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Latest Advances in Delivery and Outcomes of Cardiac Resynchronization Therapy
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Latest Advances in Delivery and Outcomes of Cardiac Resynchronization Therapy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 21288

Special Issue Editor

Dr. Alexander H. Maass

E-Mail Website
Guest Editor
Department of Cardiology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands
Interests: bradycardia; pacing; ICD; CRT; heart failure; exercise; congenital heart disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cardiac Resynchronization Therapy (CRT) is an established technique to improve morbidity and mortality in selected heart failure patients. This technique has been a game changer for heart failure treatment in patients with conduction delay, who are often non-responders to optimal medical treatment. Unfortunately, rates of non-response to CRT are from 30% to 50% depending on the outcome parameter that is chosen. Non-response rates are due to suboptimal delivery of CRT, patient selection, and device programming. Furthermore, there is controversy on which parameter and cut-off should be used to define the CRT response.

With this Special Issue, we would like to highlight recent advances in the improvement of the CRT response, including, but not restricted to, strategies to optimize implantation techniques, patient selection, or CRT programming. We encourage researchers to submit their results and proposals on how to provide optimal CRT. The measurement of outcome variables such as exercise capacity, quality of life, reverse remodeling, as well as occurrence of atrial and ventricular arrhythmias is essential to evaluate the success of this powerful treatment.

Dr. Alexander H. Maass
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • implantation
  • response
  • remodeling
  • arrhythmias
  • risk prediction
  • imaging
  • patient selection
  • alternative pacing sites

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Published Papers (5 papers)

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Research

12 pages, 2027 KiB  
Article
Left Ventricular Lead Placement Guided by Reduction in QRS Area
by Mohammed Ali Ghossein, Francesco Zanon, Floor Salden, Antonius van Stipdonk, Lina Marcantoni, Elien Engels, Justin Luermans, Sjoerd Westra, Frits Prinzen and Kevin Vernooy
J. Clin. Med. 2021, 10(24), 5935; https://doi.org/10.3390/jcm10245935 - 17 Dec 2021
Cited by 6 | Viewed by 2840
Abstract
Background: Reduction in QRS area after cardiac resynchronization therapy (CRT) is associated with improved long-term clinical outcome. The aim of this study was to investigate whether the reduction in QRS area is associated with hemodynamic improvement by pacing different LV sites and [...] Read more.
Background: Reduction in QRS area after cardiac resynchronization therapy (CRT) is associated with improved long-term clinical outcome. The aim of this study was to investigate whether the reduction in QRS area is associated with hemodynamic improvement by pacing different LV sites and can be used to guide LV lead placement. Methods: Patients with a class Ia/IIa CRT indication were prospectively included from three hospitals. Acute hemodynamic response was assessed as the relative change in maximum rate of rise of left ventricular (LV) pressure (%∆LVdP/dtmax). Change in QRS area (∆QRS area), in QRS duration (∆QRS duration), and %∆LVdP/dtmax were studied in relation to different LV pacing locations within a patient. Results: Data from 52 patients paced at 188 different LV pacing sites were investigated. Lateral LV pacing resulted in a larger %∆LVdP/dtmax than anterior or posterior pacing (p = 0.0007). A similar trend was found for ∆QRS area (p = 0.001) but not for ∆QRS duration (p = 0.23). Pacing from the proximal electrode pair resulted in a larger %∆LVdP/dtmax (p = 0.004), and ∆QRS area (p = 0.003) but not ∆QRS duration (p = 0.77). Within patients, correlation between ∆QRS area and %∆LVdP/dtmax was 0.76 (median, IQR 0.35; 0,89). Conclusion: Within patients, ∆QRS area is associated with %∆LVdP/dtmax at different LV pacing locations. Therefore, QRS area, which is an easily, noninvasively obtainable and objective parameter, may be useful to guide LV lead placement in CRT. Full article
(This article belongs to the Special Issue Latest Advances in Delivery and Outcomes of Cardiac Resynchronization Therapy)
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14 pages, 548 KiB  
Article
Aetiology of Heart Failure, Rather than Sex, Determines Reverse LV Remodelling Response to CRT
by Fatema Said, Jozine M. ter Maaten, Pieter Martens, Kevin Vernooy, Mathias Meine, Cornelis P. Allaart, Bastiaan Geelhoed, Marc A. Vos, Maarten J. Cramer, Isabelle C. van Gelder, Wilfried Mullens, Michiel Rienstra and Alexander H. Maass
J. Clin. Med. 2021, 10(23), 5513; https://doi.org/10.3390/jcm10235513 - 25 Nov 2021
Cited by 4 | Viewed by 2177
Abstract
Introduction: Cardiac resynchronization therapy (CRT) is an established therapy for patients with heart failure with reduced ejection fraction (HFrEF). Women appear to respond differently to CRT, yet it remains unclear whether this is inherent to the female sex itself, or due to other [...] Read more.
Introduction: Cardiac resynchronization therapy (CRT) is an established therapy for patients with heart failure with reduced ejection fraction (HFrEF). Women appear to respond differently to CRT, yet it remains unclear whether this is inherent to the female sex itself, or due to other patient characteristics. In this study, we aimed to investigate sex differences in response to CRT. Methods: This is a post-hoc analysis of a prospective, multicenter study (MARC) in the Netherlands, studying HFrEF patients with an indication for CRT according to the guidelines (n = 240). Primary outcome measures are left ventricular ejection fraction (LVEF) and left ventricular end systolic volume (LVESV) at 6 months follow-up. Results were validated in an independent retrospective Belgian cohort (n = 818). Results: In the MARC cohort 39% were women, and in the Belgian cohort 32% were women. In the MARC cohort, 70% of the women were responders (defined as >15% decrease in LVESV) at 6 months, compared to 55% of men (p = 0.040) (79% vs. 67% in the Belgian cohort, p = 0.002). Women showed a greater decrease in LVESV %, LVESV indexed to body surface area (BSA) %, and increase in LVEF (all p < 0.05). In regression analysis, after adjustment for BSA and etiology, female sex was no longer associated with change in LVESV % and LVESV indexed to BSA % and LVEF % (p > 0.05 for all). Results were comparable in the Belgian cohort. Conclusions: Women showed a greater echocardiographic response to CRT at 6 months follow-up. However, after adjustment for BSA and ischemic etiology, no differences were found in LV-function measures or survival, suggesting that non-ischemic etiology is responsible for greater response rates in women treated with CRT. Full article
(This article belongs to the Special Issue Latest Advances in Delivery and Outcomes of Cardiac Resynchronization Therapy)
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12 pages, 1908 KiB  
Article
Ratio between Right Ventricular Longitudinal Strain and Pulmonary Arterial Systolic Pressure: Novel Prognostic Parameter in Patients Undergoing Cardiac Resynchronization Therapy
by Silvia Deaconu, Alexandru Deaconu, Alina Scarlatescu, Ioana Petre, Sebastian Onciul, Aura Vijiiac, Diana Zamfir, Gabriela Marascu, Corneliu Iorgulescu, Andrei Dan Radu, Stefan Bogdan and Radu Vatasescu
J. Clin. Med. 2021, 10(11), 2442; https://doi.org/10.3390/jcm10112442 - 31 May 2021
Cited by 10 | Viewed by 2843
Abstract
Background: We aimed to evaluate whether right ventricle (RV) longitudinal strain indexed to pulmonary arterial systolic pressure (PASP) has prognostic significance in patients undergoing cardiac resynchronization therapy (CRT). Methods: Patients undergoing CRT were prospectively included. The primary endpoint was adverse cardiovascular events (death [...] Read more.
Background: We aimed to evaluate whether right ventricle (RV) longitudinal strain indexed to pulmonary arterial systolic pressure (PASP) has prognostic significance in patients undergoing cardiac resynchronization therapy (CRT). Methods: Patients undergoing CRT were prospectively included. The primary endpoint was adverse cardiovascular events (death and HF-related hospitalizations). RV global longitudinal strain (RVGLS) and RV free wall strain (RVfwS) were measured by speckle tracking and indexed to echocardiographic estimated PASP. Results: A total of 54 patients (64.0 ± 13.8 years; 58% male) were included. After 33 ± 12.9 months, the primary endpoint occurred in 18 patients. Baseline RVGLS/PASP and RVfwS/PASP showed good discriminative ability for response to CRT (AUC = 0.88, 95% CI (0.74–1) and AUC = 0.87, 95% CI (0.77–1)). RVGLS/PASP and RVfwS/PASP were significantly associated with high risk of events at univariate analysis (HR 0.039, 95% CI (0.001–0.8) p < 0.05, respectively HR = 0.049, 95% CI (0.0033–0.72), p < 0.05). Upon multivariate Cox regression analysis, RVGLS/PASP and RVfwS/PASP remained associated with high risk of events (HR 0.018, 95% CI (0.0005–0.64), p = 0.02 and HR 0.015, 95% CI (0.0004–0.524), p = 0.01) after correction for gender, etiology, QRS duration and morphology. Conclusions: Indexing RV longitudinal strain (global and free wall) by PASP provides a parameter, which independently identifies patients with high risk of cardiovascular events and predicts non-response to CRT. Full article
(This article belongs to the Special Issue Latest Advances in Delivery and Outcomes of Cardiac Resynchronization Therapy)
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12 pages, 7232 KiB  
Article
Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients
by Luuk I.B. Heckman, Justin G.L.M. Luermans, Karol Curila, Antonius M.W. Van Stipdonk, Sjoerd Westra, Radovan Smisek, Frits W. Prinzen and Kevin Vernooy
J. Clin. Med. 2021, 10(4), 822; https://doi.org/10.3390/jcm10040822 - 17 Feb 2021
Cited by 51 | Viewed by 9583
Abstract
Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological [...] Read more.
Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological effects of LBBP and LVSP as compared to intrinsic ventricular conduction. Methods: Fifty patients with normal cardiac function and pacemaker indication for bradycardia underwent LBBAP. Electrocardiography (ECG) characteristics were evaluated during pacing at various depths within the septum: starting at the right ventricular (RV) side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and—in patients where left bundle branch (LBB) capture was achieved—LBBP. From the ECG’s QRS duration and QRS morphology in lead V1, the stimulus- left ventricular activation time left ventricular activation time (LVAT) interval were measured. After conversion of the ECG into vectorcardiogram (VCG) (Kors conversion matrix), QRS area and QRS vector in transverse plane (Azimuth) were determined. Results: QRS area significantly decreased from 82 ± 29 µVs during RV septal pacing (RVSP) to 46 ± 12 µVs during LVSP. In the subgroup where LBB capture was achieved (n = 31), QRS area significantly decreased from 46 ± 17 µVs during LVSP to 38 ± 15 µVs during LBBP, while LVAT was not significantly different between LVSP and LBBP. In patients with normal ventricular activation and narrow QRS, QRS area during LBBP was not significantly different from that during intrinsic activation (37 ± 16 vs. 35 ± 19 µVs, respectively). The Azimuth significantly changed from RVSP (−46 ± 33°) to LVSP (19 ± 16°) and LBBP (−22 ± 14°). The Azimuth during both LVSP and LBBP were not significantly different from normal ventricular activation. QRS area and LVAT correlated moderately (Spearman’s R = 0.58). Conclusions: ECG and VCG indices demonstrate that both LVSP and LBBP improve ventricular dyssynchrony considerably as compared to RVSP, to values close to normal ventricular activation. LBBP seems to result in a small, but significant, improvement in ventricular synchrony as compared to LVSP. Full article
(This article belongs to the Special Issue Latest Advances in Delivery and Outcomes of Cardiac Resynchronization Therapy)
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11 pages, 2387 KiB  
Article
What Are the Expectations for Cardiac Resynchronization Therapy? A Validation of Two Response Definitions
by Toshiko Nakai, Yukitoshi Ikeya, Rikitake Kogawa, Naoto Otsuka, Yuji Wakamatsu, Sayaka Kurokawa, Kimie Ohkubo, Koichi Nagashima and Yasuo Okumura
J. Clin. Med. 2021, 10(3), 514; https://doi.org/10.3390/jcm10030514 - 1 Feb 2021
Cited by 20 | Viewed by 2688
Abstract
Background: The definition of response to cardiac resynchronization therapy (CRT) varies across clinical trials. There are two main definitions, i.e., echocardiographic response and functional response. We assessed which definition was more reasonable. Methods: In this study of 260 patients who had undergone CRT, [...] Read more.
Background: The definition of response to cardiac resynchronization therapy (CRT) varies across clinical trials. There are two main definitions, i.e., echocardiographic response and functional response. We assessed which definition was more reasonable. Methods: In this study of 260 patients who had undergone CRT, an echocardiographic response was defined as a reduction in a left ventricular end-systolic volume of greater than or equal to 15% or an improvement in left ventricular ejection fraction of greater than or equal to 5%. A functional response was defined as an improvement of at least one class category in the New York Heart Association functional classification. We assessed the response to CRT at 6 months after device implantation, based on each definition, and investigated the relationship between response and clinical outcomes. Results: The echocardiographic response rate was 74.2%. The functional response rate was 86.9%. Non-responder status, based on both definitions, was associated with higher all-cause mortality. Cardiac death was only associated with functional non-responder status (hazard ratio (HR) 2.65, 95% confidence interval (CI) 1.19–5.46, p = 0.0186) and heart failure hospitalization (HR 2.78, 95% CI, 1.29–5.26, p = 0.0111). Conclusion: After CRT implantation, the functional response definition of CRT response is associated with a higher response rate and better clinical outcomes than that of the echocardiographic response definition, and therefore it is reasonable to use the functional definition to assess CRT response. Full article
(This article belongs to the Special Issue Latest Advances in Delivery and Outcomes of Cardiac Resynchronization Therapy)
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