Characteristics that Predict Response After Cardiac Resynchronization Therapy

AbstractPurpose of ReviewCardiac resynchronization therapy (CRT) is an established modality for treating heart failure. However, one-third of patients do not respond and it is increasingly recognized that response is not binary and we should be aiming for “best response”. This review looks at factors predicting response and remodelling and highlights areas where we may improve both the proportion of responders but also maximize response in an individual.Recent FindingsWe review the clinical characteristics predicting response including structural and electrical remodelling and discuss areas of debate. We examine the evidence supporting the recently described move from anatomical-based placement of the left ventricular (LV) lead to an electrical approach with intra-operative electrical mapping and targeting of late activating regions of the LV. Finally, evidence for electrocardiographically guided post-implant programming, aiming for the narrowest paced QRS, is discussed. This includes the increasing use of atrioventricular and interventricular delay optimization and the use of newer algorithms and methods (Sync-AV, Adaptiv-CRT, Multipoint pacing, etc.) for achieving the best response.SummaryRecent data supports a tailored, individualized approach to patient selection, LV lead placement and programming to get the best response from CRT.
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research

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Conclusions: IAB is associated with new-onset AF and death in CRT recipients and may be helpful in the risk stratification in the context of heart failure management. Abnormal PTFV1 did not demonstrate any prognostic value.Cardiology
Source: Cardiology - Category: Cardiology Source Type: research
ConclusionsThe declared outcome of the LBBB groups reflects inevitably the survival outcome of their non ‐ICM patients and not the intended outcome of patients with LBBB. CRT‐D in patients with different aetiologies of cardiomyopathy calls for separate evaluation.
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
In conclusion, CRT improved non-uniformity of wall thickening between the LV septal and lateral regions evaluated using QGS, which is predictive of better prognosis in the chronic phase after CRT. PMID: 32493869 [PubMed - in process]
Source: The Tohoku Journal of Experimental Medicine - Category: Research Authors: Tags: Tohoku J Exp Med Source Type: research
AbstractA prolonged QRS duration (QRSd) is promising for a response to cardiac resynchronization therapy (CRT). The variation in human body sizes may affect the QRSd. We hypothesized that conduction disturbances may exist in Japanese even with a narrow (
Source: Heart and Vessels - Category: Cardiology Source Type: research
Int J Angiol DOI: 10.1055/s-0040-1708529Atrial fibrillation is the most common arrhythmia in the adult population, and its incidence and prevalence are still rising. Cardiac devices are widely used in clinical practice in the management of various rhythm disturbances and heart failure treatment. Many patients who receive a pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization therapy also experience atrial fibrillation in the course of their life. Therefore, this review aims to describe the role of these devices in the treatment and prevention of atrial fibrillation in the device recipients. In ad...
Source: International Journal of Angiology - Category: Cardiology Authors: Tags: Review Article Source Type: research
This study aimed to investigate the association between T ‐wave morphology and impaired left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (cLBBB), and the predictive value of T‐wave morphology for response to cardiac resynchronization therapy (CRT).Methods and ResultsWe enrolled 189 patients with cLBBB on electrocardiogram performed between January 2007 and December 2011 who underwent standard echocardiography. Repolarization parameters, including the QRS ‐to‐T angle (TCRT), T‐wave morphology dispersion (TMD), T‐wave loop area (PL), and T‐wave residuum (TWR), were re...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ARTICLES Source Type: research
ç MT Abstract A 32-year-old male patient was admitted to the hospital with syncope. An electrocardiogram revealed complete atrioventricular (AV) block and a right bundle branch block with a QRS duration of 218 milliseconds. The heart rate was 40 beats/minute. Echocardiography revealed that both AV valves opened to a single ventricle as well as noncompaction of the myocardium. Due to New York Heart Association class III heart failure, cardiac resynchronization therapy with a defibrillator device (CRT-D) was performed. After the implantation, the electrocardiography QRS duration was reduced to 183 ms. To our ...
Source: Turk Kardiyoloji Dernegi arsivi - Category: Cardiology Authors: Tags: Turk Kardiyol Dern Ars Source Type: research
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
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