‘Optimized’ LV only pacing using a dual chamber pacemaker as a cost effective alternative to CRT

Maneesh K. Rai, Mukund A. Prabhu, Abhishek Sharma, Ritesh Vekariya, Padmanabh Kamath, Narasimha Pai, Ramanath L. Kamath

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Cardiac Resynchronization therapy (CRT) remains largely under-used in developing countries owing to the high cost of therapy. In this pilot study, we explore ‘optimized’ Left Ventricle Only Pacing (LVOP) as a cost effective alternative to cardiac resynchronization therapy in selected patients with heart failure. Hypothesis In economically poorer patients with heart failure, left bundle branch block (LBBB) and intact AV node conduction, synchronization can be obtained using a dual chamber pacemaker (leads in right atrium and Left ventricle) with the help of 2D strain imaging. Methods and results 4 patients underwent LVOP for symptomatic heart failure. Post procedure ‘optimization’ was done using 12 lead electrocardiography and 2D- Strain imaging. Difference between Time to Peak longitudinal strain and Aortic valve Closure (Diff TPL-AC) was calculated for each segment at different AV delays and the AV delay with the smallest Diff TPL-AC was programmed. The mean AV delay that resulted in electrical and mechanical synchrony was 150 ms. After a mean follow up of 6 months, all patients had improved by at least 1 NYHA class. The mean reduction in QRS duration post procedure was −54.5 ± 22.82 ms and the mean improvement in EF was 7 ± 2.75%. Conclusion Optimized LVOP using 2D strain and ECG can be a cost-effective alternative to CRT in patients with LBBB, heart failure and normal AV node conduction.

Original languageEnglish
Pages (from-to)72-77
Number of pages6
JournalIndian Pacing and Electrophysiology Journal
Volume17
Issue number3
DOIs
Publication statusPublished - 01-05-2017

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Cardiac Resynchronization Therapy
Heart Ventricles
Costs and Cost Analysis
Heart Failure
Atrioventricular Node
Bundle-Branch Block
Electrocardiography
Heart Atria
Aortic Valve
Developing Countries

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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title = "‘Optimized’ LV only pacing using a dual chamber pacemaker as a cost effective alternative to CRT",
abstract = "Background Cardiac Resynchronization therapy (CRT) remains largely under-used in developing countries owing to the high cost of therapy. In this pilot study, we explore ‘optimized’ Left Ventricle Only Pacing (LVOP) as a cost effective alternative to cardiac resynchronization therapy in selected patients with heart failure. Hypothesis In economically poorer patients with heart failure, left bundle branch block (LBBB) and intact AV node conduction, synchronization can be obtained using a dual chamber pacemaker (leads in right atrium and Left ventricle) with the help of 2D strain imaging. Methods and results 4 patients underwent LVOP for symptomatic heart failure. Post procedure ‘optimization’ was done using 12 lead electrocardiography and 2D- Strain imaging. Difference between Time to Peak longitudinal strain and Aortic valve Closure (Diff TPL-AC) was calculated for each segment at different AV delays and the AV delay with the smallest Diff TPL-AC was programmed. The mean AV delay that resulted in electrical and mechanical synchrony was 150 ms. After a mean follow up of 6 months, all patients had improved by at least 1 NYHA class. The mean reduction in QRS duration post procedure was −54.5 ± 22.82 ms and the mean improvement in EF was 7 ± 2.75{\%}. Conclusion Optimized LVOP using 2D strain and ECG can be a cost-effective alternative to CRT in patients with LBBB, heart failure and normal AV node conduction.",
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‘Optimized’ LV only pacing using a dual chamber pacemaker as a cost effective alternative to CRT. / Rai, Maneesh K.; Prabhu, Mukund A.; Sharma, Abhishek; Vekariya, Ritesh; Kamath, Padmanabh; Pai, Narasimha; Kamath, Ramanath L.

In: Indian Pacing and Electrophysiology Journal, Vol. 17, No. 3, 01.05.2017, p. 72-77.

Research output: Contribution to journalArticle

TY - JOUR

T1 - ‘Optimized’ LV only pacing using a dual chamber pacemaker as a cost effective alternative to CRT

AU - Rai, Maneesh K.

AU - Prabhu, Mukund A.

AU - Sharma, Abhishek

AU - Vekariya, Ritesh

AU - Kamath, Padmanabh

AU - Pai, Narasimha

AU - Kamath, Ramanath L.

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Y1 - 2017/5/1

N2 - Background Cardiac Resynchronization therapy (CRT) remains largely under-used in developing countries owing to the high cost of therapy. In this pilot study, we explore ‘optimized’ Left Ventricle Only Pacing (LVOP) as a cost effective alternative to cardiac resynchronization therapy in selected patients with heart failure. Hypothesis In economically poorer patients with heart failure, left bundle branch block (LBBB) and intact AV node conduction, synchronization can be obtained using a dual chamber pacemaker (leads in right atrium and Left ventricle) with the help of 2D strain imaging. Methods and results 4 patients underwent LVOP for symptomatic heart failure. Post procedure ‘optimization’ was done using 12 lead electrocardiography and 2D- Strain imaging. Difference between Time to Peak longitudinal strain and Aortic valve Closure (Diff TPL-AC) was calculated for each segment at different AV delays and the AV delay with the smallest Diff TPL-AC was programmed. The mean AV delay that resulted in electrical and mechanical synchrony was 150 ms. After a mean follow up of 6 months, all patients had improved by at least 1 NYHA class. The mean reduction in QRS duration post procedure was −54.5 ± 22.82 ms and the mean improvement in EF was 7 ± 2.75%. Conclusion Optimized LVOP using 2D strain and ECG can be a cost-effective alternative to CRT in patients with LBBB, heart failure and normal AV node conduction.

AB - Background Cardiac Resynchronization therapy (CRT) remains largely under-used in developing countries owing to the high cost of therapy. In this pilot study, we explore ‘optimized’ Left Ventricle Only Pacing (LVOP) as a cost effective alternative to cardiac resynchronization therapy in selected patients with heart failure. Hypothesis In economically poorer patients with heart failure, left bundle branch block (LBBB) and intact AV node conduction, synchronization can be obtained using a dual chamber pacemaker (leads in right atrium and Left ventricle) with the help of 2D strain imaging. Methods and results 4 patients underwent LVOP for symptomatic heart failure. Post procedure ‘optimization’ was done using 12 lead electrocardiography and 2D- Strain imaging. Difference between Time to Peak longitudinal strain and Aortic valve Closure (Diff TPL-AC) was calculated for each segment at different AV delays and the AV delay with the smallest Diff TPL-AC was programmed. The mean AV delay that resulted in electrical and mechanical synchrony was 150 ms. After a mean follow up of 6 months, all patients had improved by at least 1 NYHA class. The mean reduction in QRS duration post procedure was −54.5 ± 22.82 ms and the mean improvement in EF was 7 ± 2.75%. Conclusion Optimized LVOP using 2D strain and ECG can be a cost-effective alternative to CRT in patients with LBBB, heart failure and normal AV node conduction.

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