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Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Cardiomyopathy V: Interprofessional Care01:29

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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...
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Dysrhythmias VI: Management of Dysrhythmias01:25

Dysrhythmias VI: Management of Dysrhythmias

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Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
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Cardiomyopathy II: Dilated Cardiomyopathy01:30

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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,...
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Heart Failure VI: Adjunct Therapies01:22

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Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
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Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

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Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
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Related Experiment Video

Updated: Aug 27, 2025

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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Impact of long-term optimizing atrioventricular delay using device-based algorithms on cardiac resynchronization

Yoshifumi Ikeda1, Ritsushi Kato2, Kenta Tsutsui2

  • 1Department of Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan. yooikeda@aol.com.

Heart and Vessels
|September 29, 2022
PubMed
Summary

Optimizing atrioventricular delay (AVD) with device-based algorithms (DBAs) significantly improves survival rates for cardiac resynchronization therapy (CRT) patients. This approach also enhances the prognosis for CRT non-responders, offering a crucial benefit.

Keywords:
Atrioventricular delayCardiac resynchronization therapyDevice-based algorithmsHeart failure

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Devices

Background:

  • Sub-optimal atrioventricular delay (AVD) is a primary reason for non-response to cardiac resynchronization therapy (CRT).
  • Device-based algorithms (DBAs) offer a potential solution by optimizing AVD using intracardiac electrograms.
  • The long-term impact of DBAs on CRT patient outcomes remains largely unexplored.

Purpose of the Study:

  • To evaluate the long-term effectiveness of optimizing AVD with DBAs in patients undergoing CRT.
  • To assess the impact of this optimization strategy on patient prognosis, including response and survival rates.
  • To specifically investigate the survival benefit of DBAs in the population of CRT non-responders.

Main Methods:

  • Retrospective review of 118 patients who received CRT between April 2008 and March 2018.
  • Classification into a treated group (n=61) using DBAs for AVD optimization and a control group (n=57).
  • Analysis of responder rates, survival rates, and multivariate analysis of prognostic factors over a median follow-up of 46 months.

Main Results:

  • The treated group demonstrated significantly higher responder (64% vs. 46%) and survival rates (85.2% vs. 64.9%) compared to the control group.
  • In CRT non-responders, the treated group showed a significantly improved survival rate (72.7% vs. 45.1%).
  • Optimizing AVD with DBAs was identified as a significant independent predictor of improved survival in CRT non-responders (HR 3.6, p=0.01).

Conclusions:

  • Long-term optimization of AVD using DBAs improves survival rates in patients receiving CRT.
  • This strategy significantly enhances the prognosis for patients who are initially non-responders to CRT.
  • DBAs represent a valuable tool for improving long-term outcomes in CRT patients, particularly non-responders.