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Advances in Devices for Cardiac Resynchronization in Heart Failure

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Abstract

Patients with advanced heart failure have a high mortality and morbidity despite medical therapy. Depending on the underlying heart disease and severity of heart failure, 3.7 to 52.8% of patients have a QRS complex ≥120 ms who may have interventricular and intraventricular dyssynchrony correctible by cardiac resynchronization therapy (CRT). The latter is usually achieved with biventiricular pacing, with the left ventricular lead placed in a tributary of the coronary sinus (CS), with a reported success rate between 88–92%. The technical advances for implantation include preformed guide sheaths to canulate the CS, over the wire leads with passive fixation mechanism, and surgical placement methods.

Device-specific CRT features include optimizing heart failure through ensurance of a high percentage of pacing, heart failure monitoring, atrioventricular and interventricular timing, and avoiding double ventricular sensing. Furthermore, arrhythmic co-morbidities of heart failure such as atrial fibrillation and ventricular tachyarrhythmias can also be managed. Recent prospective trials suggest that there is a 30% reduction in heart failure hospitalization with CRT, and preliminary results suggest a survival benefit with CRT and implantable cardioverter defibrillator over optimal medical therapy.

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References

  1. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999;353:2001–2007.

    Google Scholar 

  2. Cleland JGF, Chattopadhyay S, Khand A, et al. Prevalence and incidence of arrhythmias and sudden death in heart failure. Heart Failure Reviews 2002;7:229–242.

    Google Scholar 

  3. Yu CM, Chau E, Sanderson JE, et al. Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002;105:438–445.

    Google Scholar 

  4. Aaronson KD, Schwartz JS, Chen TM, et al. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation 1997;95:2660–2667.

    Google Scholar 

  5. Gottipaty VK, Krelis SP, Lu F, et al. The resting electrocardiogram provides a sensitive and inexpensive marker of prognosis in patients with chronic congestive heart failure (abstract). J Am Coll Cardiol 1999;2:145A.

    Google Scholar 

  6. De Sutter J, De Bondt P, Van de Wiele C, et al. Prevalence of potential candidates for biventricular pacing among patients with known coronary artery disease: A prospective registry from a single center. Pacing Clin Electrophysiol 2000;23:1718–1721.

    Google Scholar 

  7. Farwell D, Patel NR, Hall A, et al. How many people with heart failure are appropriate for biventricular resynchronization? Eur Heart J 2000;21:1246–1250.

    Google Scholar 

  8. Stellbrink C, Auricchio A, Diem B, et al. Potential benefit of biventricular pacing in patients with congestive heart failure and ventricular tachyarrhythmia. Am J Cardiol 1999;83:143D–150D.

    Google Scholar 

  9. Werling C, Weisse U, Siemon G, et al. Biventricular pacing in patients with ICD: How many patients are possible candidates? Thorac Cardiovasc Surg 2002;50:67–70.

    Google Scholar 

  10. Auricchio A, Stellbrink C, Sack S, et al. Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 2002;39:2026–2033.

    Google Scholar 

  11. Kass DA, Chen CH, Curry C, et al. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation 1999;99:1567–1573.

    Google Scholar 

  12. Nelson GS, Berger RD, Fetics BJ, et al. Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation 2000;102:3053–3059.

    Google Scholar 

  13. Abraham WT, Fisher WG, Smith AL, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002;346:1845–1853.

    Google Scholar 

  14. Auricchio A, Stellbrink C, Block M, et al. Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. The Pacing Therapies for Congestive Heart Failure Study Group. The Guidant Congestive Heart Failure Research Group. Circulation 1999;99:2993–3001.

    Google Scholar 

  15. Cazeau S, Leclercq C, Lavergne T, et al. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001;344:873–880.

    Google Scholar 

  16. Gras D, Leclercq C, Tang AS, et al. Cardiac resynchronization therapy in advanced heart failure the multicenter InSync clinical study. Eur J Heart Fail 2002;4:311–320.

    Google Scholar 

  17. Bristow MR, Feldman AM, Saxon LA. Heart failure management using implantable devices for ventricular resynchronization: Comparison of Medical therapy, PAciNg, and defibrillatION in chronic heart failure (COMPANION) trial. COMPANION Steering Committee and COMPANION Clinical Investigators. J Card Fail 2000;6:276–285.

    Google Scholar 

  18. Bristow MR, et al. Cardiac resynchronization therapy (CRT) reduces hospitalizatoins, and CRT+ an implantable defibrillator (CRT-D) reduces mortality in chronic heart failure: Preliminery results of the COMPANION trial. Presented as late breaking news in the American College of Cardiology Annual Scientific Session, 2003.

  19. Auricchio A, Stellbrink C, Sack S, et al. The pacing therapies for congestive heart failure (PATH-CHF) study: Rationale, design, and endpoints of a prospective randomized multicenter study. Am J Cardiol 1999;83:130D–135D.

    Google Scholar 

  20. Purerfellner H, Nesser HJ, Winter S, et al. Transvenous left ventricular lead implantation with the EASYTRAK lead system: The European experience. Am J Cardiol 2000;86:K157–K164.

    Google Scholar 

  21. Tse HF, Yu C, Lee KL, et al. Initial clinical experience with a new self-retaining left ventricular lead for permanent left ventricular pacing. Pacing Clin Electrophysiol 2000;23:1738–1740.

    Google Scholar 

  22. Alonso C, Leclercq C, d'Allonnes FR, et al. Six year experience of transvenous left ventricular lead implantation for permanent biventricular pacing in patients with advanced heart failure: Technical aspects. Heart 2001;86:405–410.

    Google Scholar 

  23. Tyers GF, Clark J, Wang Y, et al. Coronary sinus lead extraction. Pacing Clin Electrophysiol 2003;26:524–526.

    Google Scholar 

  24. DeRose JJ, Ashton RC, Belsley S, et al. Robotically assisted left ventricular epicardial lead implantation for biventricular pacing. J Am Coll Cardiol 2003;41:1414–1419.

    Google Scholar 

  25. Izutani H, Quan KJ, Biblo LA, et al. Biventricular pacing for congestive heart failure: Early experience in surgical epicardial versus coronary sinus lead placement. Heart Surg Forum 2002;6:E1–E6.

    Google Scholar 

  26. Barold SS, Levine PA. Significance of stimulation impedance in biventricular pacing. J Interv Card Electrophysiol 2002;6:67–70.

    Google Scholar 

  27. Barold SS, Byrd CL. Cross-ventricular endless loop tachycardia during biventricular pacing. Pacing Clin Electrophysiol 2001;24:1821–1823.

    Google Scholar 

  28. Betts TR, Allen S, Roberts PR, et al. Inapproppriate shock therapy in a heart failure defibrillator. Pacing Clin Electrophysiol 2001;24:238–240.

    Google Scholar 

  29. Kanagaratnam L, Pavia S, Schweikert R, et al. Matching approved “nondedicated” hardware to obtain biventricular pacing and defibrillation: Feasibility and troubleshooting. Pacing Clin Electrophysiol 2002;25:1066–1071.

    Google Scholar 

  30. Schreieck J, Zrenner B, Kolb C, et al. Inappropriate shock delivery due to ventricular double detection with a biventricular pacing implantable cardioverter defibrillator. Pacing Clin Electrophysiol 2001;24:1154–1157.

    Google Scholar 

  31. Lipchenka I, Garrigue S, Gilikson M, et al. Inhibition of biventricular pacemakers by oversensing of farfield atrial depolarization. Pacing Clin Electrophysiol 2002;25:365–367.

    Google Scholar 

  32. Vollman D, Luthje L, Gortler G, et al. Inhibition of bradycardia pacing and detection of ventricular fibrillation due to far-field atrial sensing in a triple chamber implantable cardioverter defibrillator. Pacing Clin Electrophysiol 2002;25:1516.

    Google Scholar 

  33. Taieb J, Benchaa T, Foltzer E, et al. Atrioventricular crosstalk in biventricular pacing: A potential cause of ventricular standstill. Pacing Clin Electrophysiol 20020;25:929–935.

    Google Scholar 

  34. Tse HF, Yu C, Park E, et al. Impedance cardiography for atrioventricular interval optimization after permanent left ventricular pacing. Pacing Clin Electrophysiol 2002;26:189–191.

    Google Scholar 

  35. Riff KM. Monitoring applications of pacemaker sensors. In: Ellenbogen KA, Kay GN, Wilkoff BL, eds. Clinical Cardiac Pacing and Defibrillation. Philadelphia: W.B. Saunders Co., 2000:Ch 11:307–324.

    Google Scholar 

  36. Leung SK, Lau CP, Lam CT, et al. Automatic optimization of resting and exercise atrioventricular interval using a peak endocardial acceleration sensor: Validation with Doppler echocardiography and direct cardiac output measurements. Pacing Clin Electrophysiol 2000;23:1762–1766.

    Google Scholar 

  37. Hill MR, Hilpisch KE, Taepke RT, et al. Relationship between hemodynamic parameters and QRS duration using interventricular pacing in Canine model of heart failure (abstract). Pacing Clin Electrophysiol 2001;24(Pt II):665.

    Google Scholar 

  38. Soggard P, Egeblad H, Pedersen AK, et al. Sequential versus simultaneous biventricular resynchronization for severe heart failure: Evaluation by tissue Doppler imaging. Circulation 2002;106(16):2078–2084.

    Google Scholar 

  39. Ohlsson A, Kubo SH, Steinhaus D, et al. Continuous ambulatory monitoring of absolute right ventricular pressure and mixed venous oxygen saturation in patients with heart failure using an implantable haemodynamic monitor: Results of a 1 year multicentre feasibility study. Eur Heart J 2001;22:942–954.

    Google Scholar 

  40. Garrigue S, Bordachar P, Reuter S, et al. Comparison of permanent left ventricular and biventricular pacing in patients with heart failure and chronic atrial fibrillation: Prospective haemodynamic study. Heart 2002;87:529–534.

    Google Scholar 

  41. Yu CM, Lau CP, Tang MO, et al. Changes in device-based thoracic impedance in decompensating congestive heart failure (abstract). Circulation 2001;104:II–419.

    Google Scholar 

  42. Mathew J, Hunsberger S, Fleg J, et al. Incidence, predictive factors, and prognostic significance of supraventricular tachyarrhythmias in congestive heart failure. Chest 2000;118:914–922.

    Google Scholar 

  43. Linde C, Leclercq C, Rex S, et al. Long-term benefits of biventricular pacing in congestive heart failure: Results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. J Am Coll Cardiol 2002;40:111–118.

    Google Scholar 

  44. Leon AR, Greenberg JM, Kanuru N, et al. Cardiac resynchronization in patients with congestive heart failure and chronic atrial fibrillation: Effect of upgrading to biventricular pacing after chronic right ventricular pacing. J Am Coll Cardiol 2002;39:1258–1263.

    Google Scholar 

  45. Leclercq C, Walker S, Linde C, et al. Comparative efects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation. Eur Heart J 2002;23:1780–1787.

    Google Scholar 

  46. Barold SS, Gallardo I, Sayad D. The DVI mode of cardiac pacing: A second coming? Am J Cardiol 2002;90:521–523.

    Google Scholar 

  47. Lau CP, Jiang ZY, Tang MO. Efficacy of ventricular rate stabilization by right ventricular pacing during atrial fibrillation. Pacing Clin Electrophysiol 1998;21:542–548.

    Google Scholar 

  48. Simpson CS, Yee R, Lee JK, et al. Safety and feasibility of a novel rate-smoothed ventricular pacing algorithm for atrial fibrillation. Am Heart J 2001;142:294–300.

    Google Scholar 

  49. Ding J, Muno E, Neuzner J, et al. Hemodynamic comparison of biventricular and left ventricular pacing for heart failure with atrial fibrillation (abstract). Pacing Clin Electrophysiol 2001;24:665.

    Google Scholar 

  50. Kuhlkamp V, for the InSyn 7272 ICD world wide investigators. Initial experience with an implantable cardioverterdefibrillator incorporating cardiac resynchronization therapy. J Am Coll Cardiol 2002;39:790–797.

    Google Scholar 

  51. Higgins SL, Yong P, Sheck D, et al. Biventricular pacing diminishes the need for implantable cardioverter defibrillator therapy. Ventak CHF Investigators. J Am Coll Cardiol 2000;36:824–827.

    Google Scholar 

  52. Thackray S, Coletta A, Jones P, et al. Clinical trials update: HIghlights of the Scientific Sessions of Heart Failure 2001, ameeting of theWorking Group on Heart Failure of the European Society of Cardiology. CONTAK-CD, CHRISTMAS, OPTIME-CHF. Eur J Heart Fail 2001;3:491–494.

    Google Scholar 

  53. Young J, Abraham WT. Results of the MIRACLE ICD trial. Presented as late breaking news in the American College of Cardiology Annual Scientific Sessions, 2002.

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Authors and Affiliations

  1. Cardiology Division, University of Hong Kong, Queen Mary Hospital, HONGKONG

    Chu-Pak Lau, Hung-Fat Tse, Kathy Lai-Fun Lee, Hon-Wah Chan, Katherine Fan, Elaine Chau & Cheuk-Man Yu

  2. Tampa General Hospital, Tampa, Florida, USA

    Serge Barold

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  1. Chu-Pak Lau
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Lau, CP., Barold, S., Tse, HF. et al. Advances in Devices for Cardiac Resynchronization in Heart Failure. J Interv Card Electrophysiol 9, 167–181 (2003). https://doi.org/10.1023/A:1026365006526

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