QRS change in heart failure: When is the right time for cardiac resynchronization therapy?

Approximately one third of patients with reduced left ventricular ejection fraction (LVEF) also have electrical mechanical dyssynchrony manifested as widened QRS durations on surface electrocardiogram [1]. The dyssynchronous contraction of the ventricle results in reduced efficiency of cardiac output, functional diastolic mitral regurgitation, and unfavorable progressive remodeling of both the left and right ventricles [2 –4]. Furthermore, QRS prolongation is a significant predictor of clinical deterioration, with increased prevalence of severe mitral regurgitation and increase risk for ventricular tachyarrhythmias, sudden cardiac death, and all-cause mortality [5].
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Editorial Source Type: research

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ConclusionsRegression of conduction abnormalities was frequent among patients undergoing coronary angiography, primarily for suspected acute coronary syndrome. After adjustment for important confounders including extent of coronary artery disease, infranodal conduction abnormalities were associated with a modest increase in cardiovascular risk.
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
AbstractIntroductionSeveral automatic algorithms have developed to optimize timing cycle setting in cardiac resynchronization therapy (CRT). The present study aims to investigate whether the novel device ‐based SyncAV algorithm could elicit better synchrony and acute hemodynamic response.Methods and Results35 patients undergoing CRT implantation were prospectively studied. Device was programmed to three biventricular (BiV) pacing modes sequentially after procedure: QuickOpt algorithm (Mode I), SyncAV algorithm with default 50ms offset (Mode II), and SyncAV algorithm with optimized offset minimizing QRS duration (QRSd) (M...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: DEVICE THERAPY Source Type: research
AbstractNon-left bundle branch block (non-LBBB) remains an uncertain indication for cardiac resynchronization therapy (CRT). Non-LBBB includes right bundle branch block (RBBB) and non-specific LV conduction delay (NSCD), two different electrocardiogram (ECG) patterns which are not generally considered to be associated with LV conduction delay as judged by the invasive assessment of the Q-LV interval. We evaluated whether a novel ECG interval (QR-max index) correlated with the degree of LV conduction delay regardless of the type of non-LBBB ECG pattern, and could, therefore, predict CRT response. In 173 non-LBBB patients on...
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
CONCLUSION: In our first Asian-Pacific real-world data, automated dynamic CRT optimization showed comparable efficacy to conventional methods regarding clinical outcomes and electromechanical remodeling. PMID: 31293111 [PubMed - in process]
Source: J Korean Med Sci - Category: General Medicine Authors: Tags: J Korean Med Sci Source Type: research
Peripartum cardiomyopathy (PPCM) is a potentially life ‐threatening condition typically presenting as heart failure with reduced ejection fraction (HFrEF) in the last month of pregnancy or in the months following delivery in women without another known cause of heart failure. This updated position statement summarizes the knowledge about pathophysiolo gical mechanisms, risk factors, clinical presentation, diagnosis and management of PPCM. As shortness of breath, fatigue and leg oedema are common in the peripartum period, a high index of suspicion is required to not miss the diagnosis. Measurement of natriuretic peptides,...
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Position Paper Source Type: research
Conclusion: While LVEDD, LVEF, 6MWD, and NYHA were significantly improved in ECHO, ECG, and QuickOpt at 6 months, there were no significant improvements in any of the groups at 12, 24, and 48 months. These findings suggested that the long-term effect of the four CRT methods for heart failure was not significantly different.Cardiology
Source: Cardiology - Category: Cardiology Source Type: research
Cardiac resynchronisation therapy (CRT) has been a cornerstone in the treatment of select advanced heart failure cases since its introduction to our armamentarium in the early 2000s.1 Indeed, 30 –60% of advanced heart failure patients exhibit evidence of dyssynchrony, when defined electrocardiographically or mechanically.2 –4 The latter is a consequence of the former. CRT has several unique features, summarised inTable 1.
Source: Radcliffe Cardiology - Category: Cardiology Authors: Source Type: research
ConclusionsCongestive heart failure is a rare complication in acromegaly-induced cardiomyopathy (occurs in only 3% of patients). Early diagnosis and treatment with curative drugs more than cardiovascular implantable electronic devices might lead to better surgical outcomes in this group of patients.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
linical Cardiology; and Council on Cardiovascular and Stroke Nursing Abstract Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure with reduced ejection fraction. Although these devices effectively improve survival, atrial and ventricular arrhythmias are common, predispose these patients to additional risk, and complicate patient management. However, there is no consensus on best practices for the medical management of these arrhythmias or on the optimal timing for procedural interventions in patients with refractory arrhythmias. Altho...
Source: Circulation - Category: Cardiology Authors: Tags: Circulation Source Type: research
The objective of this study was to evaluate the relationship between electrocardiogram (ECG) parameters and LVPET in patients with CRT.MethodsIt was an observational, prospective, and monocentric study. From May 2017 to October 2017, all patients who underwent CRT with left quadripolar lead in Rouen University Hospital were included. LVPET was evaluated by echocardiography and defined as the time between the beginning of the QRS and the beginning of pulsed Doppler signal positioned in left ventricular outflow tract in apical view. The following parameters on 12-leads ECG were assessed: QRS width in V3, sum of QRS amplitude...
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
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