Cardiac resynchronization therapy: Dire need for targeted left ventricular lead placement and optimal device
Sokratis Pastromas1, Antonis S Manolis1
1Sokratis Pastromas, Antonis S Manolis, Department of Cardiology, Evagelismos Hospital, and Athens University School of Medicine, 10676 Athens , Greece.
World Journal of Cardiology
|December 31, 2014
Summary
Optimizing cardiac resynchronization therapy (CRT) involves precise left ventricular (LV) lead placement away from scar tissue and tailored device programming. This approach maximizes patient benefits and reduces non-response rates in heart failure management.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) using biventricular pacing is standard for specific heart failure patients (NYHA class II-IV, reduced LV function, wide QRS).
- CRT improves heart failure symptoms, LV function, hospitalizations, and survival.
- Maximizing CRT efficacy requires optimizing LV lead placement and device programming to minimize non-responders.
Purpose of the Study:
- To review current data on optimal LV lead placement and device programming for CRT.
- To understand how these factors impact clinical outcomes in heart failure patients.
Main Methods:
- Review of existing clinical data and studies on CRT lead placement and programming.
- Analysis of factors influencing CRT response, including LV lead position relative to myocardial scar and latest activation site.
- Evaluation of programming parameters such as atrioventricular (AV) and interventricular (VV) intervals.
Main Results:
- Optimal LV lead placement near the latest activation site and away from myocardial scar is crucial for CRT success.
- Appropriate programming of AV and VV intervals significantly influences CRT response and patient outcomes.
- These factors are key to reducing CRT non-response rates.
Conclusions:
- Strategic LV lead implantation and precise device programming are essential for maximizing the benefits of CRT.
- Further attention to these technical aspects can improve CRT effectiveness in heart failure patients.
- Optimizing CRT parameters enhances patient outcomes and reduces therapy non-responders.
Keywords:
Biventricular pacingCardiac dyssynchronyCardiac resynchronization therapyHeart failureLeft bundle branch blockMore Related Videos
10:17Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
2.3K
06:57Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
Published on: January 31, 2019
15.6K
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
724
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
724
01:24Cardiac Catheterization III: Left Heart Catheterization
1.3K
Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
1.3K
01:21Cardiac Catheterization II: Right Heart Catheterization
2.1K
Right Heart Catheterization: An OverviewRight heart catheterization is an invasive diagnostic procedure that measures right-sided cardiac and pulmonary artery pressures, calculates cardiac output, and identifies intracardiac shunts. It provides detailed hemodynamic data essential for diagnosing and managing various cardiovascular conditions, such as pulmonary hypertension.Access SitesCommon access sites for right heart catheterization include the internal jugular vein in the neck region, the...
2.1K
01:28Electrocardiogram Fundamentals
2.1K
Introduction
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...
2.1K
01:26Cardiac Catheterization IV: Nursing Management
1.2K
Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
1.2K
01:30Cardiomyopathy II: Dilated Cardiomyopathy
807
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
807