The RV lead position, either RVA or RVHS appears to make no difference in the response to CRT but the LV lead placement play a vital role.9,30 The latest activated regions of LV or areas without transmural myocardial scar for an optimal CRT are preferred. Currently, data demonstrate that no significant difference of clinical outcomes in posterior, anterior, and lateral LV lead position was found, while the ideal pacing site of the LV should be avoided in the apex position as suggested in COMPANION trial and MADIT-CRT trial. And dual-site LV CRT, which is a new technique, is also still in progress and we are looking forward to getting more updates from that.
Cardiac Resynchronization Therapy ; Cardiac Resynchronization Therapy Devices ; Heart Failure ; therapy ; Heart Ventricles ; Hemodynamics ; Humans ; Treatment Outcome

Aged ; Cardiac Resynchronization Therapy ; methods ; Cardiac Resynchronization Therapy Devices ; China ; Female ; Humans ; Male

PATIENTS with chronic heart failure (CHF) have a high incidence of atrial/ventricular arrhythmias which seriously affect life span and quality of life. Cardiac re-synchronization therapy (CRT) can improve cardiac function and reverse myocardial remodeling, therefore improving the quality of life and reducing mortality. CRT with Home-Monitoring (HM) can be used to monitor cardiac arrhythmias and other heart physiological indexes such as intrathoracic impedance and hemodynamics. Through wireless satellites, the data from the patients are sent to a monitor center for analysis. Doctors can identify emergent information and make a rapid diagnosis based on the information stored in the monitor center. CRT with HM has been verified as a valid method to optimize drug treatment according to individual parameters.
Cardiac Resynchronization Therapy ; methods ; Cardiac Resynchronization Therapy Devices ; Chronic Disease ; Heart Failure ; drug therapy ; Heart Function Tests ; Humans ; Remote Sensing Technology ; instrumentation ; methods ; Treatment Outcome

Transvenous left ventricular (LV) lead implantation is on the increase due to cardiac resynchronization therapy (CRT). However, there has been paucity of data on the prognosis of LV lead. Consecutive 32 patients with LV lead for CRT (n=22) or pacemaker (n=10) were subjected. Serial changes in pacing threshold and impedance along with lead-related complications were evaluated. Over 2 yr follow-up, there was no significant change in relative threshold voltage to the initial value (100%, 110%, 89.6%, and 79.6% at baseline, 1, 6, and 24 months respectively, P=0.62) as well as lead impedance (816+/-272, 650+/-178, 647+/-191, and 590+/-185 ohm at baseline, 1, 6, and 24 months respectively, P=0.80). The threshold change was not affected by lead position, lead polarity, and indication of lead implantation. The cumulative rates of lead revision were 6.3% (n=2) and 9.4% (n=3) in 6 month and 2 yr follow-up, respectively. One case of phrenic nerve capture at left lateral decubitus position was detected 1 month after the implantation. However, there were no serious complications over 2 yr period. In conclusion, transvenous LV lead implantation showed favorable long-term prognosis. Pacing parameters remained stable without significant changes over 2 yr follow-up.
Adult ; Aged ; Analysis of Variance ; Cardiac Electrophysiology ; Cardiac Resynchronization Therapy ; *Cardiac Resynchronization Therapy Devices ; Female ; Follow-Up Studies ; *Heart Ventricles ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Ventricular Dysfunction, Left/therapy

Cardiac resynchronization therapy (CRT) has been shown to reduce the risk of death and hospitalization in patients with advanced heart failure with left ventricular dysfunction. However, controversy remains regarding who would most benefit from CRT. We performed a meta-analysis, and meta-regression in an attempt to identify factors that determine the outcome after CRT. A total of 23 trials comprising 10,103 patients were selected for this meta-analysis. Our analysis revealed that CRT significantly reduced the risk of all-cause mortality and hospitalization for heart failure compared to control treatment. The odds ratio (OR) of all-cause death had a linear relationship with mean QRS duration (P=0.009). The benefit in survival was confined to patients with a QRS duration > or =145 ms (OR, 0.86; 95% CI, 0.74-0.99), while no benefit was shown among patients with a QRS duration of 130 ms (OR, 1.00; 95% CI, 0.80-1.25) or less. Hospitalization for heart failure was shown to be significantly reduced in patients with a QRS duration > or =127 ms (OR, 0.77; 95% CI, 0.60-0.98). This meta-regression analysis implies that patients with a QRS duration > or =150 ms would most benefit from CRT, and in those with a QRS duration <130 ms CRT implantation may be potentially harmful.
Bundle-Branch Block/physiopathology ; Cardiac Resynchronization Therapy/*methods ; Cardiac Resynchronization Therapy Devices ; Defibrillators, Implantable ; Electrocardiography ; Heart Failure/mortality/physiopathology/*therapy ; Humans ; Myocardial Contraction/*physiology ; Treatment Outcome ; Ventricular Dysfunction, Left/mortality/physiopathology/*therapy

Congestive heart failure is a major cause of morbidity and mortality as well as a major health care cost in the developed world. Despite the introduction of highly effective heart failure medical therapies and simple devices such as cardiac resynchronization therapy that reduce mortality, improve cardiac function and quality of life, there remains a large number of patients who do not respond to these therapies or whose heart failure progresses despite optimal therapy. For these patients, cardiac transplantation is an option but is limited by donor availability as well as co-morbidities which may limit survival post-transplant. For these patients, left ventricular assist devices (LVADs) offer an alternative that can improve survival as well as exercise tolerance and quality of life. These devices have continued to improve as technology has improved with substantially improved durability of the devices and fewer post-implant complications. Pump thrombosis, stroke, gastrointestinal bleeding and arrhythmias post-implant have become less common with the newest devices, making destination therapy where ventricular assist device are implanted permanently in patients with advanced heart failure, a reality and an appropriate option for many patients. This may offer an opportunity for long term survival in many patients. As the first of the totally implantable devices are introduced and go to clinical trials, LVADs may be introduced that may truly be alternatives to cardiac transplantation in selected patients. Post-implant right ventricular failure remains a significant complication and better ways to identify patients at risk as well as to manage this complication must be developed.
Arrhythmias, Cardiac ; Cardiac Resynchronization Therapy ; Exercise Tolerance ; Health Care Costs ; Heart Failure ; Heart Transplantation ; Heart-Assist Devices ; Hemorrhage ; Humans ; Mortality ; Quality of Life ; Stroke ; Thrombosis ; Tissue Donors

BACKGROUNDCardiac resynchronization therapy (CRT) device and coronary sinus (CS) lead extraction are required due to the occurrence of systemic infection, malfunction, or upgrade. Relevant research of CS lead extraction is rare, especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate percutaneous extraction of CS leads by modified conventional techniques.

METHODSOf 200 patients referred for lead extraction from January 2007 to June 2011, 24 (12.0%) involved CS leads (24 CS leads). We prospectively analyzed clinical characteristics, optimized extraction techniques and feasibility of extraction.

RESULTSComplete procedural success was achieved in 23 patients (95.8%), and the clinical success in 24 patients (100.0%). The leading indication for CS lead extraction was infection (66.7%). Mean implant duration was (29.5 ± 20.2) months (range, 3 - 78 months). Sixteen CS leads (66.6%) were removed with locking stylets plus manual traction by superior transvenous approach. Mechanical dilatation and counter-traction was required to free fibrotic adhesions and extract 4 CS leads (16.7%), which had longer implant duration than other leads ((62.5 ± 12.3) vs. (22.9 ± 14.1) months, P < 0.05). Another 4 CS (16.7%) leads were removed by modified and innovative snare techniques from femoral vein approach. Median extraction time was 11 minutes (range, 3 - 61 minutes) per CS lead, which had significant correlation with implant duration (r = 0.8, P < 0.001). Sixteen patients (66.6%) were reimplanted with new devices at a median of 7.5 days after extraction. Median followed-up was 23.5 months (range, 8 - 61 months), three patients died due to sudden cardiac death (26 months), heart failure (45 and 57 months, respectively).

CONCLUSIONThe modified procedure was proved to be practical for percutaneous extraction of CS leads, especially in developing countries lacking expensive powered sheaths.

Aged ; Cardiac Resynchronization Therapy Devices ; adverse effects ; Coronary Sinus ; surgery ; Device Removal ; methods ; Electrodes, Implanted ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies

Aged ; Cardiac Care Facilities ; trends ; Cardiac Resynchronization Therapy ; trends ; utilization ; Cardiac Resynchronization Therapy Devices ; trends ; utilization ; Death, Sudden, Cardiac ; prevention & control ; Defibrillators, Implantable ; trends ; utilization ; Electric Countershock ; trends ; utilization ; Female ; Heart Failure ; therapy ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; Stroke Volume ; Tachycardia, Ventricular ; therapy ; Tertiary Care Centers

We applied cardiac resynchronization therapy (CRT) for desynchronized heart failure patients. We evaluated clinical outcomes including morbidity, mortality, and echocardiographic parameters in 47 patients with implanted CRT in Korea from October 2005 to May 2013. The combined outcomes of hospitalization from heart failure, heart transplantation and death were the primary end point. Median follow-up period was 17.5 months. The primary outcomes listed above occurred in 10 (21.3%) patients. Two patients (4.3%) died after CRT and 8 (17%) patients were hospitalized for recurrent heart failure. Among patients hospitalized for heart failure, 2 (4.3%) patients underwent heart transplantation. The overall free rate of heart failure requiring hospitalization was 90.1% (95% CI, 0.81-0.99) over one year and 69.4% (95% CI, 0.47-0.91) over 3 yr. We observed improvement of the New York Heart Association classification (3.1+/-0.5 to 1.7+/-0.4), decreases in QRS duration (169.1 to 146.9 ms), decreases in left ventricular (LV) end-diastolic (255.0 to 220.1 mL) and end-systolic (194.4 to 159.4 mL) volume and increases in LV ejection fraction (22.5% to 31.1%) at 6 months after CRT. CRT improved symptoms and echocardiographic parameters in a relatively short period, resulting in low mortality and a decrease in hospitalization due to heart failure.
Age Distribution ; Cardiac Resynchronization Therapy/*mortality ; Cardiac Resynchronization Therapy Devices/*statistics & numerical data ; Female ; Heart Failure/diagnosis/*mortality/*prevention & control ; *Hospital Mortality ; Hospitalization/*statistics & numerical data ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Prevalence ; Prostheses and Implants/statistics & numerical data ; Recurrence ; Republic of Korea/epidemiology ; Risk Factors ; Sex Distribution ; Survival Rate ; Treatment Outcome