![]() ![]() ![]() ![]() It showed that incorporation of active monitoring led to targeted changes with a higher frequency of medication titration and reduced HF hospitalizations. #Ivcd heart rhythm trialThe CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in Class III HF) trial was a randomized, controlled, single-blind trial that evaluated this device (active PA pressure-guided monitoring group) with standard care versus standard care with clinical assessment in 550 NYHA class III HF patients. The information can be submitted electronically to patients' healthcare providers. 44 Implantable Pulmonary Artery Pressure SensorĬardioMEMS is currently the only FDA-approved miniaturized, wireless monitoring sensor that is implanted in the pulmonary artery to measure PA pressure directly. 43 A survival benefit is seen in those patients with HF and CKD who are responsive to cardiac resynchronization therapy (CRT), as well as preservation and improvement of renal function in some cases. Intraventricular conduction delay can be seen in up to 20% to 30% of those with symptomatic HF resulting in dyssynchrony and reduction in pump performance. Thakar, in Critical Care Nephrology (Third Edition), 2019 Over the Horizon Cardiac Resynchronization Therapy This is highlighted by the observation that simultaneous BiV pacing yields evidence of ventricular activation fusion, which is necessary for reverse volumetric remodeling, in only about 55% of cases. The ability to orchestrate ventricular chamber timing should theoretically provide additional leverage for overcoming functional and physiologic conduction barriers, to obtain maximum evidence of ventricular activation wavefront fusion. 6Įquivalent conduction times between widely spaced RV and LV stimulation sites does not guarantee that simultaneous BiV pacing will generate global ventricular activation wavefront fusion.Īgainst this background, a role of timed (sequential) ventricular stimulation exists. Selection of LV pacing sites based on interventricular timing recorded by local EGMs (RV, LV) may be misleading because simultaneous activation timing at widely spaced RV and LV sites may occur in LBBB and does not indicate absence of mechanical delay. Resynchronization of the most delayed LV region may be irrelevant if there is a large intervening zone of scar. 3Īny pacing site may induce or worsen conduction block unpredictably and degrade or abolish ventricular activation wavefront fusion. Stimulation from these sites can effectively correct LV conduction delay and probably explains why some patients improve with non–LV posterior wall stimulation. Other unpredictable sites (anterior wall, apex) may be latest activated in some patients because of the effects of conduction blocks on wavefront propagation. The LV posterior wall adjacent to the mitral annulus is almost always the latest electrically activated (most delayed) site during LBBB conduction and should be targeted for LV pacing. Based on current limited understanding of the problem, the following conclusions can be made: 1 Ventricular conduction blocks present diverse and unpredictable challenges to generating ventricular activation wavefront fusion during CRT. ![]()
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