Optimization of pacing intervals in cardiac resynchronization therapy

Ulč, Ivan; Vančura, V.

doi:10.1016/j.crvasa.2013.06.001

Cited by 2 publications

(4 citation statements)

References 65 publications

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“…Echocardiography presents inherent variability of results and is highly operator dependent (Gras et al, 2009). Optimization based on intracardiac electrogram intervals has not proved yet to be of clear benefit above arbitrary AV interval (Ulč and Vančura, 2013). Multisite pacing has shown favorable results, although it is technically complex (Cazeau et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

“…Echocardiography presents inherent variability of results and is highly operator dependent. Optimization based on intracardiac electrogram intervals has not proved yet to be of clear benefit above arbitrary atrioventricular interval (Ulč and Vančura, 2013). Another optimization method based on the surface ECG uses fusion with intrinsic conduction and avoids echocardiographic atrioventricular and biventricular optimization (Arbelo et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Echocardiography presents inherent variability of results and is highly operator dependent. Optimization based on intracardiac electrogram intervals has not proved yet to be of clear benefit above arbitrary atrioventricular interval [151]. Another optimization method based on the surface ECG uses fusion with intrinsic conduction and avoids echocardiographic atrioventricular and biventricular optimization [152].…”

Section: Chapter 3 3 Optimization Of Lead Placement In the Right Ventmentioning

confidence: 99%

“…Echocardiography presents inherent variability of results and is highly operator dependent [147]. Optimization based on intracardiac electrogram intervals has not proved yet to be of clear benefit above arbitrary AV interval [151]. Multisite pacing has shown favorable results, although it is technically complex [200].…”

Section: Optimal Delay Between Pacing Leadsmentioning

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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Optimization of pacing intervals in cardiac resynchronization therapy

Cited by 2 publications

References 65 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

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