Cardiac Resynchronisation Therapy – Evolving Strategies to Enhance Response

Reverses Remodelling in Systolic Left Ventricular Dysfunction (REVERSE-HF) studies suggests the possibility of its role expanding to include well-controlled and mildly symptomatic heart failure patients (NYHA class I and II).33,34

As the population eligible for device therapy rapidly expands, the need to be more cognisant of its cost-effectiveness and to refine the selection criteria will become more important. In order to maximise the level of response derived from device therapy, we have to make certain that we not only select the appropriate patient but also thoughtfully implant the pacing leads and ensure that the patients receive co-ordinated multispeciality post-implant care. n

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11. Wokhlu A, Rea RF, Asirvatham SJ, et al., Upgrade and de novo cardiac resynchronization therapy: impact of paced or intrinsic QRS morphology on outcomes and survival,

Heart Rhythm, 2009;6:1439–47.

Jagmeet P Singh is an Associate Professor of Medicine at Massachusetts General Hospital, Harvard Medical School. He also serves as Director of the Cardiac Resynchronization Therapy Program and as a Cardiac Electrophysiologist in the Cardiac Arrhythmia Service at Massachusetts General Hospital Heart Center. Dr Singh’s research interests are in clinical cardiac electrophysiology, with an emphasis on device therapy for heart failure and

atrial fibrillation. He is the principal investigator and a member of steering committees on several single- and multicentre research studies. Dr Singh has over 100 publications, including original research articles, clinical communications, textbook chapters and editorials.

12. Varma N, Left ventricular conduction delays and relation to QRS configuration in patients with left ventricular

dysfunction, Am J Cardiol, 2009;103:1578–85.

13. Beshai JF, Grimm RA, Nagueh SF, et al., Cardiac- resynchronization therapy in heart failure with narrow

QRS complexes, N Engl J Med, 2007;357:2461–71.

14. Chung ES, Leon AR, Tavazzi L, et al., Results of the Predictors of Response to CRT (PROSPECT) trial, Circulation, 2008;117:2608–16.

15. Tournoux FB, Manzke R, Chan RC, et al., Integrating functional and anatomical information to facilitate cardiac

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2007;30:1021–2.

16. Tournoux F, Chan RC, Manzke R, et al., Integrating functional and anatomical information to guide cardiac

resynchronization therapy, Eur J Heart Fail, 2010;12:52–7.

17. Bleeker GB, Schalij MJ, Van Der Wall EE, Bax JJ, Postero- lateral scar tissue resulting in non-response to cardiac

resynchronization therapy, J Cardiovasc Electrophysiol,

2006;17:899–901.

18. Murphy RT, Sigurdsson G, Mulamalla S, et al., Tissue synchronization imaging and optimal left ventricular pacing site in cardiac resynchronization therapy, Am J Cardiol, 2006;97:1615–21.

19. Truong QA, Hoffmann U, Singh JP, Potential uses of computed tomography for management of heart failure patients with dyssynchrony, Crit Pathw Cardiol, 2008;7:185–90.

20. Truong QA, Singh JP, Cannon CP, et al., Quantitative analysis of intraventricular dyssynchrony using wall thickness by multidetector computed tomography,

JACC Cardiovasc Imaging, 2008;1:772–81.

21. Singh JP, Houser S, Heist EK, Ruskin JN, The coronary venous anatomy: a segmental approach to aid cardiac

resynchronization therapy, J Am Coll Cardiol, 2005;46:68–74.

22. Blendea D, Shah RV, Auricchio A, et al., Variability of coronary venous anatomy in patients undergoing cardiac resynchronization therapy: a high-speed rotational venography study, Heart Rhythm, 2007;4:1155–62.

23. Fung JW, Yu CM, Yip G, et al., Variable left ventricular activation pattern in patients with heart failure and left bundle branch block, Heart, 2004;90:17–19.

24. Singh JP, Fan D, Heist EK, et al., Left ventricular lead

electrical delay predicts response to cardiac resynchronization therapy, Heart Rhythm, 2006;3:1285–92.

25. Heist EK, Fan D, Mela T, et al., Radiographic left ventricular- right ventricular interlead distance predicts the acute hemodynamic response to cardiac resynchronization

therapy, Am J Cardiol, 2005;96:685–90.

26. Singh JP, Heist EK, Ruskin JN, Harthorne JW, “Dialing-in” cardiac resynchronization therapy: overcoming constraints of the coronary venous anatomy, J Interv Card Electrophysiol, 2006;17:51–8.

27. Arzola-Castaner D, Taub C, Kevin Heist E, et al., Left ventricular lead proximity to an akinetic segment and impact on outcome of cardiac resynchronization therapy,

J Cardiovasc Electrophysiol, 2006;17:623–7.

28. Leon AR, Abraham WT, Brozena S, et al., Cardiac resynchronization with sequential biventricular pacing for the treatment of moderate-to-severe heart failure, J Am Coll Cardiol, 2005;46:2298–2304.

29. Kerlan JE, Sawhney NS, Waggoner AD, et al., Prospective comparison of echocardiographic atrioventricular delay optimization methods for cardiac resynchronization therapy, Heart Rhythm, 2006;3:148–54.

30. Sawhney NS, Waggoner AD, Garhwal S, et al., Randomized prospective trial of atrioventricular delay programming for cardiac resynchronization therapy, Heart Rhythm, 2004;1: 562–7.

31. Waggoner AD, Rovner A, de las Fuentes L, et al., Clinical outcomes after cardiac resynchronization therapy: importance of left ventricular diastolic function and origin of heart failure, J Am Soc Echocardiogr, 2006;19:307–13.

32. Ritzema J, Melton IC, Richards AM, et al., Direct left atrial pressure monitoring in ambulatory heart failure patients: initial experience with a new permanent implantable device, Circulation, 2007;116:2952–9.

33. Moss AJ, Hall WJ, Cannom DS, et al., Cardiac- resynchronization therapy for the prevention of heart-

failure events, N Engl J Med, 2009;361:1329–38.

34. St John Sutton M, Ghio S, Plappert T, et al., Cardiac resynchronization induces major structural and functional reverse remodeling in patients with New York Heart Association class I/II heart failure, Circulation, 2009;120: 1858–65.

EUROPEAN CARDIOLOGY

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