MedWorm: Cardiac Resynchronization Therapy

Depression and Severe Heart Failure:

Journal of Cardiovascular Electrophysiology — Tue, 07 Feb 2012 05:00:00 +0100

Conclusions: We found a high prevalence of depressive symptoms in patients receiving CRT systems. Patients with depression should not be excluded from CRT, because they demonstrate a similar rate of response than the persons without depression and the responders are less likely to be depressed at 6 months. (J Cardiovasc Electrophysiol, Vol. pp. 1‐6) (Source: Journal of Cardiovascular Electrophysiology)

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Cardiac Resynchronization Therapy: Beyond the Heart

Pacing and Clinical Electrophysiology : PACE — Mon, 06 Feb 2012 05:00:00 +0100

(Source: Pacing and Clinical Electrophysiology : PACE)

The advent of cardiac resynchronization therapy has created a confusing terminology of heart failure.

Cardiology Journal — Mon, 06 Feb 2012 00:36:02 +0100

Authors: Barold SS, Guglin M, Herweg B PMID: 22298162 [PubMed - in process] (Source: Cardiology Journal)

Cardiac Resynchronization Therapy with or Without Anatomical Reverse Remodeling Does Not Affect Defibrillation Threshold

Pacing and Clinical Electrophysiology : PACE — Fri, 03 Feb 2012 05:00:00 +0100

Conclusions: Baseline average DFT in patients undergoing CRT‐D was ≤10 J in our study. CRT‐D with or without anatomical reverse remodeling does not affect DFT at the end of 6 months of follow‐up. High DFT level at the end of 6 months of follow‐up is rare (3.4%) among patients with current CRT‐D devices.(PACE 2012;1–6) (Source: Pacing and Clinical Electrophysiology : PACE)

A new quantification method for mechanical dyssynchrony with three-dimensional echocardiography; segmental time and volume loss for prediction of response to cardiac resynchronisation therapy

The International Journal of Cardiovascular Imaging — Thu, 02 Feb 2012 18:16:45 +0100

Abstract A novel method to assess left ventricular (LV) mechanical dyssynchrony using three-dimensional echocardiography (3DE) and semi-automated border detection was investigated, which might be superior in prediction of response to cardiac resynchronisation therapy (CRT) compared to traditional measures that rely solely on segmental time-to-contraction. Twenty-eight heart failure patients underwent real-time 3DE before CRT and at 6–12 months follow-up. Analysis of 3DE was performed using TomTec Research-Arena software featuring semi-automated endocardial border detection. The following echocardiographic parameters were calculated in a 16-segment model: areas under segmental time-volume-curves (STV); delay between contraction of the earliest and latest segment (L-E...

Biventricular pacing: current trends and future strategies

European Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

The role of biventricular pacing is expanding beyond the New York Heart Association classes III and IV heart failure (HF) patient to include less symptomatic patients, earlier in the course of their disease process. This multisite pacing strategy has substantially altered the natural course of ventricular failure, exerting its physiological impact through favourable cardiac remodelling and improving the ejection fraction. This has in turn resulted in long-term clinical benefits such as improved quality of life and functional capacity with a concomitant reduction in hospitalization for HF and overall mortality. Despite the successes of cardiac resynchronization therapy (CRT) and the recent expansion of its role in the treatment of HF patients, there remain some inherent limitations to the t...

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Indications for Cardiac Resynchronization Therapy: 2011 Update From the Heart Failure Society of America Guideline Committee

Journal of Cardiac Failure — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: Cardiac resynchronization therapy (CRT) improves survival, symptoms, quality of life, exercise capacity, and cardiac structure and function in patients with New York Heart Association (NYHA) functional class II or ambulatory class IV heart failure (HF) with wide QRS complex. The totality of evidence supports the use of CRT in patients with less severe HF symptoms. CRT is recommended for patients in sinus rhythm with a widened QRS interval (≥150 ms) not due to right bundle branch block (RBBB) who have severe left ventricular (LV) systolic dysfunction and persistent NYHA functional class II-III symptoms despite optimal medical therapy (strength of evidence A). CRT may be considered for several other patient groups for whom evidence of benefit is clinically significant but less su...

Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: Meta-analysis of randomized controlled trials

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: While CRT was very effective in reducing clinical events in patients with LBBB, it did not reduce such events in patients with wide QRS due to other conduction abnormalities. (Source: American Heart Journal)

Medtronic Announces FDA Approval Of DF4 High-Voltage Connector System For Implantable Cardioverter Defibrillator And Cardiac Resynchronization Therapy Devices

Medical Design Online News — Mon, 30 Jan 2012 14:00:00 +0100

Medtronic, Inc. today announced the U.S. Food and Drug Administration (FDA) approval and launch of the DF4 High-Voltage Connector System, a right ventricular lead and connector used with implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) to detect and accurately treat potentially life-threatening heart rhythms (Source: Medical Design Online News)

Real Time Three‐Dimensional Echocardiography in Assessment of Left Ventricular Dyssynchrony and Cardiac Resynchronization Therapy

Echocardiography — Sun, 29 Jan 2012 14:01:12 +0100

Left ventricular (LV) mechanical dyssynchrony is an important prognostic marker for higher morbidity and mortality in patients with symptomatic heart failure. However, the response rate to resynchronization varies among patients meeting current guidelines for Cardiac resynchronization therapy (CRT). Two‐dimensional echocardiography and Doppler‐based techniques have shown variable results in the assessment of LV dyssynchrony. There is an obvious need for a noninvasive tool that can reliably measure LV dyssynchrony. Accurate prediction of response to CRT will improve patient selection for such therapy. Real time three‐dimensional echocardiography (RT3DE) is a novel noninvasive imaging modality that has been recently used in quantitative evaluation of global and regional LV function. A ...

Device Therapy in Heart Failure Patients With Chronic Kidney Disease

Journal of the American College of Cardiology — Thu, 26 Jan 2012 13:57:11 +0100

We read with great interest the recent article in the Journal by Cannizzaro et al. (). The researchers provided a great overview of various trials in the use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy in patients with chronic kidney disease (CKD) and congestive heart failure (CHF). (Source: Journal of the American College of Cardiology)

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Influence of myocardial viability on responsiveness to cardiac resynchronization in ischemic dilated cardiomyopathy: a prospective observational cohort study.

Anadolu Kardiyol Der... — Thu, 26 Jan 2012 05:00:00 +0100

CONCLUSION: Patients with MV responded better than patients without MV with a significant improvement after the first week from CRT. PMID: 22281793 [PubMed - as supplied by publisher] (Source: Anadolu Kardiyol Der...)

Quantitative analysis of left ventricular dyssynchrony using cardiac computed tomography versus three-dimensional echocardiography

European Radiology — Tue, 24 Jan 2012 06:52:03 +0100

Conclusion Quantitative assessment of LV dyssynchrony is feasible by CCT. Owing to its higher reproducibility and faster analysis time compared with RT3DE, this technique may represent a valuable alternative for dyssynchrony assessment. Key Points • Quantitative assessment of left ventricular dyssynchrony is feasible by cardiac computed tomography (CCT). • This technique has been compared with real-time three-dimensional echocardiography (RT3DE). • Reproducibility is significantly higher for CCT compared with RT3DE. • Time spent for analysis is significantly shorter for CCT. • Computed tomography may represent a valuable alternative to ultrasound for dyssynchrony assessment. Content Type Journal Ar...

The role of echocardiography in quantification of left ventricular dyssynchrony: state of the art and future directions

European Journal of Echocardiography — Tue, 24 Jan 2012 05:00:00 +0100

This article discusses how echocardiography can be applied to quantify dyssynchrony in patients who are evaluated for cardiac resynchronization therapy (CRT). A number of echocardiographic indices have been proposed as markers of success of CRT. However, when tested against QRS width in prospective clinical trials, none of the echocardiographic indices are proven to give clinical benefit. One important message in this review is that future studies should focus on approaches which can differentiate between electrical and non-electrical aetiologies of dyssynchrony, since only electrical dyssynchrony is likely to respond to CRT. Just measuring velocity indices does not identify the aetiology. Myocardial strain appears more promising, but one should be aware that timing of peak systolic strain...

Absence of left ventricular apical rocking and atrial-ventricular dyssynchrony predicts non-response to cardiac resynchronization therapy

European Journal of Echocardiography — Tue, 24 Jan 2012 05:00:00 +0100

Conclusion After pre-selection of candidates for CRT by QRS duration, application of a simple composite echocardiographic index may exclude patients who would be non-responders to CRT and thus improve the global rate of therapy success. (Source: European Journal of Echocardiography)

The European CRT Survey: 1 Year Follow-up ResultsThe European CRT Survey: 1 Year Follow-up Results

Medscape Today Headlines — Mon, 23 Jan 2012 04:00:00 +0100

Does cardiac resynchronization therapy improve symptoms and reduce morbidity and mortality - for the long haul? European Journal of Heart Failure (Source: Medscape Today Headlines)

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Ventricular tachycardia or ventricular fibrillation occurs less often in patients with left bundle branch block and combined resynchronization and defibrillators than in patients with narrow QRS and conventional defibrillators

Europace — Fri, 20 Jan 2012 05:00:00 +0100

Conclusions Chronic heart failure patients with LBBB treated with CRT–ICD, experience less and delayed VT/VF episodes compared with matched controls without LBBB receiving conventional ICD. In the long-term, CRT appears to exert antiarrhythmic effects and to attenuate the particularly high arrhythmia-related risk of CHF patients with LBBB. The incremental benefit of adding the ICD option to CRT pacing in LBBB patients appears questionable. (Source: Europace)

Detection of atrial high-rate events by continuous Home Monitoring: clinical significance in the heart failure-cardiac resynchronization therapy population

Europace — Fri, 20 Jan 2012 05:00:00 +0100

Conclusion In a high-risk cohort of HF patients, device-detected atrial arrhythmias are associated with an increased incidence of TE events. A cut-off point of 3.8 h over 24 h was associated with significant increase in the event rate. Routine assessment of AHRE should be considered with other data when assessing stroke risk and considering anti-coagulation initiation and should also prompt the optimization of cardioprotective HF therapy in CRT patients. (Source: Europace)

Impact of radiocontrast use during left ventricular pacemaker lead implantation for cardiac resynchronization therapy

Europace — Fri, 20 Jan 2012 05:00:00 +0100

Conclusion Risk of CIN with CRT implantations was substantial. Increased volume of radiocontrast used for LV lead placement was associated with substantially increased risk of CIN. Minimal contrast use was associated with decreased procedural times without adverse impact on adequacy of lead placement. (Source: Europace)

Optimization of the atrioventricular delay during cardiac resynchronization therapy using a device for non-invasive measurement of cardiac index at rest and during exercise

Europace — Fri, 20 Jan 2012 05:00:00 +0100

Conclusion Shortening or lengthening of the AVD during exercise has no impact on CI in CRT patients. On the basis of our results, we conclude that in CRT patients the AVD should be programmed, fixed even during exercise. (Source: Europace)

ISHNE/EHRA expert consensus on remote monitoring of cardiovascular implantable electronic devices (CIEDs)

Europace — Fri, 20 Jan 2012 05:00:00 +0100

We are in the midst of a rapidly evolving era of technology-assisted medicine. The field of telemedicine provides the opportunity for highly individualized medical management in a way that has never been possible before. Evolving medical technologies using cardiac implantable devices (CIEDs) with capabilities for remote monitoring permit evaluation of multiple parameters of cardiovascular physiology and risk, including cardiac rhythm, device function, blood pressure values, the presence of myocardial ischaemia, and the degree of compensation of congestive heart failure. Cardiac risk, device status, and response to therapies can now be assessed with these electronic systems of detection and reporting. This document reflects the extensive experience from investigators and innovators around t...

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Is cardiac resynchronisation therapy better than right ventricular pacing after atrioventricular junction ablation for medically refractory atrial fibrillation?

Heart — Fri, 20 Jan 2012 05:00:00 +0100

Despite improvements in our understanding of the mechanisms underlying atrial fibrillation (AF) and significant advancements in the treatment options available, optimal management and symptom relief remains a challenge in some patients. In patients with medically refractory AF more aggressive measures may be required, including percutaneous catheter ablation (pulmonary vein isolation, with or without additional substrate modification) or atrioventricular (AV) junction ablation with concomitant insertion of a permanent pacemaker. The latter option, widely known as an ‘ablate and pace’ strategy, may be preferable in patients who want a definitive, albeit palliative, treatment of their symptoms and are not willing to take the risks and potential recurrences associated with AF abla...

Subcellular Structures and Function of Myocytes Impaired During Heart Failure Are Restored by Cardiac Resynchronization Therapy.

Circulation Research — Tue, 17 Jan 2012 05:00:00 +0100

Conclusions:DHF is associated with regional remodeling of the t-system. Myocytes undergo substantial structural and functional restoration after only 3 weeks of CRT. The finding suggests that t-system status can provide an early marker of the success of this therapy. The results could also guide us to an understanding of the loss and remodeling of proteins associated with the t-system. The steep relationship between free Ca(2+) and contraction suggests that some restoration of Ca(2+) release units will have a disproportionately large effect on contractility. PMID: 22253411 [PubMed - as supplied by publisher] (Source: Circulation Research)

Tissue Doppler Imaging Dyssynchrony Parameter Derived From the Myocardial Active Wall Motion Improves Prediction of Responders for Cardiac Resynchronization Therapy.

Circulation Journal — Fri, 13 Jan 2012 05:00:00 +0100

Conclusions: Modified TDI dyssynchrony parameters derived from the first active wall motion improve the ability to predict responders to CRT. PMID: 22240595 [PubMed - as supplied by publisher] (Source: Circulation Journal)

Coronary Veins: Comprehensive CT-Anatomic Classification and Review of Variants and Clinical Implications [Cardiac Imaging]

Radiographics recent issues — Wed, 11 Jan 2012 05:00:00 +0100

Recent developments in cardiac pacing and trans-coronary vein ablations have demonstrated the increasing value of imaging of the cardiac venous system (CVS), especially computed tomographic (CT) mapping of the coronary veins. In contrast to that for coronary arteries, the literature for coronary veins is scarce. Moreover, a complete, highly efficient, and clinically useful classification of the CVS is not as straightforward as for the coronary arteries. The CVS comprises polymorphous types of venous conduits with notable anatomic variations. Recent anatomic classification divides the cardiac veins into two main groups: tributaries of the greater CVS and tributaries of the lesser CVS, consisting of the thebesian vessels. The greater CVS is subdivided into two groups: coronary sinus and non&...

Dual- versus single-coil implantable defibrillator leads: review of the literature

Clinical Research in Cardiology — Tue, 10 Jan 2012 06:41:00 +0100

Abstract The preferred use of dual-coil implantable defibrillator lead systems in current implantable defibrillator therapy is likely based on data showing statistically lower defibrillation thresholds with dual-coil defibrillator lead systems. The following review will summarize the clinical data for dual- versus single-coil defibrillator leads in the left and right pectoral implant locations, and will then discuss the clinical implications of single- versus dual-coil usage for atrial defibrillation, venous complications, and the risks associated with lead extraction. It will be noted that there are no comparative clinical studies on the use and outcomes of single- versus dual-coil lead systems in implantable defibrillator therapy over a long-term follow-up. The limited l...

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Mood Disorders and Outcome in Patients Receiving Cardiac Resynchronization Therapy

Pacing and Clinical Electrophysiology : PACE — Mon, 09 Jan 2012 05:00:00 +0100

Conclusions:MD in patients with advanced but stable HF receiving CRT‐D therapy was a predictor of HFH alone or when combined with death but not mortality alone. (PACE 2011;1–9) (Source: Pacing and Clinical Electrophysiology : PACE)

Subclavian Venoplasty May Reduce Implant Times and Implant Failures in the Era of Increasing Device Upgrades

Pacing and Clinical Electrophysiology : PACE — Mon, 09 Jan 2012 05:00:00 +0100

Conclusion:The incidence of SCVOs requiring intervention is increasing in the era of device upgrades. VP performed by an electrophysiologist appears to be a safe and efficient approach to manage these SCVOs. VP seems to reduce the implant time and the need to implant on the other side as well as implant failure due to the inability to gain venous access.(PACE 2011;1–5) (Source: Pacing and Clinical Electrophysiology : PACE)

Imaging for Planning of Cardiac Resynchronization Therapy

Journal of the American College of Cardiology: Cardiovascular Imaging — Mon, 09 Jan 2012 05:00:00 +0100

Cardiac resynchronization therapy (CRT) is a novel therapy for patients with refractory heart failure (HF). Large clinical trials evaluating CRT have demonstrated significant improvements in cardiac survival, decreases in recurrent HF hospitalization, and improvements in indexes of quality of life. Although numerous mechanisms are involved in CRT's therapeutic effects, correction of both interventricular and intraventricular mechanical dyssynchrony has been postulated as the key mechanism. To date, most large randomized controlled trials evaluating CRT have identified dyssynchronous patients on the basis of prolongation of the QRS complex from the baseline electrocardiogram. Concerns have been raised regarding the use of this measure for patient selection, stemming from a significant 30% t...

Heart Failure - Cardiac Resynchronization Therapy Is Effective

Health News from Medical News Today — Thu, 05 Jan 2012 16:00:00 +0100

Heart failure continues to be the most prevalent reason for acute hospital admission, although it is stubbornly resistant to treatment. Mortality and morbidity rates remain high, despite prognosis for the condition slightly improving by the launch of innovative medical treatments in recent years. However, according to large-scale clinical trials, cardiac resynchronization therapy (CRT) improves symptoms and reduces mortality among heart failure patients. American and European guidelines now recommend CRT for the treatment and prevention of this condition... (Source: Health News from Medical News Today)

Cardiac Resynchronization Devices: Q&A with Kevin Jackson, MD

DukeHealth.org: Duke Health Features — Mon, 02 Jan 2012 19:07:05 +0100

Duke cardiologist Kevin Jackson, MD, answers questions about cardiac resynchronization devices. How does a cardiac resynchronization therapy device help heart failure patients? Kevin Jackson, MDSome heart failure patients need specialized care for hearts that pump with too little force. Such patients might benefit from an implantable device called an implantable cardioverter defibrillator (ICD). Between one-third and one-half of ICD candidates may benefit from a type of ICD called a cardiac resynchronization therapy (CRT) device. The CRT device is recommended for many heart failure patients who have both low ejection fractions (EF) and electrocardiograms (ECG) that show delayed and disorganized electrical activation of the heart, which can worsen the mechanical pumping problem. What does a...

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Effectiveness of Cardiac Resynchronization Therapy in Diabetic Patients with Ischemic and Nonischemic Cardiomyopathy

Annals of Noninvasive Electrocardiology — Sun, 01 Jan 2012 05:00:00 +0100

Conclusions: The present study shows that treatment with CRT‐D in at‐risk cardiac patients with DM is associated with substantial reductions in the risk of HF or death and improvement in cardiac remodeling in those with ischemic and nonischemic cardiomyopathy, with a more pronounced benefit in patients with nonischemic disease.Ann Noninvasive Electrocardiol 2012;17(1):14–21 (Source: Annals of Noninvasive Electrocardiology)

ISHNE/EHRA Expert Consensus on Remote Monitoring of Cardiovascular Implantable Electronic Devices (CIEDs)

Annals of Noninvasive Electrocardiology — Sun, 01 Jan 2012 05:00:00 +0100

We are in the midst of a rapidly evolving era of technology‐assisted medicine. The field of telemedicine provides the opportunity for highly individualized medical management in a way that has never been possible before. Evolving medical technologies using cardiac implantable devices with capabilities for remote monitoring permit evaluation of multiple parameters of cardiovascular physiology and risk, including cardiac rhythm, device function, blood pressure values, the presence of myocardial ischaemia, and the degree of compensation of congestive heart failure. Cardiac risk, device status, and response to therapies can now be assessed with these electronic systems of detection and reporting. This document reflects the extensive experience from investigators and innovators around the wor...

Effect of Cardiac Resynchronization Therapy on Endothelium‐Dependent Vasodilatation in the Cutaneous Microvasculature

Pacing and Clinical Electrophysiology : PACE — Sun, 01 Jan 2012 05:00:00 +0100

Conclusion:These results show that CRT improves endothelium‐dependent vasodilatory capacity in the peripheral microcirculation within 2 months of therapy. The improvement in functional capacity that is seen in patients treated with CRT may, therefore, be in part mediated by an improvement of endothelium‐dependent vasodilatory capacity. (PACE 2011; 1–8) (Source: Pacing and Clinical Electrophysiology : PACE)

RVF and Response to Cardiac Resynchronization TherapyRVF and Response to Cardiac Resynchronization Therapy

Medscape Today Headlines — Wed, 28 Dec 2011 04:00:00 +0100

What is the significance of right ventricular pre-implant systolic function in predicting response to biventricular pacing? Cardiovascular Ultrasound (Source: Medscape Today Headlines)

Treating Cardiac Arrhythmias Detected With an Implantable Cardiac Monitor in Patients After an Acute Myocardial Infarction

Current Treatment Options in Cardiovascular Medicine — Mon, 26 Dec 2011 16:45:58 +0100

Opinion statement Using an implantable cardiac monitor (ICM) in patients with acute myocardial infarction (MI) allows continuous electrocardiogram monitoring and provides a much more detailed picture of the incidence of brady- and tachyarrhythmias than conventional follow-up. The CARISMA study was the first to use the ICM in post-MI patients with moderate to severe left ventricular systolic dysfunction. Atrial fibrillation (AF) events lasting longer than 30 s were associated with an almost threefold increase in the risk of major cardiac events. This confirms the current definition of clinically significant AF episodes, as patients with episodes of shorter duration were not at increased risk. The association of AF to progressive heart failure, reinfarction, and cardiova...

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Baseline aortic pre-ejection interval predicts reverse remodeling and clinical improvement after cardiac resynchronization therapy.

Cardiology Journal — Sat, 24 Dec 2011 18:12:03 +0100

Conclusions: APEI derived from pulsed-wave Doppler, which is available in every echocardiography machine, is a simple and practical method that could be used to select patients for CRT. (Cardiol J 2011; 18, 6: 639-647). PMID: 22113751 [PubMed - in process] (Source: Cardiology Journal)

Synchronicity of systolic deformation in healthy pediatric and young adult subjects: a two-dimensional strain echocardiography study

AJP: Heart and Circulatory Physiology — Fri, 23 Dec 2011 05:00:00 +0100

Two-dimensional speckle tracking echocardiography (2DSTE) offers valuable information in the echocardiographic assessment of ventricular myocardial function. It enables the quantification and timing of systolic ventricular myocardial deformation. In addition, 2DSTE can be used to identify mechanical dyssynchrony, which is an important parameter in predicting the response to cardiac resynchronization therapy for heart failure. Detailed knowledge of normal timing of systolic deformation and its degree of synchronicity in children is lacking. We aimed to establish the normal timing of left ventricular myocardial systolic deformation using 2DSTE in a large cohort of healthy children and young adults. Transthoracic echocardiograms were acquired in 195 healthy subjects (139 children and 56 young...

European CRT survey bolsters support for CRT-D over CRT-P

theHeart.org — Wed, 21 Dec 2011 20:30:39 +0100

The survey of contemporary European cardiac resynchronization therapy practices provides lots of information on patients not well represented in clinical trials, including those with major comorbidities and women. (Source: theHeart.org)

Real-World Study Confirms HF Role for CRT (CME/CE)

MedPage Today Cardiovascular — Wed, 21 Dec 2011 17:00:00 +0100

(MedPage Today) -- Cardiac resynchronization therapy (CRT) reduced rates of death and rehospitalization among heart failure patients, who subsequently reported symptom improvement post-implant, according to a European survey. (Source: MedPage Today Cardiovascular)

Cardiac Resynchronisation Therapy In Heart Failure

Health News from Medical News Today — Wed, 21 Dec 2011 08:00:00 +0100

Substantial improvements in symptoms and survival Large-scale clinical trials have highlighted the beneficial effect of cardiac resynchronisation therapy (CRT) in the improvement of symptoms and reduction of mortality, and CRT is now recommended in the major European and American guidelines for the treatment and prevention of heart failure.(1) Clinical trials, however, are performed in carefully selected subjects and their results are not always applicable to the general population... (Source: Health News from Medical News Today)

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Optimization of Cardiac Resynchronization Therapy: Importance of Programmed Parameters

Journal of Cardiovascular Electrophysiology — Wed, 21 Dec 2011 05:00:00 +0100

Optimization of Cardiac Resynchronization Therapy. One of the basic tenets of cardiac resynchronization therapy (CRT) is that optimization of programmed parameters is important to maximize the therapeutic response. Both atrioventricular (AV) and interventricular (VV) timing intervals have been suggested as potential methods to improve response rates. A variety of techniques have been described to determine the optimal AV and VV delays. Many of these methods have demonstrated acute hemodynamic benefits; however, multicenter data proving long‐term clinical benefit have been lacking. Echocardiography‐guided methods have been most commonly employed, but no technique has been shown to be superior. In fact, many of these techniques have poor reproducibility and are time‐consuming. Devic...

Cardiac Resynchronization Therapy: Fusion or No Fusion with the Intrinsic Rhythm?

Pacing and Clinical Electrophysiology : PACE — Wed, 21 Dec 2011 05:00:00 +0100

(Source: Pacing and Clinical Electrophysiology : PACE)

The benefits of cardiac resynchronisation therapy in heart failure

European Society of Cardiology — Mon, 19 Dec 2011 14:46:30 +0100

The European CRT Survey, whose follow-up results are published today in the European Journal of Heart Failure, suggests that CRT does indeed reduce rates of death and re-hospitalisation among heart failure patients. The survey - a joint initiative of the Heart Failure Association and European Heart Rhythm Association of the European Society of Cardiology (ESC) - gathered information on more than 2000 patients at 141 centres in 13 European countries. Topics: Heart Failure (HF) (Source: European Society of Cardiology)

The European CRT Survey: 1 year (9-15 months) follow-up results

European Journal of Heart Failure — Sun, 18 Dec 2011 05:00:00 +0100

Conclusions Outcomes including death and hospitalization in this European CRT survey were consistent with results from clinical trials of CRT. At 1 year follow-up, most patients who received a CRT device considered their symptoms improved compared with their pre-implant assessment. Although prospective, this is an observational study of successful CRT implantations, and outcomes in subgroup analyses must be interpreted with appropriate conservatism. Clinical study no: NCT 01185392 (Source: European Journal of Heart Failure)

Association of galectin-3 and fibrosis markers with long-term cardiovascular outcomes in patients with heart failure, left ventricular dysfunction, and dyssynchrony: insights from the CARE-HF (Cardiac Resynchronization in Heart Failure) trial

European Journal of Heart Failure — Sun, 18 Dec 2011 05:00:00 +0100

Conclusions Increased Gal-3 and PIIINP, and low MMP-1 are associated with adverse long-term cardiovascular outcomes but did not predict response to CRT. CRT did not favourably affect serum concentrations of ECCM markers. (Source: European Journal of Heart Failure)

Effect of cardiac resynchronization therapy on cardiotrophin-1 circulating levels in patients with heart failure

Internal and Emergency Medicine — Fri, 16 Dec 2011 16:56:34 +0100

Abstract Cardiotrophin-1 (CT-1) is a member of the interleukin (IL-6) family of cytokines. Plasma CT-1 levels correlate with the left ventricle mass index in patients with dilatated cardiomyopathy and congestive heart failure (CHF). The aim of this paper was to evaluate CT-1 plasma levels, before and after cardiac resynchronization therapy CRT, and to characterizeits prognostic role in patients with CHF. Fifty-two consecutive patients (M/F = 39/13; 56 ± 11 years old) underwent clinical and echocardiographic evaluation, and blood sample collection at baseline. The same evaluation was repeated 6.4 ± 0.79 months after CRT. Patients with a decreased LV end-systolic volume by at least 15% (reverse remodeling) were considered echo respon...

Electrical devices for left ventricular dysfunction and heart failure: do we need revised guidelines?

Journal of Interventional Cardiac Electrophysiology — Fri, 16 Dec 2011 06:54:28 +0100

Abstract Three recent trials have demonstrated the benefit of cardiac resynchronization therapy (CRT) in the New York Heart Association (NYHA) class II patients with heart failure (HF) with ischemic or nonischemic cardiomyopathy as well as in NYHA class I (asymptomatic) patients mostly with ischemic cardiomyopathy. Earlier intervention with CRT in asymptomatic or minimally symptomatic patients improves survival and reduces HF hospitalizations. The reduction or the prevention of HF hospitalizations is of paramount importance because the HF episodes seem to alter the natural history of disease and are associated with deterioration of left ventricular (LV) function and a marked increase in mortality. The CRT benefit is greatest in patients with a QRS ≥150 ms. At this t...

Relationship between endocardial activation sequences defined by high-density mapping to early septal contraction (septal flash) in patients with left bundle branch block undergoing cardiac resynchronization therapy

Europace — Tue, 13 Dec 2011 05:00:00 +0100

Conclusion A strong association exists between electrical activation and mechanical deformation of the septum. Correction of both mechanical synchrony and the functional conduction block by CRT may explain the favourable response in patients with SF. (Source: Europace)

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Implantation of a biventricular implantable cardioverter-defibrillator guided by an electroanatomic mapping system

Europace — Tue, 13 Dec 2011 05:00:00 +0100

Conclusions The NavX system shows great potential during the implantation of an CRT–ICD device. It seems to be feasible, safe, and extremely beneficial in terms of a reduction in X-ray exposure. Furthermore, there is benefit of more detailed information and accuracy during the CS lead placement. (Source: Europace)

The long-term survival and the risks and benefits of implantable cardioverter defibrillators in patients with hypertrophic cardiomyopathy

Heart — Mon, 12 Dec 2011 05:00:00 +0100

Conclusions HCM patients with an ICD have a significant cardiovascular mortality and are exposed to frequent inappropriate shocks and implant complications. These data suggest that new strategies are required to improve patient selection for ICDs and to prevent disease progression in those that receive a device. (Source: Heart)

FDA Panel Barely OKs Wider Indication on Defibrillator

MedPage Today Campaign '08 — Fri, 09 Dec 2011 17:49:18 +0100

WASHINGTON (MedPage Today) -- An FDA advisory panel voted 3-2 to expand the indication for Medtronic's cardiac resynchronization therapy defibrillators (CRT-Ds) to treat a milder form of heart failure. (Source: MedPage Today Campaign '08)

Impact of chronic atrial fibrillation in patients with severe heart failure and indication for CRT

Herzschrittmachertherapie und Elektrophysiologie — Thu, 08 Dec 2011 18:22:18 +0100

Conclusion Patients with severe HF and chronic AF had a comparable improvement with CRT as those in SR. CRT is a successful treatment option in patients with chronic AF offering the potential to restore SR in a significant number of patients. Content Type Journal ArticleCategory OriginalarbeitPages 1-7DOI 10.1007/s00399-011-0155-9Authors G. Luedorff, Department of Cardiology, Schuechtermann-Klinik, Heart Center Osnabrueck-Bad Rothenfelde, Ulmenallee 11, 49214 Bad Rothenfelde, GermanyR. Grove, Department of Cardiology, Schuechtermann-Klinik, Heart Center Osnabrueck-Bad Rothenfelde, Ulmenallee 11, 49214 Bad Rothenfelde, GermanyM. Kowalski, Department of Cardiology, Schuechtermann-Klinik, Heart Center Osnabrueck-Bad Rothenfelde, Ulmenallee 11, 49214 Bad Rothenfelde, Ger...

Acute Clinical Evaluation of a Left Ventricular Automatic Threshold Determination Algorithm Based on Evoked Response Sensing

Pacing and Clinical Electrophysiology : PACE — Thu, 08 Dec 2011 05:00:00 +0100

Conclusion:In this study, the results suggest that the LVAT algorithm is accurate at determining pacing thresholds in multiple pacing configurations and a wide range of LV leads in CRT‐D/P patients. (PACE 2011;1–5) (Source: Pacing and Clinical Electrophysiology : PACE)

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Acute Performance of a Right Ventricular Automatic Pacing Threshold Algorithm for Implantable Defibrillators

Pacing and Clinical Electrophysiology : PACE — Thu, 08 Dec 2011 05:00:00 +0100

Conclusion:The RVcoil to Can evoked response sensing based RV AT algorithm can reliably measure pacing threshold for ICDs, including CRT‐Ds. (PACE 2011;1–10) (Source: Pacing and Clinical Electrophysiology : PACE)

Cardiac Resynchronization Therapy in the Real World: Comparison With the COMPANION Study

Journal of Cardiac Failure — Mon, 05 Dec 2011 05:00:00 +0100

Conclusions: Survival and CV hospitalization outcomes in a real-world clinical setting are as good as, or better than, those demonstrated in the COMPANION research trial. (Source: Journal of Cardiac Failure)

Boston gets FDA clearance for new cardiac devices

Hospital Management — Mon, 05 Dec 2011 00:00:00 +0100

Boston Scientific has received US Food and Drug Administration (FDA) approval for its Incepta, Energen, and Punctua cardiac resynchronisation therapy defibrillators (CRT-Ds) and implantable cardioverter defibrillators (ICDs). (Source: Hospital Management)

Brain responses to cardiac electrical stimulation: a new EEG method for evaluating cardiac sensation.

The Tohoku Journal of Experimental Medicine — Sun, 04 Dec 2011 00:24:12 +0100

In this study, we investigated whether electrical stimulation of the heart provokes brain responses in humans. We examined 15 patients (age: 65.4 ± 3.1 years old, 11 males and 4 females) implanted with either a cardiac pacemaker or cardiac resynchronization therapy (CRT) device. Electroencephalogram (EEG) was simultaneously recorded from the vertex during right ventricular pacing at 70-100 beats/min at baseline (1.5 V) and intense (6-8 V) stimulation sessions. We evaluated brain responses to cardiac electrical stimulation by measuring cerebral potentials that were obtained by subtracting the average of 100 EEG waves triggered by cardiac pacing during baseline stimulation from those during the intense stimulation. Intense stimulation of the cardiac pacemaker or CRT device reproducibly indu...

Missouri Baptist Medical Center Physicians Are First in Missouri to Implant New Heart Failure Device

HSMN NewsFeed — Fri, 02 Dec 2011 17:46:47 +0100

ST. LOUIS, MO -- (Healthcare Sales & Marketing Network) -- Cardiologists at Missouri Baptist Medical Center, one of Missouri's leading heart centers, were the first in the state to implant a new type of cardiac resynchronization therapy defibrillator (CRT-... Devices, CardiologySt. Jude Medical, cardiac resynchronization therapy, CRT-D, quadripolar pacing (Source: HSMN NewsFeed)

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Optimisation of atrioventricular delay during exercise improves cardiac output in patients stabilised with cardiac resynchronisation therapy

Heart — Fri, 02 Dec 2011 05:00:00 +0100

Conclusions Haemodynamically optimal AV delay shortened progressively with increasing heart rate during exercise, which suggests the need for programming of rate-adaptive AV delay in CRT recipients. (Source: Heart)

The Emerging Role of Cardiac Resynchronization Therapy in Milder Heart Failure: Are We Implanting Too Late for Response?

Current Heart Failure Reports — Thu, 01 Dec 2011 19:29:48 +0100

We present a review of the data supporting implantation of cardiac resynchronization devices in early stage heart failure. In addition, we present evidence that may suggest patients are often implanted too late for clinical benefit, potentially contributing to the relatively high nonresponder rate seen in randomized trials and clinical practice. Content Type Journal ArticleCategory Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)Pages 1-6DOI 10.1007/s11897-011-0075-3Authors Jason Bradfield, UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095-1679, USANoel G. Boyle, UCLA Cardiac Arrhythmia Center, Ronald Rea...

Heart Hospital Of Austin Physician First In Texas To Implant New Heart Failure Device

Medical Design Online News — Thu, 01 Dec 2011 10:27:00 +0100

On November 30, 2011, a physician at Heart Hospital of Austin became the first in Texas to implant the Unify Quadra™ cardiac resynchronization therapy defibrillator (CRT-D) and Quartet® Left Ventricular Quadripolar Pacing Lead (Source: Medical Design Online News)

Effect of Left Ventricular Dyssynchrony on Cardiac Sympathetic Activity in Heart Failure Patients With Wide QRS Duration.

Circulation Journal — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: Dyssynchrony is associated with cardiac sympathetic activity, and (123)I-MIBG scintigraphy may be valuable for predicting the response to CRT. PMID: 22130315 [PubMed - as supplied by publisher] (Source: Circulation Journal)

St Jude, Boston Scientific release new CRT devices

theHeart.org — Wed, 30 Nov 2011 18:45:09 +0100

Boston Scientific and St Jude Medical both announced FDA approval of new cardiac resynchronization therapy systems. (Source: theHeart.org)

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Long-Term Outcome of Echocardiographic Super-Responders to CRTLong-Term Outcome of Echocardiographic Super-Responders to CRT

Medscape Today Headlines — Wed, 30 Nov 2011 11:50:18 +0100

Find out what defines a 'super-responder' to cardiac resynchronization therapy. Heart (Source: Medscape Today Headlines)

FDA approves three new Boston Sci CRT-Ds/ICDs

Cardiovascular Business News — Wed, 30 Nov 2011 11:16:05 +0100

Physicians now have three more options for cardiac resynchronization therapy defibrillators (CRT-Ds) and implantable cardioverter defibrillators (ICDs) after the FDA approved Boston Scientific’s Incepta, Energen and Punctua devices to treat both heart failure and sudden cardiac death. (Source: Cardiovascular Business News)

Boston Scientific Announces FDA Approval And First Implant For New Devices To Treat Heart Failure And Sudden Cardiac Death

Medical Design Online News — Wed, 30 Nov 2011 10:38:00 +0100

Boston Scientific Corporation (NYSE: BSX) announces FDA approval of its INCEPTA™, ENERGEN™ and PUNCTUA™ cardiac resynchronization therapy defibrillators (CRT-Ds) and implantable cardioverter defibrillators (ICDs) to treat heart failure and sudden cardiac death (Source: Medical Design Online News)

FDA gives nod to St. Jude's CRT-D system and pacing lead

Cardiovascular Business News — Wed, 30 Nov 2011 09:12:50 +0100

The FDA has given the green light to St. Jude Medical’s Unify Quadra cardiac resynchronization therapy defibrillator (CRT-D) and Quartet left ventricular quadripolar pacing lead. (Source: Cardiovascular Business News)

Unusual Combination of Holt‐Oram Syndrome and Persistent Left Superior Vena Cava

Congenital Heart Disease — Wed, 30 Nov 2011 05:00:00 +0100

Conclusion. We report an uncommon association of HO and PLSVC. This association was only reported twice in the past and this is the first one that constitutes a casual finding during the attempt of CRT device implant. This is a combination that may complicate a device implant and recognition of it in advance may avoid performing potentially unsuccessful procedures. (Source: Congenital Heart Disease)

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Adverse response to cardiac resynchronisation therapy in patients with septal scar on cardiac MRI preventing a septal right ventricular lead position

Journal of Interventional Cardiac Electrophysiology — Wed, 30 Nov 2011 04:55:30 +0100

Conclusions The presence of septal scar was associated with a poor acute and chronic response to CRT. This may relate to the inability to achieve a RV septal lead placement. Content Type Journal ArticlePages 1-10DOI 10.1007/s10840-011-9630-9Authors Simon G. Duckett, Department of Imaging Sciences, The Rayne Institute, Kings College London, London, Great Britain, UKMatthew Ginks, Department of Imaging Sciences, The Rayne Institute, Kings College London, London, Great Britain, UKAnoop Shetty, Department of Imaging Sciences, The Rayne Institute, Kings College London, London, Great Britain, UKSenthil Kirubakaran, Department of Imaging Sciences, The Rayne Institute, Kings College London, London, Great Britain, UKJulian Bostock, The Department of Cardiology, Guy’s and St...

Aliskiren-associated acute kidney injury in a patient with pre-existing chronic kidney disease and dilated cardiomyopathy

Clinical and Experimental Nephrology — Wed, 30 Nov 2011 04:53:04 +0100

We report a case of acute kidney injury (AKI) caused by a novel direct renin inhibitor, aliskiren. A 43-year-old Japanese man with dilated cardiomyopathy on cardiac resynchronization therapy with defibrillator and chronic kidney disease (CKD) was started on aliskiren in addition to enalapril, carvedilol, furosemide, and spironolactone for worsening cardiac function suggested by the elevation of serum brain natriuretic peptide. After 1 month, he noticed general malaise, loss of appetite and his serum creatinine level increased from 2.0 to 7.24 mg/dL. He had no evidence of exacerbation of hemodynamic instability (heart failure or hypotension) or post-renal cause of AKI. Although a cessation of aliskiren did not ameliorate AKI, renal function returned to baseline after withhol...

St. Jude Medical Announces FDA Approval Of Industry's First Quadripolar Pacing System

Medical Design Online News — Tue, 29 Nov 2011 22:30:00 +0100

St. Jude Medical, Inc., a global medical device company, recently announced it has received U.S. Food and Drug Administration (FDA) approval of its Unify Quadra cardiac resynchronization therapy defibrillator (CRT-D) and Quartet Left Ventricular Quadripolar Pacing Lead (Source: Medical Design Online News)

Quad‐Site Pacing Using a Quadripolar Left Ventricular Pacing Lead

Pacing and Clinical Electrophysiology : PACE — Tue, 29 Nov 2011 05:00:00 +0100

Pacing the left ventricle (LV) from multiple sites simultaneously may result in a better response to cardiac resynchronization therapy (CRT). We sought to assess whether multisite pacing using a quadripolar LV lead improves acute hemodynamic response (AHR) to CRT. We paced four ventricular sites simultaneously using two vectors of a Quartet lead, a right ventricular apical lead, and an additional LV lead temporarily placed in an anterior branch of the coronary sinus. Multisite pacing using the Quartet lead alone did not improve the AHR but “quad‐site” pacing using an additional temporary LV lead did increase dP/dtmax. (PACE 2011;:1–3) (Source: Pacing and Clinical Electrophysiology : PACE)

Prediction of a Good Response to Cardiac Resynchronization Therapy in Patients with Severe Dilated Cardyomyopathy: Could Conventional Echocardiography Be the Answer after All?

Echocardiography — Mon, 28 Nov 2011 05:00:00 +0100

Conclusions: Contribution of LVSI and LVFS is to be confirmed in larger trials. Simplicity of their assessment by conventional echocardiography could be an argument for adding them to the inclusion criteria for CRT in severe heart failure patients. (Echocardiography ****;**:1‐9) (Source: Echocardiography)

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Ventricular dyssynchrony assessed by gated myocardial perfusion SPECT using a geometrical approach: a feasibility study

European Journal of Nuclear Medicine and Molecular Imaging — Thu, 24 Nov 2011 06:49:44 +0100

Conclusion It is feasible to quantify ventricular dyssynchrony in MPS using the geometrical approach as implemented by Corridor4DM. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s00259-011-1991-xAuthors Berlinda J. van der Veen, Department of Nuclear Medicine, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The NetherlandsImad Al Younis, Department of Nuclear Medicine, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The NetherlandsNina Ajmone-Marsan, Department of Cardiology, Leiden University Medical Centre, Leiden, The NetherlandsJos J. M. Westenberg, Department of Radiology, Leiden University Medical Centre, Leiden, The NetherlandsJeroen J. Bax, Department of Cardiology, Leiden University Medical Centre, Leide...

Ablate and pace yields significant benefit in RV-, CRT-paced patients

MedWire News - Cardiology — Wed, 23 Nov 2011 00:00:00 +0100

"Ablate and pace” therapy yields a significant clinical benefit in right ventricular-paced patients and cardiac resynchronization therapy-paced patients, study findings suggest. (Source: MedWire News - Cardiology)

Left Ventricular Systolic Dyssynchrony Index by Three‐Dimensional Echocardiography in Patients with Decreased Left Ventricular Function: Comparison with Tissue Doppler Echocardiography

Echocardiography — Fri, 18 Nov 2011 05:00:00 +0100

Conclusions: SDI derived from 3DE is a useful parameter to assess global LV systolic dyssynchrony and predict responses to CRT. (Echocardiography ****;**:1‐7) (Source: Echocardiography)

Additive value of severe diastolic dysfunction and contractile reserve in the identification of responders to cardiac resynchronization therapy

European Journal of Heart Failure — Fri, 18 Nov 2011 05:00:00 +0100

Conclusion Heart failure patients with severe diastolic dysfunction and absence of myocardial CR during DSE had a poorer clinical and echocardiographic response to CRT. The associated evaluations of diastolic function and CR had an additive value in the identification of responders to CRT. (Source: European Journal of Heart Failure)

Clinical trials update from the European Society of Cardiology Meeting 2011: ARISTOTLE, SMART-AV: QLV substudy, SHIFT: echocardiography and quality of life substudies, European CRT Survey, and Basic Science Update

European Journal of Heart Failure — Fri, 18 Nov 2011 05:00:00 +0100

This article provides information and a commentary on key trials relevant to the pathophysiology, prevention, and treatment of heart failure presented at the European Society of Cardiology meeting held in Paris, France in August 2011. Unpublished reports should be considered as preliminary, since analyses may change in the final publication. Results from ARISTOTLE suggest that apixaban is more effective than warfarin for the prevention of stroke in patients with atrial fibrillation. Electrical dyssynchrony, measured by the time from onset of electrical activity on the surface ECG to activation of myocardium by intrinsic conduction at the pacing site (QLV), was a strong and independent predictor of improvement in ventricular function after cardiac resynchronization therapy (CRT) in an obser...

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Heart failure and non-ST-segment elevation myocardial infarction: A review for a widespread situation.

European Journal of Internal Medicine — Wed, 16 Nov 2011 18:02:00 +0100

In conclusion, heart failure during a NSTEMI is a common and meaningful situation which warrants careful management and further investigation to reach stronger evidence for clinical recommendations. PMID: 22075276 [PubMed - in process] (Source: European Journal of Internal Medicine)

Implantable Cardioverter-Defibrillator Patients Who Are Upgraded and Respond to Cardiac Resynchronization Therapy Have Less Ventricular Arrhythmias Compared With Nonresponders

Journal of the American College of Cardiology — Wed, 16 Nov 2011 17:36:37 +0100

Conclusions: After upgrade from ICD to CRT-D, nonresponders to CRT showed a significant increase in VA burden requiring appropriate device therapy. (Source: Journal of the American College of Cardiology)

Effective prediction of response to cardiac resynchronization therapy using a novel program of gated myocardial perfusion single photon emission computed tomography

Europace — Wed, 16 Nov 2011 05:00:00 +0100

Conclusions The estimation of LVMD using this novel GMPS program could be an alternative or a complementary approach to QRS duration in CRT patient selection. This finding warrants further assessment of our approach in larger studies. (Source: Europace)

Right ventricular lead positioning does not influence the benefits of cardiac resynchronization therapy in patients with heart failure and atrial fibrillation

Europace — Wed, 16 Nov 2011 05:00:00 +0100

Conclusion In this randomized controlled study, the exact RV pacing site, either apex or outflow tract, did not influence the benefits of CRT in a group of patients with chronic heart failure and AF. ClinicalTrials.gov ID: NCT00457834. (Source: Europace)

Clinical factors and echocardiographic techniques related to the presence, size, and location of acoustic windows for leadless cardiac pacing

Europace — Wed, 16 Nov 2011 05:00:00 +0100

Conclusions Adequate AWs were present in nearly all patients. Despite smaller hearts, ischaemic cardiomyopathy patients had adequate AWs. A simple procedure performed as an adjunct to pre-implant echocardiography can screen patients and identify transmitter implant locations for an ultrasound-mediated leadless pacing system. (Source: Europace)

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Actions elicited during scheduled and unscheduled in-hospital follow-up of cardiac devices: results of the ATHENS multicentre registry

Europace — Wed, 16 Nov 2011 05:00:00 +0100

Conclusions Our registry demonstrates that ‘some actions’ are taken during about 20% of scheduled in-hospital follow-up of CIEDs. These data should encourage the use of remote follow-up systems. (Source: Europace)

Mitral regurgitation and cardiac resynchronization therapy: how long and what should we expect?

Europace — Wed, 16 Nov 2011 05:00:00 +0100

(Source: Europace)

Temporal diffeomorphic free-form deformation: Application to motion and strain estimation from 3D echocardiography

Medical Image Analysis — Wed, 16 Nov 2011 05:00:00 +0100

Graphical abstract: Quantification of 3D Myocardial strain in one patient undergoing CRT before therapy and at follow-up.Highlights: ► We propose a new diffeomorphic temporal registration algorithm. ► It recovers strain and motion from an input 3D ultrasound image sequence. ► Longitudinal strain was quantified on 9 healthy volunteers and 13 CRT patients. ► On volunteers, results are in agreement with clinical literature. ► On patients, results match CRT outcome as quantified by reverse remodeling.Abstract: This paper presents a new registration algorithm, called Temporal Diffeomorphic Free Form Deformation (TDFFD), and its application to motion and strain quantification from a sequence of 3D ultrasound (US) images. The originality of our approach resides in enforcing time consist...

Treatment options in end-stage heart failure: where to go from here?

Netherlands Heart Journal — Tue, 15 Nov 2011 05:00:00 +0100

This article will review the conventional and novel treatment modalities of heart failure. PMID: 22083426 [PubMed - as supplied by publisher] (Source: Netherlands Heart Journal)

Mortality and Cost Associated With Cardiovascular Implantable Electronic Device Infections [Original Investigation]

Archives of Internal Medicine — Mon, 14 Nov 2011 05:00:00 +0100

Conclusions Infection associated with CIED procedures resulted in substantial incremental admission mortality and long-term mortality that varied with the CIED type and occurred, in part, after discharge. Almost half of the incremental admission cost was for intensive care. (Source: Archives of Internal Medicine)

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Correction of Mitral Regurgitation in Nonresponders to Cardiac Resynchronization Therapy by MitraClip Improves Symptoms and Promotes Reverse Remodeling

Journal of the American College of Cardiology — Sun, 13 Nov 2011 02:25:40 +0100

Conclusions: FMR treatment with the MitraClip in CRT nonresponders was feasible, safe, and demonstrated improved functional class, increased LVEF, and reduced ventricular volumes in about 70% of these study patients. (Source: Journal of the American College of Cardiology)

The determinants of clinical outcome and clinical response to CRT are not the same

Heart Failure Reviews — Fri, 11 Nov 2011 12:48:11 +0100

Abstract The purpose of treatment is to alter outcomes favourably. From a clinical perspective, these outcomes may include symptoms, quality of life, disability, morbidity and mortality. However, a good outcome does not mean that the intervention was effective and a seemingly poor outcome could have been worse without intervention. Patients may have a good outcome either because their disease was due to run a benign course, or because they responded to the intended treatment or because they responded to some other ancillary treatment. Clearly, there is a link between response and outcome but it is loose and uncertain. The clinical substrate being treated is often a stronger determinant of outcome than the response to the intervention. The concepts of outcome and response c...

Left ventricular endocardial pacing in cardiac resynchronisation therapy: Moving from bench to bedside.

Netherlands Heart Journal — Wed, 09 Nov 2011 05:00:00 +0100

Authors: Bracke FA, van Gelder BM, Dekker LR, Houthuizen P, Ter Woorst JF, Teijink JA Abstract In cardiac resynchronisation therapy, failure to implant a left ventricular lead in a coronary sinus branch has been reported in up to 10% of cases. Although surgical insertion of epicardial leads is considered the standard alternative, this is not without morbidity and technical limitations. Endocardial left ventricular pacing can be an alternative as it has been associated with a favourable acute haemodynamic response compared with epicardial pacing in both animal and human studies. In this paper, we discuss left ventricular endocardial pacing and compare it with epicardial surgical implantation. Ease of application and procedural complications and morbidity compare favourably with epic...

Application of the Seattle Heart Failure Model in Patients on Cardiac Resynchronization Therapy

Pacing and Clinical Electrophysiology : PACE — Sun, 06 Nov 2011 04:00:00 +0100

Conclusion: The SHFM successfully stratifies HF patients on CRT/CRT‐D and can be reliably applied to help clinicians in predicting survival in this clinical setting. (PACE 2011; 1–7) (Source: Pacing and Clinical Electrophysiology : PACE)

Rates of Upgrade of ICD Recipients to CRT in Clinical Practice and the Potential Impact of the More Liberal Use of CRT at Initial Implant

Pacing and Clinical Electrophysiology : PACE — Sun, 06 Nov 2011 04:00:00 +0100

Conclusion: In this retrospective single center study, rates of CRT upgrade in ICD recipients over the medium term were low, which may reflect underuse in otherwise appropriate candidates. The more liberal use of CRT at initial implant in patients with a reduced LVEF, a broad QRS, but only mild heart failure symptoms would require approximately 50% increase in CRT use in ICD recipients at initial implant, and may help address some of the suggested underutilization. (PACE 2011; 1–8) (Source: Pacing and Clinical Electrophysiology : PACE)

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The Right Ventricular Septum Presents the Optimum Site for Maximal Electrical Separation During Left Ventricular Pacing

Journal of Cardiovascular Electrophysiology — Thu, 03 Nov 2011 04:00:00 +0100

Conclusion: MES was observed most commonly at the RV septum and rarely at the RV apex. Better correction of electrical and mechanical dyssynchrony by CRT may be achieved by placing the RV lead in a site outside of the apex in the majority of patients. Clinical studies exploring RV septal pacing in CRT seem warranted. (J Cardiovasc Electrophysiol, Vol. pp. 1–5) (Source: Journal of Cardiovascular Electrophysiology)

Comparison between Tissue Doppler Imaging (TDI) and Tissue Synchronization Imaging (TSI) in Evaluation of Left Ventricular Dyssynchrony in Patients with Advanced Heart Failure

Echocardiography — Wed, 02 Nov 2011 04:00:00 +0100

Conclusion: With the aid of selected LV dyssynchrony indices, the TSI method may confer enough sensitivity for a speedy evaluation and initial screening of LV dyssynchrony in HF patients; however, the current technology of TSI does not seem specific enough to replace TDI in the evaluation of dyssynchrony. (Echocardiography ****;**:1‐6) (Source: Echocardiography)

Clinical course and outcome of patients enrolled in US and non-US centres in MADIT-CRT

European Heart Journal — Tue, 01 Nov 2011 04:00:00 +0100

Conclusion Patients enrolled in US and non-US centres in MADIT-CRT displayed significant differences in baseline clinical and echocardiographic characteristics and in the frequency of procedure-related complications, but experienced an overall similar clinical and echocardiographic response to CRT-D. (Source: European Heart Journal)

Editorial Comment on “Natural History of End-Stage LV Dysfunction: Has it Improved from the Classic Franciosa and Cohn Graph?”

Cardiology Clinics — Tue, 01 Nov 2011 04:00:00 +0100

In “Natural History of End-Stage LV Dysfunction: Has It Improved from the Classic Franciosa and Cohn Graph?” Dr Daniel Jacoby and colleagues argue that prognosis of patients with heart failure has indeed improved since the landmark dismal depiction nearly 3 decades ago in the classic graph by Franciosa and Cohn (76% mortality at 3 years). Dr Jacoby and colleagues attribute this improvement in outlook to the advent of effective heart failure therapies, including angiotensin-converting enzyme inhibitors, β-blockers, aldosterone inhibitors, cardiac resynchronization therapy, and the implantable cardioverter defibrillator. (Source: Cardiology Clinics)

Clinical Impact of Off‐Label Cardiac Resynchronization Therapy in End‐Stage Heart Failure Patients on Continuous Intravenous Inotrope

Clinical Cardiology — Tue, 01 Nov 2011 04:00:00 +0100

Conclusions:Our retrospective data showed potential benefits of CRT among EHFpatients. Treatment of mitral regurgitation might be an essential qualification for managing EHF patients with CRT. © 2011 Wiley Periodicals, Inc.The authors have no funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)

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Impact of Mitral Regurgitation on the Outcome of Patients Treated with CRT‐D: Data from the InSync ICD Italian Registry

Pacing and Clinical Electrophysiology : PACE — Tue, 01 Nov 2011 04:00:00 +0100

Conclusions: This observational analysis supports the use of CRT‐D in HF patients with clinically significant MR; MR had no major influence on patient outcome. (PACE 2011; 1–9) (Source: Pacing and Clinical Electrophysiology : PACE)

Biophysical Modeling to Simulate the Response to Multisite Left Ventricular Stimulation Using a Quadripolar Pacing Lead

Pacing and Clinical Electrophysiology : PACE — Mon, 31 Oct 2011 04:00:00 +0100

Conclusion: Biophysical modeling predicts that in the presence of posterolateral scar MCRT offers an improved response over conventional CRT. Maximizing the activation wave area in the LV had the most consistent correlation with CRT response, independent of pacing protocol, scar size, or lead location. (PACE 2011; 1–11) (Source: Pacing and Clinical Electrophysiology : PACE)

[Cardiac resynchronization therapy for patients with atrial fibrillation].

Orvosi Hetilap — Sun, 30 Oct 2011 04:00:00 +0100

Authors: Mihálcz A, Abrahám P, Kardos A, Földesi C, Szili-Török T Abstract Atrial fibrillation and chronic heart failure are two major and even growing cardiovascular conditions that often coexist. Cardiac resynchronization therapy is an important, device-based, non-pharmacological approach in a selected group of chronic heart failure patients that has been shown to improve left ventricular function and to reduce both morbidity and mortality in large randomized trials. The latest European and American guidelines have considered atrial fibrillation patients with heart failure eligible for cardiac resynchronization therapy. This review summarizes current literature concerning the following topics: prognostic relevance of atrial fibrillation in heart failure, effects of cardiac r...

Cardiac resynchronization therapy to prevent life-threatening arrhythmias in patients with congestive heart failure

Journal of Electrocardiology — Wed, 26 Oct 2011 08:41:35 +0100

Abstract: Various clinical data demonstrate that cardiac resynchronization therapy (CRT) provides a favorable structural as well as electrical remodeling. The CArdiac Resynchronization–Heart Failure study, which tested the pure effect of CRT (using CRT devices without the capability of defibrillation) clearly showed a significant reduction in the total mortality by partly preventing sudden cardiac death. The antiarrhythmic effects of CRT are explained, at least in part, by ionic and genetic modulation of ventricular myocytes. It has been revealed in animal experiments to mimic disorganized ventricular contraction that CRT reverses down-regulation of certain K+ channels and abnormal Ca2+ homeostasis in the failing heart. However, CRT can be proarrhythmic in some particular cases especiall...

Pre-implant right ventricular function might be an important predictor of the response to cardiac resynchronization therapy

BioMed Central — Wed, 26 Oct 2011 04:00:00 +0100

Conclusions: Pre-implant decreased RV systolic function might be an important way to predict a poor response to CRT implicating that other treatments should be considered. Furthermore we found that 3D- echocardiography and Tissue Doppler Imaging were feasible to detect short-term changes in LV function. (Source: BioMed Central)

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Coronary Imaging With Cardiovascular Magnetic Resonance: Current State of the Art

Progress in Cardiovascular Diseases — Sat, 22 Oct 2011 01:47:04 +0100

Abstract: Cardiovascular magnetic resonance allows noninvasive and radiation-free visualization of both the coronary arteries and veins, with the advantage of an integrated assessment of cardiac function, viability, perfusion, and anatomy. This combined approach provides valuable integrated information for patients with coronary artery disease and patients undergoing cardiac resynchronization therapy. Moreover, magnetic resonance offers the possibility of coronary vessel wall imaging, therefore assessing the anatomy and pathology of the normal and diseased coronary vessels noninvasively.Coronary magnetic resonance angiography is challenging because of cardiac and respiratory motion and the small size and tortuous path of the coronary vessels. Several technical solutions have been developed...

Implantable cardioverter-defibrillators in France: practices and regional variability

Europace — Fri, 21 Oct 2011 04:00:00 +0100

Conclusion Despite an increasing rate of ICD implantation in France, important regional disparities persist, with a median position occupied by Ile de France. (Source: Europace)

Extrasystolic stimulation with bi-ventricular pacing: an acute haemodynamic evaluation

Europace — Fri, 21 Oct 2011 04:00:00 +0100

Conclusions Biventricular pacing in combination with ESS, with maintenance of sinus rate, improves myocardial contractility in patients undergoing CRT. (Source: Europace)

Cost effectiveness of cardiac resynchronization therapy in Greece: an analysis based on the CArdiac REsychronization in Heart Failure trial

Europace — Fri, 21 Oct 2011 04:00:00 +0100

Conclusions The results of the economic evaluation of CRT in Greek health-care setting indicate that it is a cost-effective treatment compared with traditional pharmacological therapy. Cardiac resynchronization therapy can therefore be recommended for routine use in patients with moderate-to-severe heart failure and markers of dyssynchrony. (Source: Europace)

Rationale and design for programming implantable cardioverter-defibrillators in patients with primary prevention indication to prolong time to first shock (PROVIDE) study

Europace — Fri, 21 Oct 2011 04:00:00 +0100

Conclusion The PROVIDE trial is a randomized controlled study, designed to assess if a pre-selected combination of programming parameters can reduce shock burden among patients receiving ICDs/CRT-Ds for primary prevention. (Source: Europace)

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Feasibility of percutaneous implantation of transapical endocardial left ventricular pacing electrode for cardiac resynchronization therapy

Europace — Fri, 21 Oct 2011 04:00:00 +0100

We report the outcome of this technique and its evolution from a minithoracotomy to a percutaneous approach. Twenty patients underwent alternative resynchronization therapy with transapical endocardial left ventricular (LV) pacing lead implantation in a multicentre, international study between October 2007 and March 2010. Eighteen patients underwent minithoracotomy and transapical puncture under direct observation. Two recent patients had transthoracic echocardiography-guided percutaneous apical puncture to enter the LV cavity. A 19 or 21 ga needle and two-stage Seldinger dilatation with 4 and 7 Fr sheaths were then used to introduce the lead. In the two patients with closed-chest insertion of the electrode there was no puncture related bleeding or lung damage. Lead dislocation occurred in...

Echocardiography-based qualification and response assessment to cardiac resynchronisation therapy in patients with chronic heart failure. The matrix metalloproteinase-9 substudy.

Kardiologia Polska — Thu, 20 Oct 2011 12:35:03 +0100

Conclusions: The CRT induces favourable myocardial remodelling, resulting in NT-proBNP level decrease, improvement of regional and global biventricular function, and MMP-9 level reduction, in ischaemic HF patients. The changes of MMP-9 level may be predicted by baseline left atrial end-diastolic diameter and correlate with LV end-diastolic diameter change during CRT. Kardiol Pol 2011; 69, 10: 1043-1051. PMID: 22006606 [PubMed - in process] (Source: Kardiologia Polska)

Comparison of the Efficacy of Two Surgical Alternatives for Cardiac Resynchronization Therapy: Trans‐Apical versus Epicardial Left Ventricular Pacing

Pacing and Clinical Electrophysiology : PACE — Thu, 20 Oct 2011 04:00:00 +0100

Conclusions: Our data suggest that trans‐apical endocardial LV lead implantation is an alternative to epicardial LV pacing. (PACE 2011;1–7) (Source: Pacing and Clinical Electrophysiology : PACE)

How to improve outcomes with cardiac resynchronisation therapy: importance of lead positioning

Heart Failure Reviews — Wed, 19 Oct 2011 05:50:28 +0100

Abstract Cardiac resynchronisation therapy (CRT), by retiming the failing heart, improves symptoms, reduces hospitalisations and improves survival in patients with left ventricular dysfunction and QRS prolongation. However, not all patients “respond” to CRT. Successful CRT depends on appropriate patient selection, optimal lead positioning, device programming/optimisation and optimal medical therapy. This review article focuses on the importance of lead positioning in improving outcomes. Content Type Journal ArticlePages 1-9DOI 10.1007/s10741-011-9287-6Authors Peter J. Cowburn, Wessex Cardiac Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UKChristophe Leclercq, Départment de Cardiologie et Maladies Vasculaires, CHU, Pontchaillou, 2, rue Hen...

Alternative methods for the assessment of mechanical dyssynchrony using phase analysis of gated single photon emission computed tomography myocardial perfusion imaging

The International Journal of Cardiovascular Imaging — Tue, 18 Oct 2011 05:59:06 +0100

Abstract Measurement of left ventricular (LV) mechanical dyssynchrony from single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) allows optimization of cardiac resynchronization therapy in heart failure patients. We compared the discriminatory ability and reproducibility of a new software method, Corridor 4DM (4DM) to the established method, Emory Cardiac Toolbox (ECTb) in normals and heart failure patients. LV dyssynchrony was measured in 100 control (Group 1) and 100 patients with LVEF <35% (Group 2) using time to peak thickening with first harmonic, fourth harmonic, and volume curve methods with the 4DM software, and compared to ECTb. Of the 3 4DM methods, first harmonic had the best correlation with the ECTb (R = 0.88, slope...

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Electrical and Mechanical Cardiac Resynchronisation by Novel Direct His-bundle Pacing in a Heart Failure Patient

Heart, Lung and Circulation — Mon, 17 Oct 2011 04:00:00 +0100

We present a case of a heart failure patient in whom CRT was considered and treated by DHBP. In addition to electrical resynchronisation and optimal clinical response, echocardiography showed successful ventricular mechanical synchrony. To our knowledge, these latter findings are for the first time described in the setting of CRT by DHBP. (Source: Heart, Lung and Circulation)

Cardiac resynchronisation therapy response predicts occurrence of atrial fibrillation in non‐ischaemic dilated cardiomyopathy

International Journal of Clinical Practice — Sun, 16 Oct 2011 04:39:13 +0100

Conclusions: This is the first study analysing long‐term effects of CRT in a homogeneous population of patients with non‐ischaemic dilated cardiomyopathy, indicating the favourable role of this non‐pharmacological therapy on the prevention of AF. (Source: International Journal of Clinical Practice)

The relationship between ventricular electrical delay and left ventricular remodelling with cardiac resynchronization therapy

European Heart Journal — Fri, 14 Oct 2011 04:00:00 +0100

Conclusion Electrical dyssynchrony, as measured by QLV, was strongly and independently associated with reverse remodelling and QOL with CRT. Acute measurements of QLV may be useful to guide LV lead placement. (Source: European Heart Journal)

Reverse remodelling induces progressive ventricular resynchronization after cardiac resynchronization therapy 'from vicious to virtuous cycle'

European Journal of Echocardiography — Thu, 13 Oct 2011 04:00:00 +0100

Conclusion CRT can stop the vicious cycle of remodelling and dyssynchrony, and actually, turn it into the virtuous cycle of reverse remodelling and further resynchronization. (Source: European Journal of Echocardiography)

CRT-D favorably remodels left atrium, decreases risk for tachyarrhythmias

MedWire News - Heart Failure — Wed, 12 Oct 2011 01:44:23 +0100

Analysis of MADIT-CRT participants has shown that cardiac resynchronization therapy-defibrillator -mediated reverse remodeling of the left atrium is favorable and associated with a significant decrease in the risk for atrial tachyarrhythmias. (Source: MedWire News - Heart Failure)

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Presence of Extensive LV Remodeling Limits the Benefits of CRT in Patients With Intraventricular Dyssynchrony

Journal of the American College of Cardiology: Cardiovascular Imaging — Mon, 10 Oct 2011 04:00:00 +0100

Conclusions In this nonrandomized, open-label clinical study, despite intraventricular electrical and mechanical dyssynchrony, extensive LV remodeling at baseline negatively impacted CRT results in terms of LV function improvement and incidence of cardiac events at follow-up. (Source: Journal of the American College of Cardiology: Cardiovascular Imaging)

Cardiac Resynchronization Therapy Reduces Left Atrial Volume and the Risk of Atrial Tachyarrhythmias in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy)

Journal of the American College of Cardiology — Sun, 09 Oct 2011 01:54:10 +0100

Objectives: We hypothesized that reductions in left atrial volume (LAV) with a cardiac resynchronization therapy–defibrillator (CRT-D) would translate into a subsequent reduction in the risk of atrial tachyarrhythmias (AT).Background: There is limited information regarding the effect of CRT-D on the risk of AT.Methods: Percent reduction in LAV at 1 year following CRT-D implantation (pre-specified as low [lowest quartile: (Source: Journal of the American College of Cardiology)

Synchronicity of systolic deformation in healthy pediatric and young adult subjects: a two-dimensional strain echocardiography study.

American Journal of Physiology. Heart and Circulatory Physiology — Fri, 07 Oct 2011 04:00:00 +0100

Conclusion: This is the first report that establishes reference values per cardiac segment for time to peak systolic myocardial strain values in all three directions assessed with 2DSTE in a large pediatric and young adult cohort. We emphasize the need for using age specific reference values as well as heart rate correction for the adequate interpretation of 2DSTE measurements. PMID: 21984551 [PubMed - as supplied by publisher] (Source: American Journal of Physiology. Heart and Circulatory Physiology)

CRT-D favorably remodels left atrium, decreases risk for tachyarrhythmias

MedWire News - Cardiology — Fri, 07 Oct 2011 00:00:00 +0100

Long-term follow-up of cardiac resynchronization therapy: mechanical resynchronization and reverse left ventricular remodeling are predictive for long-term transplant-free survival

The International Journal of Cardiovascular Imaging — Sat, 01 Oct 2011 06:43:59 +0100

Abstract We sought to determine whether correction of mechanical left ventricular (LV) dyssynchrony as defined by tissue Doppler imaging (TDI) is predictive for transplant-free long-term survival in patients (pts.) undergoing cardiac resynchronization therapy (CRT). In 76 CRT recipients TDI curves from the septal, lateral, anterior, and inferior basal LV were obtained at baseline and after 6 ± 4 months. A time difference between regional electromechanical delays (EMD) of ≥40 ms was considered dyssynchronous. At follow-up, pts. were classified as TDI-responders (TDI-R: dyssynchrony at baseline, corrected by CRT) versus non-responders (TDI-NR: either not dyssynchronous at baseline, or persisting dyssynchrony). Pts. were then followed by standard echocar...

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Role of cardiac resynchronization therapy and atrioventricular junction ablation in patients with permanent atrial fibrillation

European Heart Journal — Sat, 01 Oct 2011 04:00:00 +0100

(Source: European Heart Journal)

Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial

European Heart Journal — Sat, 01 Oct 2011 04:00:00 +0100

Conclusions In patients undergoing ‘Ablate and Pace’ therapy for severely symptomatic permanent atrial fibrillation, CRT is superior to RV apical pacing in reducing the clinical manifestations of HF. (ClinicalTrials.gov number: NCT00111527) (Source: European Heart Journal)

Usefulness of the 12-lead electrocardiogram in the follow-up of patients with cardiac resynchronization devices. Part I.

Cardiology Journal — Thu, 29 Sep 2011 20:25:03 +0100

Authors: Barold SS, Herweg B Abstract Cardiac resynchronization therapy (CRT) has added a new dimension to the electrocardiographic evaluation of pacemaker function. During left ventricular (LV) pacing from the posterior or posterolateral coronary vein, a correctly positioned lead V1 registers a tall R wave and there is right axis deviation in the frontal plane with few exceptions. During simultaneous biventricular stimulation from the right ventricular (RV) apex and LV site in the coronary venous system, the QRS complex is often positive (dominant) in lead V1 and the frontal plane QRS axis usually points to the right superior quadrant and occasionally the left superior quadrant. The reported incidence of a dominant R wave in lead V1 during simultaneous biventricular pacing (RV ape...

QRS duration determines CRT success in non-LBBB patients

MedWire News - Heart Failure — Thu, 29 Sep 2011 01:41:50 +0100

Cardiac resynchronization therapy is more likely to be effective in patients with advanced heart failure and non-left bundle branch block morphologies if they have a longer QRS duration, US study findings suggest. (Source: MedWire News - Heart Failure)

Improvement in pump function with endocardial biventricular pacing increases with activation time at the left ventricular pacing site in failing canine hearts

AJP: Heart and Circulatory Physiology — Wed, 28 Sep 2011 04:00:00 +0100

Recently, attention has been focused on comparing left ventricular (LV) endocardial (ENDO) with epicardial (EPI) pacing for cardiac resynchronization therapy. However, the effects of ENDO and EPI lead placement at multiple sites have not been studied in failing hearts. We hypothesized that differences in the improvement of ventricular function due to ENDO vs. EPI pacing in dyssynchronous (DYSS) heart failure may depend on the position of the LV lead in relation to the original activation pattern. In six nonfailing and six failing dogs, electrical DYSS was created by atrioventricular sequential pacing of the right ventricular apex. ENDO was compared with EPI biventricular pacing at five LV sites. In failing hearts, increases in the maximum rate of LV pressure change (dP/dt; r = 0.64), eject...

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Ventricular Activation Sequence during Left Ventricular Pacing Promotes QRS Complex Oversensing in the Atrial Channel

Pacing and Clinical Electrophysiology : PACE — Wed, 28 Sep 2011 04:00:00 +0100

Conclusions: Oversensing artifacts in the atrial channel are likely caused by depolarization of the basal part of the right ventricle. The novel mechanism of QRS oversensing outside PVARP, caused by a reversed ventricular activation sequence during LV‐only pacing, may be important in some CRT patients. (PACE 2011; 1–5) (Source: Pacing and Clinical Electrophysiology : PACE)

HeartNet for HF May Boost CRT 'Efficiency'HeartNet for HF May Boost CRT 'Efficiency'

Medscape Today Headlines — Mon, 26 Sep 2011 14:58:20 +0100

The mesh restraint, slipped over the ventricles, seems to turn nonresponders to cardiac resynchronization therapy into responders, and researchers think they know how the device does this. Heartwire (Source: Medscape Today Headlines)

The European cardiac resynchronization therapy survey: patient selection and implantation practice vary according to centre volume

Europace — Mon, 26 Sep 2011 04:00:00 +0100

Conclusions High-volume centres explore newer indications in their CRT practice and implant devices more frequently in patients with mild symptoms and narrow QRS durations. Electrophysiologists dominate implantation practice at HVol centres and duration of hospitalization is substantially shorter at these centres. (Source: Europace)

Transseptal left ventricular endocardial pacing: preliminary experience from a femoral approach with subclavian pull-through

Europace — Mon, 26 Sep 2011 04:00:00 +0100

Conclusion This technique for LV endocardial lead implantation is an alternative for failed CS and superior transseptal attempts using standard techniques and equipment. It is also applicable for pacing sites that are more easily reached from a femoral approach. (Source: Europace)

Rate responsive pacing using cardiac resynchronization therapy in patients with chronotropic incompetence and chronic heart failure

Europace — Mon, 26 Sep 2011 04:00:00 +0100

Conclusion When rate responsive pacing using a CRT device is achieved in patients with advanced CHF and severe CI, parameters of aerobic exercise performance improve acutely. Routine exercise testing to ensure successful restoration of heart rate response may be beneficial to optimize CRT settings in this patient population. (Source: Europace)

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Adjusting the timing of left-ventricular pacing using electrocardiogram and device electrograms

Europace — Mon, 26 Sep 2011 04:00:00 +0100

Conclusion Optimal AV during LV pacing can be approximated from the intrinsic AV conduction time. (Source: Europace)

Safety, efficacy, and performance of new discrimination algorithms to reduce inappropriate and unnecessary shocks: the PainFree SST clinical study design

Europace — Mon, 26 Sep 2011 04:00:00 +0100

Conclusion Inappropriate and unnecessary shock delivery remains a significant clinical issue for patients receiving device therapies, which has considerable consequences for patients and the healthcare system. The PainFree SST study will investigate the ability of new algorithms to reduce inappropriate shocks. Results from this study are expected in mid-2013. (Source: Europace)

Assessment of left ventricular dyssynchrony in pacing-induced left bundle branch block compared with intrinsic left bundle branch block

Europace — Mon, 26 Sep 2011 04:00:00 +0100

Conclusion Right ventricular-pacing results in less early basal activation and more often early mid-septal and late lateral wall activation in comparison with intrinsic LBBB. Imaging techniques that only visualize the basal- or mid-part of the LV may result in a serious underestimation of dyssynchrony in patients with pacing-induced LBBB. (Source: Europace)

Strong coherence between heart rate variability and intracardiac repolarization lability during biventricular pacing is associated with reverse electrical remodeling of the native conduction and improved outcome

Journal of Electrocardiology — Mon, 26 Sep 2011 04:00:00 +0100

Conclusion: Strong coherence between heart rate variability and intracardiac repolarization lability during biventricular pacing is associated with RER of the native conduction with CRT. Low coherence is associated with increased risk of VT/ventricular fibrillation or death. (Source: Journal of Electrocardiology)

HeartNet for HF may boost CRT "efficiency," help reverse remodeling

theHeart.org — Fri, 23 Sep 2011 20:45:00 +0100

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Characteristics and long-term outcome of echocardiographic super-responders to cardiac resynchronisation therapy: 'real world' experience from a single tertiary care centre

Heart — Fri, 23 Sep 2011 04:00:00 +0100

Conclusions All three definitions of super-response are highly predictive for a favourable outcome after CRT. However, even patients with pronounced reverse left ventricular remodelling experience appropriate ICD discharges during follow-up. (Source: Heart)

Baseline left ventricular dP/dtmax rather than the acute improvement in dP/dtmax predicts clinical outcome in patients with cardiac resynchronization therapy

European Journal of Heart Failure — Wed, 21 Sep 2011 04:00:00 +0100

Conclusion Left ventricular dP/dtmax measured at baseline and during CRT are predictors of 1-year survival free from all-cause mortality, HTX, or LVAD implantation, but the acute improvement in dP/dtmax is not correlated to clinical outcome. (Source: European Journal of Heart Failure)

The effect of cardiac resynchronization therapy on left ventricular diastolic function assessed with speckle-tracking echocardiography

European Journal of Heart Failure — Wed, 21 Sep 2011 04:00:00 +0100

Conclusions Novel diastolic strain rate indices are useful for evaluating changes in LV diastolic function after CRT. Improvement in diastolic function was only observed in responders to CRT and patients with non-ischaemic aetiology. (Source: European Journal of Heart Failure)

QRS duration determines CRT success in non-LBBB patients

MedWire News - Cardiology — Wed, 21 Sep 2011 00:00:00 +0100

St. Jude Medical Announces European Launch Of Smaller Quadripolar Pacing System

Medical Design Online News — Tue, 20 Sep 2011 12:02:00 +0100

St. Jude Medical, Inc. , a global medical device company, recently announced the European launch of the Unify Quadra cardiac resynchronization therapy defibrillator (CRT-D) (Source: Medical Design Online News)

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Increasing knowledge and changing views in cardiac resynchronization therapy

Heart Failure Reviews — Tue, 20 Sep 2011 05:48:49 +0100

Content Type Journal ArticlePages 1-5DOI 10.1007/s10741-011-9281-zAuthors Laszlo Buga, Academic Cardiology, University of Hull, Castle Hill Hospital, MRTDS Building, Castle Road, Cottingham, Kingston-upon-Hull, HU16 5JQ UKJohn GF Cleland, Academic Cardiology, University of Hull, Castle Hill Hospital, MRTDS Building, Castle Road, Cottingham, Kingston-upon-Hull, HU16 5JQ UK Journal Heart Failure ReviewsOnline ISSN 1573-7322Print ISSN 1382-4147 (Source: Heart Failure Reviews)

Efficient characterization of inhomogeneity in contraction strain pattern.

Biomechanics and Modeling in Mechanobiology — Sat, 17 Sep 2011 04:00:00 +0100

Authors: Nazzal CM, Mulligan LJ, Criscione JC Abstract Cardiac dyssynchrony often accompanies patients with heart failure (HF) and can lead to an increase in mortality rate. Cardiac resynchronization therapy (CRT) has been shown to provide substantial benefits to the HF population with ventricular dyssynchrony; however, there still exists a group of patients who do not respond to this treatment. In order to better understand patient response to CRT, it is necessary to quantitatively characterize both electrical and mechanical dyssynchrony. The quantification of mechanical dyssynchrony via characterization of contraction strain field inhomogeneity is the focus of this modeling investigation. Raw data from a 3D finite element (FE) model were received from Roy Kerckhoffs et al. and an...

Cardiac resynchronization therapy and reverse molecular remodeling: importance of mitochondrial redox signaling.

Circulation Research — Fri, 16 Sep 2011 04:00:00 +0100

Authors: Zweier JL, Chen CA, Talukder MA PMID: 21921269 [PubMed - in process] (Source: Circulation Research)

Cardiac resynchronisation therapy is efficacious in patients with mild heart failure symptoms

Evidence-Based Medicine — Fri, 16 Sep 2011 04:00:00 +0100

Context Heart failure (HF) is common and associated with considerable mortality and morbidity and decline in quality of life. Since the beginning of this century, cardiac resynchronisation therapy (CRT) has emerged as a new modality to treat patients with HF already on optimal pharmacological treatment. A systematic review of major clinical trials found that CRT, when added to medical treatment, reduces morbidity and mortality in HF patients who have a left ventricular ejection fraction (LVEF) less than 35%, sinus rhythm, QRS>120 ms and advanced HF symptoms.1 Until recently, the efficacy of CRT in less symptomatic HF patients remained the major unanswered question in this field; the Resynchronization/Defibrillation for Ambulatory Heart Failure Trial (RAFT) addressed this specific questi...