13 results on '"Sohaib SMA"'
Search Results
2. Efficacy of pulmonary vein isolation in preventing atrial fibrillation: meta-analysis of randomized controlled trials with an invasive control procedure
- Author
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Sau, A, Howard, J, Al-Aidarous, S, Martins, J, Al-Khayatt, B, Lim, PB, Kanagaratnam, P, Whinnett, Z, Peters, N, Sikkel, M, Francis, D, Sohaib, SMA, Wellcome Trust, Rosetrees Trust, Imperial College Healthcare NHS Trust- BRC Funding, and British Heart Foundation
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Science & Technology ,Cardiac & Cardiovascular Systems ,Cardiovascular System & Hematology ,Cardiovascular System & Cardiology ,Life Sciences & Biomedicine ,1102 Cardiorespiratory Medicine and Haematology - Abstract
Introduction Pulmonary vein isolation (PVI) is a commonly used element in treatment of atrial fibrillation (AF) but has never been tested in an intentionally placebo (sham) controlled trial. Nevertheless there have been several randomized controlled trials (RCTs) in which both arms receive an ablation procedure but the only difference between treatment arms is inclusion or omission of PVI. As long as both doctor and patient have reason to believe that the procedures in both arms are effective, such RCTs could be an effective proxy for placebo controlled trials. Methods Medline and Cochrane databases were searched for RCTs comparing catheter ablation including PVI with left atrial ablation excluding PVI. The primary efficacy endpoint was freedom from AF/atrial tachycardia at 6 months. A random-effects meta-analysis was performed using the restricted maximum likelihood (REML) estimator. Results Overall, seven studies (909 patients) met inclusion criteria. Across the 7 trials, mean age was 57.3, 70.2% of participants were male. In four trials (352 patients) the non-PVI ablation procedure was performed in both arms, while PVI was performed in only one arm. The non-PVI ablation procedures were complex fractionated atrial electrogram ablation (2 studies), ganglionated plexi ablation (1 study) and focal impulse and rotor modulation (1 study). In these, AF recurrence was significantly lower when PVI was included (RR 0.48, 95% CI 0.26-0.90, I2 64.4%)In an analysis of all 7 studies, AF recurrence was significantly lower in ablation with an ablation strategy including PVI compared to one without PVI (Figure 1, RR 0.67, 95% CI 0.53-0.85, p = 0.001, I2 0%). Neither type of AF (persistent vs. paroxysmal, p=0.43) nor type of non-PVI ablation (p=0.35) were significant moderators of the effect size. A sensitivity analysis omitting each study in turn showed similar results to the primary analysis. In particular exclusion of the retracted OASIS trial showed results similar to the primary analysis. Conclusion PVI significantly reduces AF recurrence against a procedural control. A true placebo controlled trial of PVI versus placebo PVI (and no other procedure) might show an even larger efficacy because there would be no background efficacy in the control arm. It remains unknown how these convincing reductions in electrically documented AF would relate to symptom regression, since the correspondence between arrhythmia and symptoms is imperfect. A placebo (sham) controlled RCT would be the ideal method of testing this.
- Published
- 2019
3. Roadmap for cardiovascular education across the European Society of Cardiology: inspiring better knowledge and skills, now and for the future
- Author
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Kotecha, D, Bax, JJ, Carrera, C, Casadei, B, Merkely, B, Anker, SD, Vardas, PE, Kearney, PP, Roffi, M, Ros, M, Vahanian, A, Weidinger, F, Beeri, R, Budaj, A, Calabro, P, Czerwinska-Jelonkiewicz, K, D'Ascenzi, F, De Potter, T, Fox, KF, Hartikainen, J, McAdam, B, Milicic, D, Pasquet, AA, Sionis, A, Sohaib, SMA, Tsioufis, C, Verhorst, PMJ, and Kirchhof, P
- Subjects
Knowledge ,Skills ,ESC ,Training ,Curriculum ,Assessment ,European Society of Cardiology ,Education - Abstract
Aims The provision of high-quality education allows the European Society of Cardiology (ESC) to achieve its mission of better cardiovascular practice and provides an essential component of translating new evidence to improve outcomes Methods and results The 4th ESC Education Conference, held in Sophia Antipolis (December 2016), brought together ESC education leaders, National Directors of Training of 43 ESC countries, and representatives of the ESC Young Community. Integrating national descriptions of education and cardiology training, we discussed innovative pathways to further improve knowledge and skills across different training programmes and health care systems. We developed an ESC roadmap supporting better cardiology training and continued medical education (CME), noting: (i) The ESC provides an excellent framework for unbiased and up-to-date cardiovascular education in close cooperation with its National Societies. (ii) The ESC should support the harmonization of cardiology training, curriculum development, and professional dialogue and mentorship. (iii) ESC congresses are an essential forum to learn and discuss the latest developments in cardiovascular medicine. (iv) The ESC should create a unified, interactive educational platform for cardiology training and continued cardiovascular education combining Webinars, eLearning Courses, Clinical Cases, and other educational programmes, along with ESC Congress content, Practice Guidelines and the next ESC Textbook of Cardiovascular Medicine. (v) ESC-delivered online education should be integrated into National and regional cardiology training and CME programmes. Conclusion These recommendations support the ESC to deliver excellent and comprehensive cardiovascular education for the next generation of specialists. Teamwork between international, national and local partners is essential to achieve this objective.
- Published
- 2019
4. Meta-Analysis of Randomized Controlled Trials of Atrial Fibrillation Ablation With Pulmonary Vein Isolation Versus Without
- Author
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Sau, A, Howard, J, Al-Aidarous, S, Ferreira-Martins, J, Al-Khayatt, B, Lim, PB, Kanagaratnam, P, Whinnett, Z, Peters, N, Sikkel, M, Francis, D, Sohaib, SMA, Wellcome Trust, Rosetrees Trust, Imperial College Healthcare NHS Trust- BRC Funding, and British Heart Foundation
- Subjects
Male ,AF, atrial fibrillation ,PAF, paroxysmal atrial fibrillation ,PVI, pulmonary vein isolation ,PsAF, persistent atrial fibrillation ,GP, ganglionated plexi ,PWI, posterior wall isolation ,Middle Aged ,ablation ,Article ,CFAE, complex fractionated atrial electrograms ,Pulmonary Veins ,Recurrence ,LVEF, left ventricular ejection fraction ,Atrial Fibrillation ,AT, atrial tachycardia ,Catheter Ablation ,Humans ,Female ,RCT, randomized controlled trial ,pulmonary vein isolation ,Randomized Controlled Trials as Topic - Abstract
Objectives This meta-analysis examined the ability of pulmonary vein isolation (PVI) to prevent atrial fibrillation in randomized controlled trials (RCTs) in which the patients not receiving PVI nevertheless underwent a procedure. Background PVI is a commonly used procedure for the treatment of atrial fibrillation (AF), and its efficacy has usually been judged against therapy with anti-arrhythmic drugs in open-label trials. There have been several RCTs of AF ablation in which both arms received an ablation, but the difference between the treatment arms was inclusion or omission of PVI. These trials of an ablation strategy with PVI versus an ablation strategy without PVI may provide a more rigorous method for evaluating the efficacy of PVI. Methods Medline and Cochrane databases were searched for RCTs comparing ablation including PVI with ablation excluding PVI. The primary efficacy endpoint was freedom from atrial fibrillation (AF) and atrial tachycardia at 12 months. A random-effects meta-analysis was performed using the restricted maximum likelihood estimator. Results Overall, 6 studies (n = 610) met inclusion criteria. AF recurrence was significantly lower with an ablation including PVI than an ablation without PVI (RR: 0.54; 95% confidence interval [CI]: 0.33 to 0.89; p = 0.0147; I2 = 79.7%). Neither the type of AF (p = 0.48) nor the type of non-PVI ablation (p = 0.21) was a significant moderator of the effect size. In 3 trials the non-PVI ablation procedure was performed in both arms, whereas PVI was performed in only 1 arm. In these studies, AF recurrence was significantly lower when PVI was included (RR: 0.32; 95% CI: 0.14 to 0.73; p = 0.007, I2 78%). Conclusions In RCTs where both arms received an ablation, and therefore an expectation amongst patients and doctors of benefit, being randomized to PVI had a striking effect, reducing AF recurrence by a half., Central Illustration
- Published
- 2018
5. Utilization and perception of same-day discharge in electrophysiological procedures and device implantations: an EHRA survey.
- Author
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König S, Svetlosak M, Grabowski M, Duncker D, Nagy VK, Bogdan S, Vanduynhoven P, Sohaib SMA, Malaczynska-Raipold K, Lane DA, Lenarczyk R, Bollmann A, Hindricks G, Potpara TS, and Kosiuk J
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- Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac therapy, Europe, Humans, Perception, Surveys and Questionnaires, Catheter Ablation, Patient Discharge
- Abstract
The aim of this European Heart Rhythm Association (EHRA) survey was to assess the utilization of same-day discharge (SDD) in electrophysiology (EP). An online-based questionnaire was shared with the EHRA community between 12 and 30 June 2020 and recorded institutional information, complication assessment, recent experiences, and opinions regarding possible advantages or concerns with SDD. In total, 218 responses from 49 countries provided information on current SDD management. Overall, SDD was implemented in 77.5%, whereas this proportion was significantly higher in tertiary and high-volume centres (83.8% and 85.3%, both P < 0.01). The concept of SDD was most commonly used following implantations of cardiac event recorders (97%), diagnostic EP procedures (72.2%), and implantations of pacemakers with one or two intracardiac leads (50%), while the lowest SDD utilization was observed after catheter ablations of left atrial or ventricular arrhythmias. Within SDD-experienced centres, ∼90% respondents stated that this discharge concept is recommendable or highly recommendable and reported that rates of increased rehospitalization and complication rates were low. Most respondents assumed a better utilization of hospital resources (78.2%), better cost effectiveness (77.3%), and an improved patients' comfort but were concerned about possible impairment of detection (72.5%) and management (78.7%) of late complications. In conclusion, >75% of respondents already implement SDD following EP interventions with a large heterogeneity with regard to specific procedures. Further research is needed to confirm or disprove existing and expected benefits and obstacles., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2021
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6. Young@Heart: empowering the next generation of cardiovascular researchers.
- Author
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Hoes MF, Te Riele ASJM, Gladka MM, Westenbrink BD, van Hout GPJ, van den Hoogenhof MMG, Ghigo A, Bollini S, Purcell NH, Sohaib SMA, Kardys I, and Kuster DWD
- Abstract
In recognition of the increasing health burden of cardiovascular disease, the Dutch CardioVascular Alliance (DCVA) was founded with the ambition to lower the cardiovascular disease burden by 25% in 2030. To achieve this, the DCVA is a platform for all stakeholders in the cardiovascular field to align policies, agendas and research. An important goal of the DCVA is to guide and encourage young researchers at an early stage of their careers in order to help them overcome challenges and reach their full potential. Young@Heart is part of the DCVA that supports the young cardiovascular research community. This article illustrates the challenges and opportunities encountered by young cardiovascular researchers in the Netherlands and highlights Young@Heart's vision to benefit from these opportunities and optimise collaborations to contribute to lowering the cardiovascular disease burden together as soon as possible.
- Published
- 2020
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7. Meta-Analysis of Randomized Controlled Trials of Atrial Fibrillation Ablation With Pulmonary Vein Isolation Versus Without.
- Author
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Sau A, Howard JP, Al-Aidarous S, Ferreira-Martins J, Al-Khayatt B, Lim PB, Kanagaratnam P, Whinnett ZI, Peters NS, Sikkel MB, Francis DP, and Sohaib SMA
- Subjects
- Female, Humans, Male, Middle Aged, Randomized Controlled Trials as Topic, Recurrence, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Catheter Ablation methods, Catheter Ablation statistics & numerical data, Pulmonary Veins surgery
- Abstract
Objectives: This meta-analysis examined the ability of pulmonary vein isolation (PVI) to prevent atrial fibrillation in randomized controlled trials (RCTs) in which the patients not receiving PVI nevertheless underwent a procedure., Background: PVI is a commonly used procedure for the treatment of atrial fibrillation (AF), and its efficacy has usually been judged against therapy with anti-arrhythmic drugs in open-label trials. There have been several RCTs of AF ablation in which both arms received an ablation, but the difference between the treatment arms was inclusion or omission of PVI. These trials of an ablation strategy with PVI versus an ablation strategy without PVI may provide a more rigorous method for evaluating the efficacy of PVI., Methods: Medline and Cochrane databases were searched for RCTs comparing ablation including PVI with ablation excluding PVI. The primary efficacy endpoint was freedom from atrial fibrillation (AF) and atrial tachycardia at 12 months. A random-effects meta-analysis was performed using the restricted maximum likelihood estimator., Results: Overall, 6 studies (n = 610) met inclusion criteria. AF recurrence was significantly lower with an ablation including PVI than an ablation without PVI (RR: 0.54; 95% confidence interval [CI]: 0.33 to 0.89; p = 0.0147; I
2 = 79.7%). Neither the type of AF (p = 0.48) nor the type of non-PVI ablation (p = 0.21) was a significant moderator of the effect size. In 3 trials the non-PVI ablation procedure was performed in both arms, whereas PVI was performed in only 1 arm. In these studies, AF recurrence was significantly lower when PVI was included (RR: 0.32; 95% CI: 0.14 to 0.73; p = 0.007, I2 78%)., Conclusions: In RCTs where both arms received an ablation, and therefore an expectation amongst patients and doctors of benefit, being randomized to PVI had a striking effect, reducing AF recurrence by a half., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2019
- Full Text
- View/download PDF
8. Multicenter Randomized Controlled Crossover Trial Comparing Hemodynamic Optimization Against Echocardiographic Optimization of AV and VV Delay of Cardiac Resynchronization Therapy: The BRAVO Trial.
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Whinnett ZI, Sohaib SMA, Mason M, Duncan E, Tanner M, Lefroy D, Al-Obaidi M, Ellery S, Leyva-Leon F, Betts T, Dayer M, Foley P, Swinburn J, Thomas M, Khiani R, Wong T, Yousef Z, Rogers D, Kalra PR, Dhileepan V, March K, Howard J, Kyriacou A, Mayet J, Kanagaratnam P, Frenneaux M, Hughes AD, and Francis DP
- Subjects
- Action Potentials, Aged, Blood Pressure, Cross-Over Studies, Exercise Test, Exercise Tolerance, Female, Heart Failure diagnostic imaging, Heart Failure physiopathology, Heart Rate, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Recovery of Function, Time Factors, Treatment Outcome, United Kingdom, Blood Pressure Determination, Cardiac Resynchronization Therapy adverse effects, Echocardiography, Doppler, Heart Failure therapy, Hemodynamics
- Abstract
Objectives: BRAVO (British Randomized Controlled Trial of AV and VV Optimization) is a multicenter, randomized, crossover, noninferiority trial comparing echocardiographic optimization of atrioventricular (AV) and interventricular delay with a noninvasive blood pressure method., Background: Cardiac resynchronization therapy including AV delay optimization confers clinical benefit, but the optimization requires time and expertise to perform., Methods: This study randomized patients to echocardiographic optimization or hemodynamic optimization using multiple-replicate beat-by-beat noninvasive blood pressure at baseline; after 6 months, participants were crossed over to the other optimization arm of the trial. The primary outcome was exercise capacity, quantified as peak exercise oxygen uptake. Secondary outcome measures were echocardiographic left ventricular (LV) remodeling, quality-of-life scores, and N-terminal pro-B-type natriuretic peptide., Results: A total of 401 patients were enrolled, the median age was 69 years, 78% of patients were men, and the New York Heart Association functional class was II in 84% and III in 16%. The primary endpoint, peak oxygen uptake, met the criterion for noninferiority (p
noninferiority = 0.0001), with no significant difference between the hemodynamically optimized arm and echocardiographically optimized arm of the trial (mean difference 0.1 ml/kg/min). Secondary endpoints for noninferiority were also met for symptoms (mean difference in Minnesota score 1; pnoninferiority = 0.002) and hormonal changes (mean change in N-terminal pro-B-type natriuretic peptide -10 pg/ml; pnoninferiority = 0.002). There was no significant difference in LV size (mean change in LV systolic dimension 1 mm; pnoninferiority < 0.001; LV diastolic dimension 0 mm; pnoninferiority <0.001). In 30% of patients the AV delay identified as optimal was more than 20 ms from the nominal setting of 120 ms., Conclusions: Optimization of cardiac resynchronization therapy devices by using noninvasive blood pressure is noninferior to echocardiographic optimization. Therefore, noninvasive hemodynamic optimization is an acceptable alternative that has the potential to be automated and thus more easily implemented. (British Randomized Controlled Trial of AV and VV Optimization [BRAVO]; NCT01258829)., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2019
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9. Roadmap for cardiovascular education across the European Society of Cardiology: inspiring better knowledge and skills, now and for the future.
- Author
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Kotecha D, Bax JJ, Carrera C, Casadei B, Merkely B, Anker SD, Vardas PE, Kearney PP, Roffi M, Ros M, Vahanian A, Weidinger F, Beeri R, Budaj A, Calabrò P, Czerwińska-Jelonkiewicz K, D'Ascenzi F, De Potter T, Fox KF, Hartikainen J, McAdam B, Milicic D, Pasquet AA, Sionis A, Sohaib SMA, Tsioufis C, Verhorst PMJ, and Kirchhof P
- Subjects
- Europe, Humans, Practice Guidelines as Topic, Cardiology education, Cardiology organization & administration, Education, Medical, Continuing organization & administration, Societies, Medical organization & administration
- Abstract
Aims: The provision of high-quality education allows the European Society of Cardiology (ESC) to achieve its mission of better cardiovascular practice and provides an essential component of translating new evidence to improve outcomes., Methods and Results: The 4th ESC Education Conference, held in Sophia Antipolis (December 2016), brought together ESC education leaders, National Directors of Training of 43 ESC countries, and representatives of the ESC Young Community. Integrating national descriptions of education and cardiology training, we discussed innovative pathways to further improve knowledge and skills across different training programmes and health care systems. We developed an ESC roadmap supporting better cardiology training and continued medical education (CME), noting: (i) The ESC provides an excellent framework for unbiased and up-to-date cardiovascular education in close cooperation with its National Societies. (ii) The ESC should support the harmonization of cardiology training, curriculum development, and professional dialogue and mentorship. (iii) ESC congresses are an essential forum to learn and discuss the latest developments in cardiovascular medicine. (iv) The ESC should create a unified, interactive educational platform for cardiology training and continued cardiovascular education combining Webinars, eLearning Courses, Clinical Cases, and other educational programmes, along with ESC Congress content, Practice Guidelines and the next ESC Textbook of Cardiovascular Medicine. (v) ESC-delivered online education should be integrated into National and regional cardiology training and CME programmes., Conclusion: These recommendations support the ESC to deliver excellent and comprehensive cardiovascular education for the next generation of specialists. Teamwork between international, national and local partners is essential to achieve this objective., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2019
- Full Text
- View/download PDF
10. Women in Cardiology: The British Junior Cardiologists' Association identifies challenges.
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Sinclair HC, Joshi A, Allen C, Joseph J, Sohaib SMA, Calver A, and Smith R
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- Female, Humans, Male, Mentors, Personnel Staffing and Scheduling, Sex Distribution, Sexism, Societies, Medical, United Kingdom, Work-Life Balance, Cardiology education, Career Choice, Education, Medical, Graduate, Physicians, Women statistics & numerical data
- Published
- 2019
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11. His Resynchronization Versus Biventricular Pacing in Patients With Heart Failure and Left Bundle Branch Block.
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Arnold AD, Shun-Shin MJ, Keene D, Howard JP, Sohaib SMA, Wright IJ, Cole GD, Qureshi NA, Lefroy DC, Koa-Wing M, Linton NWF, Lim PB, Peters NS, Davies DW, Muthumala A, Tanner M, Ellenbogen KA, Kanagaratnam P, Francis DP, and Whinnett ZI
- Subjects
- Aged, Aged, 80 and over, Cardiac Resynchronization Therapy Devices, Electrocardiography, Female, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome, Bundle of His, Bundle-Branch Block complications, Bundle-Branch Block therapy, Cardiac Resynchronization Therapy methods, Heart Failure complications
- Abstract
Background: His bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT)., Objectives: The authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function., Methods: Patients with heart failure and left bundle branch block referred for conventional biventricular CRT were recruited. Using noninvasive epicardial electrocardiographic imaging, the authors identified patients in whom His bundle pacing shortened left ventricular activation time. In these patients, the authors compared the hemodynamic effects of His bundle pacing against biventricular pacing using a high-multiple repeated alternation protocol to minimize the effect of noise, as well as comparing effects on ventricular activation., Results: In 18 of 23 patients, left ventricular activation time was significantly shortened by His bundle pacing. Seventeen patients had a complete electromechanical dataset. In them, His bundle pacing was more effective at delivering ventricular resynchronization than biventricular pacing: greater reduction in QRS duration (-18.6 ms; 95% confidence interval [CI]: -31.6 to -5.7 ms; p = 0.007), left ventricular activation time (-26 ms; 95% CI: -41 to -21 ms; p = 0.002), and left ventricular dyssynchrony index (-11.2 ms; 95% CI: -16.8 to -5.6 ms; p < 0.001). His bundle pacing also produced a greater acute hemodynamic response (4.6 mm Hg; 95% CI: 0.2 to 9.1 mm Hg; p = 0.04). The incremental activation time reduction with His bundle pacing over biventricular pacing correlated with the incremental hemodynamic improvement with His bundle pacing over biventricular pacing (R = 0.70; p = 0.04)., Conclusions: His resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
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12. Cardiac resynchronization therapy: mechanisms of action and scope for further improvement in cardiac function.
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Jones S, Lumens J, Sohaib SMA, Finegold JA, Kanagaratnam P, Tanner M, Duncan E, Moore P, Leyva F, Frenneaux M, Mason M, Hughes AD, Francis DP, and Whinnett ZI
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- Action Potentials, Aged, Blood Pressure, Bundle-Branch Block diagnosis, Bundle-Branch Block physiopathology, Cardiac Resynchronization Therapy adverse effects, Computer Simulation, Female, Heart Failure diagnosis, Heart Failure physiopathology, Heart Rate, Humans, Male, Middle Aged, Models, Cardiovascular, Recovery of Function, Time Factors, Treatment Outcome, United Kingdom, Atrioventricular Node physiopathology, Bundle-Branch Block therapy, Cardiac Resynchronization Therapy methods, Heart Failure therapy, Hemodynamics, Ventricular Function, Left
- Abstract
Aims: Cardiac resynchronization therapy (CRT) may exert its beneficial haemodynamic effect by improving ventricular synchrony and improving atrioventricular (AV) timing. The aim of this study was to establish the relative importance of the mechanisms through which CRT improves cardiac function and explore the potential for additional improvements with improved ventricular resynchronization., Methods and Results: We performed simulations using the CircAdapt haemodynamic model and performed haemodynamic measurements while adjusting AV delay, at low and high heart rates, in 87 patients with CRT devices. We assessed QRS duration, presence of fusion, and haemodynamic response. The simulations suggest that intrinsic PR interval and the magnitude of reduction in ventricular activation determine the relative importance of the mechanisms of benefit. For example, if PR interval is 201 ms and LV activation time is reduced by 25 ms (typical for current CRT methods), then AV delay optimization is responsible for 69% of overall improvement. Reducing LV activation time by an additional 25 ms produced an additional 2.6 mmHg increase in blood pressure (30% of effect size observed with current CRT). In the clinical population, ventricular fusion significantly shortened QRS duration (Δ-27 ± 23 ms, P < 0.001) and improved systolic blood pressure (mean 2.5 mmHg increase). Ventricular fusion was present in 69% of patients, yet in 40% of patients with fusion, shortening AV delay (to a delay where fusion was not present) produced the optimal haemodynamic response., Conclusions: Improving LV preloading by shortening AV delay is an important mechanism through which cardiac function is improved with CRT. There is substantial scope for further improvement if methods for delivering more efficient ventricular resynchronization can be developed., Clinical Trial Registration: Our clinical data were obtained from a subpopulation of the British Randomised Controlled Trial of AV and VV Optimisation (BRAVO), which is a registered clinical trial with unique identifier: NCT01258829, https://clinicaltrials.gov., (© The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2017
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13. Atrioventricular Optimized Direct His Bundle Pacing Improves Acute Hemodynamic Function in Patients With Heart Failure and PR Interval Prolongation Without Left Bundle Branch Block.
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Sohaib SMA, Wright I, Lim E, Moore P, Lim PB, Koawing M, Lefroy DC, Lusgarten D, Linton NWF, Davies DW, Peters NS, Kanagaratnam P, Francis DP, and Whinnett ZI
- Abstract
Objectives: The purpose of this study was to investigate whether heart failure patients with narrow QRS duration (or right bundle branch block) but with long PR interval gain acute hemodynamic benefit from atrioventricular (AV) optimization. We tested this with biventricular pacing and (to deliver pure AV shortening) direct His bundle pacing., Background: Benefits of pacing for heart failure have previously been indicated by acute hemodynamic studies and verified in outcome studies. A new target for pacing in heart failure may be PR interval prolongation, which is associated with 58% higher mortality regardless of QRS duration., Methods: We enrolled 16 consecutive patients with systolic heart failure, PR interval prolongation (mean, 254 ± 62 ms) and narrow QRS duration (n = 13; mean QRS duration: 119 ± 17 ms) or right bundle branch block (n = 3; mean, QRS duration: 156 ± 18 ms). We successfully delivered temporary direct His bundle pacing in 14 patients and temporary biventricular pacing in 14 participants. We performed AV optimization using invasive systolic blood pressure obtaining parabolic responses (mean R
2 : 0.90 for His, and 0.85 for biventricular pacing)., Results: The mean increment in systolic BP compared with intrinsic ventricular conduction was 4.1 mm Hg (95% confidence interval [CI]: +1.9 to +6.2 mm Hg for His and 4.3 mm Hg [95% CI: +2.0 to +6.5 mm Hg] for biventricular pacing. QRS duration lengthened with biventricular pacing (change = +22 ms [95% CI: +18 to +25 ms]) but not with His pacing (change = +0.5 ms [95% CI: -2.6 to +3.6 ms)., Conclusions: AV-optimized pacing improves acute hemodynamic function in patients with heart failure and long PR interval without left bundle branch block. That it can be achieved by single-site His pacing shows that its mechanism is AV shortening. The improvement is ∼60% of the effect size previously reported for biventricular pacing in left bundle branch block. Randomized, blinded trials are warranted to test for long-term beneficial effects., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)- Published
- 2015
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