Right atrial appendage pacing in cardiac resynchronization therapy – haemodynamic consequences of interatrial conduction delay

Dąbrowska−Kugacka, Alicja; Lewicka, Ewa; Faran, Anna; Kozłowski, Dariusz; Kempa, Maciej; Raczak, Grzegorz

doi:10.5114/aoms.2011.24146

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…Forcing short atrioventricular times can result in delay of completion of LA mechanical systole until after mitral valve closure, increasing LA pressure, and thereby the risk of incident AF. 33 This effect is similar to the proposed mechanism of AF induced by asynchronous right ventricular pacing in patients with atrioventricular block. In RAFT, programmed atrioventricular delay settings were standardized to relatively short intervals in the CRT-D group and to minimize ventricular pacing in the ICD group (DDI or managed ventricular pacing mode), which may in part explain the lack of a reduction in postrandomization AF/AT with CRT-D.…”

Section: Does Crt Increase the Risk Of Af/at?supporting

confidence: 64%

Frequency and Outcomes of Postrandomization Atrial Tachyarrhythmias in the Resynchronization/Defibrillation in Ambulatory Heart Failure Trial

Wilton

Exner

Wyse

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background— Whether adding cardiac resynchronization therapy (CRT-D) to an implanted cardioverter–defibrillator alters the risk of atrial fibrillation or other atrial tachyarrhythmias (AF/AT), or if postimplantation AF/AT modulate the benefits of CRT-D, remain unknown. Methods and Results— We studied 972 Resynchronization/Defibrillation in Ambulatory Heart Failure Trial (RAFT) participants without permanent AF, who were randomized to CRT-D (n=495) versus nonresynchronization defibrillator (implanted cardioverter–defibrillator; n=477) within the predefined stratum eligible for an atrial lead. Occurrence of postrandomization AF/AT was prospectively assessed, and Cox models were used to test the independent association between the postrandomization AF/AT and the RAFT primary composite outcome of all-cause mortality or hospitalization for heart failure. Over 41 (±19) months, postrandomization AF/AT occurred in 216 (45.3%) patients randomized to implanted cardioverter–defibrillator and 249 (50.3%) randomized to CRT-D. After adjusting for competing risk of death, randomization to CRT-D increased risk of postrandomization AF/AT (hazard ratio, 1.20; 95% confidence interval, 1.00–1.42; P =0.045). Postrandomization AF/AT, which remained paroxysmal in 69.5%, did not reduce biventricular pacing percentage. In adjusted models, postrandomization AF/AT was not associated with the primary outcome (hazard ratio, 1.04; 95% confidence interval, 0.84–1.30). However, AF/AT was associated with a borderline decreased risk of mortality (hazard ratio, 0.75; 95% confidence interval, 0.58–1.00) but increased risk of heart failure hospitalization (hazard ratio, 1.43; 95% confidence interval, 1.08–1.90). Conclusions— In RAFT, nearly half of the patients developed postrandomization AF/AT, and those randomized to CRT-D had borderline significant higher risk. Postrandomization AF/AT was associated with risk of heart failure hospitalization, but not with the primary composite outcome. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00251251.

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Section: Does Crt Increase the Risk Of Af/at?supporting

confidence: 64%

Frequency and Outcomes of Postrandomization Atrial Tachyarrhythmias in the Resynchronization/Defibrillation in Ambulatory Heart Failure Trial

Wilton

Exner

Wyse

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…However, not every patient has the same benefit of cardiac resynchronization. Echocardiography may help optimize CRT, by enabling programming atrioventricular and interventricular delay with best hemodynamic response [ 13 ]. Furthermore, it plays an important role in detecting patients who are more likely to respond favorably to resynchronization therapy.…”

Section: Discussionmentioning

confidence: 99%

Contractile reserve assessed by dobutamine test identifies super-responders to cardiac resynchronization therapy

Vukajlović¹,

Milašinović²,

Angelkov³

et al. 2014

aoms

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IntroductionIn this study, we sought to determine whether myocardial contractile reserve (CR) assessed by dobutamine stress echocardiography (DSE) can identify patients who experience nearly complete normalization of left ventricular (LV) function after the implantation of a cardiac resynchronization therapy (CRT) pacemaker.Material and methodsThe study group consisted of 55 consecutive patients with non-ischemic dilated cardiomyopathy, LV ejection fraction (LVEF) < 35%, and prolonged QRS complex duration, who were scheduled for CRT pacemaker implantation. The DSE (20 µg/kg/min) was performed in all patients. The CR assessment was based on a change in the wall motion score index (ΔWMSI) and ΔLVEF during DSE. Super-response was defined as an increase in LVEF to > 50% and reduction in left ventricular end-systolic dimension to < 40 mm 12 months following the CRT implantation.ResultsA total of 7 patients (12.7%) were identified as super-responders to CRT. When compared to non-super-responders, these patients had significantly higher values of the dobutamine-induced change in ΔWMSI (1.031 ±0.120 vs. 0.49 ±0.371, p < 0.01), and ΔEF (17.9 ±2.2 vs. 8.8 ±6.2, p < 0.01). Receiver operating characteristic analysis showed that dobutamine-induced changes in ΔWMSI ≥ 0.7 and ≥ 14% for ΔEF are the best discriminators for a super-response. Patients with ΔWMSI ≥ 0.7 and ΔEF ≥ 14% are significantly less often hospitalized (p < 0.01) for worsening of heart failure during 28.5 ±3.0 months of the follow-up.ConclusionsContractile reserve assessed by DSE can identify patients with dilated cardiomyopathy who are likely to experience near normalization of LV function following CRT.

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“…Significant interatrial delay may results in left atrial contraction during LV systole, which may negatively affect CRT outcome. In such cases simultaneous activation of both atria could be achieved by implantation of the atrial lead in the interatrial septum [53]. …”

Section: 12 Leads Ecg Remains the Gold Standard Test For Crt Patiementioning

confidence: 99%

Predictors of Cardiac Resynchronization Therapy Response: The Pivotal Role of Electrocardiogram

Hebaishi

Shehri

Moghairi

2013

The Scientific World Journal

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Heart failure affects millions of patients all over the world, and its treatment is a major clinical challenge. Cardiac dyssynchrony is common among patients with advanced heart failure. Resynchronization therapy is a major advancement in heart failure management, but unfortunately not all patients respond to this therapy. Hence, many diagnostic tests have been used to predict the response and prognosis after cardiac resynchronization therapy. In this paper we summarize the usefulness of different diagnostic modalities with special emphasis on the role of surface electrocardiogram as a major predictor of response to cardiac resynchronization therapy.

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Right atrial appendage pacing in cardiac resynchronization therapy – haemodynamic consequences of interatrial conduction delay

Cited by 4 publications

References 7 publications

Frequency and Outcomes of Postrandomization Atrial Tachyarrhythmias in the Resynchronization/Defibrillation in Ambulatory Heart Failure Trial

Frequency and Outcomes of Postrandomization Atrial Tachyarrhythmias in the Resynchronization/Defibrillation in Ambulatory Heart Failure Trial

Contractile reserve assessed by dobutamine test identifies super-responders to cardiac resynchronization therapy

Predictors of Cardiac Resynchronization Therapy Response: The Pivotal Role of Electrocardiogram

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