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Cardiac Resynchronization Therapy in Patients with Congestive Heart Failure and Permanent Right Ventricular Pacing, Combined with Atirial Fibrillation
The 9th Annual Scientific Meeting
•
JHFS
S319
P-073
P-075
Role of Acute Haemodynamic Study to Predict the Acute and Chronic Effects of Cardiac Resynchronization Therapy TAKAHIRO DOI, SATOSHI SHIZUTA, KEI NISHIYAMA, YUKIKO NISHIO, TAKESHI KIMURA, TORU KITA The Depertment of Cardiology, University of Kyoto, Kyoto, Japan
Feasibility of Cardiac CT for Detecting the Optimum Coronary Sinus Branch in Cardiac Resynchronization Therapy HARUTOSHI ONO, MASAHARU HIRANO, YOSHINARI GOSEKI, MASAO YAMADA, MASASHI KAWADE, SHINTARO KIUCHI, KUNIHIKO TERAOKA, AKIRA YAMASHINA The Second Department of Internal Medicine, University of Tokyo, Tokyo, Japan
Background: Cardiac re-synchronization therapy (CRT) by biventricular pacing (BiV) is effective treatment for a severe congestive heart failure (CHF). However, it is a critical problem that the present CRT also creates the patients not respond to this treatment called Non-Responder. Methods and Results: We underwent acute haemodynamic studies by test pacing for 33 consecutive patients with severe CHF between March 2003 and March 2005, and implanted CRT device for 16 patients (mean age; 68⫾8 years, 13 men(81%)). At baseline, 13% of patients were ischemic cardiomyopathies, mean left ventricular EF was 26.2⫾7%, mean NYHA was 3⫾0.5, and mean BNP was 396⫾306 pg/ml. We compared the acute hemodynamic changes associated with pacing the right ventricular apex (RVA) alone, or BiV pacing of the RVA and LV together. BIV pacing resulted in higher cardiac output (P⬍0.01) and dp/dt (P⬍0.01) than baseline RV pacing measurements. Compared the parameters between baseline and 3 months after implantation, EF (P⫽0.03), NYHA (⬍0.0001), and BNP (P⫽0.03) were improved respectively. Conclusions: In patients with severe CHF, BIV pacing resulted in a significant acute improvement in cardiac output and dp/dt compared with baseline RV pacing alone. These results provide a basis for initiating long-term studies examining the chronic effects of BiV pacing in patients with refractory CHF.
Background: Multi-Detector CT has received positive feedback as a noninvasive method of assessing the arterio-venous system. However, accurate evaluation of the Coronary Sinus (CS) anatomy is required for left ventricular lead placement in cardiac resynchronization therapy (CRT). We assessed the resolution of CS from cardiac CT and examined the possibility of CRT application. Method and Results: Cardiac CT was preformed to 15 patients who were scheduled for permanent pacemaker implantation or Electrophysiological study. We measured the following: CS ostium diameter, CS branch diameter, angle between CS branch and the main tract, distance from CS otium to CS branch, in lateral and postero-lateral branches. The results are shown in Table 1. Conclusion: Cardiac CT may be helpful in detecting the optimal CS branch for CRT.
P-074
P-076
The Difference of Optimal AV Delay Between Left and Right Heart in Patients with Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy in Patients with Congestive Heart Failure and Permanent Right Ventricular Pacing, Combined with Atirial Fibrillation SHINICHI HIRAMATSU, MASAMICHI TANAKA, EIKI HIROSE, TSUYOSHI MATSUNAKA, HIDEYUKI SAIKI, MAKOTO SUZUKI, YUKIO KAZETANI Division of Cardiology, Department of Medicine, Ehime Prefectural Central Hospital, Matsuyama, Japan
CHIKASHI SUGA, KAZUO MATSUMOTO, RITSUSHI KATO, MASAHIRO UENISHI, YUKIO ASANO, TAKAO NAMIKI, SHIGEYUKI NISHIMURA Department of Cardiology, Saitama Medical School, Saitama, Japan Purpose: Optimal AV delay (OAVD) is generally set up to left heart OAVD which is determined by echocardiography in patients with cardiac resynchronization therapy (CRT). However, there may be difference between left and right heart OAVD in association with intra-atrial conduction disturbance or ventricular dyssynchrony. The purpose of this study was to evaluate the difference of OAVD between leftand right heart and to determine the cause of difference of OAVD in patients with CRT. Method: This study included 6 CRT patients who were echocardiographically evaluated left and right OAVD (5 Males, mean age 60.1⫾17.4 years). We calculated the difference of left and right heart OAVD (d-OAVD), and assessed any relationship between d-OAVD and age, QRS width before CRT, paced P width, BNP, NYHA class, LVEDD, LVEF and LAD. Result: Averaged d-OAVD was 24.7⫾37.5 (0-97) msec. There were no correlations between d-OAVD and age, QRS width, BNP, NYHA class, LVEDD, LVEF and LAD (p⫽NS). However, d-OAVD significantly correlated with paced P width (r⫽0.795, p⬍0.05). Conclusion: There was a maximum of 97msec d-OAVD suggesting an association with intra-atrial conduction disturbance. Alternative atrial pacing site which improves atrial conduction might be useful to reduce d-OAVD, though hemodynamic significance of d-OAVD is yet unknown.
Background: Effects of CRT in patients with congestive heart failure, permanent right ventricular pacing and atirial fibrillation are controversial. However, some investigators reported the efficacy of CRT in those patients (Europace 2004;6,438, JACC 2002;39:1258). Aim: The aim of this study was to confirm the effects of upgrading to CRT patients with congestive heart failure, permanent right ventricular pacing and atirial fibrillation. Method: We studied 3 patient with congestive heart failure (mean LVEF 20%, NYHA functional class 3 despite maximal medical therapy), permanent right ventricular pacing and atirial fibrillation (2 patients were chronic and 1 patients was persistent). We implanted LV lead additionally in those patients. In this follow up period, we evaluated the incidence of cardiac adversed event (death of any cause, all hospitalization due to cardiac disease), NYHA functional class, Mitral regurgitation (MR) grade, LVEF on echocardiogram, and plasma concentration of brain natriuretic peptide (BNP), serially.The average of follow up period was 4.6 months. Results: No adversed event was observed in this follow up period. All patients demonstrated the improvement in NYHA class. MR decreased in 2 patients. However, LVEF and BNP were unchaged significantly. Conclusion: We confirmed the efficacy of CRT in congestive heart failure, permanent right ventricular pacing and atirial fibrillation. However, the efficacy might be limited comparing with the efficacy in optimal candidates.
•
JHFS
S319
P-073
P-075
Role of Acute Haemodynamic Study to Predict the Acute and Chronic Effects of Cardiac Resynchronization Therapy TAKAHIRO DOI, SATOSHI SHIZUTA, KEI NISHIYAMA, YUKIKO NISHIO, TAKESHI KIMURA, TORU KITA The Depertment of Cardiology, University of Kyoto, Kyoto, Japan
Feasibility of Cardiac CT for Detecting the Optimum Coronary Sinus Branch in Cardiac Resynchronization Therapy HARUTOSHI ONO, MASAHARU HIRANO, YOSHINARI GOSEKI, MASAO YAMADA, MASASHI KAWADE, SHINTARO KIUCHI, KUNIHIKO TERAOKA, AKIRA YAMASHINA The Second Department of Internal Medicine, University of Tokyo, Tokyo, Japan
Background: Cardiac re-synchronization therapy (CRT) by biventricular pacing (BiV) is effective treatment for a severe congestive heart failure (CHF). However, it is a critical problem that the present CRT also creates the patients not respond to this treatment called Non-Responder. Methods and Results: We underwent acute haemodynamic studies by test pacing for 33 consecutive patients with severe CHF between March 2003 and March 2005, and implanted CRT device for 16 patients (mean age; 68⫾8 years, 13 men(81%)). At baseline, 13% of patients were ischemic cardiomyopathies, mean left ventricular EF was 26.2⫾7%, mean NYHA was 3⫾0.5, and mean BNP was 396⫾306 pg/ml. We compared the acute hemodynamic changes associated with pacing the right ventricular apex (RVA) alone, or BiV pacing of the RVA and LV together. BIV pacing resulted in higher cardiac output (P⬍0.01) and dp/dt (P⬍0.01) than baseline RV pacing measurements. Compared the parameters between baseline and 3 months after implantation, EF (P⫽0.03), NYHA (⬍0.0001), and BNP (P⫽0.03) were improved respectively. Conclusions: In patients with severe CHF, BIV pacing resulted in a significant acute improvement in cardiac output and dp/dt compared with baseline RV pacing alone. These results provide a basis for initiating long-term studies examining the chronic effects of BiV pacing in patients with refractory CHF.
Background: Multi-Detector CT has received positive feedback as a noninvasive method of assessing the arterio-venous system. However, accurate evaluation of the Coronary Sinus (CS) anatomy is required for left ventricular lead placement in cardiac resynchronization therapy (CRT). We assessed the resolution of CS from cardiac CT and examined the possibility of CRT application. Method and Results: Cardiac CT was preformed to 15 patients who were scheduled for permanent pacemaker implantation or Electrophysiological study. We measured the following: CS ostium diameter, CS branch diameter, angle between CS branch and the main tract, distance from CS otium to CS branch, in lateral and postero-lateral branches. The results are shown in Table 1. Conclusion: Cardiac CT may be helpful in detecting the optimal CS branch for CRT.
P-074
P-076
The Difference of Optimal AV Delay Between Left and Right Heart in Patients with Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy in Patients with Congestive Heart Failure and Permanent Right Ventricular Pacing, Combined with Atirial Fibrillation SHINICHI HIRAMATSU, MASAMICHI TANAKA, EIKI HIROSE, TSUYOSHI MATSUNAKA, HIDEYUKI SAIKI, MAKOTO SUZUKI, YUKIO KAZETANI Division of Cardiology, Department of Medicine, Ehime Prefectural Central Hospital, Matsuyama, Japan
CHIKASHI SUGA, KAZUO MATSUMOTO, RITSUSHI KATO, MASAHIRO UENISHI, YUKIO ASANO, TAKAO NAMIKI, SHIGEYUKI NISHIMURA Department of Cardiology, Saitama Medical School, Saitama, Japan Purpose: Optimal AV delay (OAVD) is generally set up to left heart OAVD which is determined by echocardiography in patients with cardiac resynchronization therapy (CRT). However, there may be difference between left and right heart OAVD in association with intra-atrial conduction disturbance or ventricular dyssynchrony. The purpose of this study was to evaluate the difference of OAVD between leftand right heart and to determine the cause of difference of OAVD in patients with CRT. Method: This study included 6 CRT patients who were echocardiographically evaluated left and right OAVD (5 Males, mean age 60.1⫾17.4 years). We calculated the difference of left and right heart OAVD (d-OAVD), and assessed any relationship between d-OAVD and age, QRS width before CRT, paced P width, BNP, NYHA class, LVEDD, LVEF and LAD. Result: Averaged d-OAVD was 24.7⫾37.5 (0-97) msec. There were no correlations between d-OAVD and age, QRS width, BNP, NYHA class, LVEDD, LVEF and LAD (p⫽NS). However, d-OAVD significantly correlated with paced P width (r⫽0.795, p⬍0.05). Conclusion: There was a maximum of 97msec d-OAVD suggesting an association with intra-atrial conduction disturbance. Alternative atrial pacing site which improves atrial conduction might be useful to reduce d-OAVD, though hemodynamic significance of d-OAVD is yet unknown.
Background: Effects of CRT in patients with congestive heart failure, permanent right ventricular pacing and atirial fibrillation are controversial. However, some investigators reported the efficacy of CRT in those patients (Europace 2004;6,438, JACC 2002;39:1258). Aim: The aim of this study was to confirm the effects of upgrading to CRT patients with congestive heart failure, permanent right ventricular pacing and atirial fibrillation. Method: We studied 3 patient with congestive heart failure (mean LVEF 20%, NYHA functional class 3 despite maximal medical therapy), permanent right ventricular pacing and atirial fibrillation (2 patients were chronic and 1 patients was persistent). We implanted LV lead additionally in those patients. In this follow up period, we evaluated the incidence of cardiac adversed event (death of any cause, all hospitalization due to cardiac disease), NYHA functional class, Mitral regurgitation (MR) grade, LVEF on echocardiogram, and plasma concentration of brain natriuretic peptide (BNP), serially.The average of follow up period was 4.6 months. Results: No adversed event was observed in this follow up period. All patients demonstrated the improvement in NYHA class. MR decreased in 2 patients. However, LVEF and BNP were unchaged significantly. Conclusion: We confirmed the efficacy of CRT in congestive heart failure, permanent right ventricular pacing and atirial fibrillation. However, the efficacy might be limited comparing with the efficacy in optimal candidates.