Resynchronization Therapy

Morphological study regarding alternative His bundle pacing Introduction: Permanent cardiac pacing is a method of choice in the treatment of specific arrhythmias and conduction disturbances. The latest includes not only implantation to the top of the right ventricle's apex, but also at its outlet and in the area of membranous septum, where the His bundle is located.

Morfologiczne aspekty stymulacji serca Wstep: Stala stymulacja peczka Hisa zapewnia najbardziej fizjologiczny front depolaryzacji mieśnia komor. Cel pracy: Morfologiczna ocena mozliwości stymulacji peczka Hisa i uszkodzen powstalych w wyniku wkrecania elektrody z aktywną fiksacją w okolice przegrody bloniastej (PB). Material i metody: Badanie objelo 32 serca ludzi doroslych, obojga plci (13K, 19M), w wieku 19–82 lat. Do badan uzywano elektrody z aktywną fiksacją, ktorą wkrecano w PB (3–4 obroty). Analizowano obraz makro- i mikroskopowy okolicy PB po umieszczeniu w niej powyzszej elektrody. PB zostala podzielona na 5 cześci: przednio-gorną (PG), tylno-gorną (TG), tylno-dolną (TD), przednio-dolną (PD) i centralną (CC). Badano rowniez mozliwośc uszkodzenia w wyniku implantacji elektrody nastepujących struktur serca: ściany aorty (AO), platka przegrodowego zastawki trojdzielnej (TR), drogi odplywu lewej komory (DOLK). Wyniki: Na podstawie naszych obserwacji stwierdziliśmy, iz tylko w 62...

The primary objectives of this study were to compare the implantation course of triple-site (double left-single right) and conventional cardiac resynchronization devices. The secondary target was to assess mid-term outcomes of both types of cardiac resynchronization therapy (CRT).
METHODS:
Fifty-four patients with NYHA classes III-IV, left ventricular EF<or=35% and QRS>or=120 ms were included; 27 received triple-site pacemakers (TRIV group), 27 conventional CRT devices (BIV group). Procedural course, clinical data, QRS duration, echocardiographic parameters, peak oxygen consumption (VO2max) and 6-minute walking distance (6MWD) were screened for inter-group differences.
RESULTS:
Procedure duration was higher in TRIV than in BIV group (197.6 vs. 137.6 min, P<0.001), fluoroscopy exposure and complication-rates were similar. After 3 months of CRT, triple-site pacing was associated with a more significant (P<0.05) NYHA class reduction (by 1.4 vs. 1.0 class, respectively), increase in VO(2) max (2.9 vs. 1.1 mL/kg/min) and 6MWD (98.7 vs. 51.6 m) than conventional CRT. A higher EF and more improved intraventricular synchrony were observed in the TRIV than in the BIV group. The response rate in the TRIV group was 96.3% vs. 62.9% in the conventional group (P=0.002). Triple-site stimulation was an independent predictor of response to CRT (adjusted odds ratio 26.4, P=0.01).
CONCLUSIONS:
Triple-site resynchronization appears to be more beneficial than conventional CRT. Upgrade to triple-site CRT may be considered in non-responders to standard resynchronization

The primary objectives of this study were to compare the implantation course of triple-site (double left–single right) and conventional cardiac resynchronization devices. The secondary target was to assess mid-term outcomes of both types of cardiac resynchronization therapy (CRT).Fifty-four patients with NYHA classes III–IV, left ventricular EF ≤ 35% and QRS ≥ 120 ms were included; 27 received triple-site pacemakers (TRIV group), 27 conventional CRT devices (BIV group). Procedural course, clinical data, QRS duration, echocardiographic parameters, peak oxygen consumption (VO2max) and 6-minute walking distance (6MWD) were screened for inter-group differences.Procedure duration was higher in TRIV than in BIV group (197.6 vs. 137.6 min, P < 0.001), fluoroscopy exposure and complication-rates were similar. After 3 months of CRT, triple-site pacing was associated with a more significant (P < 0.05) NYHA class reduction (by 1.4 vs. 1.0 class, respectively), increase in VO2 max (2.9 vs. 1.1 mL/kg/min) and 6MWD (98.7 vs. 51.6 m) than conventional CRT. A higher EF and more improved intraventricular synchrony were observed in the TRIV than in the BIV group. The response rate in the TRIV group was 96.3% vs. 62.9% in the conventional group (P = 0.002). Triple-site stimulation was an independent predictor of response to CRT (adjusted odds ratio 26.4, P = 0.01).Triple-site resynchronization appears to be more beneficial than conventional CRT. Upgrade to triple-site CRT may be considered in non-responders to standard resynchronization.