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1.
Heart Rhythm ; 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33781981

RESUMO

BACKGROUND: Left bundle branch pacing (LBBP) is an emerging physiologic pacing modality. However, little is known regarding pacing at different locations on the LBB. OBJECTIVE: The present study was designed to explore pacing and physiologic characteristics associated with different LBBP locations. METHODS: The study included 68 consecutive patients with normal unpaced QRS duration and successful LBBP implantation. Patients were divided into three groups according to the paced QRS complex: left bundle branch trunk pacing (LBTP), left posterior fascicular pacing (LPFP) and left anterior fascicular pacing (LAFP). ECG characteristics, pacing parameters and fluoroscopic localization were collected and analyzed. RESULTS: There were 17 (25.0%), 35 (51.5%) and 16 (23.5%) patients in the LBTP, LPFP and LAFP groups, respectively. All subgroups had relatively narrow paced QRS complex (128.6±9.1 ms vs. 133.7±11.2 ms vs. 134.8±9.6 ms, P=0.170), fast left ventricular activation (70.4±9.0 ms vs. 70.6±10.2 ms, vs. 71.0±9.0 ms, P=0.986), as well as low and stable pacing thresholds. Delayed right ventricular activation and interventricular dysynchrony were similar between groups. Fluoroscopic imaging indicated that the lead tip was located most commonly in the basal-middle region of the septum (67.7%) and this was independent of paced QRS morphology group (88.2% vs. 57.1% vs. 68.8%, P=0.106). CONCLUSIONS: Pacing at different sites of the LBB resulted in similar intraventricular and interventricular electrical synchrony in patients with intact conduction system. Fluoroscopic imaging alone could not predict specific LBBP paced ECG morphology.

2.
J Am Heart Assoc ; 10(6): e018127, 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33663225

RESUMO

Background The hemodynamic effects of cardiac resynchronization therapy in patients with left ventricular assist devices (LVADs) are uncharacterized. We aimed to quantify the hemodynamic effects of different ventricular pacing configurations in patients with LVADs, focusing on short-term changes in load-independent right ventricular (RV) contractility. Methods and Results Patients with LVADs underwent right heart catheterization during spontaneous respiration without sedation and with pressures recorded at end expiration. Right heart catheterization was performed at different pacemaker configurations (biventricular pacing, left ventricular pacing, RV pacing, and unpaced conduction) in a randomly generated sequence with >3 minutes between configuration change and hemodynamic assessment. The right heart catheterization operator was blinded to the sequence. RV maximal change in pressure over time normalized to instantaneous pressure was calculated from digitized hemodynamic waveforms, consistent with a previously validated protocol. Fifteen patients with LVADs who were in sinus rhythm were included. Load-independent RV contractility, as assessed by RV maximal change in pressure over time normalized to instantaneous pressure, was higher in biventricular pacing compared with unpaced conduction (15.7±7.6 versus 11.0±4.0 s-1; P=0.003). Thermodilution cardiac output was higher in biventricular pacing compared with unpaced conduction (4.48±0.7 versus 4.38±0.8 L/min; P=0.05). There were no significant differences in heart rate, ventricular filling pressures, or atrioventricular valvular regurgitation across all pacing configurations. Conclusions Biventricular pacing acutely improves load-independent RV contractility in patients with LVADs. Even in these patients with mechanical left ventricular unloading via LVAD who were relative pacing nonresponders (required LVAD support despite cardiac resynchronization therapy), biventricular pacing was acutely beneficial to RV contractility.

3.
J Cardiovasc Electrophysiol ; 32(4): 1077-1084, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33650717

RESUMO

INTRODUCTION: Catheter ablation (CA) of frequent premature ventricular contractions (PVC) is increasingly performed in older patients as the population ages. The aim of this study was to assess the impact of age on procedural characteristics, safety and efficacy on PVC ablations. METHODS: Consecutive patients with symptomatic PVCs undergoing CA between 2015 and 2020 were evaluated. Acute ablation success was defined as the elimination of PVCs at the end of the procedure. Sustained success was defined as an elimination of symptoms, and ≥80% reduction of PVC burden determined by Holter-electrocardiogram during long-term follow. Patients were sub-grouped based on age (<65 vs. ≥65 years). RESULTS: A total of 114 patients were enrolled (median age 64 years, 71% males) and followed up for a median duration of 228 days. Baseline and procedural data were similar in both age groups. A left-sided origin of PVCs was more frequently observed in the elderly patient group compared to younger patients (83% vs. 67%; p = .04). The median procedure time was significantly shorter in elderly patients (160 vs. 193 min; p = .02). The rates of both acute (86% vs. 92%; p = .32) and sustained success (70% vs. 71%; p = .90) were similar between groups. Complications rates (3.7%) did not differ between the two groups. CONCLUSION: In a large series of patients with a variety of underlying arrhythmia substrates, similar rates of acute procedural success, complications, and ventricular arrhythmia-free-survival were observed after CA of PVCs. Older age alone should not be a reason to withhold CA of PVCs.

4.
Artigo em Inglês | MEDLINE | ID: mdl-33640347

RESUMO

OBJECTIVES: This study sought to assess the impact of a more detailed classification of response on survival. BACKGROUND: Cardiac resynchronization therapy (CRT) improves functional status and outcomes in selected populations with heart failure (HF). However, approximately 30% of patients do not improve with CRT by various metrics, and they are traditionally classified as nonresponders. METHODS: REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) was a randomized trial of CRT among patients with mild HF. Patients were classified as Improved, Stabilized, or Worsened using prespecified criteria based on the clinical composite score (CCS) and change in left ventricular end-systolic volume index (LVESVi). All-cause mortality across CRT ON subgroups at 5 years was compared. RESULTS: Of the 406 subjects surviving 1 year, 5-year survival differed between CCS subgroups (p = 0.03), with increased mortality in the Worsened response group. Of the 353 subjects with adequate echocardiograms, survival differed significantly between response groups (p < 0.001), also due to increased mortality in the Worsened group. When combining CCS and LVESVi results, the lowest survival was observed among subjects who worsened for both measures, whereas the highest survival occurred in subjects who did not worsen by either endpoint. Multivariate analysis showed that LVESVi worsening with CRT at 6 months, baseline LVESVi, and gender were independent predictors of survival. CONCLUSIONS: For both CCS and reverse remodeling, patients who worsen with CRT have a high mortality, although remodeling was the more important endpoint. Patients who stabilize early with CRT have a much better prognosis than previously recognized, suggesting that the current convention of nonresponder classification should be modified. (REVERSE [Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction]; NCT00271154).

6.
Am Heart J ; 235: 158-162, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33596412

RESUMO

The WiSE system is a novel, leadless endocardial system that can provide cardiac resynchronization therapy in patients who cannot be treated with a conventional epicardial left ventricular lead. Safety and efficacy were being evaluated in the pivotal, randomized, double-blind SOLVE-CRT Trial (Stimulation of the Left Ventricular Endocardium for Cardiac Resynchronization Therapy.) The trial was initiated in 2018; however, patient enrollment was significantly impacted by the COVID-19 pandemic necessitating a change in design. This article describes the revised trial and the scientific rationale for the specific changes in the protocol.

7.
Artigo em Inglês | MEDLINE | ID: mdl-33491861

RESUMO

BACKGROUND: Alcohol septal ablation (ASA) is a proven method of septal reduction for patients with drug refractory, symptomatic hypertrophic obstructive cardiomyopathy (HOCM). This procedure is associated with a 6.5-11% risk of complete heart block (CHB). OBJECTIVE: The aim of this study is to determine factors that predict CHB and to develop a clinical tool for risk stratification of patients. METHODS: Patients were enrolled into an ongoing ASA study. A total of 636 patient procedures were included, 527 of whom were used in the development of the prediction tool, and 109 of whom were used for independent validation. Multivariate analysis was performed with odds ratios used to develop the clinical prediction tool. This was then internally and externally validated. RESULTS: Of the 527 in the prediction cohort, 46 developed CHB. The predictors of CHB were age ≥50 years, pre-ASA left bundle branch block (LBBB), transient procedural high-grade block, post-ASA PR prolongation ≥68 ms, and new bifascicular block. An 11-point clinical prediction tool was developed to classify these factors. Internal validation using a receiver operating characteristic curve revealed an area under the curve of 0.88 for the clinical prediction tool. External validation using 109 contemporary patients revealed a 98% negative predictive value, 24% positive predictive value, 75% sensitivity, and 81% specificity in high-risk patients. CONCLUSION: Among patients undergoing ASA, the risk of CHB can be predicted with easily obtained clinical and electrocardiographic factors. This clinical prediction tool allows identification of high-risk patients who may benefit from additional monitoring and therapy.

8.
J Cardiovasc Electrophysiol ; 32(3): 792-801, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33492734

RESUMO

BACKGROUND: Traditionally, implantation of the subcutaneous implantable cardioverter defibrillator (S-ICD) requires incisions near the lateral chest wall, the xyphoid, and the superior sternal region (three-incision technique [3IT]). A two-incision technique (2IT) avoids the superior incision and has been shown to be a viable alternative in small studies with limited follow-up. OBJECTIVES: To report on the long-term safety and efficacy of the 2IT compared to the 3IT procedure in a large patient cohort. METHODS: Patients enrolled in the S-ICD post approval study (PAS) were stratified by procedural technique (2IT vs. 3IT). Baseline demographics, comorbidities and procedural outcomes were collected. Complications and S-ICD effectiveness in treating ventricular arrhythmias through an average 3-year follow-up period were compared. RESULTS: Of 1637 patients enrolled in the S-ICD PAS, 854 pts (52.2%) were implanted using the 2IT and 782 were implanted using the 3IT (47.8%). The 2IT became more prevalent over time, increasing from 40% to 69% of implants (Q1-Q4). Mean procedure time was shorter with 2IT (69.0 vs. 86.3 min, p < .0001). No other differences in outcomes were observed between the two groups, including rates of infection, electrode migration, inappropriate shocks and first shock efficacy for treating ventricular arrhythmias. CONCLUSION: In this large cohort of patients implanted with an S-ICD and followed for 3 years the 2IT was as safe and effective as the 3IT while significantly reducing procedure time.

9.
Can J Cardiol ; 2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33271225

RESUMO

BACKGROUND: Atrial fibrillation (AF) is often detected during hospitalization for surgery or medical illness and is often assumed to be due to the acute condition. METHODS: ASSERT enrolled patients >65 years old without AF. Pacemakers or implantable cardioverter defibrillators recorded device-detected AF. We identified participants who were hospitalized and compared the prevalence of AF before and after hospitalization. RESULTS: Among 2580 participants, 436 (16.9%) had a surgical or medical hospitalization. In the 30 days following a first hospitalization, 43 participants (9.9%, 95% confidence interval [CI] 7.2%-13.1%) had >6 minutes of device-detected AF; 20 (4.6%, 95% CI 2.8%-7.0%) had >6 hours. More participants had AF >6 minutes in the 30 days following hospitalization, as compared to the period 30-60 days before hospitalization (9.9% versus 4.4%, P < 0.001). Similar results were observed for episodes >6 hours (4.6% versus 2.3%, P = 0.03). Roughly half of participants with device-detected AF in the 30 days following hospitalization had ≥1 episodes of the same duration in the 6 months prior (50% [95% CI 31.3%-68.7%] for >6 minutes; 68.8% [95% CI 41.3%-89.0%] for >6 hours). Those with AF in the 30 days following hospitalization were more likely to have had AF in the past (adjusted OR 7.2 95%CI 3.2-15.8 for episodes >6 minutes; adjusted OR 32.6, 95%CI 10.3-103.4 for >6 hours). CONCLUSIONS: The prevalence of device-detected AF increases around the time of hospitalization for non-cardiac surgery or medical illness. About half of patients with AF around the time of hospitalization previously had similar episodes.

10.
JACC Clin Electrophysiol ; 6(12): 1537-1550, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33213814

RESUMO

OBJECTIVES: This study evaluated spontaneous arrhythmias and clinical outcomes in the S-ICD System PAS (Subcutaneous Implantable Cardioverter-Defibrillator Post Approval Study) cohort. BACKGROUND: The U.S. S-ICD PAS trial patient population more closely resembles transvenous ICD cohorts than earlier studies, which included many patients with little structural heart disease and few comorbidities. Early outcomes and low peri-operative complication rates were demonstrated in the S-ICD PAS cohort, but there are no data detailing spontaneous arrhythmias and clinical outcomes. METHODS: The S-ICD PAS prospective registry included 1,637 de novo patients from 86 U.S. centers. Descriptive statistics, Kaplan-Meier time to event, and multivariate logistic regression were performed using data out to 365 days. RESULTS: Patients (68.5% men; mean ejection fraction of 32.0%; 42.9% ischemic; 13.4% on dialysis) underwent implantation for primary (76.6%) or secondary prevention indication. The complication-free rate was 92.5%. The appropriate shock (AS) rate was 5.3%. A total of 395 ventricular tachycardia (VT) or fibrillation (VF) episodes were appropriately sensed, with 131 (33.2%) self-terminating. First and final shock efficacy (up to 5 shocks) for the 127 discrete AS episodes were 91.3% and 100.0%, respectively. Discrete AS episodes included 67 monomorphic VT (MVT) and 60 polymorphic VT (PVT)/VF, with first shock efficacy of 95.2% and 86.7%, respectively. There were 19 storm events in 18 subjects, with 84.2% conversion success. Storm episodes were more likely PVT/VF (98 of 137). CONCLUSIONS: In the first year after implantation, a predominantly primary prevention population with low ejection fraction demonstrated a high complication-free rate and spontaneous event shock efficacy for MVT and PVT/VF arrhythmias at rapid ventricular rates. (Subcutaneous Implantable Cardioverter-Defibrillator System Post Approval Study [S-ICD PAS; NCT01736618).

12.
J Med Econ ; : 1-8, 2020 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-33043737

RESUMO

AIMS: Although cardiac resynchronization therapy (CRT) has proven beneficial in several randomized trials, a subset of patients have limited clinical improvement. The AdaptivCRT algorithm provides automated selection between synchronized left ventricular or biventricular pacing with optimization of atrioventricular delays. The rationale and design of the economic analysis of the AdaptResponse clinical trial are described. RATIONALE: The costs associated with HF hospitalization are substantial and are compounded by a high rate of readmission. HF hospitalization payments range from $1,001 for Greece to $12,235 for US private insurance. When examining the breakdown of HF-related costs, it is clear that approximately 55% of the hospitalization costs are directly attributable to length of stay. Notably, the mean costs of a CRT patient in need of a HF-related hospitalization are currently estimated to be an average of $10,679. METHODS: The economic analysis of the AdaptResponse trial has two main objectives. The hospital provider objective seeks to test the hypothesis that AdaptivCRT reduces the incidence of all-cause re-admissions after a heart failure admission within 30 days of the index event. A negative binomial regression model will be used to estimate and compare the number of readmissions after an index HF hospitalization. The payer economic objective will assess cost-effectiveness of CRT devices with the AdaptivCRT algorithm relative to traditional CRT programming. This analysis will be conducted from a U.S. payer perspective. A decision analytic model comprised of a 6-month decision tree and a Markov model for long term extrapolation will be used to evaluate lifetime costs and benefits. CONCLUSION: AdaptivCRT may offer improvements over traditional device programming in patient outcomes. How the data from AdaptResponse will be used to demonstrate if these clinical benefits translate into substantial economic gains is herein described.

13.
Artigo em Inglês | MEDLINE | ID: mdl-33022815

RESUMO

BACKGROUND: Catheter ablation is an effective treatment for patients with atrial fibrillation (AF) and heart failure (HF). However, little is known about how healthcare utilization and cost change after ablation in this population. We sought to determine healthcare utilization and cost patterns among patients with AF and HF undergoing ablation. METHODS: Using a large United States administrative database, we identified (n = 1568) treated with ablation with a primary and secondary diagnosis of AF and HF, respectively, were evaluated 1-year pre- and postablation for outcomes including inpatient admissions (AF or HF), emergency department (ED) visits, cardioversions, length of stay (LOS), and cost. A secondary analysis was extended to 3-years postablation. RESULTS: Reductions were observed in AF-related admissions (64%), LOS (65%), cardioversions (52%), ED visits (51%, all values, p < .0001), and HF-related admissions (22%, p = .01). There was a 40% reduction in inpatient admission cost ($4165 preablation to $2510 postablation, p < .0001). In a sensitivity analysis excluding repeat-ablation patients, a greater reduction in overall AF management cost was observed compared to the full cohort (-43% vs. -2%). Comparing 1-year pre- to 3-years postablation, both total mean AF-management cost ($850 per-patient per-month 1-year pre- to $546 3-years postablation, p < .0001) and AF-related healthcare utilization was reduced. CONCLUSIONS: Catheter ablation in patients with AF and HF resulted in significant reductions in healthcare utilization and cost through 3-years of follow-up. This reduction was observed regardless of whether repeat ablation was performed, reflecting the positive impact of ablation on longer term cost reduction.

14.
JACC Clin Electrophysiol ; 6(10): 1291-1299, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33092757

RESUMO

OBJECTIVE: The aim of this study was to assess pacing and electrophysiological parameters, as well as short-term outcomes, among patients undergoing left bundle branch pacing (LBBP) or His bundle pacing (HBP). BACKGROUND: There are limited data directly comparing different conduction system pacing modalities. METHODS: Consecutive patients undergoing de novo conduction system pacing for bradycardia indications were evaluated. Procedural and fluoroscopic times and pacing characteristics were compared between groups at implantation and at 3-month follow-up. RESULTS: This study included 251 subjects. HBP was successful in 109 (87.2%) of 125 patients, compared with 115 (91.3%) of 126 for LBBP. The mean procedure time (78 ± 36 min vs. 54 ± 24 min, p < 0.001) and fluoroscopy duration (12 ± 5 min vs. 5 ± 2.8 min, p < 0.001) were significantly longer for HBP compared with LBBP. The paced QRS duration (113.7 ± 24.4 ms vs. 114.1 ± 11.2 ms) were similar between groups (p = 0.87). Capture threshold was significantly lower (1.3 ± 0.6 V/1.0 ms vs. 0.6 ± 0.2 V/0.4 ms, p < 0.001), whereas R-wave amplitude was significantly higher (2.8 ± 3.0 mV vs. 12.5 ± 9.0 mV, p < 0.001) with LBBP compared with HBP at implantation. During follow-up, a capture threshold >3.0 V occurred in 8 HBP patients versus 0 LBBP patients (p = 0.003). CONCLUSIONS: LBBP has similar paced QRS durations and success rates, but shorter procedure and fluoroscopy durations, as well as better pacing parameters compared with HBP. Further prospective study is needed to compare long-term outcomes, safety, and pacing stability with these 2 conduction system pacing modalities.

15.
Circulation ; 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33073614

RESUMO

Background: The Subcutaneous ICD (S-ICD) is safe and effective for sudden cardiac death prevention. However, patients in previous S-ICD studies had fewer comorbidities, less left ventricular dysfunction and received more inappropriate shocks (IAS) than in typical transvenous (TV)-ICD trials. The UNTOUCHED trial was designed to evaluate the IAS rate in a more typical, contemporary ICD patient population implanted with the S-ICD using standardized programming and enhanced discrimination algorithms. Methods: Primary prevention patients with left ventricular ejection fraction (LVEF) ≤ 35% and no pacing indications were included. Generation 2 or 3 S-ICD devices were implanted and programmed with rate-based therapy delivery for rates ≥ 250 beats per minute (bpm) and morphology discrimination for rates ≥200 and < 250 bpm. Patients were followed for 18 months. The primary endpoint was the IAS free rate compared to a 91.6% performance goal, derived from the results for the ICD-only patients in the MADIT-RIT study. Kaplan-Meier analyses were performed to evaluate event-free rates for IAS, all cause shock, and complications. Multivariable proportional hazard analysis was performed to determine predictors of endpoints. Results: S-ICD implant was attempted in 1116 patients and 1111 patients were included in post-implant follow-up analysis. The cohort had a mean age of 55.8±12.4 years, 25.6% women, 23.4% black race, 53.5% with ischemic heart disease, 87.7% with symptomatic heart failure and a mean LVEF of 26.4±5.8%. Eighteen-month freedom from IAS was 95.9% (Lower confidence limit LCL 94.8%). Predictors of reduced incidence of IAS were implanting the most recent generation of device, using the three-incision technique, no history of atrial fibrillation, and ischemic etiology. The 18-month all cause shock free rate was 90.6% (LCL 89.0%), meeting the prespecified performance goal of 85.8%. Conversion success rate for appropriate, discrete episodes was 98.4%. Complication free rate at 18 months was 92.7%. Conclusions: This study demonstrates high efficacy and safety with contemporary S-ICD devices and programming despite the relatively high incidence of co-morbidities in comparison to earlier S-ICD trials. The inappropriate shock rate (3.1% at one year) is the lowest reported for the S-ICD and lower than many TV ICD studies using contemporary programming to reduce IAS. Clinical Trial Registration: URL https://clinicaltrials.gov Unique Identifier NCT02433379.

16.
Circ Arrhythm Electrophysiol ; 13(10): e008370, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32911981

RESUMO

BACKGROUND: His bundle pacing (HBP) is the most physiological pacing modality. However, HBP has longer procedure times with frequent high capture thresholds, which likely contributes to the low adoption of this approach. The aim of this study is to compare HBP implantation with a novel imaging technique versus the standard implantation technique. METHODS: This study included 50 patients with standard pacing indications randomized to HBP with visualization of the tricuspid valve annulus (N=25, the visualization group) or with the standard method (N=25, the control group). In the visualization group, the tricuspid valve annulus was imaged by contrast injection in the right ventricle during fluoroscopy. The site for HBP was identified in relationship to the tricuspid septal leaflet and interventricular septum. RESULTS: Permanent HBP was successful in 92% in the visualization group and 88% in the control group. The fluoroscopic time for HBP lead placement was significantly shorter in the visualization group (7.1±3.3 minutes) compared with the control group (10.1±5.6 minutes, P=0.03). Total procedural and fluoroscopic times were also significantly shorter in the visualization group (91.0±15.7 and 9.6±3.8 minutes) than the control group (104.4±17.8 and 12.7±6.2 minutes, P=0.01 and 0.04, respectively). There was no significant difference in capture threshold between groups. In the visualization group, there was a quantitative association between the HBP site and the tricuspid valve annulus. CONCLUSIONS: The visualization technique shortens the procedural and fluoroscopic times for HBP implantation. Moreover, anatomic localization of HBP sites is strongly associated with physiological characteristics of pacing, which can help guide optimal lead placement. Registration: URL: https://www.chictr.org.cn/index.aspx. Unique identifier: ChiCTR2000029834.

17.
ESC Heart Fail ; 7(5): 2972-2982, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32790108

RESUMO

AIMS: Response to cardiac resynchronization therapy (CRT) is known to be associated with a number of clinical characteristics, including QRS duration and morphology, gender, height, and the aetiology of heart failure (HF). We assessed the relation of gender and baseline characteristics with QRS duration and Kansas City Cardiomyopathy Questionnaire. METHODS AND RESULTS: AdaptResponse is a global randomized trial. The trial enrolled CRT-indicated patients with New York Heart Association classes II-IV HF, left bundle branch block (QRS ≥ 140 ms in men, ≥130 ms in women), and baseline PR interval ≤200 ms. In total, 3620 patients were randomized, including 1569 women (43.3%) approaching the actual proportion of women in the HF population. Women were older and more often New York Heart Association class III or IV than men (55.6% vs. 48.7%), had less frequent ischaemic cardiomyopathy (21.2% vs. 39.5%), and had a 5.1 ms shorter QRS duration than men. Women were more often depressed (18.5% vs. 9.7%), had a significantly lower Kansas City Cardiomyopathy Questionnaire score, and had differences in medication prescriptions. CONCLUSIONS: AdaptResponse is the largest randomized CRT trial and enrolled more women than any other landmark CRT trial. Women differed from men with regard to baseline characteristics and quality of life. Whether these differences translate into clinical outcome differences will be examined further in the AdaptResponse trial.

19.
Circ Arrhythm Electrophysiol ; 13(8): e008267, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32701363

RESUMO

BACKGROUND: Left bundle branch pacing (LBBP) is a technique for conduction system pacing, but it often results in right bundle branch block morphology on the ECG. This study was designed to assess simultaneous pacing of the left and right bundle branch areas to achieve more synchronous ventricular activation. METHODS: In symptomatic bradycardia patients, the distal electrode of a bipolar pacing lead was placed at the left bundle branch area via a transventricular-septal approach. This was used to pace the left bundle branch area, while the ring electrode was used to pace the right bundle branch area. Bilateral bundle branch area pacing (BBBP) was achieved by stimulating the cathode and anode in various pacing configurations. QRS duration, delayed right ventricular activation time, left ventricular activation time, and interventricular conduction delay were measured. Pacing stability and short-term safety were assessed at 3-month follow-up. RESULTS: BBBP was successfully performed in 22 of 36 patients. Compared with LBBP, BBBP resulted in greater shortening of QRS duration (109.3±7.1 versus 118.4±5.7 ms, P<0.001). LBBP resulted in a paced right bundle branch block configuration, with a delayed right ventricular activation time of 115.0±7.5 ms and interventricular conduction delay of 34.0±8.8 ms. BBBP fully resolved the right bundle branch block morphology in 18 patients. In the remaining 4 patients, BBBP partially corrected the right bundle branch block with delayed right ventricular activation time decreasing from 120.5±4.7 ms during LBBP to 106.1±4.2 ms during BBBP (P=0.005). CONCLUSIONS: LBBP results in a relatively narrow QRS complex but with an interventricular activation delay. BBBP can diminish the delayed right ventricular activation, producing more physiological ventricular activation. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Potenciais de Ação , Bradicardia/terapia , Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Frequência Cardíaca , Idoso , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Estimulação Cardíaca Artificial/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda , Função Ventricular Direita
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