by CRT, as evidenced by efficacy of CRT in canine hearts with isolated LBBB and in CRT patients with LBBB compared to CRT patients with other conduction disorders. 2, 3 In this review we will explore current knowledge concerning the electrical substrate in CRT candidates and apply this to current CRT practice. We will then discuss why the electrical substrate is both essential and sufficient for successful CRT. We will show that this is true if the electrical substrate is defined more accurately than just by duration of the QRS complex. LBBBA century has passed since Eppinger and Tothberger first described LBBB by associating distinctive electrophysiological changes with the destruction of only a small region in the interventricular septum in the canine heart. 4 The typical QRSmorphology changes seen in the esophageal-to-rectal lead in the dogs were directly extrapolated to leads II and III in human patients. This misinterpretation caused LBBB to be erroneously diagnosed as right bundle branch block (RBBB) and vice versa in the first quarter of the past century.It was only until decades after the rectification that the anatomy of the left bundle branch (LBB) and the significance of its dysfunction were investigated in detail. In 1972, Demoulin et al reported their histopathological findings in human patients without known cardiac disease, showing that the LBB emerges from the His bundle between the non-coronary and right-coronary aortic cusps and runs as a 6-10-mm wide ribbon-like structure inferiorly and slightly anteriorly over the septal subendocardium. 5 With considerable variation, the fibers of the LBB quickly separate to form fasciculi in anterior, posterior and often septal main radiations (Figure 1). The LBB enables fast activation of the left ventricle (LV) because it ends in a rich peripheral Purkinje network that couples with individual (sub)endocardial myocardial cells. 6 Extensive electrical mapping in isolated human hearts with an intact LBB showed up to 3 LV endocardial breakthrough si...

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“…Cardiac resynchronization (CRT) is a proven heart failure therapy, but a minority of patients (pts) have no clinical benefit 1 . The lack of improvement is multi-faceted, owing both to pts selection and technical CRT issues.…”

Section: Introductionmentioning

confidence: 99%

“…The lack of improvement is multi-faceted, owing both to pts selection and technical CRT issues. Phrenic nerve stimulation (PNS), high myocardial threshold (HMT), left ventricular lead dislodgement (LD) and failure to achieve the target pacing site are the most frequent technical issues 1,2 , that were aimed at by the introduction of new left ventricular leads such as the quadripolar (QL) and the bipolar active fixation leads (AFL) 3–6 . This is the first study comparing 3 different LV lead platforms for CRT with defibrillator: bipolar passive fixation lead (BL), QL and AFL.…”

Section: Introductionmentioning

confidence: 99%

Cardiac resynchronization therapy: a comparison among left ventricular bipolar, quadripolar and active fixation leads

Ziacchi

Diemberger

Corzani

et al. 2018

Sci Rep

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We evaluated the performance of 3 different left ventricular leads (LV) for resynchronization therapy: bipolar (BL), quadripolar (QL) and active fixation leads (AFL). We enrolled 290 consecutive CRTD candidates implanted with BL (n = 136) or QL (n = 97) or AFL (n = 57). Over a minimum 10 months follow-up, we assessed: (a) composite technical endpoint (TE) (phrenic nerve stimulation at 8 V@0.4 ms, safety margin between myocardial and phrenic threshold <2V, LV dislodgement and failure to achieve the target pacing site), (b) composite clinical endpoint (CE) (death, hospitalization for heart failure, heart transplantation, lead extraction for infection), (c) reverse remodeling (RR) (reduction of end systolic volume >15%). Baseline characteristics of the 3 groups were similar. At follow-up the incidence of TE was 36.3%, 14.3% and 19.9% in BL, AFL and QL, respectively (p < 0.01). Moreover, the incidence of RR was 56%, 64% and 68% in BL, AFL and QL respectively (p = 0.02). There were no significant differences in CE (p = 0.380). On a multivariable analysis, “non-BL leads” was the single predictor of an improved clinical outcome. QL and AFL are superior to conventional BL by enhancing pacing of the target site: AFL through prevention of lead dislodgement while QL through improved management of phrenic nerve stimulation.

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Non-Responders to Cardiac Resynchronization Therapy - The Magnitude of the Problem and the Issues -

Cited by 201 publications

References 42 publications

Reliability of Implantable Cardioverter Defibrillator Home Monitoring in Forecasting the Need for Regular Office Visits, and Patient Perspective

Reliability of Implantable Cardioverter Defibrillator Home Monitoring in Forecasting the Need for Regular Office Visits, and Patient Perspective

Cardiac Resynchronization Therapy - Refocus on the Electrical Substrate -

Cardiac resynchronization therapy: a comparison among left ventricular bipolar, quadripolar and active fixation leads

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