Last Build Date: Tue, 29 Mar 2016 02:30:53 +0100
Sat, 26 Mar 2016 09:34:19 +0100Abstract Echocardiographic assessment of left ventricular (LV) dyssynchrony is used to predict response to cardiac resynchronization therapy (CRT). However, the association between reduction in the extent of speckle tracking based LV-dyssynchrony and echocardiographic response to CRT has not been explored yet. The aim of this study was to assess the changes in the extent of LV dyssynchrony as a result of CRT and its association with echocardiographic response to CRT in a large consecutive series of patients. We studied 138 patients with standard CRT indication. Time-based speckle tracking longitudinal strain (maximal delay between 6-segments in 4-chamber view) was performed to assess LV-dyssynchrony at baseline and after a mean follow-up of 22 ± 8 months. Echocardiographic CR...
Wed, 23 Mar 2016 23:00:00 +0100(Source: Heart Rhythm)
Wed, 23 Mar 2016 23:00:00 +0100We thank Kutyifa et. al. for highlighting their sub-analysis of the MADIT-CRT study which assessed prolonged PR interval (PRI) in a subset of patients with non-LBBB QRS configuration. At the time of their publication, our article had been submitted for review and therefore not included in our original review. (Source: Heart Rhythm)
Mon, 21 Mar 2016 23:00:00 +0100Conclusion: This study has illustrated the variable quality of online material on the topic of Cardiac Resynchronisation Therapy. Furthermore, there was also no apparent correlation between highly‐ranked, popular websites and their quality. Health care professionals should be encouraged to guide their patients towards the online material that contains reliable information.This article is protected by copyright. All rights reserved (Source: Pacing and Clinical Electrophysiology : PACE)
Mon, 21 Mar 2016 23:00:00 +0100Conclusions: BV‐EN pacing produces significant increases in both LV and RV AHR above that achievable with conventional epicardial pacing. RV AHR cannot be used as a surrogate for optimizing LV AHR, however, compromise biventricular optimization is possible. The beneficial effect of endocardial LV pacing on RV function may have important clinical benefits beyond conventional CRT.This article is protected by copyright. All rights reserved (Source: Pacing and Clinical Electrophysiology : PACE)
Mon, 21 Mar 2016 00:00:00 +0100Conclusion The aetiology of cardiomyopathy should be taken into consideration for the therapy of ICD patients. The protective role of CRT devices should be pointed out in ischaemic cardiomyopathy (ICM) and a more rigorous antiarrhythmic treatment should be considered for ICM patients with secondary prevention or for dilated cardiomyopathy patients with AF. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusion Adding an ICD backup is associated with better survival in CRT recipients. This effect was evident among patients with ICM, but not in patients with NICM. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusion Mortality among CRT-D recipients ≥80 years old is higher than in younger patients but is not excessive. The risk of appropriate device shocks in older patients is relatively low and significantly less than in younger patients. These observations suggest that CRT-pacemakers should be given due consideration in elderly HF patients. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusion Nearly two-thirds of CRT-D patients had AHR episodes within 2.5 years after implantation. Almost 90% of AHRs were indeed AA. Misdetections were caused by far-field sensing or noise. A two-step diagnostic algorithm (>9% of time spent in AHRs and episode duration >36 s) allowed for proper detection of AA with a high hit-rate and specificity. (Source: Europace)
Fri, 18 Mar 2016 00:00:00 +0100Publication date: Available online 17 March 2016 Source:Journal of Cardiology Cases Author(s): Masashi Kamioka, Minoru Nodera, Hitoshi Suzuki, Yasuchika Takeishi A high defibrillation threshold (DFT) infrequently occurs during device implantation. The major cause of high DFT is pneumothorax. However, there are few data about shock coil and left ventricular tip–right ventricular coil (LV tip–RV coil) impedance as a marker of a high DFT caused by pneumothorax. A 65-year-old man, diagnosed with dilated cardiomyopathy, was referred for cardiac resynchronization therapy (CRT) defibrillator implantation with single shock coil lead. The shock coil impedance was high and LV tip–RV coil impedance was normal just before DFT test. Then, high DFT was detected. Afterwards, pneumothorax was ...
Fri, 18 Mar 2016 00:00:00 +0100Conclusions Late LVRR has better clinical and echocardiographic outcomes than no LVRR, although with a suboptimal response compared to the early LVRR population. Ischemic etiology and NYHA functional class
Tue, 15 Mar 2016 00:00:00 +0100We describe a case of non-ischemic cardiomyopathy with heart failure, taken up for cardiac resynchronization therapy with defibrillator (CRT-D) implantation. The quadripolar left ventricular lead was impossible to advance into the target lateral branch of the coronary sinus. We made a veno-venous loop, advancing the coronary guidewire through the middle cardiac vein to coronary sinus and then to superior vena cava. The guidewire then snared through the same left subclavian vein and exteriorized. Over this loop, the left ventricular lead of the CRT-D device was implanted successfully. This novel approach can be used to successfully implant the LV lead in difficult to implant situations, obviating the need for thoracotomy or other methods of LV lead implantation. (Source: Indian Heart Journa...
Tue, 15 Mar 2016 00:00:00 +0100Conclusion La télésurveillance propose une large variété d’alertes permettant la détection des TSV avec une relative hétérogénéité des différents systèmes. Des études complémentaires sont nécessaires afin d’apprendre à les programmer et à les utiliser dans les différentes populations de patients porteurs de DAI. Background Remote monitoring systems of implantable cardioverter defibrillators (ICD) offer automatics alerts in case of occurrence of supraventricular tachycardia (SVT). Aims To list all specific and nonspecific SVT alerts and describe their prevalence. Methods At first, the alerts notifying SVT were listed from their name appearing on the websites of the five remote monitoring systems that are: Home Monitoring™, Latitude Patient Management™, Carelink ...
Mon, 14 Mar 2016 00:00:00 +0100A 50-year-old man with dilated cardiomyopathy had persistent dyspnea despite receiving guideline-directed medical treatment, including cardiac resynchronization therapy. He underwent heart transplantation, which was successful without complications. (Source: The Journal of Heart and Lung Transplantation)
Mon, 14 Mar 2016 00:00:00 +0100Cardiac resynchronization therapy (CRT) can effectively treat patients with heart failure (HF), reduce mortality rates, promote heart repair and reduce hospital admissions, but 30% of patients do not respond (Ypenburg et al. (2008)). The outcome of CRT procedures depends on factors such as patient selection, device programming, absence of myocardial scar, and left ventricular (LV) lead placement (Bax et al. (2004); Khan et al. (2009); Ypenburg et al. (2008); Sawhney et al. (2004)). A good LV lead placement plays an especially important role in effective alleviation of LV dyssynchrony, the key benefit from CRT (Bleeker et al. (Source: Medical Image Analysis)
Fri, 11 Mar 2016 00:00:00 +0100Fluoroscopic guidance is the standard tool used in device implantation. This means that both the patient and the operator are exposed to radiation, which may sometimes be high. The possibility of single-lead permanent pacemaker implantation without fluoroscopy has already been demonstrated. (Source: Heart Rhythm)
Fri, 11 Mar 2016 00:00:00 +0100Conclusions: Accessing the cardiac veins for CRT implantation was difficult in ∼10% of patients with HF. Cardiac vein accessibility was high in patients with non‐ischemic HF and in females.This article is protected by copyright. All rights reserved (Source: Pacing and Clinical Electrophysiology : PACE)
Wed, 09 Mar 2016 12:35:15 +0100Atrioventricular junction (AVJ) ablation is an effective therapy in patients with symptomatic atrial fibrillation who are intolerant to or unsuccessfully managed with rhythm control or medical rate control strategies. A drawback is that the procedure mandates a pacing system. Overall, the safety and efficacy of AVJ ablation is high with a majority of the patients reporting significant improvement in symptoms and quality-of-life measures. Risk of sudden cardiac death after device implantation is low, especially with an appropriate postprocedure pacing rate. Mortality benefit with AVJ ablation has been shown in patients with heart failure and cardiac resynchronization therapy devices. (Source: Heart Failure Clinics)
Fri, 04 Mar 2016 21:34:34 +0100Conclusion: Female CRT recipients, at mid-term, have a favorable prognosis than male patients and this benefit appears to be more evident in nonischemic patients. Thus, we strongly believe that the apparent under-utilization of CRT in females is an anomaly that should be corrected. (Source: Journal of Cardiovascular Medicine)
Fri, 04 Mar 2016 21:34:34 +0100Conclusion: Candidates to cardiac resynchronization therapy with a basal QRS greater than 160 ms have a higher chance of requiring echo-guided tailoring of interventricular delay value. A strategy based on these data can potentially improve device programming, reducing by one-third the need for optimization, according to our findings, and at the same time avoid unnecessary time-consuming procedures. (Source: Journal of Cardiovascular Medicine)
Fri, 04 Mar 2016 21:34:34 +0100The Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK HF) trial, published in April 2013 [Curtis AB, Worley SJ, Adamson PB, et al; Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK HF) Trial Investigators. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med 2013; 368:1585–1593], explored whether cardiac resynchronization therapy (CRT) was superior to conventional pacing in patients with conventional indications for pacing, left ventricular dysfunction and NYHA (New York Heart Association) class I–III. The trial took 8 years and a source of concern is selection bias, because participating centers had an average of two patients enrolled per ...
Wed, 02 Mar 2016 13:02:01 +0100CONCLUSION: African-Americans experience the same survival benefits from CRT as Caucasian patients reported in major clinical trials. Publication indices used to find publications listed in references: PubMed. PMID: 26928486 [PubMed - as supplied by publisher] (Source: Journal of the National Medical Association)
Wed, 02 Mar 2016 00:00:00 +0100Abstract Myocardial strain measurement with two-dimensional speckle-tracking echocardiography (2D-STE) is of paramount importance in the early detection of subclinical left ventricular (LV) systolic dysfunction and the prediction of patient outcomes in various types of heart disease, especially when assessed with global longitudinal strain (GLS). The routine application of myocardial strain parameters requires the definition of normal values and an understanding of their reliabilities. One of the most important potential limitations to widespread clinical application of this technique is inter-vendor differences in normal strain values. Recent clinical reports indicate that the smallest differences were noted in GLS measurements among three orthogonal directions. Because the contr...
Tue, 01 Mar 2016 17:07:06 +0100The beneficial effects of cardiac resynchronization therapy (CRT) have been well established in large, randomized trials. Despite the documented success of this treatment strategy, a significant proportion of patients with heart failure do not achieve the desired response. The aim of this review was to delineate factors contributing to a successful CRT response, emphasizing the interrelated roles of QRS morphology and QRS interval duration. More data are available on QRS duration, as this factor has been used as an enrollment criterion in clinical trials. Response to CRT seems to increase as the QRS duration becomes longer, with greatest benefit in QRS duration ≥150 ms. Recent data have placed more emphasis on QRS morphology, demonstrating variability in clinical response between patien...
Tue, 01 Mar 2016 06:00:00 +0100Heart failure with reduced ejection fraction (HFrEF) represents at least half of the cases of heart failure, which is a syndrome defined as the inability of the heart to supply the body's tissues with an adequate amount of blood under conditions of normal cardiac filling pressure. HFrEF is responsible for high costs and rates of mortality, morbidity, and hospital admissions, mainly in developed countries. Thus, the need for better diagnostic methods and therapeutic approaches and consequently better outcomes is clear. In this article, we review the principal aspects of pathophysiology and diagnosis of HFrEF, with focus on emerging biomarkers and on recent echocardiographic methods for the assessment of left ventricular function. Furthermore, we discuss several major developments in pharmac...
Tue, 01 Mar 2016 00:00:00 +0100Ventricular electrical delay at the stimulation site is a fundamental mechanism for the enhanced cardiac resynchronization therapy (CRT) response in the presence of left bundle brunch block (LBBB) or more prolonged QRS duration. Several studies have demonstrated that electrical delay, between the right ventricle (RV) and left ventricle (LV) catheter, impact the acute hemodynamic response, the reverse LV remodeling, and total mortality and hospitalizations for worsening of heart failure in patients undergoing CRT [1–5]. (Source: International Journal of Cardiology)
Tue, 01 Mar 2016 00:00:00 +0100By resynchronizing left and right ventricular contraction, cardiac resynchronization therapy (CRT) has demonstrated to improve left ventricular (LV) systolic function, induce LV reverse remodeling and reduce mitral regurgitation with subsequent improvement in heart failure symptoms.(1) Pooled data from 1343 patients showed that CRT induced significant LV reverse remodeling (≥10‐15% reduction in LV end‐systolic volume) in 57% of patients.(2) Similarly, the percentage of patients improving ≥1‐point New York Heart Association functional class has been reported as much as 67%.(2) (Source: Journal of Cardiovascular Electrophysiology)
Fri, 26 Feb 2016 00:00:00 +0100Conclusions— CRT implantation is a relatively safe procedure that has become safer in higher risk patients. However, significant disparities in CRT utilization exist in certain demographic subgroups, and these disparities have persisted across the years. (Source: Circulation: Arrhythmia and Electrophysiology)
Fri, 26 Feb 2016 00:00:00 +0100Authors: Rosa I, Marini C, Stella S, Ancona F, Spartera M, Margonato A, Agricola E Abstract Chronic functional mitral regurgitation (FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy (DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in FMR, such as annular dilatation and dysfunction, left ventricle (LV) remodeling, dysfunction and dyssynchrony, papillary muscles displacement and dyssynchrony. The best therapeutic choice for FMR is still debated. When optimal medical treatment has already been set, a further option for cardiac resynchronization therapy (CRT) and/or surgical correction should be considered. CRT is able to contrast most of the pathophysiologic determinants of FMR by minimizing LV dyssynchrony ...
Thu, 25 Feb 2016 15:15:02 +0100Conclusions. Increased RDW levels accurately predict the long-term mortality of CRT patients independently of NT-proBNP. Reclassification analysis revealed that the RDW improves the risk stratification and could enhance the optimal patient selection for CRT. PMID: 26903690 [PubMed - in process] (Source: Disease Markers)
Thu, 25 Feb 2016 14:39:38 +0100Boston Scientific FDAapproval for the ACUITYX4 Quadripolar Left Ventricular (LV) leads. The FDA approval of the quadripolar leads, the wires that connect cardiac resynchronization therapy (CRT) devices to the heart, marks the first time the company will offer a full X4 CRT system – both the device and the leads – to the U.S. market. (Source: Medical Design Online News)
Thu, 25 Feb 2016 00:00:00 +0100Conclusion Tissue inhibitor of matrix metalloproteinase-1 is a powerful predictor of long-term mortality in HF patients treated with CRT. (Source: Europace)
Thu, 25 Feb 2016 00:00:00 +0100Conclusion In our case, to our knowledge the first reported in humans, the extraction of this new model of active fixation lead was proved to be a safe and effective procedure at 8 months after implantation. Indeed, under angiographic and fluoroscopic check, there was no documented dissection or damage to the CS during and after removal of the lead. The rotation manoeuvre was effective when combined with moderate traction of the lead itself. (Source: Europace)
Wed, 24 Feb 2016 00:00:00 +0100Abstract Implantable devices are indicated in the primary and secondary prevention of potentially life-threatening ventricular tachyarrhythmias in patients with heart failure. Early studies, including the landmark MADIT trials, showed that implantable cardioverter–defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices can play a significant role in aborting and preventing ventricular arrhythmias, respectively, that can cause sudden cardiac death. To this day, there have been a number of randomized controlled trials, with respective substudy analyses, that have attempted to better understand the indications for these interventions in patient care. Here, we summarize the major results of these studies, and we discuss the role of ICD therapy for both ischemic a...
Wed, 24 Feb 2016 00:00:00 +0100Cardiac resynchronization therapy (CRT) is a device therapy that is designed to correct dyssynchronous contraction of the failing heart. Randomized controlled trials have demonstrated the therapeutic efficacy of CRT in the reduction of mortality (Moss et al., 2009) and hospitalization(Tang et al., 2010), and recovery of exercise capacity and improvement of contractile functions in a subset of heart failure (HF) patients who are characterized by a wide QRS morphology on electrocardiogram (ECG) and reduced ejection fraction (EF) (Chen et al., 2013; Linde et al., 2008; Young et al., 2003). (Source: Medical Image Analysis)
Tue, 23 Feb 2016 15:34:13 +0100FDA-Approved ACUITY X4 Quadripolar Left Ventricular Leads to be used in Trial Pursuing MRI Labeling for Cardiac Defibrillation and Resynchronization Systems MARLBOROUGH, Mass., Feb. 23, 2016 -- (Healthcare Sales & Marketing Network) -- Boston Scientif... Devices, Cardiology, FDABoston Scientific, Quadripolar Leads, cardiac resynchronization therapy (Source: HSMN NewsFeed)
Tue, 23 Feb 2016 03:56:00 +0100Medtronic plc (NYSE:MDT) today announced that it has received CE (Conformité Européenne) Mark for the first and only cardiac resynchronization therapy defibrillators (CRT-Ds) approved for 3 Tesla (T) magnetic resonance imaging (MRI) scans, providing CRT-D patients with access to the most advanced imaging diagnostic procedures available. (Source: News from Angioplasty.Org)
Tue, 23 Feb 2016 00:00:00 +0100Publication date: Available online 21 February 2016 Source:Cor et Vasa Author(s): Eraldo Occhetta, Gabriele Dell’Era, Chiara Sartori, Anna Degiovanni, Elisa Maggi, Paolo Marino Patients with right bundle branch block (RBBB) and heart failure (HF) are not well represented in large randomized clinical trials evaluating the efficacy of cardiac resynchronization therapy (CRT), which included mainly left bundle branch block morphology. According to a recent meta-analysis, in our series we have 14 patients with RBBB and HF treated with conventional CRT (biventricular pacing), all of them turned out to be “non-responders”. Bifocal pacing, a particular modality of simultaneous pacing with two leads implanted in the right ventricle, is a current option in case of unsuccessful biventri...
Mon, 22 Feb 2016 17:00:01 +0100Medtronic (NYSE:MDT) said today it won CE Mark approval in the European Union for its full line of magnetic resonance imaging safe cardiac resynchronization therapy defibrillators, now approved for use with 3 Tesla MRI machines. The approval includes Fridley, Minn.-based Medtronic’s Claria MRI quad CRT-D SureScan, Amplia MRI quad CRT-D and Compia MRI quad systems, which are also approved for lower-power 1.5 Tesla scanners. “The ability to provide CRT-D patients with access to MRI scans is a significant, necessary advancement that may help save lives. The most common magnetic field strength for an MRI is 1.5T, particularly for cardiac MRI; however, many institutions are installing 3T scanners to provide increased image clarity for conditions involving the brain and spine. With ...
Mon, 22 Feb 2016 14:06:08 +0100Medtronic has received CEMark for the first and only cardiac resynchronization therapy defibrillators (CRT-Ds) approved for 3 Tesla magnetic resonance imaging (MRI) scans, providing CRT-D patients with access to the most advanced imaging diagnostic procedures available. The Claria MRIQuad CRT-D SureScan, Amplia MRI(TM)Quad CRT-D SureScanand Compia MRIQuad CRT-D SureScansystemsare approved for MRI scans without positioning restrictions. (Source: Medical Design Online News)
Mon, 22 Feb 2016 00:00:00 +0100CONCLUSIONS: Remote monitoring of implantable devices is feasible, safe and effective in supervising patients with CRT-D devices. Daily-based remote monitoring of a large population of heart failure patients allows to continuous "triage" high risk patients and select those individuals who require urgent intervention. PMID: 26898970 [PubMed - as supplied by publisher] (Source: Polish Heart Journal)
Sat, 20 Feb 2016 00:00:00 +0100Electro-mechanical de-coupling is hypothesized to explain non-response of dyssynchrony patient to cardiac resynchronization therapy (CRT). In this pilot study, we investigated regional electromechanical uncoupling in 10 patients referred for CRT using two non-invasive electrical and mechanical imaging techniques (CMR tissue tracking and ECGI). (Source: Journal of Electrocardiology)
Fri, 19 Feb 2016 20:44:02 +0100CONCLUSION: During the 4-year follow-up, patients with documented VT/VF were characterized by significantly higher LV mechanical dispersion as compared with patients without electrical events. Measurement of LV mechanical dispersion might be helpful in determining the risk of sudden cardiac death. PMID: 26883898 [PubMed - as supplied by publisher] (Source: Herz)
Thu, 18 Feb 2016 08:43:25 +0100The FDA has approved two new technologies that expand St. Jude Medical’s portfolio for cardiac resynchronization therapy (CRT) and neurostimulation in the U.S. market. St. Jude announced that its MultiPoint Pacing (MPP) technology would be added to the company’s Quadra CRT device offerings in the beginning of 2016, and that the Axium Neurostimulator System was approved for dorsal root ganglion (DRG) stimulation for patients with chronic pain in their lower limbs. (Source: Medical Design Online News)
Thu, 18 Feb 2016 00:00:00 +0100We report the case of a 71-year-old woman with metastatic NSCLC treated with cisplatin/pemetrexed and then erlotinib maintenance therapy. After 26 months of TKI therapy, she developed dilated cardiomyopathy. Despite symptomatic treatment, left ventricular ejection fraction decreased to 25%. Ischemic heart disease was excluded by coronary angiography and cardiac magnetic resonance imaging, and no other cause was found. Erlotinib was stopped, and cardiac resynchronization therapy by pacemaker was initiated. This case report highlights the possible cardiotoxic effects of long-term erlotinib and suggests the need for close clinical and echocardiographic follow-up of patients receiving long-term TKI therapy. PMID: 26886479 [PubMed - as supplied by publisher] (Source: Oncology)
Thu, 18 Feb 2016 00:00:00 +0100I was interested to read the recent article by Furniss, et al.  describing a remarkable technique for accessing difficult cardiac veins when performing Cardiac Resynchronisation Therapy (CRT). The authors correctly point out that up to 12% of patients suffer from procedural failures that prevent an appropriate response, and that a number of these are from challenging anatomy. (Source: Heart, Lung and Circulation)
Wed, 17 Feb 2016 17:12:45 +0100We report the case of a 71-year-old woman with metastatic NSCLC treated with cisplatin/pemetrexed and then erlotinib maintenance therapy. After 26 months of TKI therapy, she developed dilated cardiomyopathy. Despite symptomatic treatment, left ventricular ejection fraction decreased to 25%. Ischemic heart disease was excluded by coronary angiography and cardiac magnetic resonance imaging, and no other cause was found. Erlotinib was stopped, and cardiac resynchronization therapy by pacemaker was initiated. This case report highlights the possible cardiotoxic effects of long-term erlotinib and suggests the need for close clinical and echocardiographic follow-up of patients receiving long-term TKI therapy.Oncology (Source: Oncology)
Wed, 17 Feb 2016 15:42:02 +0100CONCLUSIONS: Patients with notch duration greater than 67.5 ms are associated with poor response to CRT. Notch duration > 67.5 ms predicts non-response to therapy with 50.0% specificity and 72.1% sensitivity. PMID: 25920477 [PubMed - in process] (Source: Scandinavian Cardiovascular Journal)
Wed, 17 Feb 2016 15:42:02 +0100CONCLUSIONS: In heart-failure patients with CRT-P therapy, occurrence of VHR episodes within the first year post-implant was an independent predictor of higher 5-year mortality and inferior long-term survival, but not of death from malignant arrhythmia. PMID: 25658030 [PubMed - in process] (Source: Scandinavian Cardiovascular Journal)
Wed, 17 Feb 2016 15:42:02 +0100CONCLUSION: Combining prolonged t-IVT and the conventionally used broad QRS duration has a significantly higher specificity in identifying patients likely to respond to CRT. Moreover, in AF patients, only prolonged t-IVT independently predicted CRT response. PMID: 25117854 [PubMed - indexed for MEDLINE] (Source: Scandinavian Cardiovascular Journal)
Wed, 17 Feb 2016 15:03:12 +0100St. Jude Medical (NYSE:STJ) said the FDA approved its MultiPoint pacing technology for its Quadra Allure defibrillators and pacemakers, plus a new set of quadripolar pacing leads called Quartet LV. The Little Canada, Minn.-based medical device company said the MultiPoint tech is the 1st to hit the U.S. market that allows physicians to tailor pacing therapy by controlling multiple pulses to the left ventricle for each heartbeat. Each lead in the system can deliver 2 pulses per heartbeat, St. Jude said. The new Quartet LV leads have more electrode spacing options and a new, S-curved design, the company said. “Continuing our quadripolar leadership, MultiPoint pacing represents our commitment to invest and innovate in state of the art heart failure treatment options,” chief techn...
Wed, 17 Feb 2016 07:07:02 +0100CONCLUSIONS: HRV and HRT are improved after CRT but these improvements are more remarkable in patients with LBBB. CO, QRS configuration (but not duration) were two independent parameters affecting TO, LF and LF/HF ratio after CRT. PMID: 26875903 [PubMed - in process] (Source: European Review for Medical and Pharmacological Sciences)
Wed, 17 Feb 2016 00:00:00 +0100Authors: van Everdingen WM, Schipper JC, van 't Sant J, Misier KR, Meine M, Cramer MJ PMID: 26886921 [PubMed - as supplied by publisher] (Source: Netherlands Heart Journal)
Tue, 16 Feb 2016 00:00:00 +0100Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator (ICD) implantation improve morbidity and mortality in selected patients. Many centres still admit patients overnight. We evaluated the safety, feasibility and cost savings of same-day CRT/ICD device implantation by performing a retrospective study of all consecutive elective CRT/ICD implants at a tertiary centre between January 2009-April 2013. All emergency/inpatient cases were excluded. Data were collected on baseline demographics, implantation indication, procedure details, complications (categorized as immediate [4months]) and mortality (30day and 1year). (Source: The American Journal of Cardiology)
Sat, 13 Feb 2016 21:12:02 +0100CONCLUSIONS: In an unselected population of Catalonia, we observe that CRT was effective and decreased the number of hospital admissions. PMID: 26869206 [PubMed - as supplied by publisher] (Source: Medicina Clinica)
Fri, 12 Feb 2016 00:00:00 +0100Conclusion Data of metabolic scintigraphy may be useful for the integrated prediction of CRT efficacy. (Source: Annals of Nuclear Medicine)
Fri, 12 Feb 2016 00:00:00 +0100Conclusions In our real-life registry, women account for the minority of ICD recipients and presented with a different clinical profile. Whereas female cardiac resynchronization therapy recipients had a lower incidence of appropriate ICD therapies and all-cause death than their male counterparts, the observed rates of inappropriate shocks and early complications in all ICD recipients were comparable. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01992458. (Source: JAHA:Journal of the American Heart Association)
Fri, 12 Feb 2016 00:00:00 +0100Conclusions These findings establish the first objective assessment of the incidence, risk factors, and economic burden of lead damage following cardiac implantable electronic device replacement in the United States. New care algorithms are warranted to avoid these events, which impose substantial burdens on patients, physicians, and payors. (Source: JAHA:Journal of the American Heart Association)
Thu, 11 Feb 2016 18:04:36 +0100Biotronik said today it won Japanese regulatory clearance for its Itrevia 7 HF-T cardiac resynchronization therapy defibrillator, now approved for full-body MRI-scanning. With the clearance, physicians in Japan are now cleared to perform MRI scans at 1.5 tesla strength on patients implanted with the Itrevia CRT-D. “In addition to having indispensable diagnostic information in the field of cerebrovascular treatment and orthopedics, MRI offers extensive diagnostic cardiovascular information. Many CRT-D patients undergo a cardiac MRI before implantation to assess the late gadolinium enhancement. However, until now CMR after CRT-D implantation was not possible, thus no assessment on the presence or absence of any changes could be achieved. Now with the condition change, post-operative c...
Thu, 11 Feb 2016 00:00:00 +0100Conclusion A specific LV mechanical dyssynchrony pattern, characterized by ApRock and SF, is associated with a more favourable long-term survival after CRT. Both parameters are also indicators of an effective therapy. (Source: European Heart Journal Cardiovascular Imaging)
Thu, 11 Feb 2016 00:00:00 +0100Conclusion In heart failure patients with CRT, worse longitudinal function before CRT was an important predictor of fatal outcome during 2 years, independently of CRT response. Mechanical dispersion at 6 months was a strong predictor of ventricular arrhythmias. CRT response by reverse remodelling was dependent on improvement of both longitudinal and circumferential function. (Source: European Heart Journal Cardiovascular Imaging)
Thu, 11 Feb 2016 00:00:00 +0100Temporary pacemakers are used in a variety of critical care settings. These life-saving devices are reviewed in 2 major categories in this review: first, the insertion and management of epicardial pacemakers after and during cardiac surgery; and second, the insertion of transvenous temporary pacemakers for the emergent treatment of bradyarrhythmias. Temporary epicardial pacemakers are used routinely in patients recovering from cardiac surgery. Borrowing from advances in cardiac resynchronization therapy there are many theoretical and untested benefits to pacing the postoperative cardiac surgery patient. Temporary transvenous pacing is traditionally an emergency procedure to stabilize patients suffering from hemodynamically unstable bradyarrhythmia. We review the traditional and expanding u...
Wed, 10 Feb 2016 00:00:00 +0100Conclusions Our data, for the first time, show improved survival in patients enrolled promptly into RM following CIED implantation. This advantage was observed across all CIED device types. (Source: Journal of Interventional Cardiac Electrophysiology)
Tue, 09 Feb 2016 08:24:17 +0100Continuing its track record of introducing the first magnetic resonance imaging (MRI)-safe cardiac devices to the market, Medtronic recently gained approval from the U.S. Food and Drug Administration (FDA) for cardiac resynchronization therapy defibrillators (CRT-Ds) for heart failure patients undergoing MRI scans. (Source: Medical Design Online News)
Tue, 09 Feb 2016 02:56:02 +0100Authors: Atreya AR, Cook JR, Lindenauer PK Abstract Cardiac implantable electronic devices (CIEDs) which include devices such as permanent pacemakers, implantable cardioverter-defibrillators and cardiac resynchronization therapy devices are well established therapies that have been shown to improve quality of life and prolong survival in appropriately selected patients, and are being increasing utilized across the world. However, CIED implantations are invasive procedures and a thorough understanding of the potential complications is required to prevent deleterious patient outcomes. In this review, we will discuss frequent complications (infection, hematoma or bleeding, and procedural mechanical complications) that may harm patients after CIED implantation, and the steps that can b...
Tue, 09 Feb 2016 00:00:00 +0100ConclusionHigher all‐cause mortality in older CRT‐P versus CRT‐D patients is largely explained by baseline clinical and demographic differences between the two groups, which are likely the drivers of device selection in real‐world clinical practice, where the published guidelines remain ambiguous. There is a need for randomized studies to determine optimal CRT device selection.This article is protected by copyright. All rights reserved (Source: Journal of Cardiovascular Electrophysiology)
Tue, 09 Feb 2016 00:00:00 +0100Response to Letter Regarding Article, "Circulating MicroRNA-30d Is Associated With Response to Cardiac Resynchronization Therapy in Heart Failure and Regulates Cardiomyocyte Apoptosis: A Translational Pilot Study". Circulation. 2016 Feb 9;133(6):e389-90 Authors: Melman YF, Shah R, Danielson K, Xiao J, Simonson B, Barth A, Chakir K, Lewis GD, Lavender Z, Truong QA, Kleber A, Das R, Rosenzweig A, Wang Y, Kass DA, Singh JP, Das S PMID: 26858296 [PubMed - in process] (Source: Circulation)
Tue, 09 Feb 2016 00:00:00 +0100Letter by Sardu et al Regarding Article, "Circulating MicroRNA-30d Is Associated With Response to Cardiac Resynchronization Therapy in Heart Failure and Regulates Cardiomyocyte Apoptosis: A Translational Pilot Study". Circulation. 2016 Feb 9;133(6):e388 Authors: Sardu C, Paolisso G, Marfella R PMID: 26858295 [PubMed - in process] (Source: Circulation)
Mon, 08 Feb 2016 00:00:00 +0100Publication date: December 2015 Source:Cardiac Electrophysiology Clinics, Volume 7, Issue 4 Author(s): Luigi Padeletti, Martina Nesti, Giuseppe Boriani (Source: Cardiac Electrophysiology Clinics)
Mon, 08 Feb 2016 00:00:00 +0100This article reviews current understanding of these cellular and subcellular mechanisms, arguing that these aspects are key to improving CRT use, as well as translating its benefits to a wider HF population. (Source: Cardiac Electrophysiology Clinics)
Mon, 08 Feb 2016 00:00:00 +0100This article explores the electrophysiologic and hemodynamic changes that occur during CRT in patient and animal studies. It also addresses how novel techniques, such as multipoint and endocardial pacing, can further improve the electromechanical response. (Source: Cardiac Electrophysiology Clinics)
Mon, 08 Feb 2016 00:00:00 +0100Publication date: December 2015 Source:Cardiac Electrophysiology Clinics, Volume 7, Issue 4 Author(s): John Gorcsan, Bhupendar TayalTeaser Echocardiographic imaging plays a major role in patient selection for cardiac resynchronization therapy (CRT). One-third of patients do not respond; there is interest in advanced echocardiographic imaging to improve response. Current guidelines favor CRT for patients with electrocardiographic (ECG) QRS width of 150 milliseconds or greater and left bundle branch block. ECG criteria are imperfect; there is interest in advanced echocardiographic imaging to improve patient selection. This discussion focuses on newer echocardiographic methods to improve patient selection, improve delivery, and identify patients at risk for poor outcomes and serious vent...
Mon, 08 Feb 2016 00:00:00 +0100Publication date: December 2015 Source:Cardiac Electrophysiology Clinics, Volume 7, Issue 4 Author(s): Francisco LeyvaTeaser Randomized, controlled trials have shown that cardiac resynchronization therapy (CRT) is beneficial in patients with heart failure, impaired left ventricular (LV) systolic function, and a wide QRS complex. Other studies have shown that targeting the LV pacing site can also improve patient outcomes. Cardiovascular magnetic resonance (CMR) is a radiation-free imaging modality that provides unparalleled spatial resolution. In addition, emerging data suggest that targeted LV lead deployment over viable myocardium improves the outcome of patients undergoing CRT. This review explores the role of CMR in the preoperative workup of patients undergoing CRT. (Source: Cardiac...
Mon, 08 Feb 2016 00:00:00 +0100Publication date: December 2015 Source:Cardiac Electrophysiology Clinics, Volume 7, Issue 4 Author(s): Attila Roka, Rasmus Borgquist, Jagmeet SinghTeaser Although cardiac resynchronization therapy improves morbidity and mortality in patients with cardiomyopathy, heart failure, and electrical dyssynchrony, the rate of nonresponders using standard indications and implant techniques is still high. Optimal coronary sinus lead positioning is important to increase the chance of successful resynchronization. Patient factors such as cause of heart failure, type of dyssynchrony, scar burden, coronary sinus anatomy, and phrenic nerve capture may affect the efficacy of the therapy. Several modalities are under investigation. Alternative left ventricular lead implantation strategies are occasiona...
Mon, 08 Feb 2016 00:00:00 +0100Publication date: December 2015 Source:Cardiac Electrophysiology Clinics, Volume 7, Issue 4 Author(s): Advay G. Bhatt, Jonathan S. SteinbergTeaser Robot-assisted left ventricular lead implantation for cardiac resynchronization therapy is a feasible and safe technique with superior visualization, dexterity, and precision to target the optimal pacing site. The technique has been associated with clinical response and beneficial reverse remodeling comparable with the conventional approach via the coronary sinus. The lack of clinical superiority and a residual high nonresponder rate suggest that the appropriate clinical role for the technique remains as rescue therapy. (Source: Cardiac Electrophysiology Clinics)
Mon, 08 Feb 2016 00:00:00 +0100Publication date: December 2015 Source:Cardiac Electrophysiology Clinics, Volume 7, Issue 4 Author(s): Edmond M. Cronin, Bruce L. WilkoffTeaser Expanded indications for cardiac resynchronization therapy and the increasing incidence of cardiac implantable electronic device infection have led to an increased need for coronary sinus (CS) lead extraction. The CS presents unique anatomical obstacles to successful lead extraction. Training and facility requirements for CS lead extraction should mirror those for other leads. Here we review the indications, technique, and results of CS lead extraction. Published success rates and complications are similar to those reported for other leads, although multiple techniques may be required. Re-implantation options may be limited, which should be inc...
Mon, 08 Feb 2016 00:00:00 +0100Publication date: December 2015 Source:Cardiac Electrophysiology Clinics, Volume 7, Issue 4 Author(s): Edward Sze, James P. DaubertTeaser Cardiac resynchronization therapy (CRT) improves left ventricular function, especially in patients with left bundle branch block or those receiving chronic right ventricular pacing. CRT is typically accomplished by placing a right ventricular endocardial pacing lead and a left ventricular pacing lead via the coronary sinus to a coronary vein overlying the lateral or posterolateral left ventricle. CRT can be combined with an implantable defibrillator or with a pacemaker. Limited data are available to compare these two versions of CRT head to head. This review summarizes the relevant trials and meta-analyses regarding these two forms of CRT. (Source: C...
Mon, 08 Feb 2016 00:00:00 +0100Publication date: December 2015 Source:Cardiac Electrophysiology Clinics, Volume 7, Issue 4 Author(s): Jean-Claude Daubert, Raphaël Martins, Christophe LeclercqTeaser Both cardiac resynchronization therapy with a pacemaker (CRT-P) and with a biventricular implantable cardioverter-defibrillator (CRT-D) are electrical treatment modalities validated for the management of chronic heart failure. There is no strong scientific evidence that a CRT-D must be offered to all candidates. Common sense should limit the prescription of these costly and complicated devices. The choice of CRT-P is currently acceptable. A direction to explore could be to downgrade from CRT-D to CRT-P at the time of battery depletion in patients with large reverse remodeling and no ventricular tachycardia and ventricul...
Mon, 08 Feb 2016 00:00:00 +0100Publication date: December 2015 Source:Cardiac Electrophysiology Clinics, Volume 7, Issue 4 Author(s): Maria Rosa CostanzoTeaser The benefits of cardiac resynchronization therapy (CRT) on the outcomes of patients with heart failure are unquestionable. Women are under-represented in all CRT studies. Most of the available data show that CRT produces a greater clinical benefit in women than men. In several studies, women have left bundle branch block more frequently than men. Women have a remarkably high (90%) CRT response over a wide range of QRS lengths (130–175 milliseconds). Use of a QRS duration of 150 milliseconds as the threshold for CRT prescription may deny a life-saving therapy to many women likely to benefit from CRT. (Source: Cardiac Electrophysiology Clinics)
Mon, 08 Feb 2016 00:00:00 +0100Publication date: December 2015 Source:Cardiac Electrophysiology Clinics, Volume 7, Issue 4 Author(s): Mariëlle Kloosterman, Alexander H. Maass, Michiel Rienstra, Isabelle C. Van GelderTeaser The landmark trials on cardiac resynchronization therapy (CRT) have focused on patients with sinus rhythm at inclusion. Little data are available on the efficacy of CRT in patients with atrial fibrillation (AF), while AF has a high prevalence (20–40%) among patients receiving CRT. This review focuses on the detrimental effect of AF on CRT response and discusses management of patients with AF during CRT. Uncertainty remains as to which thresholds of AF burden can lead to a reduced response to CRT and every effort should be made in trying to assess and guarantee successful biventricular pacing ...
Fri, 05 Feb 2016 21:00:00 +0100The U.S. FDA has cleared the first and only MR-conditional cardiac resynchronization therapy defibrillators (CRT-Ds) for the treatment of heart failure: Medtronic's Amplia and Compia MRI™ Quad CRT-D SureScan® systems. This approval expands Medtronic’s portfolio to include a complete line of MR-conditional cardiac devices, including MR-conditional pacemakers, implantable cardiac defibrillators (ICDs), insertable cardiac monitors (ICMs) and now CRT-Ds. (Source: News from Angioplasty.Org)
Fri, 05 Feb 2016 20:00:57 +0100Say hello to MassDevice +3, a bite-sized view of the top three medtech stories of the day. This feature of MassDevice.com’s coverage highlights our 3 biggest and most influential stories from the day’s news to make sure you’re up to date on the headlines that continue to shape the medical device industry. 3. Dehaier restructures to focus on wearables China’s Dehaier Medical Systems said that it plans to ditch its unprofitable medical device businesses so it can focus on its wearable sleep respiratory business. Dehaier said it plans to form a new subsidiary called Connection Wearable Health Technology by the end of this month, aiming to focus on “wearable sleep respiratory and mobile health related businesses.” Read more 2. Secondary offering co...
Fri, 05 Feb 2016 13:30:05 +0100Medtronic (NYSE:MDT) today claimed title to being to only company with cardiac resynchronization therapy defibrillators approved by the FDA for MRI scans. The Fridley, Minn.-based medical device giant said the FDA approved its Amplia and Complia MRI Quad CRT-D SureScan devices for MRI scans on any part of the body without positioning restrictions. Medtronic plans to have the heart failure devices on the market “in the coming months,” according to a press release. “With FDA approval of Amplia MRI and Compia MRI, Medtronic continues to lead the market in MR-conditional implantable cardiac devices, bringing greater access to patients that need this vital diagnostic test to identify other potential life-threatening diseases,” heart failure general manager Dr. David S...
Fri, 05 Feb 2016 13:30:05 +0100Medtronic (NYSE:MDT) today claimed title to being to only company with cardiac resynchronization therapy defibrillators approved by the FDA for MRI scans. The Fridley, Minn.-based medical device giant said the FDA approved its Amplia and Compia MRI Quad CRT-D SureScan devices for MRI scans on any part of the body without positioning restrictions. Medtronic plans to have the heart failure devices on the market “in the coming months,” according to a press release. “With FDA approval of Amplia MRI and Compia MRI, Medtronic continues to lead the market in MR-conditional implantable cardiac devices, bringing greater access to patients that need this vital diagnostic test to identify other potential life-threatening diseases,” heart failure general manager Dr. David St...
Thu, 04 Feb 2016 00:00:00 +0100Authors: Petrovic, Ivana / Stankovic, Ivan / Milasinovic, Goran / Nikcevic, Gabrijela / Kircanski, Bratislav / Jovanovic, Velibor / Raspopovic, Srdjan / Radovanovic, Nikola / Pavlovic, Sinisa U. (Source: Journal of Medical Biochemistry)
Wed, 03 Feb 2016 00:00:00 +0100Conclusions In sRV patients with LD with/without an rLV, the leads should be placed at furthest sites in the longitudinal RV direction. In patients with an rLV and SD, the leads should be placed laterally on opposite sides of both ventricles. (Source: Europace)
Wed, 03 Feb 2016 00:00:00 +0100In this study, we evaluated the effects of CRT on RV function. (Source: International Journal of Cardiology)
Mon, 01 Feb 2016 06:00:00 +0100Abstract: For patients with coronary artery disease, larger scar burdens are associated with higher risk of ventricular arrhythmia. Left ventricular (LV) dyssynchrony is associated with increased risk of sudden cardiac death in patients with heart failure. The purpose of this study was to assess the values of LV dyssynchrony and myocardial scar assessed by myocardial perfusion SPECT (MPS) in predicting the development of ventricular arrhythmia in ischemic cardiomyopathy. Twenty-two patients (16 males, mean age: 66 ± 13) with irreversible ischemic cardiomyopathy received cardiac resynchronization therapy (CRT) for at least 12 months were enrolled for MPS. Quantitative parameters, including LV dyssynchrony with phase standard deviation (phase SD) and bandwidth, left ventricular ejectio...
Mon, 01 Feb 2016 00:00:00 +0100Conclusion This study demonstrates that septal RV pacing in CRT is non-inferior to apical RV pacing for LV reverse remodelling at 6 months with no difference in the clinical outcome. No recommendation for optimal RV lead position can hence be drawn from this study. ClinicalTrials. gov number NCT 00833352. (Source: European Heart Journal)
Mon, 01 Feb 2016 00:00:00 +0100Summary In recent years, there have been major advances in structural interventional cardiology, which have revolutionized the practice of cardiology. Appropriate selection and follow‐up of patients undergoing these structural heart interventions is vital. Multi‐detector computed tomography (MDCT) has emerged as a key imaging modality in the peri‐procedural assessment of patients undergoing multiple structural cardiac interventions. The purpose of this review is to provide an evidence‐based clinical update on the roles of MDCT in both established and evolving structural heart interventions, including transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve implantation (TMVI). The utility of MDCT in the peri‐procedural assessment of patients undergoing pulmona...
Sat, 30 Jan 2016 04:04:19 +0100ConclusionsSuccessful CRT produces a significant reduction in QRS power below 10 Hz, particularly when baseline QRS <150ms. These results indicate that QRS frequency changes after CRT provide additional predictive value to QRS alone.This article is protected by copyright. All rights reserved (Source: Journal of Cardiovascular Electrophysiology)
Fri, 29 Jan 2016 00:00:00 +0100Cardiac resynchronization therapy (CRT) is an important therapeutic strategy in heart failure. However, there is a high incidence of lead implantation failure and suboptimal response, particularly in ischemic cardiomyopathy. This failure rate may partly be secondary to lack of suitable coronary sinus branches for lead implantation. We sought to assess the presence of coronary sinus (CS) tributaries in patients with ischemic and non-ischemic cardiomyopathy. (Source: Journal of Cardiovascular Computed Tomography)
Fri, 29 Jan 2016 00:00:00 +0100CONCLUSIONS: CRT with a quadripolar LV lead was associated with an improvement of EF greater than that observed in patients receiving a bipolar LV lead. In devices with a quadripolar lead, CRT programming based on the best QRS shortening is reliable and effective. PMID: 26821688 [PubMed - as supplied by publisher] (Source: Circulation Journal)
Thu, 28 Jan 2016 00:00:00 +0100ConclusionsIndexing the QRSd by BMI improves patient selection for CRT by eliminating the influence of body weight and length on QRSd. QRS index is a novel indicator that provides promising results for prediction of CRT response. (Source: Annals of Noninvasive Electrocardiology)
Thu, 28 Jan 2016 00:00:00 +0100In this study we aim to investigate the relation of baseline RV function with response to CRT as assessed by change in LV ejection fraction (EF). (Source: The American Journal of Cardiology)
Thu, 28 Jan 2016 00:00:00 +0100Conclusions— Overall, patients with mild HF but without left bundle branch block morphology did not derive clinical benefit with CRT-D during long-term follow-up. Relatively shorter QRS was associated with a significantly increased risk with CRT-D relative to implantable cardioverter–defibrillator -only. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00180271, NCT01294449, and NCT02060110. (Source: Circulation: Heart Failure)
Wed, 27 Jan 2016 00:00:00 +0100Conclusions The combined option of CRT+ICD seems to be better than the option of CRT alone, although no clear improvement in survival was found for the combined option. It would be advisable to perform a direct comparative study of these two options. (Source: Heart Asia)
Mon, 25 Jan 2016 00:00:00 +0100We have described the use of femoral access followed by pull through of the lead to a pectoral position to circumvent difficulty in implanting a left ventricular (LV) lead by standard methods. (Source: Heart Rhythm)
Mon, 25 Jan 2016 00:00:00 +0100We have described the use of femoral access followed by pull through of the lead to a pectoral position to circumvent difficulty in implanting a left ventricular (LV) lead by standard methods. (Source: Heart Rhythm)
Fri, 22 Jan 2016 16:51:02 +0100Authors: Vervloet DM, DE Sutter J Abstract The aim of this review is to provide the clinical cardiologist and nuclear medicine specialist a brief overview of the currently accepted clinical use of cardiac nuclear imaging for the diagnosis and management of patients with heart failure based on recent (2012-2015) European Society of Cardiology (ESC) guidelines. We used the most recent ESC guidelines on heart failure, management of stable coronary artery disease, cardiac pacing, myocardial revascularisation, non-cardiac surgery and ventricular arrhythmias and sudden death. Nowadays cardiac nuclear imaging is useful in almost every step in heart failure from diagnostics to treatment. In first diagnosis of heart failure radionuclide imaging can provide information on ventricular functio...