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Cardiac Electrophysiology Clinics

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https://read.qxmd.com/read/30717859/evolving-strategies-in-heart-failure-management-an-eye-toward-cardiac-resynchronization-therapy
#1
EDITORIAL
Gopi Dandamudi, Jagmeet P Singh
No abstract text is available yet for this article.
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717858/cardiac-resynchronization-therapy
#2
EDITORIAL
Ranjan K Thakur, Andrea Natale
No abstract text is available yet for this article.
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717857/benefits-of-multisite-multipoint-pacing-to-improve-cardiac-resynchronization-therapy-response
#3
REVIEW
Bernard Thibault, Blandine Mondésert, Julia Cadrin-Tourigny, Marc Dubuc, Laurent Macle, Paul Khairy
This article provides a general overview of the underlying mechanisms that support pacing from more discrete points and/or a wider vector (multisite and multipoint pacing) to improve left ventricular resynchronization. We performed a critical overview of the current literature and to identify some remaining knowledge gaps to spur further research. It was not our goal to provide a systematic review with a comprehensive bibliography, but rather to focus on selected publications that, in our opinion, have either expertly reviewed a specific aspect of cardiac resynchronization therapy or have been landmark studies in the field...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717856/optimizing-cardiac-resynchronization-therapy-devices-in-follow-up-to-improve-response-rates-and-outcomes
#4
REVIEW
Jose María Tolosana, Josep Brugada
Although cardiac resynchronization therapy (CRT) will improve symptoms and survival in selected heart failure patients, there still remains a high percentage of CRT recipients who do not obtain benefit from the therapy. During CRT follow-up, an effort should be made to identify and to treat reversible causes of nonresponse to CRT. This effort includes optimization of medical therapy, checking for appropriate and effective biventricular pacing, and treatment of arrhythmias and other reversible causes of CRT malfunction...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717855/challenging-implants-require-tools-and-techniques-not-tips-and-tricks
#5
REVIEW
Seth J Worley
The EP Clinics article "How to implant CRT devices in a busy clinical practice" describes the basics of the "interventional telescoping technique". This article focuses on specific circumstances where the tools and techniques are invaluable: (1) inability to locate the coronary sinus (CS), (2) inability to advance a catheter into the CS, (3) patients with CS atresia, (4) unstable CS access, (4) angulated target veins, (5) small and/or tortuous target veins, (6) target veins into which a wire cannot be advanced, (7) target veins with a drain pipe takeoff, (8) target veins close to the CS ostium...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717854/how-to-implant-cardiac-resynchronization-therapy-in-a-busy-clinical-practice
#6
REVIEW
Daniel J Friedman, Kevin P Jackson
Implantation of cardiac resynchronization therapy devices represents one of the more challenging and time-consuming procedures for the clinical electrophysiologist. This article reviews several strategies used to improve efficiency, safety, and effectiveness of cardiac resynchronization therapy implantation. The cornerstone of our strategy to improve efficiency, safety, and quality of cardiac resynchronization therapy implantation is the use of a telescoping guide system with high-quality venography. Competency in subclavian venoplasty and snaring techniques are essential to maintain efficiency and effectiveness during difficult cases...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717853/updated-clinical-evidence-for-effective-cardiac-resynchronization-therapy-in-congestive-heart-failure-and-timing-of-implant
#7
REVIEW
Natalia Hernandez, David T Huang
Investigative works of the past 20 years have compiled extensive data on the effectiveness and implications of cardiac resynchronization therapy (CRT) in patients with heart failure. Since then, CRT has become a well-accepted and widely adapted adjunctive therapy for patients with heart failure with ventricular dyssynchrony. This overview discusses the updated knowledge on the benefits afforded with CRT and reviews the major clinical trials that have established CRT at its current practice. Based on the data, the indications of CRT and the timing of appropriate implant of CRT devices with respect to heart failure status will be presented...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717852/cardiac-magnetic-resonance-as-a-tool-to-assess-dyssynchrony
#8
REVIEW
Edmond Obeng-Gyimah, Saman Nazarian
Cardiac resynchronization therapy (CRT) improves cardiac mechanics and quality of life in many patients with evidence of electromechanical cardiac dyssynchrony. However, up to 30% of patients receiving CRT do not respond to therapy. The mediator for poor response likely varies among patients; however, careful evaluation of mechanical dyssynchrony may inform management strategies. In this article, some of the methods and supporting evidence for dyssynchrony assessment with MRI as a predictor for CRT response are presented...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717851/why-dyssynchrony-matters-in-heart-failure
#9
REVIEW
Bhupendar Tayal, Peter Sogaard, Niels Risum
Cardiac resynchronization therapy (CRT) is an electrical therapy to resolve an electrical problem. Any method to predict CRT response must specifically reflect the electrical substrate. Time-to-peak dyssynchrony is too unspecific for prediction of response because dyssynchrony by this approach may reflect the presence of scar or fibrosis even in the absence of conduction delay. New methods are based on the actual physiology of activation delay-induced heart failure (HF) and are superior to time-to-peak methods in predicting CRT response...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717850/contemporary-treatment-of-heart-failure
#10
REVIEW
Maya H Barghash, Sean P Pinney
Heart failure (HF) affects 2.4% of the adult population in the United States and is associated with high health care costs. Medical and device therapy delay disease progression and improve survival in HF with reduced ejection fraction. Stage D HF is characterized by significant functional limitation, frequent HF hospitalization for decompensation, intolerance of medical therapy, use of inotropes, and high diuretic requirement. Advanced therapies with left ventricular assist devices and cardiac transplantation reduce mortality and improve quality of life, and early referral to specialized centers is imperative for patient selection and success with these therapies...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717849/evolving-role-of-permanent-his-bundle-pacing-in-conquering-dyssynchrony
#11
REVIEW
Parikshit S Sharma, Pugazhendhi Vijayaraman
Permanent His bundle pacing (PHBP) has shown significant clinical benefits in patients requiring ventricular pacing compared with conventional right ventricular pacing. There is an emerging role for PHBP in patients with interventricular dyssynchrony. This article reviews the mechanisms and the available data on the use of PHBP in overcoming dyssynchrony.
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717848/left-ventricular-endocardial-pacing-leadless-pacing
#12
REVIEW
Alan Hanley, E Kevin Heist
Several clinical trials have established the role of cardiac resynchronization therapy in patients with heart failure, impaired left ventricular function and dyssynchrony. Challenges to traditional therapy include coronary sinus anatomy and failure to respond. Left ventricular endocardial pacing could overcome anatomic constraints, provide more flexibility, and allow for more physiologic activation. Cases and case series have demonstrated the promise of the approach. Preclinical studies support the superior hemodynamic effects of left ventricular endocardial pacing...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717847/role-of-atrioventricular-junctional-ablation-and-cardiac-resynchronization-therapy-in-patients-with-chronic-atrial-fibrillation
#13
REVIEW
Jonathan S Steinberg
There remains a great deal of uncertainty whether general application of cardiac resynchronization therapy (CRT) to patients with atrial fibrillation (AF) provides any benefit assuming all other eligibility criteria are met. Preliminary observations suggest that performing atrioventricular junction ablation can improve the results of CRT in patients with AF by rendering the patient pacemaker dependent. Ongoing randomized clinical trials may provide more definitive answers in the future.
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717846/cardiac-resynchronization-therapy-in-preserved-to-mildly-reduced-systolic-function
#14
REVIEW
Chance M Witt, Yong-Mei Cha
Cardiac resynchronization therapy has been proven to be clearly beneficial for patients with heart failure, a prolonged QRS duration, and a left ventricular ejection fraction ≤35%. Ejection fraction cutoff, however, is arbitrary and very likely excludes many patients who could benefit from cardiac resynchronization. This article describes the major detrimental effects of left bundle branch block and summarizes the data regarding the potential beneficial effects of cardiac resynchronization in patients with a left ventricular ejection fraction greater than 35%...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717845/explanting-chronic-coronary-sinus-leads
#15
REVIEW
Theofanie Mela
Cardiac resynchronization therapy (CRT) has become the gold standard for patients with systolic left ventricular function, left ventricular ejection fraction less than or equal to 35%, wide complex QRS, and symptomatic heart failure. Annual implantation volume has steadily increased because of expanding indications for CRT. Improved survival resulted in many of these patients having their CRT devices for many years and eventually requiring an increased number of device-related procedures, including coronary sinus lead revisions and replacements following a coronary sinus lead extraction...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717844/increasing-role-of-remote-monitoring-of-cardiac-resynchronization-therapy-devices-in-improving-outcomes
#16
REVIEW
Suneet Mittal
Remote monitoring has become an essential component of the care of patients with a cardiac implantable electronic device, including those undergoing cardiac resynchronization therapy-defibrillator implantations. It allows for earlier detection of battery- and lead-related issue, atrial and ventricular arrhythmias, and may facilitate early identification of patients at risk for developing an exacerbation of heart failure. The data for the clinical utility of remote monitoring have been mixed. Additional studies are ongoing to determine how best to detect heart failure in these patients and how best to manage these patients based on the information...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717843/gender-based-differences-in-cardiac-resynchronization-therapy-response
#17
REVIEW
Marin Nishimura, Ulrika Birgersdotter-Green
Cardiac resynchronization therapy (CRT) has been shown to have a multitude of beneficial effects in select patients with systolic heart failure, by enhancing reverse remodeling, improving quality of life and functional status, reducing risk of heart failure admission, and most importantly, improving survival. Although women were underrepresented in the clinical trials, they were demonstrated to derive greater therapeutic benefit from CRT compared with men. Importantly, women were noted to derive benefit at a lesser degree of QRS prolongation than men, well below the now generally accepted cutoff of QRS ≥150 milliseconds...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717842/the-many-faces-of-heart-failure
#18
REVIEW
David Snipelisky, Sunit-Preet Chaudhry, Garrick C Stewart
Heart failure is a heterogeneous clinical syndrome stemming from cardiac overload and injury that leads to considerable morbidity and mortality. This review highlights the many faces of heart failure, a major and growing public health problem, including its causes, classification, underlying pathophysiology, and variable progression. An individualized, patient-centered treatment approach that focuses on guideline-directed pharmacologic and device therapies is required for optimal management of this complex syndrome...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30717841/economic-impact-of-chronic-heart-failure-management-in-today-s-cost-conscious-environment
#19
REVIEW
Chonyang Albert, Jerry D Estep
"Heart failure is a global pandemic that is becoming an increasingly common diagnosis due to aging of the population and increased longevity. Understanding the scope and costs of current heart failure management will lead to improved health economic decision making. Interventions to reduce spending in heart failure care have been centered on reduction of readmissions, improvement in transitions of care, and innovations in technology that have further improved quality of life. Technological advancements in outpatient monitoring offers the hope of further reducing morbidity, mortality, and cost in heart failure...
March 2019: Cardiac Electrophysiology Clinics
https://read.qxmd.com/read/30396585/lead-management-for-electrophysiologists
#20
EDITORIAL
Noel G Boyle, Bruce L Wilkoff
No abstract text is available yet for this article.
December 2018: Cardiac Electrophysiology Clinics
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