Optimal Pacing for Right Ventricular and Biventricular Devices

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Presentation transcript:

Optimal Pacing for Right Ventricular and Biventricular Devices by Anne M. Gillis Circ Arrhythm Electrophysiol Volume 7(5):968-977 October 21, 2014 Copyright © American Heart Association, Inc. All rights reserved.

Mechanisms by which right ventricular (RV) apical pacing causes heart failure (HF) and atrial fibrillation (AF). Mechanisms by which right ventricular (RV) apical pacing causes heart failure (HF) and atrial fibrillation (AF). LA indicates left atrial; and LVEF, left ventricular ejection fraction. Anne M. Gillis Circ Arrhythm Electrophysiol. 2014;7:968-977 Copyright © American Heart Association, Inc. All rights reserved.

Time to development of persistent atrial fibrillation (AF) in patients randomized to conventional DDD pacing (AV delays, 120–180 ms) was significantly shorter when compared with those randomized to DDD with minimal pacing algorithms programmed on. Time to development of persistent atrial fibrillation (AF) in patients randomized to conventional DDD pacing (AV delays, 120–180 ms) was significantly shorter when compared with those randomized to DDD with minimal pacing algorithms programmed on. The minimal pacing algorithms were either a Search AV hysteresis feature or the Managed Ventricular Pacing algorithm which mode switches from AAI to DDD. Reprinted from Sweeney et al5 with permission of the publisher. Copyright © 2007, Massachusetts Medical Society. Anne M. Gillis Circ Arrhythm Electrophysiol. 2014;7:968-977 Copyright © American Heart Association, Inc. All rights reserved.

Meta-analysis of randomized clinical trials comparing the effect of right ventricular (RV) apical to alternate RV pacing sites on left ventricular ejection fraction (LVEF; trials with mid- and long-term [>1 year] follow-up). Meta-analysis of randomized clinical trials comparing the effect of right ventricular (RV) apical to alternate RV pacing sites on left ventricular ejection fraction (LVEF; trials with mid- and long-term [>1 year] follow-up). Reprinted from Shimony et al35 with permission of the publisher. Copyright © 2012, Oxford Journals. CI indicates confidence intervals; and WMD, weighted mean difference. Anne M. Gillis Circ Arrhythm Electrophysiol. 2014;7:968-977 Copyright © American Heart Association, Inc. All rights reserved.

The primary outcome in Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK-HF; time to death, an urgent care visit for heart failure requiring intravenous therapy or an increase in left ventricular end-systolic volume index, ≥15%) was significantly reduced in the biventricular group (n=186; 53.3%) compared with the right ventricular pacing group (n=220; 64.3%; P<0.001). The primary outcome in Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK-HF; time to death, an urgent care visit for heart failure requiring intravenous therapy or an increase in left ventricular end-systolic volume index, ≥15%) was significantly reduced in the biventricular group (n=186; 53.3%) compared with the right ventricular pacing group (n=220; 64.3%; P<0.001). Reprinted from Curtis et al8 with permission of the publisher. Copyright © 2013, Massachusetts Medical Society. Anne M. Gillis Circ Arrhythm Electrophysiol. 2014;7:968-977 Copyright © American Heart Association, Inc. All rights reserved.

Top, Examples of QLV measurements in 2 patients showing onset of QRS and peak of the left ventricular (LV) electrogram (EGM). Top, Examples of QLV measurements in 2 patients showing onset of QRS and peak of the left ventricular (LV) electrogram (EGM). Bottom, Changes in LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), ejection fraction (EF), and Quality of Life (QoL) at 6-month follow-up for the QLV quartiles. Data are median±interquartile range (box). Significant improvements in LV volumes, LVEF, and QoL were observed in the QLV quartiles 95 to 120 ms and 120 to 195 ms. Reprinted from Gold et al51 with permission of the publisher. Copyright © 2011, Oxford Journals. Anne M. Gillis Circ Arrhythm Electrophysiol. 2014;7:968-977 Copyright © American Heart Association, Inc. All rights reserved.

Meta-analysis of clinical studies evaluating AV and VV interval optimization on cardiovascular outcomes. Meta-analysis of clinical studies evaluating AV and VV interval optimization on cardiovascular outcomes. Data from studies based on intention to treat. Reprinted from Auger et al58 with permission of the publisher. Copyright © 2013, Elsevier Publishers. CI indicates confidence interval; CLEAR, Clinical Evaluation of Advanced Resynchronization; DECREASE HF, Device Evaluation of Contak Renewal 2 and Easytrak 2; FREEDOM, Frequent Optimization Study Using the QuickOpt Method; M-H, Mantel-Haenszel; OPT, optimization; RHYTHM-II, Resynchronization for the Hemodynamic Treatment of Heart Failure Management; and SMART-AV, SmartDelay Determined AV Optimization: Comparison of Other AV Delay Methods Used in Cardiac Resynchronization Therapy. Anne M. Gillis Circ Arrhythm Electrophysiol. 2014;7:968-977 Copyright © American Heart Association, Inc. All rights reserved.

Survival in patients with cardiac resynchronization therapy was followed up in the ALTITUDE registry based on cumulative % biventricular (BiV) pacing dichotomized at 98.5% and atrial fibrillation (AFib) burden dichotomized at 5%. Survival in patients with cardiac resynchronization therapy was followed up in the ALTITUDE registry based on cumulative % biventricular (BiV) pacing dichotomized at 98.5% and atrial fibrillation (AFib) burden dichotomized at 5%. Reprinted from Hayes et al63 with permission of the publisher. Copyright © 2011, Elsevier Publishers. Anne M. Gillis Circ Arrhythm Electrophysiol. 2014;7:968-977 Copyright © American Heart Association, Inc. All rights reserved.

Left, Event-free survival from death or first heart failure (HF) hospitalization based on % synchronized left ventricular pacing (sLVP). Left, Event-free survival from death or first heart failure (HF) hospitalization based on % synchronized left ventricular pacing (sLVP). Right, Proportion of patients with improved clinical composite score at 6- and 12-month follow-up based on % sLVP. Reprinted from Birnie et al66 with permission of the publisher. Copyright © 2013, Elsevier Publishers. Anne M. Gillis Circ Arrhythm Electrophysiol. 2014;7:968-977 Copyright © American Heart Association, Inc. All rights reserved.