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Cardiac Resynchronization Therapy: Clinical Results and Evolution of Candidate Selection

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

Deadline for manuscript submissions: closed (25 July 2022) | Viewed by 7592

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Prof. Dr. Antonio Rapacciuolo

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Guest Editor

Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy
Interests: heart failure; cardiac resynchronization therapy; arrhythmias; interventional cardiology; translational research in cardiology

Special Issue Information

Dear Colleagues,

Over the last 25 years, cardiac resynchronization therapy (CRT) has become an established therapy for patients with advanced heart failure, depressed left ventricular function, and wide QRS complex. A successful cardiac resynchronization improves cardiac output, leading to reverse left ventricular remodeling and an improvement in symptoms, quality of life and clinical outcome.

Despite that, almost 30% of patients do not respond adequately to the therapy.

In recent years, several studies have investigated the potential role of different cardiac imaging modalities in the identification of best candidates for CRT and for a better post-implant optimization. Unfortunately, to date, the optimal strategy for improving the CRT response remains debated.

The aim of this Special Issue is to provide an updated overview of the diagnostic approaches available to identify potential predictors of favorable outcomes and, on the other hand, novel techniques able to guide adequate improvement of resynchronization therapy.

We look forward to receiving your submissions.

Prof. Dr. Antonio Rapacciuolo
Guest Editor

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Keywords

heart failure
cardiac resynchronization therapy
patients’ selection
new insights
optimization
technologies

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Research

12 pages, 2614 KiB

Open AccessArticle

Orthodromic and Antidromic Snare Techniques for Left Ventricular Lead Implantation in Cardiac Resynchronization Therapy

by Juwon Kim, Sung Ho Lee, Hye Ree Kim, Tae-Wan Chung, Ji-Hoon Choi, Ju Youn Kim, Kyoung-Min Park, Young Keun On, June Soo Kim and Seung-Jung Park

J. Clin. Med. 2022, 11(8), 2133; https://doi.org/10.3390/jcm11082133 - 11 Apr 2022

Cited by 3 | Viewed by 2811

Abstract

The snare technique can be used to overcome unsuitable cardiac venous anatomies for left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) procedures. However, limited data exist regarding performance of the snare technique. We classified 262 patients undergoing CRT procedure into the snare (n = 20) or conventional group (n = 242) according to the LV lead implantation method. We compared the safety, efficacy, and composite outcome (all-cause death and heart failure readmission) at 3 years post-implant between the snare and conventional groups. In the snare group, all LV leads were implanted safely using orthodromic (n = 15) or antidromic (n = 5) techniques, and no immediate complications occurred including vessel perforation, tamponade, and lead dislodgement. During follow-up, LV lead threshold and impedance remained stable without requiring lead revision in the snare group. There were no significant between-group differences regarding LV ejection fraction increase (12 ± 13% vs. 12 ± 13%, p = 0.929) and LV end-systolic volume reduction (18 ± 48% vs. 28 ± 31%, p = 0.501). Both groups exhibited comparable CRT-response rates (62.5% vs. 60.6%, p = 1.000). The risk of primary outcome was not significantly different between the two groups (25.9% vs. 30.9%, p = 0.817). In patients who failed conventional LV lead implantation for CRT, the snare technique could be a safe and effective solution to overcome difficult coronary venous anatomy. Full article

(This article belongs to the Special Issue Cardiac Resynchronization Therapy: Clinical Results and Evolution of Candidate Selection)

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7 pages, 1055 KiB

Open AccessArticle

Anodal Capture for Multisite Pacing with a Quadripolar Left Ventricular Lead: A Feasibility Study

by Alexandre Bodin, Arnaud Bisson, Clémentine Andre, Dominique Babuty and Nicolas Clementy

J. Clin. Med. 2021, 10(24), 5886; https://doi.org/10.3390/jcm10245886 - 15 Dec 2021

Cited by 1 | Viewed by 2187

Abstract

Background: Up to 40% of patients are CRT non-responders. Multisite pacing, using a unique quadripolar lead, also called multipoint/multipole pacing (MPP), is a potential alternative. We sought to determine the feasibility of intentional anodal capture using a single LV quadripolar lead, to reproduce MPP without the need of a specific algorithm (so-called “pseudo MPP”). Methods: Consecutive patients implanted with a commercially available CRT device and a quadripolar LV lead in our department were prospectively included. The electric charge (Q, in Coulomb) of RV and LV pacing spikes were calculated for all available LV pacing configurations at the threshold. The best MPP was defined as the configuration with the lowest consumption (Q_RV + Q_{best LV1} + Q_{best LV2}). The best “pseudo MPP” (Q_RV + Q_{LV1–LV2 with anodal capture}) and best BVp (Q_RV + Q_{best LV}) were also calculated. A theoretical longevity was estimated for each configuration at the threshold without a safety margin. Results: A total of 235 configurations were tested in 15 consecutive patients. “Pseudo-MPP” was feasible in 80% of patients with 3.1 ± 2.6 vectors available per-patient and LV_proximal-LV_distal (most distant electrodes) vectors were available in 47% of patients. Each MPP pacing spike electrical charge was comparable to “pseudo-MPP” (18,428 ± 6863 µC and 20,528 ± 5509 µC, respectively, p = 0.15). Theoretical longevity was 6.2 years for MPP, 5.6 years for “pseudo-MPP” and 13.7 years for BVp. Conclusions: “Pseudo MPP” using intentional anodal capture with a quadripolar left ventricular lead, mimicking conventional multisite pacing, is feasible in most of CRT patients, with comparable energy consumption. Further studies on their potential clinical impact are needed. Full article

(This article belongs to the Special Issue Cardiac Resynchronization Therapy: Clinical Results and Evolution of Candidate Selection)

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10 pages, 1463 KiB

Open AccessArticle

Does the Age Affect the Outcomes of Cardiac Resynchronization Therapy in Elderly Patients?

by Teresa Strisciuglio, Giuseppe Stabile, Domenico Pecora, Giuseppe Arena, Salvatore Ivan Caico, Massimiliano Marini, Patrizia Pepi, Antonio D’Onofrio, Antonio De Simone, Giuseppe Ricciardi, Sandra Badolati, Alfredo Spotti, Gavino Casu, Francesco Solimene, Carmelo La Greca, Giuseppe Ammirati, Valerio Pergola, Lucio Addeo, Maurizio Malacrida, Emanuele Bertaglia and Antonio Rapacciuolo Show full author list Hide full author list

J. Clin. Med. 2021, 10(7), 1451; https://doi.org/10.3390/jcm10071451 - 1 Apr 2021

Cited by 7 | Viewed by 1730

Abstract

Background: More and more heart failure (HF) patients aged ≥ 75 years undergo cardiac resynchronization therapy (CRT) device implantation, however the data regarding the outcomes and their predictors are scant. We investigated the mid- to long-term outcomes and their predictors in CRT patients aged ≥ 75 years. Methods: Patients in the Cardiac Resynchronization Therapy Modular (CRT MORE) Registry were divided into three age-groups: <65 (group A), 65–74 (group B) and ≥75 years (group C). Mortality, hospitalization, and composite event rate were evaluated at 1 year and during long-term follow-up. Results: Patients (n = 934) were distributed as follows: group A 242; group B 347; group C 345. On 12-month follow-up examination, 63% of patients ≥ 75 years displayed a positive clinical response. Mortality was significantly higher in patients ≥ 75 years than in the other two groups, although the rate of hospitalizations for HF worsening was similar to that of patients aged 65–74 (7 vs. 9.5%, respectively; p = 0.15). Independent predictors of death and of negative clinical response were age >80 years, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Over long-term follow-up (1020 days (IQR 680-1362)) mortality was higher in patients ≥ 75 years than in the other two groups. Hospitalization and composite event rates were similar in patients ≥ 75 years and those aged 65–74 (9 vs. 11.8%; p = 0.26, and 26.7 vs. 20.5%; p = 0.06). Conclusion: Positive clinical response and hospitalization rates do not differ between CRT recipients ≥ 75 years and those aged 65–74. However, age > 80 years, COPD and CKD are predictors of worse outcomes. Full article

(This article belongs to the Special Issue Cardiac Resynchronization Therapy: Clinical Results and Evolution of Candidate Selection)

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