72 results on '"Anoop Shetty"'
Search Results
2. Myocardial Stiffness Estimation: A Novel Cost Function for Unique Parameter Identification.
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Anastasia Nasopoulou, Bojan Blazevic, Andrew Crozier, Wenzhe Shi, Anoop Shetty, C. Aldo Rinaldi, Pablo Lamata, and Steven A. Niederer
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- 2015
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3. Assessing long-term survival and hospitalization following transvenous lead extraction in patients with cardiac resynchronization therapy devices: A propensity score–matched analysis
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Mark K. Elliott, Steven A. Niederer, Vishal Mehta, Justin Gould, Anoop Shetty, Hugh O’Brien, Baldeep S. Sidhu, and Christopher A. Rinaldi
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medicine.medical_specialty ,genetic structures ,medicine.medical_treatment ,Population ,Cardiac resynchronization therapy ,Clinical ,Propensity score matching ,Internal medicine ,Medicine ,Mortality ,education ,Implantable Devices ,education.field_of_study ,business.industry ,Transvenous lead extraction ,Cardiac Resynchronization Therapy Devices ,Hazard ratio ,Confidence interval ,Transvenous lead ,Hospitalization ,Cohort ,Cardiology ,CRT ,business - Abstract
Background Longer-term outcomes of patients post transvenous lead extraction (TLE) are poorly understood in patients with cardiac resynchronization therapy (CRT) devices. Objectives A propensity score (PS)–matched analysis evaluating outcomes post TLE in CRT and non-CRT populations was performed. Methods Data from consecutive patients undergoing TLE between 2000 and 2019 were prospectively collected. Patients surviving to discharge and reimplanted with the same device were included. The cohort was split depending on presence of CRT device. Associations with all-cause mortality and hospitalization were assessed by Kaplan-Meier estimates. An exploratory endpoint was evaluated whether early (7 days) reimplantation was associated with poorer outcomes. Results Of 1005 patients included, 285 (25%) had a CRT device. Median follow-up was 57.00 [27.00–93.00] months, age at explant was 67.7 ± 12.1 years, 83.3% were male, and 54.4% had an infective indication for TLE. PS was calculated using 43 baseline characteristics. After matching, 192 CRT patients were compared with 192 non-CRT patients. In the matched cohort, no significant difference with respect to mortality (hazard ratio [HR] = 1.01, 95% confidence interval [CI] [0.74–1.39], P = .093) or hospitalization risk (HR = 1.2, 95% CI [0.87–1.66], P = .265) was observed. In the matched CRT group, late reimplantation was associated with increased mortality (HR = 1.64, [1.04–2.57], P = .032) and hospitalization risk (HR = 1.57, 95% CI [1.00–2.46], P = .049]. Conclusion Outcomes of CRT patients post TLE are similarly as poor as those of non-CRT patients in matched populations. Reimplantation within 7 days was associated with better outcomes in a CRT population but was not observed in a non-CRT population, suggesting prolonged periods without biventricular pacing should be avoided.
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- 2021
4. Personalised Biophysical Model to Optimise Left Ventricle Pacing Location for Cardiac Resynchronisation Therapy Over Time.
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Angela W. C. Lee, Manav Sohal, Jonathan M. Behar, Simon Claridge, Anoop Shetty, Thomas Jackson, Eoin R. Hyde, Gernot Plank, Reza Razavi, Pablo Lamata, Christopher Aldo Rinaldi, and Steven A. Niederer
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- 2016
5. Long-term survival following transvenous lead extraction: Importance of indication and comorbidities
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Paolo Bosco, Suraj Kadiwar, Justin Gould, Christopher A. Rinaldi, Christopher Blauth, Anoop Shetty, Vittoria Vergani, Jaswinder Gill, Tiffany Kemp, Vishal Mehta, Baldeep S. Sidhu, and Mark K. Elliott
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Male ,Pacemaker, Artificial ,medicine.medical_specialty ,Prosthesis-Related Infections ,Long Term Adverse Effects ,Comorbidity ,Kaplan-Meier Estimate ,Infection group ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Physiology (medical) ,Internal medicine ,Catheterization, Peripheral ,Long term survival ,medicine ,Humans ,In patient ,Multiple Chronic Conditions ,030212 general & internal medicine ,Major complication ,Renal Insufficiency, Chronic ,Device Removal ,Aged ,business.industry ,Hazard ratio ,Stroke Volume ,Prognosis ,Confidence interval ,Defibrillators, Implantable ,Transvenous lead ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Long-term outcomes are poorly understood, and data in patients undergoing transvenous lead extraction (TLE) are lacking.The purpose of this study was to evaluate factors influencing survival in patients undergoing TLE depending on extraction indication.Clinical data from consecutive patients undergoing TLE in the reference center between 2000 and 2019 were prospectively collected. The total cohort was divided into groups depending on whether there was an infective or noninfective indication for TLE. We evaluated the association of demographic, clinical, and device-related and procedure-related factors on mortality.A total of 1151 patients were included. Mean follow-up was 66 months, and mortality was 34.2% (n = 392). Of these patients, 632 (54.9%) and 519 (45.1%) were for infective and noninfective indications, respectively. A higher proportion in the infection group died (38.6% vs 28.5%; P.001). In the total cohort, multivariable analysis demonstrated increased mortality risk with age75 years (hazard ratio [HR] 2.98; 95% confidence interval [CI] 2.35-3.78; P.001), estimated glomerular filtration rate60 mL/min/1.73 mLong-term mortality for patients undergoing TLE remains high. Consensus guidelines recommend evaluating risk for major complications when determining whether to proceed with TLE. This study suggests also assessing longer-term outcomes when considering TLE in those with a high risk of medium- and long-term mortality, particularly for noninfective indications.
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- 2021
6. An Automatic Data Assimilation Framework for Patient-Specific Myocardial Mechanical Parameter Estimation.
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Jiahe Xi, Pablo Lamata, Wenzhe Shi, Steven A. Niederer, Sander Land, Daniel Rueckert, Simon G. Duckett, Anoop Shetty, C. Aldo Rinaldi, Reza Razavi, and Nic Smith
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- 2011
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7. Image and Physiological Data Fusion for Guidance and Modelling of Cardiac Resynchronization Therapy Procedures.
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YingLiang Ma, Simon G. Duckett, Phani Chinchapatnam, Anoop Shetty, C. Aldo Rinaldi, Tobias Schaeffter, and Kawal S. Rhode
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- 2010
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8. The estimation of patient-specific cardiac diastolic functions from clinical measurements.
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Jiahe Xi, Pablo Lamata, Steven A. Niederer, Sander Land, Wenzhe Shi, Xiahai Zhuang, Sébastien Ourselin, Simon G. Duckett, Anoop Shetty, C. Aldo Rinaldi, Daniel Rueckert, Reza Razavi, and Nic Smith
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- 2013
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9. Cardiac resynchronization therapy pacemaker implant in a patient with ARTO mitral device in situ
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Anoop Shetty, Steven Williams, Thomas Nguyen, and Gillian Falkner
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Male ,Cardiac Catheterization ,Pacemaker, Artificial ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Prosthesis Design ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Mitral valve ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Coronary sinus ,Aged ,Mitral regurgitation ,business.industry ,Mitral Valve Insufficiency ,General Medicine ,Pacemaker implant ,medicine.disease ,medicine.anatomical_structure ,Echocardiography ,Heart failure ,Cardiology ,Implant ,Cardiology and Cardiovascular Medicine ,business - Abstract
The ARTO device is a percutaneous device for functional mitral regurgitation composed of a transseptal anchor and a T-bar sitting in the coronary sinus which reduce the minor axis of the mitral valve. We present a case showing the technical feasibility of an LV lead implant in patients with an ARTO device in situ.
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- 2021
10. Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction
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Jaswinder Gill, Christopher A. Rinaldi, Anoop Shetty, Bradley Porter, Baldeep S. Sidhu, Benjamin Sieniewicz, Justin Gould, Steven Williams, Paolo Bosco, Thomas Teall, and Christopher Blauth
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Pacemaker, Artificial ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,bailout femoral extraction ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Humans ,Medicine ,Prospective Studies ,Registries ,030212 general & internal medicine ,Major complication ,Thoracotomy ,Lead (electronics) ,Vein ,Device Removal ,Aged ,business.industry ,Mortality rate ,transvenous lead extraction ,Equipment Design ,General Medicine ,Femoral Vein ,Middle Aged ,Defibrillators, Implantable ,Surgery ,Dwell time ,medicine.anatomical_structure ,Equipment Failure ,Implant ,Cardiology and Cardiovascular Medicine ,business ,femoral lead extraction ,Lead extraction - Abstract
Background: Transvenous lead extraction (TLE) may be performed by superior approach using the original implant vein or via a femoral approach; however, limited comparative data exists. We compare outcomes between femoral versus nonfemoral TLE approaches and determine predictors of bailout transfemoral lead extraction in patients undergoing initial TLE via the original implant vein by a superior approach. Methods: All consecutive TLEs between October 2000 and March 2018 were prospectively collected (n = 1052). Patients were dichotomized into femoral (n = 118) and nonfemoral (n = 934) groups. Results: Demographics were balanced between femoral vs nonfemoral groups. Patients in the femoral group had significantly higher mean lead dwell times (11.6 ± 9.7 vs 6.6 ± 6.6 years, P
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- 2019
11. Are Robotic-Assisted Catheter Ablation Lesions Different from Standard Catheter Ablation in Paroxysmal AF Patients? : Novel CMRI Findings Made Possible with Semi-automatic 3-D Visualisation.
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Aruna Arujuna, Rashed Karim, Anoop Shetty, C. Aldo Rinaldi, Michael Cooklin, Reza Razavi, Mark D. O'Neill, Jaswinder S. Gill, and Kawal S. Rhode
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- 2011
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12. Real-Time Cardiac MR Anatomy and Dyssynchrony Overlay for Guidance of Cardiac Resynchronization Therapy Procedures: Clinical Results Update.
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YingLiang Ma, Anoop Shetty, Simon G. Duckett, C. Aldo Rinaldi, Tobias Schaeffter, Reza Razavi, Gerry Carr-White, and Kawal S. Rhode
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- 2011
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13. Biophysical Modeling Predicts Ventricular Tachycardia Inducibility and Circuit Morphology: A Combined Clinical Validation and Computer Modeling Approach
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Jaswinder Gill, Christopher A. Rinaldi, Manav Sohal, Anoop Shetty, Jatin Relan, Nicholas Ayache, Rashed Karim, Peter Taggart, Rocio Cabrera-Lozoya, Reza Razavi, Hervé Delingette, Maxime Sermesant, Zhong Chen, and Kawal Rhode
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medicine.medical_specialty ,Ischemic cardiomyopathy ,medicine.diagnostic_test ,business.industry ,0206 medical engineering ,Magnetic resonance imaging ,02 engineering and technology ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,medicine.disease ,020601 biomedical engineering ,03 medical and health sciences ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Physiology (medical) ,Internal medicine ,Heart rate ,cardiovascular system ,medicine ,Cardiology ,In patient ,Computer modelling ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business - Abstract
Computational modelling of cardiac arrhythmogenesis and arrhythmia maintenance has made a significant contribution to the understanding of the underlying mechanisms of arrhythmia. We hypothesized that a cardiac model using personalized electro-anatomical parameters could define the underlying ventricular tachycardia (VT) substrate and predict re-entrant VT circuits. We used a combined modelling and clinical approach in order to validate the concept. Non-contact electroanatomic mapping studies were performed in seven patients (5 ischemics, 2 non-ischemics). Three ischemic cardiomyopathy patients underwent a clinical VT stimulation study. Anatomical information was obtained from cardiac magnetic resonance imaging (CMR) including high-resolution scar imaging. A simplified biophysical mono-domain action potential model personalized with the patients’ anatomical and electrical information was used to perform in silico VT stimulation studies for comparison. The personalized in silico VT stimulations were able to predict VT inducibility as well as the macroscopic characteristics of the VT circuits in patients who had clinical VT stimulation studies. Patients with positive clinical VT stimulation studies had wider distribution of action potential duration restitution curve (APD-RC) slopes and APDs than patient 3 with a negative VT stimulation study. The exit points of re-entrant VT circuits encompassed a higher percentage of the maximum APD-RC slope compared to the scar and non-scar areas, 32%, 4% and 0.2% respectively. Conclusions: VT stimulation studies can be simulated in silico using a personalized biophysical cardiac model. Myocardial spatial heterogeneity of APD restitution properties and conductivity may help predict the location of crucial entry/exit points of re-entrant VT circuits.
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- 2016
14. Mechanistic insights into the benefits of multisite pacing in cardiac resynchronization therapy: The importance of electrical substrate and rate of left ventricular activation
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Tom Jackson, Reza Razavi, Jonathan M. Behar, Angela W.C. Lee, Zhong Chen, C. Aldo Rinaldi, Frits W. Prinzen, Eoin R. Hyde, Anoop Shetty, Simon Claridge, Steven A. Niederer, Julian Bostock, Manav Sohal, Fysiologie, and RS: CARIM - R2 - Cardiac function and failure
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Male ,medicine.medical_specialty ,Haemodynamic response ,medicine.medical_treatment ,Bundle-Branch Block ,Cardiac resynchronization therapy ,Hemodynamics ,Acute hemodynamic response ,Ventricular Function, Left ,Cohort Studies ,Physiology (medical) ,Internal medicine ,Humans ,Medicine ,Cardiac Resynchronization Therapy Devices ,Aged ,Heart Failure ,Bundle branch block ,business.industry ,Left bundle branch block ,Middle Aged ,medicine.disease ,Defibrillators, Implantable ,Treatment Outcome ,medicine.anatomical_structure ,Multisite pacing ,Ventricle ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Noncontact mapping - Abstract
Multisite pacing (MSP) of the left ventricle is proposed as an alternative to conventional single-site LV pacing in cardiac resynchronization therapy (CRT). Reports on the benefits of MSP have been conflicting. A paradigm whereby not all patients derive benefit from MSP is emerging.We sought to compare the hemodynamic and electrical effects of MSP with the aim of identifying a subgroup of patients more likely to derive benefit from MSP.Sixteen patients with implanted CRT systems incorporating a quadripolar LV pacing lead were studied. Invasive hemodynamic and electroanatomic assessment was performed during the following rhythms: baseline (non-CRT); biventricular (BIV) pacing delivered via the implanted CRT system (BIV(implanted)); BIV pacing delivered via an alternative temporary LV lead (BIV(alternative)); dual-vein MSP delivered via 2 LV leads; MultiPoint Pacing delivered via 2 vectors of the quadripolar LV lead.Seven patients had an acute hemodynamic response (AHR) of10% over baseline rhythm with BIV(implanted) and were deemed nonresponders. AHR in responders vs nonresponders was 21.4% ± 10.4% vs 2.0% ± 5.2% (P.001). In responders, neither form of MSP provided incremental hemodynamic benefit over BIV(implanted). Dual-vein MSP (8.8% ± 5.7%; P = .036 vs BIV(implanted)) and MultiPoint Pacing (10.0% ± 12.2%; P = .064 vs BIV(implanted)) both improved AHR in nonresponders. Seven of 9 responders to BIV(implanted) had LV endocardial activation characterized by a functional line of block during intrinsic rhythm that was abolished with BIV pacing. All these patients met strict criteria for left bundle branch block (LBBB). No nonresponders exhibited this line of block or met strict criteria for LBBB.Patients not meeting strict criteria for LBBB appear most likely to derive benefit from MSP.
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- 2015
15. Predictors of mortality and outcomes in transvenous lead extraction for systemic and local infection cohorts
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Christopher A. Rinaldi, Anoop Shetty, Jaswinder Gill, Magdalena Klis, Benjamin Sieniewicz, Steven Williams, Jessica Webb, Bradley Porter, Baldeep S. Sidhu, Justin Gould, and Thomas Teall
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Male ,medicine.medical_specialty ,Pacemaker, Artificial ,Prosthesis-Related Infections ,Demographics ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,Local infection ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Cause of Death ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Major complication ,Prospective Studies ,Device Removal ,Aged ,business.industry ,General Medicine ,Transvenous lead ,Defibrillators, Implantable ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND Transvenous lead extraction (TLE) may be necessary due to infective and noninfective indications. We aim to identify predictors of 30-day mortality and risk factors between infective versus noninfective groups and systemic versus local infection subgroups. METHODS A total of 925 TLEs between October 2000 and December 2016 were prospectively collected and dichotomized (infective group n = 505 vs noninfective group n = 420 and systemic infection n = 164 vs local infection n = 341). RESULTS All-cause major complication including deaths was significantly higher (5.1%, n = 26 vs 1.2%, n = 5, P = 0.001) as well as 30-day mortality (4.0%, n = 20 vs 0.2%, n = 1, P
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- 2018
16. Transvenous lead extraction in patients with cardiac resynchronization therapy devices is not associated with increased 30-day mortality
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Anoop Shetty, Mark D O'Neill, Christopher A. Rinaldi, Benjamin Sieniewicz, Simon Claridge, Jaswinder Gill, Steven Williams, Bradley Porter, Baldeep S. Sidhu, Magdalena Klis, and Justin Gould
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Male ,medicine.medical_specialty ,Multivariate analysis ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Comorbidity ,030204 cardiovascular system & hematology ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Physiology (medical) ,Internal medicine ,Cause of Death ,Medicine ,Humans ,030212 general & internal medicine ,Cardiac Resynchronization Therapy Devices ,Prospective Studies ,Mortality ,Lead (electronics) ,Device Removal ,Aged ,Ejection fraction ,business.industry ,Mortality rate ,Middle Aged ,medicine.disease ,Transvenous lead ,Cardiology ,Equipment Failure ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
AIMS Transvenous lead extraction (TLE) may be necessary due to system infection/erosion or lead malfunction. Cardiac resynchronization therapy (CRT) patients undergoing TLE may be at greater risk due to increased comorbidities. We examined whether patients with CRT systems undergoing TLE had more comorbidities and higher 30-day mortality than those with non-CRT devices. METHODS AND RESULTS All TLEs between October 2000 and December 2016 were prospectively collected. During this period 925 TLEs occurred (CRT group 231, non-CRT group 694). Cardiac resynchronization therapy patients were older (68.1 ± 10.8 years vs. 64.3 ± 16.1 years, P = 0.024); more likely male (85.7% vs. 69%, P
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- 2018
17. ECG imaging of ventricular tachycardia: evaluation against simultaneous non-contact mapping and CMR-derived grey zone
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Olaf Dössel, Kawal Rhode, Reza Razavi, YingLiang Ma, Zhong Chen, Rashed Karim, Julian Bostock, Manav Sohal, Martin W. Krueger, Danila Potyagaylo, Anoop Shetty, Christopher A. Rinaldi, Nicholas Ayache, Jatin Relan, Walther H. W. Schulze, Hervé Delingette, Maxime Sermesant, Institute of Biomedical Engineering [Karlsruhe], Karlsruhe Institute of Technology (KIT), Imaging Sciences and Biomedical Engineering Division [London], Guy's and St Thomas' Hospital [London]-King‘s College London, Analysis and Simulation of Biomedical Images (ASCLEPIOS), Inria Sophia Antipolis - Méditerranée (CRISAM), and Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)
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Non contact mapping ,Materials science ,Heart Ventricles ,Scar tissue ,Biomedical Engineering ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,030218 nuclear medicine & medical imaging ,Tikhonov regularization ,03 medical and health sciences ,ECG imaging ,0302 clinical medicine ,medicine ,[INFO.INFO-IM]Computer Science [cs]/Medical Imaging ,Humans ,Non-contact mapping ,Monomorphic Ventricular Tachycardia ,Body Surface Potential Mapping ,Clinical validation ,Inverse problem of ECG ,Thorax ,medicine.disease ,Magnetic Resonance Imaging ,Computer Science Applications ,Grey zone ,Catheter Ablation ,Tachycardia, Ventricular ,Mr images ,Electrophysiologic Techniques, Cardiac ,Smoothing ,Biomedical engineering - Abstract
ECG imaging is an emerging technology for the reconstruction of cardiac electric activity from non-invasively measured body surface potential maps. In this case report, we present the first evaluation of transmurally imaged activation times against endocardially reconstructed isochrones for a case of sustained monomorphic ventricular tachycardia (VT). Computer models of the thorax and whole heart were produced from MR images. A recently published approach was applied to facilitate electrode localization in the catheter laboratory, which allows for the acquisition of body surface potential maps while performing non-contact mapping for the reconstruction of local activation times. ECG imaging was then realized using Tikhonov regularization with spatio-temporal smoothing as proposed by Huiskamp and Greensite and further with the spline-based approach by Erem et al. Activation times were computed from transmurally reconstructed transmembrane voltages. The results showed good qualitative agreement between the non-invasively and invasively reconstructed activation times. Also, low amplitudes in the imaged transmembrane voltages were found to correlate with volumes of scar and grey zone in delayed gadolinium enhancement cardiac MR. The study underlines the ability of ECG imaging to produce activation times of ventricular electric activity-and to represent effects of scar tissue in the imaged transmembrane voltages.
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- 2017
18. Personalised biophysical model to optimize left ventricle pacing location for Cardiac Resynchronisation Therapy over time
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Anoop Shetty, Simon Claridge, Steven A. Niederer, Manav Sohal, Gernot Plank, Pablo Lamata, Tom Jackson, Reza Razavi, Jonathan M. Behar, Christopher A. Rinaldi, Eoin R. Hyde, and Angela W.C. Lee
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medicine.medical_specialty ,Haemodynamic response ,Cardiac anatomy ,business.industry ,Free wall ,Catheter ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,medicine ,Cardiology ,cardiovascular system ,Implant ,business - Abstract
Cardiac Resynchronisation Therapy (CRT) causes changes in cardiac anatomy, electrophysiology and mechanics of the heart after 3-6 months of treatment. Multi-pole pacing (MPP) and multi-vein pacing (MVP) are new technologies that offer the ability to change the location of the pacing site post implant, however, the long term benefits of shifting the left ventricle (LV) pacing site are still uncertain. A personalised biophysical electromechanical model of a patient's heart was developed from MRI, echocardiogram, ECG and pressure catheter recordings, before and after sustained CRT treatment. Simulations of biventricular pacing of the heart were performed for 49 pacing sites across the LV free wall, in the model of the patient prior to- and after sustained pacing. The optimal region for LV pacing was determined by the acute haemodynamic response (AHR). After sustained CRT treatment the heart remodels and the models predict that the optimal region for pacing the LV would expand by 46% after this remodeling. The expansion in the optimal LV pacing region after remodeling predicts that if LV lead location was placed within the optimal region prior to CRT treatment, it will remain within the optimal region after sustained pacing.
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- 2017
19. Cardiac Resynchronization Therapy Upgrade: Verschlimmbesserung?
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Christopher A. Rinaldi and Anoop Shetty
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Lv function ,medicine.medical_specialty ,Ejection fraction ,Heart block ,business.industry ,Task force ,medicine.medical_treatment ,Cardiomyopathy ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,medicine.disease ,Defibrillators, Implantable ,Heart Rhythm ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,0302 clinical medicine ,Upgrade ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiac Resynchronization Therapy Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
The implant rates of cardiac resynchronization therapy (CRT) increased rapidly through the first decade of this millennium but have plateaued more recently and may even have started to decrease in Europe and the United States.1,2 The upgrade of existing pacemakers and implantable cardioverter defibrillators (ICDs) to CRT currently accounts for a quarter of all CRT procedures3 and is a potential growth area. Kiehl et al4 recently showed that 12.3% of patients with preserved left ventricular (LV) function who were implanted with a pacemaker for complete heart block developed pacing-induced cardiomyopathy, but the small proportion that underwent CRT upgrades responded well echocardiographically. The 2012 ACCF/AHA/HRS (American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society) Guideline5 gives a class IIA recommendation to CRT upgrade at generator replacement if LV function is severely impaired and the expected pacing requirement is high. The 2013 ESC (European Society of Cardiology) guideline6 goes further and gives a class I (level of evidence B) recommendation to CRT upgrade in device patients with LV ejection fraction 150 ms are most likely to respond to de novo CRT therapy,7 it is not clear whether upgrade patients respond in the same way. See Article by Vamos et al In this respect, Vamos et al8 are to be congratulated for adding to the …
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- 2017
20. Delayed Trans-Septal Activation Results in Comparable Hemodynamic Effect of Left Ventricular and Biventricular Endocardial Pacing
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Anoop Shetty, Eva Sammut, Tom Jackson, Reza Razavi, Zhong Chen, Steven A. Niederer, C. Aldo Rinaldi, Julian Bostock, Manav Sohal, Frits W. Prinzen, Fysiologie, and RS: CARIM - R2 - Cardiac function and failure
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Male ,medicine.medical_specialty ,Haemodynamic response ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Magnetic Resonance Imaging, Cine ,cardiac resynchronization therapy ,heart failure ,Hemodynamics ,Ventricular Function, Left ,QRS complex ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Coronary sinus ,Endocardium ,Bundle branch block ,business.industry ,Body Surface Potential Mapping ,Middle Aged ,bundle-branch block ,medicine.disease ,Treatment Outcome ,Heart failure ,Anesthesia ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background— We sought to compare left ventricular (LV epi ) and biventricular epicardial pacing (BIV epi ) with LV (LV endo ) and BIV endocardial pacing (BIV endo ) in patients with chronic heart failure with an emphasis on the underlying electrophysiological mechanisms and hemodynamic effects. Methods and Results— Ten patients with chronically implanted cardiac resynchronization devices underwent temporary LV endo and BIV endo pacing with an LV endocardial roving catheter. A pressure wire and noncontact mapping array were placed to the LV cavity to measure LVdP/dt max and perform electroanatomical mapping. At the optimal endocardial position, the acute hemodynamic response (AHR) was superior to epicardial stimulation, the AHR to BIV endo pacing and LV endo pacing being comparable (21±15% versus 22±17%; P =NS). During intrinsic conduction, QRS duration was 185±30 ms, endocardial LV total activation time 92±27 ms, and trans-septal activation time 60±21 ms. With LV endo pacing, QRS duration (187±29 ms; P =NS) and endocardial LV total activation time (91±23 ms; P =NS) were comparable with intrinsic conduction. There was no significant difference in endocardial LV total activation time between LV endo and BIV endo pacing (91±23 versus 85±15 ms; P =NS). Assessment of isochronal maps identified slow trans-septal conduction with both LV endo and BIV endo pacing resulting in activation of almost the entire LV endocardium prior to septal breakout, thereby limiting any possible fusion with either pacing mode. Conclusions— The equivalent AHR to LV endo and BIV endo pacing may be explained by prolonged trans-septal conduction limiting fusion of electrical wavefronts. The optimal AHR was associated with predominantly LV pre-excitation and depolarization. Our results suggest that LV pacing alone may offer a viable endocardial stimulation strategy to achieve cardiac resynchronization.
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- 2014
21. A comparison of left ventricular endocardial, multisite, and multipolar epicardial cardiac resynchronization: an acute haemodynamic and electroanatomical study
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Kyungmoo Ryu, Aldo Rinaldi, Stuart Rosenberg, Matthew Ginks, Steven A. Niederer, Julian Bostock, Manav Sohal, Sana Amraoui, Reza Razavi, Zhong Chen, Gerald Carr-White, Anoop Shetty, and Jaswinder Gill
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Male ,medicine.medical_specialty ,Haemodynamic response ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Hemodynamics ,Cardiac Resynchronization Therapy ,Ventricular Dysfunction, Left ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Lead (electronics) ,Coronary sinus ,Heart Failure ,business.industry ,Body Surface Potential Mapping ,Stroke Volume ,Middle Aged ,medicine.disease ,Catheter ,Treatment Outcome ,Heart failure ,Cardiac resynchronization ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Alternative forms of cardiac resynchronization therapy (CRT), including biventricular endocardial (BV-Endo) and multisite epicardial pacing (MSP), have been developed to improve response. It is unclear which form of stimulation is optimal. We aimed to compare the acute haemodynamic response (AHR) and electrophysiological effects of BV-Endo with MSP via two separate coronary sinus (CS) leads or a single-quadripolar CS lead. Methods and results Fifteen patients with a previously implanted CRT system received a second temporary CS lead and left ventricular (LV) endocardial catheter. A pressure wire and non-contact mapping array were placed into the LV cavity to measure LVd P /d t max and perform electroanatomical mapping. Conventional CRT, BV-Endo, and MSP were then performed (MSP-1 via two epicardial leads and MSP-2 via a single-quadripolar lead). The best overall AHR was found using BV-Endo pacing with a 19.6 ± 13.6% increase in AHR at the optimal endocardial site over baseline ( P < 0.001). There was an increase in LVd P /d t max with MSP-1 and MSP-2 compared with conventional CRT, but this was not statistically significant. Biventricular endocardial pacing from the optimal site was significantly superior to conventional CRT ( P = 0.039). The AHR achieved when BV-Endo pacing was highly site specific. Within individuals, the best pacing modality varied and was affected by the underlying substrate. Left ventricular activation times did not predict the optimal haemodynamic configuration. Conclusion Biventricular endocardial pacing and not MSP was superior to conventional CRT, but was highly site specific. Within individuals, however, different methods of stimulation are optimal and may need to be tailored to the underlying substrate.
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- 2014
22. Noninvasive Assessment of LV Contraction Patterns Using CMR to Identify Responders to CRT
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Reza Razavi, Sana Amraoui, Zhong Chen, Gerald Carr-White, Anoop Shetty, Eva Sammut, Manav Sohal, Christopher A. Rinaldi, and Simon G. Duckett
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Male ,medicine.medical_specialty ,Contraction (grammar) ,medicine.medical_treatment ,Bundle-Branch Block ,Cardiac resynchronization therapy ,Magnetic Resonance Imaging, Cine ,cardiac resynchronization therapy ,Ventricular Function, Left ,Predictive Value of Tests ,Surveys and Questionnaires ,Internal medicine ,Image Interpretation, Computer-Assisted ,cardiac MRI ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,cardiovascular diseases ,Aged ,left ventricular contraction patterns ,Ischemic cardiomyopathy ,Ventricular Remodeling ,Bundle branch block ,Left bundle branch block ,business.industry ,Patient Selection ,Middle Aged ,medicine.disease ,Myocardial Contraction ,Treatment Outcome ,medicine.anatomical_structure ,Radiology Nuclear Medicine and imaging ,Ventricle ,Heart failure ,Exercise Test ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance ,Nuclear medicine ,Software - Abstract
ObjectivesType II activation describes the U-shaped electrical activation of the left ventricle (LV) with a line of block in patients with left bundle branch block (LBBB). We sought to determine if a corresponding pattern of contraction could be identified using cardiac magnetic resonance (CMR) cine imaging and whether this predicted response to cardiac resynchronization therapy (CRT).BackgroundU-shaped LV electrical activation in LBBB has been shown to predict favorable response to CRT. It is not known if the degree of electromechanical coupling is such that the same is true for LV contraction patterns.MethodsA total of 52 patients (48% ischemic) scheduled for CRT implantation prospectively underwent pre-implantation CMR cine analysis using endocardial contour tracking software to generate time−volume curves and contraction propagation maps. These were analyzed to assess the contraction sequence of the LV. The effect of contraction pattern on CRT response in terms of reverse remodeling (RR) and clinical parameters (New York Heart Association functional class, 6-min walk distance and Heart Failure Questionnaire score) was assessed at 6 months.ResultsTwo types of contraction pattern were identified; homogenous spread from septum to lateral wall (type I, n = 27) and presence of block with a subsequent U-shaped contraction pattern (type II, n = 25). Rates of RR in those with a type 2 pattern were significantly greater at 6 months (80% vs. 26%, p < 0.001) as was mean increase in 6-min walk distance (126 ± 106 m vs. 55 ± 60 m; p = 0.004).ConclusionsCine CMR can identify a U-shaped pattern of contraction which predicts increased echocardiographic and clinical response rates to CRT in patients with LBBB.
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- 2013
23. Lower incidence of inappropriate shock therapy in patients with combined cardiac resynchronisation therapy defibrillators (CRT-D) compared with patients with non-CRT defibrillators (ICDs)
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Julian Bostock, Tushar Kotecha, Senthil Kirubakaran, Jaswinder Gill, Manav Sohal, Zhong Chen, Mark D O'Neill, Anoop Shetty, Aruna Arujuna, Christopher A. Rinaldi, Matthew Wright, Michael Cooklin, and Siobhan Crichton
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medicine.medical_specialty ,Multivariate analysis ,business.industry ,Proportional hazards model ,Incidence (epidemiology) ,Hazard ratio ,Retrospective cohort study ,Atrial fibrillation ,General Medicine ,medicine.disease ,Heart failure ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,In patient ,cardiovascular diseases ,business - Abstract
Summary Introduction: A significant number of patients experience inappropriate shock therapy (IST) from implantable cardioverter-defibrillators (ICD). An increasing number of patients with advanced heart failure receive combined ICD and cardiac resynchronisation therapy devices (CRT-D). The incidence of IST in this group is less well described. We aimed to assess the incidence and predictors of IST in CRT-D patients. Methods: A retrospective cohort study of prospectively collected data on patients who received an ICD and CRT-D between October 2007 and January 2009 at our institution were studied. The primary outcome measures were the IST event rate and all-cause mortality. Results: A total of 185 patients with ICD/CRT-D (100/85) were included in the analysis. Eighteen patients experienced 35 episodes of IST during the follow-up (21 ± 13 months). There was a significantly lower IST cumulative event rate in the CRT-D vs. ICD group, 5% (CI: 1–13%) vs. 19% (95% CI: 11–30%) by 24 months, (p = 0.017). The majority of the IST was caused by atrial arrhythmias with atrial fibrillation accounting for 28 episodes of IST in nine patients. Multivariate analysis using Cox hazard model including baseline characteristics and coexisting appropriate shock therapy showed that a history of atrial fibrillation/flutter was the strongest independent predictor of IST with a hazard ratio of 3.53 (p = 0.019). Conclusion: Patients with CRT-D had a significantly lower incidence of IST compared with patients receiving an ICD. Given that atrial arrhythmia remained the commonest trigger for IST, our finding lends support to the hypothesis that CRT may reduce atrial fibrillation burden in patients receiving CRT-D.
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- 2013
24. Left Ventricular Epicardial Electrograms Show Divergent Changes in Action Potential Duration in Responders and Nonresponders to Cardiac Resynchronization Therapy
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C. Aldo Rinaldi, Zhong Chen, Julian Bostock, Jaswinder Gill, Manav Sohal, Gerald Carr-White, Nicholas Child, Ryan Boucher, Peter Taggart, Ben Hanson, Anoop Shetty, and Eva Sammut
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Male ,medicine.medical_specialty ,Heart Ventricles ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Action Potentials ,Amiodarone ,QT interval ,Cardiac Resynchronization Therapy ,Interquartile range ,Physiology (medical) ,Internal medicine ,Humans ,Medicine ,Repolarization ,Ventricular remodeling ,Aged ,Heart Failure ,Ventricular Remodeling ,business.industry ,Arrhythmias, Cardiac ,Stroke Volume ,medicine.disease ,Implantable cardioverter-defibrillator ,Treatment Outcome ,Echocardiography ,Heart failure ,cardiovascular system ,Cardiology ,Female ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,circulatory and respiratory physiology ,medicine.drug - Abstract
Background— A consistent feature of electrophysiological remodeling in heart failure is ventricular action potential duration (APD) prolongation. However, the effect of reverse remodeling on APD during cardiac resynchronization therapy (CRT) has not been determined in these patients. We hypothesized (1) that CRT may alter APD and (2) that the effect of CRT on APD may be different in patients who exhibit a good hemodynamic response to CRT compared with those with a poor response. Methods and Results— Left ventricular (LV) activation recovery intervals, as a surrogate for APD, were measured from the LV epicardium in 13 patients at day 0, 6 weeks, and 6 months after CRT implant. Responders to CRT were defined as those demonstrating a ≥15% reduction in LV end-systolic volume at 6 months. The responder group had a significant reduction in LV activation recovery interval (mean, −13±12 ms; median, −16 ms; interquartile range, −2 to −19 ms) during right ventricular pacing at 6 months ( P P Conclusions— In patients with heart failure, LV epicardial APD (activation recovery interval) altered during CRT. The effect on APD was opposite in patients showing a good hemodynamic response compared with nonresponders. The findings may provide an explanation for the persistent high incidence of arrhythmias in some patients with CRT and the additional mortality benefit observed in responders of CRT.
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- 2013
25. Benefits of Endocardial and Multisite Pacing Are Dependent on the Type of Left Ventricular Electric Activation Pattern and Presence of Ischemic Heart Disease
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Gerald Carr-White, Julian Bostock, Matthew Ginks, Anoop Shetty, Cliff Bucknall, Simon G. Duckett, Jaswinder Gill, C. Aldo Rinaldi, Pier D. Lambiase, Kawal Rhode, Peter Taggart, Christophe Leclercq, Janet L. Peacock, Reza Razavi, Cardiothoracic Centre, Guy's and St Thomas' Hospital [London], The Heart Hospital [London], University College of London [London] (UCL), University College Hospital, King‘s College London, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], and CHU Pontchaillou [Rennes]
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Gadolinium DTPA ,Male ,medicine.medical_treatment ,Myocardial Ischemia ,Hemodynamics ,030204 cardiovascular system & hematology ,electrophysiology mapping ,MESH: Magnetic Resonance Imaging ,Cardiac Resynchronization Therapy ,0302 clinical medicine ,Medicine ,030212 general & internal medicine ,MESH: Treatment Outcome ,MESH: Bundle-Branch Block ,MESH: Middle Aged ,Ejection fraction ,Middle Aged ,Magnetic Resonance Imaging ,MESH: Electrophysiologic Techniques, Cardiac ,Treatment Outcome ,endocardium ,cardiovascular system ,Cardiology ,MESH: Myocardial Ischemia ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Female ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,MESH: Cardiac Resynchronization Therapy ,MESH: Hemodynamics ,medicine.medical_specialty ,Heart Ventricles ,Bundle-Branch Block ,MESH: Gadolinium DTPA ,Cardiac resynchronization therapy ,03 medical and health sciences ,QRS complex ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Physiology (medical) ,Internal medicine ,bundle branch block ,Humans ,cardiovascular diseases ,Endocardium ,Heart Failure ,MESH: Humans ,Ischemic cardiomyopathy ,Bundle branch block ,business.industry ,medicine.disease ,MESH: Male ,Heart failure ,MESH: Heart Failure ,MESH: Heart Ventricles ,business ,MESH: Female - Abstract
Background— There is considerable heterogeneity in the myocardial substrate of patients undergoing cardiac resynchronization therapy (CRT), in particular in the etiology of heart failure and in the location of conduction block within the heart. This may account for variability in response to CRT. New approaches, including endocardial and multisite left ventricular (LV) stimulation, may improve CRT response. We sought to evaluate these approaches using noncontact mapping to understand the underlying mechanisms. Methods and Results— Ten patients (8 men and 2 women; mean [SD] age 63 [12] years; LV ejection fraction 246%; QRS duration 161 [24] ms) fulfilling conventional CRT criteria underwent an electrophysiological study, with assessment of acute hemodynamic response to conventional CRT as well as LV endocardial and multisite pacing. LV activation pattern was assessed using noncontact mapping. LV endocardial pacing gave a superior acute hemodynamic response compared with conventional CRT (26% versus 37% increase in LV dP/dt max , respectively; P P =0.08). The majority (71%) of patients with nonischemic heart failure etiology or functional block responded to conventional CRT, whereas those with myocardial scar or absence of functional block often required endocardial or multisite pacing to achieve CRT response. Conclusions— Endocardial or multisite pacing may be required in certain subsets of patients undergoing CRT. Patients with ischemic cardiomyopathy and those with narrower QRS, in particular, may stand to benefit.
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- 2012
26. Analysis of lead placement optimization metrics in cardiac resynchronization therapy with computational modelling
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Reza Razavi, Simon G. Duckett, Christopher A. Rinaldi, Bojan Blazevic, Anoop Shetty, Nicolas P. Smith, Manav Sohal, Andrew Crozier, Matthew Ginks, Pablo Lamata, Steven A. Niederer, and Gernot Plank
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Male ,Patient-Specific Modeling ,medicine.medical_specialty ,Response to therapy ,Haemodynamic response ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Action Potentials ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Heart Rate ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Sinus rhythm ,Cardiac Resynchronization Therapy Devices ,Aged ,Aged, 80 and over ,Heart Failure ,Computational model ,business.industry ,Models, Cardiovascular ,Signal Processing, Computer-Assisted ,Stroke Volume ,Equipment Design ,Middle Aged ,Supplement: Reviews ,medicine.disease ,Surgery ,Treatment Outcome ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Lead Placement ,business ,Electrophysiologic Techniques, Cardiac ,030217 neurology & neurosurgery - Abstract
Aims The efficacy of cardiac resynchronization therapy (CRT) is known to vary considerably with pacing location, however the most effective set of metrics by which to select the optimal pacing site is not yet well understood. Computational modelling offers a powerful methodology to comprehensively test the effect of pacing location in silico and investigate how to best optimize therapy using clinically available metrics for the individual patient. Methods and results Personalized computational models of cardiac electromechanics were used to perform an in silico left ventricle (LV) pacing site optimization study as part of biventricular CRT in three patient cases. Maps of response to therapy according to changes in total activation time (ΔTAT) and acute haemodynamic response (AHR) were generated and compared with preclinical metrics of electrical function, strain, stress, and mechanical work to assess their suitability for selecting the optimal pacing site. In all three patients, response to therapy was highly sensitive to pacing location, with laterobasal locations being optimal. ΔTAT and AHR were found to be correlated ( ρ
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- 2016
27. Percutaneous Extraction of Cardiac Implantable Electronic Devices (CIEDs) in Octogenarians
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Mark D O'Neill, Jaswinder Gill, Anoop Shetty, Shoaib Hamid, Steven Williams, Cliff Bucknall, Matthew Wright, John Whitaker, Debashis Roy, Julian Bostock, Manav Sohal, Michael Cooklin, C. Aldo Rinaldi, Nikhil Patel, and Aruna Arujuna
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medicine.medical_specialty ,education.field_of_study ,Percutaneous ,business.industry ,Population ,Patient characteristics ,General Medicine ,medicine.disease ,Surgery ,Younger adults ,Medicine ,Endocarditis ,Cardiology and Cardiovascular Medicine ,business ,education ,Survival rate ,Survival analysis ,Lead extraction - Abstract
Background: As the population receiving cardiac device therapy ages, the number of extraction procedures performed in octogenarians is increasing. This group has more comorbidities and may be at higher risk of such procedures. Objectives: Document the safety and success of percutaneous lead extraction in octogenarians. Methods: All extraction cases performed between January 2001 and April 2011 entered into a computer database were analyzed for patient characteristics and indications, extraction technique, procedural success, and complications. Success and complications were classified according to the Heart Rhythm Society consensus statement. Outcomes in octogenarians were compared to younger patients undergoing extraction during the same period. Results: Four hundred and six cases were performed: 72 procedures in octogenarians (mean age 84, range 80–95) and 334 in younger adults (mean age 62, range 20–79). Octogenarians had a greater number of comorbidities per case. Infection was the commonest indication for extraction in both groups. One hundred forty-one leads were extracted in octogenarians and 657 in younger patients. Laser assistance was required in 51.4% of octogenarians versus 49.7% of younger patients. Procedural success was achieved in 71/72 (98.6%) octogenarians versus 329/334 (98.5%) younger patients. No procedural mortality occurred in either group. Overall, complications were more frequent in octogenarians with major and minor complications occurring in 2.8 and 8.3% of octogenarians versus 0.6 and 3.0% of younger patients (P = 0.014). Conclusions: Procedural success was equally high in octogenarians and younger patients. Percutaneous lead extraction can be performed effectively and safely in octogenarians and is associated with a higher complication rate but no increased mortality. (PACE 2012;00:1–9)
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- 2012
28. Trends, indications and outcomes of cardiac implantable device system extraction: a single UK centre experience over the last decade
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Anoop Shetty, Debashis Roy, Steven Williams, Nik Patel, Shoaib Hamid, Michael Cooklin, Jaswinder Gill, Mark D O'Neill, Christopher A. Rinaldi, Aruna Arujuna, Senthil Kirubakaran, C. Bucknall, Christopher Blauth, J. Whittaker, and Julian Bostock
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medicine.medical_specialty ,Percutaneous ,Multivariate analysis ,business.industry ,Extraction (chemistry) ,Retrospective cohort study ,General Medicine ,Surgery ,Statistical significance ,Cohort ,medicine ,Lead (electronics) ,business ,Coronary sinus - Abstract
Summary Background: The rising number of device implantation has seen a parallel in the rising numbers of lead extraction. Herein we have analysed our experience in cardiac device and lead extraction in a single tertiary centre over the last decade. Method: Retrospective analysis of all consecutive patients undergoing lead extractions performed between 2001 and 2010. Procedural success and complications as defined by the Heart Rhythm Society policy. Results: A total of 745 leads were extracted with a procedural success of 98.9% [382 cases; partial success in 6.9% (26) cases] and failure in 1.1% (4). Major complication rate was 1% (four cases) and minor complication rate was 3.6%. By both univariate and multivariate analysis only duration of lead implantation was an indicator for success (p
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- 2012
29. Biophysical Modeling Predicts Ventricular Tachycardia Inducibility and Circuit Morphology: A Combined Clinical Validation and Computer Modeling Approach
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Zhong, Chen, Rocio, Cabrera-Lozoya, Jatin, Relan, Manav, Sohal, Anoop, Shetty, Rashed, Karim, Herve, Delingette, Jaswinder, Gill, Kawal, Rhode, Nicholas, Ayache, Peter, Taggart, Christopher Aldo, Rinaldi, Maxime, Sermesant, and Reza, Razavi
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Aged, 80 and over ,Male ,Patient-Specific Modeling ,Time Factors ,Myocardium ,Models, Cardiovascular ,Action Potentials ,Middle Aged ,Magnetic Resonance Imaging ,Biomechanical Phenomena ,Heart Conduction System ,Heart Rate ,Predictive Value of Tests ,Tachycardia, Ventricular ,Humans ,Female ,Prospective Studies ,Electrophysiologic Techniques, Cardiac ,Aged - Abstract
Computational modeling of cardiac arrhythmogenesis and arrhythmia maintenance has made a significant contribution to the understanding of the underlying mechanisms of arrhythmia. We hypothesized that a cardiac model using personalized electro-anatomical parameters could define the underlying ventricular tachycardia (VT) substrate and predict reentrant VT circuits. We used a combined modeling and clinical approach in order to validate the concept.Non-contact electroanatomic mapping studies were performed in 7 patients (5 ischemics, 2 non-ischemics). Three ischemic cardiomyopathy patients underwent a clinical VT stimulation study. Anatomical information was obtained from cardiac magnetic resonance imaging (CMR) including high-resolution scar imaging. A simplified biophysical mono-domain action potential model personalized with the patients' anatomical and electrical information was used to perform in silico VT stimulation studies for comparison. The personalized in silico VT stimulations were able to predict VT inducibility as well as the macroscopic characteristics of the VT circuits in patients who had clinical VT stimulation studies. The patients with positive clinical VT stimulation studies had wider distribution of action potential duration restitution curve (APD-RC) slopes and APDs than the patient with a negative VT stimulation study. The exit points of reentrant VT circuits encompassed a higher percentage of the maximum APD-RC slope compared to the scar and non-scar areas, 32%, 4%, and 0.2%, respectively.VT stimulation studies can be simulated in silico using a personalized biophysical cardiac model. Myocardial spatial heterogeneity of APD restitution properties and conductivity may help predict the location of crucial entry/exit points of reentrant VT circuits.
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- 2015
30. The Acute Hemodynamic Response to LV Pacing within Individual Branches of the Coronary Sinus using a Quadripolar Lead
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Anoop Shetty, Christopher A. Rinaldi, Matthew Ginks, Stamatis Kapetanakis, YingLiang Ma, Reza Razavi, Gerald Carr-White, Simon G. Duckett, Kawal Rhode, and Julian Bostock
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medicine.medical_specialty ,business.industry ,Haemodynamic response ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Hemodynamics ,General Medicine ,Coronary circulation ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Cardiology ,medicine ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,Vein ,business ,Coronary sinus - Abstract
Background: It is not clear whether there is a large difference in acute hemodynamic response (AHR) to left ventricle (LV) pacing in different regions of the same coronary sinus (CS) vein. Using the four electrodes available on a Quartet LV lead, we evaluated the AHR to pacing within individual branches of the CS. Methods: An acute hemodynamic study was attempted in 20 patients. In each patient, we assessed AHR in a number of CS veins and along a significant proportion of each CS branch using three different bipolar configurations. We compared the AHR achieved when pacing using each different vector and also the highest AHR achieved in any position within the same patient with the lowest achieved in that patient. Results: Sixty-four different CS positions in 19 patients were successfully assessed. No significant difference in AHR was found overall between the three vectors tested. The mean percentage difference in AHR between the CS branch vectors with the lowest and highest dP/dt(max) was +6.5 +/- 5.4% (P
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- 2011
31. Multi-site left ventricular pacing as a potential treatment for patients with postero-lateral scar: insights from cardiac magnetic resonance imaging and invasive haemodynamic assessment
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C. Aldo Rinaldi, YingLiang Ma, Matthew Ginks, Shoaib Hamid, Kawal Rhode, Anoop Shetty, Simon G. Duckett, Reza Razavi, Gerald Carr-White, Stamatis Kapetanakis, and Julian Bostock
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Male ,medicine.medical_specialty ,Haemodynamic response ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Hemodynamics ,Ventricular Dysfunction, Left ,Cardiac magnetic resonance imaging ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Vein ,Aged ,Heart Failure ,Coronary Vein ,medicine.diagnostic_test ,business.industry ,Cardiac Pacing, Artificial ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Multi-site left ventricular (LV) pacing may be superior to single-site stimulation in correcting dyssynchrony and avoiding areas of myocardial scar. We sought to characterize myocardial scar using cardiac magnetic resonance imaging (CMR). We aimed to quantify the acute haemodynamic response to single-site and multi-site LV stimulation and to relate this to the position of the LV leads in relation to myocardial scar. Methods Twenty patients undergoing cardiac resynchronization therapy had implantation of two LV leads. One lead (LV1) was positioned in a postero-lateral vein, the second (LV2) in a separate coronary vein. LV d P /d t max was recorded using a pressure wire during stimulation at LV1, LV2, and both sites simultaneously (LV1 + 2). Patients were deemed acute responders if ΔLV d P /d t max was ≥10%. Cardiac magnetic resonance imaging was performed to assess dyssynchrony as well as location and burden of scar. Scar anatomy was registered with fluoroscopy to assess LV lead position in relation to scar. Results LV d P /d t max increased from 726 ± 161 mmHg/s in intrinsic rhythm to 912 ± 234 mmHg/s with LV1, 837 ± 188 mmHg/s with LV2, and 932 ± 201 mmHg/s with LV1 and LV2. Nine of 19 (47%) were acute responders with LV1 vs. 6/19 (32%) with LV2. Twelve of 19 (63%) were acute responders with simultaneous LV1 + 2. Two of three patients benefitting with multi-site pacing had the LV1 lead positioned in postero-lateral scar. Conclusion Multi-site LV pacing increased acute response by 16% vs. single-site pacing. This was particularly beneficial in patients with postero-lateral scar identified on CMR.
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- 2011
32. Biophysical Modeling to Simulate the Response to Multisite Left Ventricular Stimulation Using a Quadripolar Pacing Lead
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Anoop Shetty, Julian Bostock, Gernot Plank, Nicolas P. Smith, Reza Razavi, Christopher A. Rinaldi, and Steven A. Niederer
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Human heart ,General Medicine ,medicine.disease ,Ventricular stimulation ,Surgery ,QRS complex ,Internal medicine ,Heart failure ,Heart rate ,cardiovascular system ,medicine ,Cardiology ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business ,Lead (electronics) - Abstract
Background: Response to cardiac resynchronization therapy (CRT) is reduced in patients with posterolateral scar. Multipolar pacing leads offer the ability to select desirable pacing sites and/or stimulate from multiple pacing sites concurrently using a single lead position. Despite this potential, the clinical evaluation and identification of metrics for optimization of multisite CRT (MCRT) has not been performed. Methods: The efficacy of MCRT via a quadripolar lead with two left ventricular (LV) pacing sites in conjunction with right ventricular pacing was compared with single-site LV pacing using a coupled electromechanical biophysical model of the human heart with no, mild, or severe scar in the LV posterolateral wall. Result: The maximum dP/dtmax improvement from baseline was 21%, 23%, and 21% for standard CRT versus 22%, 24%, and 25% for MCRT for no, mild, and severe scar, respectively. In the presence of severe scar, there was an incremental benefit of multisite versus standard CRT (25% vs 21%, 19% relative improvement in response). Minimizing total activation time (analogous to QRS duration) or minimizing the activation time of short-axis slices of the heart did not correlate with CRT response. The peak electrical activation wave area in the LV corresponded with CRT response with an R2 value between 0.42 and 0.75. Conclusion: Biophysical modeling predicts that in the presence of posterolateral scar MCRT offers an improved response over conventional CRT. Maximizing the activation wave area in the LV had the most consistent correlation with CRT response, independent of pacing protocol, scar size, or lead location. (PACE 2012; 35:204–214)
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- 2011
33. Invasive Acute Hemodynamic Response to Guide Left Ventricular Lead Implantation Predicts Chronic Remodeling in Patients Undergoing Cardiac Resynchronization Therapy
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Anoop Shetty, C. Aldo Rinaldi, Gerry Carr-White, Matthew Ginks, Stam Kapetanakis, Jaswinder Gill, Shoaib Hamid, Simon G. Duckett, Julian Bostock, Reza Razavi, and Eliane Cunliffe
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Cardiomyopathy, Dilated ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiomyopathy ,Cardiac resynchronization therapy ,cardiac resynchronization therapy ,heart failure ,LV-dP/dtmax ,030204 cardiovascular system & hematology ,reverse remodeling ,Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,acute hemodynamic response ,Internal medicine ,medicine ,Ventricular Pressure ,Humans ,030212 general & internal medicine ,Cardiac Resynchronization Therapy Devices ,Ventricular remodeling ,Coronary sinus ,Aged ,Ischemic cardiomyopathy ,Ventricular Remodeling ,business.industry ,Dilated cardiomyopathy ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Treatment Outcome ,Heart failure ,Cardiology ,cardiovascular system ,Female ,business ,Cardiology and Cardiovascular Medicine - Abstract
ObjectivesWe evaluated the relationship between acute hemodynamic response (AHR) and reverse remodeling (RR) in cardiac resynchronization therapy (CRT).BackgroundCRT reduces mortality and morbidity in heart failure patients; however, up to 30% of patients do not derive symptomatic benefit. Higher proportions do not remodel. Multicenter trials have shown echocardiographic techniques are poor at improving response rates. We hypothesized the degree of AHR at implant can predict which patients remodel.MethodsThirty-three patients undergoing CRT (21 dilated and 12 ischemic cardiomyopathy) were studied. Left ventricular (LV) volumes were assessed before and after CRT. The AHR (maximum rate of left ventricular pressure [LV-dP/dtmax]) was assessed at implant with a pressure wire in the LV cavity. Largest percentage rise in LV-dP/dtmax from baseline (atrial antibradycardia pacing or right ventricular pacing with atrial fibrillation) to dual-chamber pacing (DDD)-LV was used to determine optimal coronary sinus LV lead position. Reverse remodeling was defined as reduction in LV end systolic volume ≥15% at 6 months.ResultsThe LV-dP/dtmax increased significantly from baseline (801 ± 194 mm Hg/s to 924 ± 203 mm Hg/s, p < 0.001) with DDD-LV pacing for the optimal LV lead position. The LV end systolic volume decreased from 186 ± 68 ml to 157 ± 68 ml (p < 0.001). Eighteen (56%) patients exhibited RR. There was a significant relationship between percentage rise in LV-dP/dtmax and RR for DDD-LV pacing (p < 0.001). A similar relationship for AHR and RR in dilated cardiomyopathy and ischemic cardiomyopathy (p = 0.01 and p = 0.006) was seen.ConclusionsAcute hemodynamic response to LV pacing is useful for predicting which patients are likely to remodel in response to CRT both for dilated cardiomyopathy and ischemic cardiomyopathy. Using AHR has the potential to guide LV lead positioning and improve response rates.
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- 2011
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34. Percutaneous Lead and System Extraction in Patients with Cardiac Resynchronization Therapy (CRT) Devices and Coronary Sinus Leads
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Julian Bostock, Shoaib Hamid, Anoop Shetty, C. Aldo Rinaldi, Michael Cooklin, Jaswinder Gill, John Whitaker, Steven Williams, Margaret Mobb, Cliff Bucknall, Aruna Arujuna, Nikhil Patel, and Christopher Blauth
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medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Cardiac Resynchronization Therapy Devices ,Cardiac resynchronization therapy ,Context (language use) ,General Medicine ,Surgery ,Text mining ,medicine ,Cardiology and Cardiovascular Medicine ,Lead (electronics) ,Complication ,business ,Coronary sinus - Abstract
Background: Cardiac resynchronization therapy (CRT) device and coronary sinus (CS) lead extraction is required due to the occurrence of system infection, malfunction, or upgrade. Published series of CS lead extraction are limited by small sample sizes. We present a 10-year experience of CRT device and CS lead extraction. Methods: All lead extractions between 2000 and 2010 were entered into a computer database. From these, a cohort of 71 cases involving a CRT device or CS lead was analyzed for procedural method, success, and complications. Results: Sixty coronary sinus leads were extracted in 71 cases (median age 71 years; 90% male) by manual traction/locking stylets (n = 54) or using a laser sheath (n = 6). Procedural success was achieved in 98% of CS leads. A total of 143 non-CS leads were extracted, with laser required in 46% of cases. The mean duration of lead implantation was 35.8 months (range 1–116 months) and 2.86 ± 1.07 leads were extracted per case. CRT extraction case load increased significantly over time. Minor complications occurred in four (5.6%) cases and major complications in one (1.4%) case. There were no intraprocedural deaths, but two deaths occurred within 30 days of extraction. Conclusions: Our 10-year experience confirms that percutaneous removal of CS leads can be achieved with high procedural success. Our recorded complication rates are no higher than those of non-CS lead extraction series, and should be taken in the context of the frail nature of CRT patients. Ongoing audit of procedure success and complications will be required to further guide best practice in CS lead extraction. (PACE 2011; 34:1209–1216)
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- 2011
35. Use of a quadripolar left ventricular lead to achieve successful implantation in patients with previous failed attempts at cardiac resynchronization therapy
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Anoop Shetty, Simon G. Duckett, Eric Rosenthal, Christopher A. Rinaldi, and Julian Bostock
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Adult ,Male ,medicine.medical_specialty ,Phrenic nerve stimulation ,Ventricular lead ,medicine.medical_treatment ,Heart Ventricles ,Cardiac resynchronization therapy ,Quadripolar lead ,Cardiac Resynchronization Therapy ,Clinical Research ,Physiology (medical) ,Internal medicine ,medicine ,Failed implant ,Humans ,In patient ,Cardiac Resynchronization Therapy Devices ,Treatment Failure ,Lead (electronics) ,Coronary sinus ,Phrenic nerve ,Aged ,business.industry ,Coronary Sinus ,Middle Aged ,Pacing and Resynchronization Therapy ,Electrodes, Implanted ,Phrenic nerve stimulation (PNS) ,Phrenic Nerve ,Treatment Outcome ,cardiovascular system ,Cardiology ,CRT ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies - Abstract
Aims Problems with implanting a left ventricular (LV) lead during cardiac resynchronization therapy (CRT) procedures are not uncommon and may occur for a variety of reasons including phrenic nerve stimulation (PNS) and high capture thresholds. We aimed to perform successful CRT in patients with previous LV lead problems using the multiple pacing configurations available with the St Jude Quartet model 1458Q quadripolar LV lead to overcome PNS or high capture thresholds. Methods and results Four patients with previous failed attempts at LV lead implantation underwent a further attempt at CRT using a Quartet lead. In all four cases, successful CRT was achieved using a Quartet lead placed in a branch of the coronary sinus. Problems with PNS or high capture thresholds were seen in all four patients but were successfully overcome. Satisfactory lead parameters were seen at implant, pre-discharge, and at short-term follow-up (8.5 ± 5 weeks). Conclusion The Quartet lead allows 10 different pacing vectors to be used and may overcome common pacing problems because of the multiple pacing configurations available. Problems with either PNS or unsatisfactory pacing parameters experienced during CRT may be resolved simply by changing the pacing configuration using this quadripolar lead system.
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- 2011
36. Advanced Image Fusion to Overlay Coronary Sinus Anatomy with Real-Time Fluoroscopy to Facilitate Left Ventricular Lead Implantation in CRT
- Author
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Michael Cooklin, Tobias Schaeffter, Julian Bostock, Anoop Shetty, Matthew Ginks, Kawal Rhode, Jas S. Gill, Benjamin R. Knowles, Reza Razavi, Gerry Carr-White, C. Aldo Rinaldi, Simon G. Duckett, and YingLiang Ma
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Cardiac Resynchronization Therapy Devices ,Cardiac resynchronization therapy ,Image registration ,Magnetic resonance imaging ,General Medicine ,Anatomy ,Cardiac magnetic resonance imaging ,Angiography ,cardiovascular system ,medicine ,Fluoroscopy ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Coronary sinus - Abstract
Background: Failure rate for left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) is up to 12%. The use of segmentation tools, advanced image registration software, and high-fidelity images from computerized tomography (CT) and cardiac magnetic resonance (CMR) of the coronary sinus (CS) can guide LV lead implantation. We evaluated the feasibility of advanced image registration onto live fluoroscopic images to allow successful LV lead placement. Methods: Twelve patients (11 male, 59 ± 16.8 years) undergoing CRT had three-dimensional (3D) whole-heart imaging (six CT, six CMR). Eight patients had at least one previously failed LV lead implant. Using segmentation software, anatomical models of the cardiac chambers, CS, and its branches were overlaid onto the live fluoroscopy using a prototype version of the Philips EP Navigator software to guide lead implantation. Results: We achieved high-fidelity segmentations of cardiac chambers, coronary vein anatomy, and accurate registration between the 3D anatomical models and the live fluoroscopy in all 12 patients confirmed by balloon occlusion angiography. The CS was cannulated successfully in every patient and in 11, an LV lead was implanted successfully. (One patient had no acceptable lead values due to extensive myocardial scar.) Conclusion: Using overlaid 3D segmentations of the CS and cardiac chambers, it is feasible to guide CRT implantation in real time by fusing advanced imaging and fluoroscopy. This enabled successful CRT in a group of patients with previously failed implants. This technology has the potential to facilitate CRT and improve implant success. (PACE 2011; 34:226–234)
- Published
- 2010
37. Myocardial Stiffness Estimation: A Novel Cost Function for Unique Parameter Identification
- Author
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Bojan Blazevic, Anoop Shetty, Anastasia Nasopoulou, Andrew Crozier, Wenzhe Shi, Pablo Lamata, C. Aldo Rinaldi, and Steven A. Niederer
- Subjects
Mathematical optimization ,Estimation theory ,Computer science ,business.industry ,media_common.quotation_subject ,Myocardial stiffness ,Machine learning ,computer.software_genre ,Clinical biomarker ,Identification (information) ,In patient ,Artificial intelligence ,business ,Function (engineering) ,Cardiac mechanics ,computer ,media_common - Abstract
Myocardial stiffness is a clinical biomarker used to diagnose and stratify diseases such as heart failure. This biomechanical property can be inferred from the personalisation of computational cardiac models to clinical measures. Nevertheless, previous attempts have been unable to determine a unique set of material constitutive parameters. In this study we address this shortcoming by proposing a new cost function that allows us to uncouple key parameters and uniquely describe passive material properties in patients from available clinical data.
- Published
- 2015
38. Quad-Site Pacing Using a Quadripolar Left Ventricular Pacing Lead
- Author
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C. Aldo Rinaldi, Anoop Shetty, Paresh A. Mehta, and Julian Bostock
- Subjects
medicine.medical_specialty ,Haemodynamic response ,business.industry ,medicine.medical_treatment ,Treatment outcome ,Cardiac resynchronization therapy ,General Medicine ,Ventricular pacing ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,Lead (electronics) ,business ,Coronary sinus - Abstract
Pacing the left ventricle (LV) from multiple sites simultaneously may result in a better response to cardiac resynchronization therapy (CRT). We sought to assess whether multisite pacing using a quadripolar LV lead improves acute hemodynamic response (AHR) to CRT. We paced four ventricular sites simultaneously using two vectors of a Quartet lead, a right ventricular apical lead, and an additional LV lead temporarily placed in an anterior branch of the coronary sinus. Multisite pacing using the Quartet lead alone did not improve the AHR but "quad-site" pacing using an additional temporary LV lead did increase dP/dt(max).
- Published
- 2011
39. Myocardial tissue characterization by cardiac magnetic resonance imaging using T1 mapping predicts ventricular arrhythmia in ischemic and non-ischemic cardiomyopathy patients with implantable cardioverter-defibrillators
- Author
-
Mark D O'Neill, Reza Razavi, Catalina Tobon-Gomez, Tobias Ratko Voigt, Tom Jackson, Zhong Chen, Michael Cooklin, Amedeo Chiribiri, Anoop Shetty, Francis Murgatroyd, Gerry Carr-White, Eva Sammut, Jaswinder Gill, C. Aldo Rinaldi, Julian Bostock, Tobias Schaeffter, Manav Sohal, Nicholas Child, and Matthew Wright
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Magnetic Resonance Imaging, Cine ,Ventricular tachycardia ,Cardiac magnetic resonance imaging ,Interquartile range ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,medicine ,Secondary Prevention ,Humans ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,Aged ,Ischemic cardiomyopathy ,medicine.diagnostic_test ,business.industry ,Myocardium ,Hazard ratio ,Middle Aged ,Implantable cardioverter-defibrillator ,medicine.disease ,Prognosis ,Fibrosis ,United Kingdom ,Defibrillators, Implantable ,Death, Sudden, Cardiac ,Predictive value of tests ,Cardiology ,Tachycardia, Ventricular ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies - Abstract
Background Diffuse myocardial fibrosis may provide a substrate for the initiation and maintenance of ventricular arrhythmia. T1 mapping overcomes the limitations of the conventional delayed contrast-enhanced cardiac magnetic resonance (CE-CMR) imaging technique by allowing quantification of diffuse fibrosis. Objective The purpose of this study was to assess whether myocardial tissue characterization using T1 mapping would predict ventricular arrhythmia in ischemic and non–ischemic cardiomyopathies. Methods This was a prospective longitudinal study of consecutive patients receiving implantable cardioverter-defibrillators in a tertiary cardiac center. Participants underwent CMR myocardial tissue characterization using T1 mapping and conventional CE-CMR scar assessment before device implantation. The primary end point was an appropriate implantable cardioverter-defibrillator therapy or documented sustained ventricular arrhythmia. Results One hundred thirty patients (71 ischemic and 59 non–ischemic) were included with a mean follow-up period of 430 ± 185 days (median 425 days; interquartile range 293 days). At follow-up, 23 patients (18%) experienced the primary end point. In multivariable-adjusted analyses, the following factors showed a significant association with the primary end point: secondary prevention (hazard ratio [HR] 1.70; 95% confidence interval [95% CI] 1.01–1.91), noncontrast T1 _native for every 10-ms increment in value (HR 1.10; CI 1.04–1.16; 90-ms difference between the end point–positive and end point–negative groups), and Grayzone _2sd-3sd for every 1% left ventricular increment in value (HR 1.36; CI 1.15–1.61; 4% difference between the end point–positive and end point–negative groups). Other CE-CMR indices including Scar _2sd , Scar _FWHM , and Grayzone _2sd-FWHM were also significantly, even though less strongly, associated with the primary end point as compared with Grayzone _2sd-3sd . Conclusion Quantitative myocardial tissue assessment using T1 mapping is an independent predictor of ventricular arrhythmia in both ischemic and non–ischemic cardiomyopathies.
- Published
- 2014
40. Extraction of Pacing Leads Jailed by a Stent in a Mustard Circulation
- Author
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Shay Cullen, Anoop Shetty, Fiona Walker, and Pier D. Lambiase
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Treatment outcome ,Stent ,Corrected transposition ,social sciences ,General Medicine ,Ventricular pacing ,Vena cava syndrome ,Surgery ,Great arteries ,Internal medicine ,medicine ,Manual traction ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Lead extraction - Abstract
A case of successful lead extraction of atrial and ventricular pacing leads "jailed" by a stent in the superior limb of a Mustard baffle in a 40-year-old man with surgically corrected transposition of the great arteries and pacemaker pocket infection. Manual traction alone was sufficient to remove the jailed leads with no subsequent complications.
- Published
- 2010
41. Improvement in acute contractility and hemodynamics with multipoint pacing via a left ventricular quadripolar pacing lead
- Author
-
Erwan Donal, Taraneh Ghaffari Farazi, Tasneem Z. Naqvi, Allen Keel, Marcus Simon, Christophe Leclercq, Wolfgang Kranig, Klaus Gutleben, C. Aldo Rinaldi, Anoop Shetty, Timothy R. Betts, Kyungmoo Ryu, Pierre Bordachar, and Salem Kacet
- Subjects
Cardiac function curve ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Hemodynamics ,Contractility ,Cardiac Resynchronization Therapy ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Lead (electronics) ,Prospective cohort study ,Aged ,Heart Failure ,business.industry ,Equipment Design ,Middle Aged ,medicine.disease ,Myocardial Contraction ,Electrodes, Implanted ,Heart failure ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Radial stress - Abstract
A quadripolar left ventricular (LV) pacing can deliver multipoint pacing (MPP). It is unknown if this confers improved cardiac function compared to conventional cardiac resynchronization therapy (CRT).We aimed to characterize changes in acute cardiac contractility and hemodynamics with multisite left ventricular "multipoint" pacing (MPP) in a prospective multicenter study in patients implanted with a CRT-defibrillator incorporating a quadripolar LV lead. The device was programmed to deliver MPP acutely pacing with eight configurations of varying timing delays. Global peak LV radial strain and LV outflow velocity time integral (LVOT VTI) were measured for conventional CRT and each MPP configuration. Out of the eight tested MPP configurations, the one that yielded the best echocardiographic measurement for each patient was defined as "optimal MPP". Forty CRT recipients had complete radial strain datasets suitable for analysis. Compared to conventional CRT, the mean peak radial strain was significantly higher for the optimal MPP configuration (18.3 ± 7.4 vs. 9.3 ± 5.3%, p 0.001), and at least one MPP configuration was significantly superior (20%) in 63% of patients. LVOT VTI data were collected in a subset of 13 patients. In these patients, mean VTI was significantly higher for optimal MPP compared to conventional CRT (13.5 ± 2.7 vs. 10.9 ± 3.3 cm, p 0.01).MPP delivered via a quadripolar LV lead resulted in a significant improvement in acute cardiac contractility and hemodynamics compared to conventional CRT in the majority of patients studied.Clinicaltrials.gov identifier NCT01044784.
- Published
- 2013
42. Pulmonary vein isolation: the impact of pulmonary venous anatomy on long-term outcome of catheter ablation for paroxysmal atrial fibrillation
- Author
-
Peter M. Kistler, Michael C.G. Wong, Anoop Shetty, Sonia Azzopardi, Ashley Nisbet, Liang-Han Ling, Jonathan M. Kalman, Tomos E. Walters, Alex J.A. McLellan, Joseph B. Morton, Diego Ruggiero, and Andrew J. Taylor
- Subjects
Male ,medicine.medical_specialty ,Isolation (health care) ,medicine.medical_treatment ,Catheter ablation ,Magnetic resonance angiography ,Pulmonary vein ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Venous anatomy ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,Middle Aged ,Ablation ,medicine.disease ,Magnetic Resonance Imaging ,Treatment Outcome ,Pulmonary Veins ,Cardiology ,Catheter Ablation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
Circumferential pulmonary vein (PV) isolation is the cornerstone of catheter ablation for atrial fibrillation (AF); however, PV reconnection remains problematic.To assess the impact of PV anatomy on outcome after AF ablation.One hundred two patients with paroxysmal AF underwent cardiac magnetic resonance (60%) or computed tomography (40%) before AF ablation. PV anatomy was classified according to the presence of common PVs, accessory PVs, PV branching pattern, and the dimensions of the PV ostia, intervenous ridges (IVRs), and the left PV-left atrial appendage ridge.Four discrete PVs were present in 48(47%) of the patients: a left common PV in 38(37%), a right common PV in 2(2%), an accessory right PV in 20(20%), and left PV in 4(4%). At a mean follow-up of 12 ± 4 months, 75 of 102 (74%) patients were free of recurrent AF. A LCPV was associated with an increase in freedom from AF (87% vs 66% for 4 PV anatomy; P = .03). Greater left IVR length (16.9 ± 3.5 mm vs 14.0 ± 3.0 mm; P ≤ .001) and width (1.4 ± 0.6 mm vs 1.1 ± 0.6 mm; P = .02) were associated with increased AF recurrence. After multivariate analysis, abnormal anatomy (LCPV or accessory PV) and left IVR length were found to be the only independent predictors of freedom from AF.Four discrete PVs are present in the minority of patients with paroxysmal AF undergoing PV isolation. The presence of a LCPV is associated with an increased freedom from AF after catheter ablation. PV anatomy may in part explain the variable outcome to electrical isolation in patients with paroxysmal AF.
- Published
- 2013
43. Concealed atrial ectopic focus originating from the tricuspid annulus
- Author
-
Anoop Shetty and Jonathan M. Kalman
- Subjects
Adult ,Male ,Tachycardia, Ectopic Atrial ,Focus (computing) ,medicine.medical_specialty ,business.industry ,Electrocardiography ,Physiology (medical) ,Internal medicine ,medicine ,Tricuspid annulus ,Cardiology ,Humans ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business ,Atrial ectopic - Published
- 2013
44. Simultaneous non-contact mapping fused with CMR derived grey zone to explore the relationship with ventricular tachycardia substrate in ischaemic cardiomyopathy
- Author
-
Anoop Shetty, Hervé Delingette, Walther H. W. Schulze, Nicholas Ayache, YingLiang Ma, Reza Razavi, Kawal Rhode, Zhong Chen, Julian Bostock, Manav Sohal, Rashed Karim, Jatin Relan, Maxime Sermesant, and Aldo Rinaldi
- Subjects
Non contact mapping ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Ischaemic cardiomyopathy ,Ventricular tachycardia ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,cardiovascular diseases ,Engineering & allied operations ,Angiology ,Medicine(all) ,Radiological and Ultrasound Technology ,business.industry ,medicine.disease ,Anatomical landmark ,Grey zone ,lcsh:RC666-701 ,Poster Presentation ,Cardiology ,cardiovascular system ,ddc:620 ,Cardiology and Cardiovascular Medicine ,Cardiac magnetic resonance ,business - Abstract
Background Cardiac magnetic resonance (CMR) imaging enables characterization of myocardial scar and the ‘grey zone’, an admixture of scar and healthy myocardium, which is an independent predictor of ventricular arrhythmia. We explored the relationship between the grey zone and ventricular tachycardia circuits (VT) in ischaemic cardiomyopathy. Methods Two patients with previous myocardial infarct underwent high-resolution late gadolinium enhanced CMR scar imaging (1.2x1.2x2.6mm) and a VT-stimulation study. The LV scar core was segmented using full-width-half-maximum method; and the grey zone was segmented with a cut-off signal intensity below that of the scar core and above 2 standard-deviation of the remote healthy myocardium. A multi-electrode array (MEA) was positioned in the LV cavity for simultaneous electroanatomical mapping during the study. The MEA shell was registered with the CMR-derived LV shell using anatomical landmark registration (Figure 1a,b) for comparison. Results Sustained monomorphic VT (SMVT) was induced in both patients. Scar core and grey zone regions correlated well with the low voltage area (≤ 30% maximum voltage) seen on the MEA (Figure 1a,c,d). The exit point during SMVT
- Published
- 2013
45. An integrated platform for image-guided cardiac resynchronization therapy
- Author
-
Anoop Shetty, Christopher A. Rinaldi, Geert Gijsbers, Tobias Schaeffter, Kawal Rhode, Patrick Etyngier, Reza Razavi, Simon G. Duckett, Roland W. M. Bullens, and YingLiang Ma
- Subjects
Models, Anatomic ,medicine.medical_specialty ,medicine.medical_treatment ,Heart Ventricles ,Movement ,Cardiac resynchronization therapy ,Cardiac Resynchronization Therapy ,Cardiac magnetic resonance imaging ,medicine ,Fluoroscopy ,Humans ,Radiology, Nuclear Medicine and imaging ,Lead (electronics) ,Coronary Vein ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,medicine.disease ,Magnetic Resonance Imaging ,Catheter ,Heart failure ,Radiology ,business ,Software - Abstract
Cardiac resynchronization therapy (CRT) is an effective procedure for patients with heart failure but 30% of patients do not respond. This may be due to sub-optimal placement of the left ventricular (LV) lead. It is hypothesized that the use of cardiac anatomy, myocardial scar distribution and dyssynchrony information, derived from cardiac magnetic resonance imaging (MRI), may improve outcome by guiding the physician for optimal LV lead positioning. Whole heart MR data can be processed to yield detailed anatomical models including the coronary veins. Cine MR data can be used to measure the motion of the LV to determine which regions are late-activating. Finally, delayed Gadolinium enhancement imaging can be used to detect regions of scarring. This paper presents a complete platform for the guidance of CRT using pre-procedural MR data combined with live x-ray fluoroscopy. The platform was used for 21 patients undergoing CRT in a standard catheterization laboratory. The patients underwent cardiac MRI prior to their procedure. For each patient, a MRI-derived cardiac model, showing the LV lead targets, was registered to x-ray fluoroscopy using multiple views of a catheter looped in the right atrium. Registration was maintained throughout the procedure by a combination of C-arm/x-ray table tracking and respiratory motion compensation. Validation of the registration between the three-dimensional (3D) roadmap and the 2D x-ray images was performed using balloon occlusion coronary venograms. A 2D registration error of 1.2 ± 0.7 mm was achieved. In addition, a novel navigation technique was developed, called Cardiac Unfold, where an entire cardiac chamber is unfolded from 3D to 2D along with all relevant anatomical and functional information and coupled to real-time device detection. This allowed more intuitive navigation as the entire 3D scene was displayed simultaneously on a 2D plot. The accuracy of the unfold navigation was assessed off-line using 13 patient data sets by computing the registration error of the LV pacing lead electrodes which was found to be 2.2 ± 0.9 mm. Furthermore, the use of Unfold Navigation was demonstrated in real-time for four clinical cases.
- Published
- 2012
46. Infarct myocardium tissue heterogeneity assessment using pre-contrast and post-contrast T1 maps acquired with Modified Look-Locker Inversion Recovery (MOLLI) imaging
- Author
-
Andrea J. Wiethoff, Tobias Schaeffter, Aldo Rinaldi, Reza Razavi, Zhong Chen, Tobias Ratko Voigt, David C. Murday, Siobhan Crichton, Anoop Shetty, Eike Nagel, and Valentina O. Puntmann
- Subjects
Medicine(all) ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Pathology ,Radiological and Ultrasound Technology ,business.industry ,Look locker ,media_common.quotation_subject ,Inversion recovery ,Pre contrast ,Grey zone ,Tissue heterogeneity ,lcsh:RC666-701 ,Internal medicine ,Poster Presentation ,medicine ,Cardiology ,Contrast (vision) ,Radiology, Nuclear Medicine and imaging ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Angiology ,media_common - Abstract
We aim to explore tissue heterogeneity assessment using T1 maps generated with the modified Look Locker (MOLLI) sequence in patients with previous myocardial infarct. Conclusion: Differences between healthy myocardium and scarred tissues can be reliably distinguished from the R1 values derived from pre-contrast T1 maps.Potentially, patients without scarred myocardium do not need post-contrast imaging. Inpatients with scarred tissues, ΔR1 value derived from both thepre- and the post-contrast T1 maps provides better distinction between grey zone and scar core than either pre-contrast or post-contrast R1 value alone.
- Published
- 2012
47. The estimation of patient-specific cardiac diastolic functions from clinical measurements
- Author
-
Daniel Rueckert, Pablo Lamata, Jiahe Xi, C. Aldo Rinaldi, Sebastien Ourselin, Wenzhe Shi, Sander Land, Nic Smith, Xiahai Zhuang, Simon G. Duckett, Anoop Shetty, Reza Razavi, and Steven A. Niederer
- Subjects
Male ,02 engineering and technology ,030204 cardiovascular system & hematology ,Residual ,Ventricular Dysfunction, Left ,0302 clinical medicine ,CONTRACTION ,PASSIVE MYOCARDIUM ,Mathematics ,Radiological and Ultrasound Technology ,Estimation theory ,Left ventricular (LV) mechanics ,Diastolic heart failure ,MECHANICAL-PROPERTIES ,Patient specific ,Computer Graphics and Computer-Aided Design ,medicine.anatomical_structure ,MATERIAL PARAMETER-ESTIMATION ,Radiology Nuclear Medicine and imaging ,Dynamic contrast-enhanced MRI ,REGISTRATION ,Cardiology ,MR-IMAGES ,HEART ,Computer Vision and Pattern Recognition ,Algorithms ,Adult ,STRAIN ,medicine.medical_specialty ,Heart Ventricles ,0206 medical engineering ,Diastole ,Magnetic Resonance Imaging, Cine ,Health Informatics ,Sensitivity and Specificity ,Article ,03 medical and health sciences ,DATA ASSIMILATION ,Internal medicine ,Elastic Modulus ,VENTRICULAR MYOCARDIUM ,Image Interpretation, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Constitutive material parameter estimation ,Aged ,Reproducibility of Results ,Stroke Volume ,medicine.disease ,Image Enhancement ,020601 biomedical engineering ,Ventricle - Abstract
An unresolved issue in patients with diastolic dysfunction is that the estimation of myocardial stiffness cannot be decoupled from diastolic residual active tension (AT) because of the impaired ventricular relaxation during diastole. To address this problem, this paper presents a method for estimating diastolic mechanical parameters of the left ventricle (LV) from cine and tagged MRI measurements and LV cavity pressure recordings, separating the passive myocardial constitutive properties and diastolic residual AT. Dynamic C(1)-continuous meshes are automatically built from the anatomy and deformation captured from dynamic MRI sequences. Diastolic deformation is simulated using a mechanical model that combines passive and active material properties. The problem of non-uniqueness of constitutive parameter estimation using the well known Guccione law is characterized by reformulation of this law. Using this reformulated form, and by constraining the constitutive parameters to be constant across time points during diastole, we separate the effects of passive constitutive properties and the residual AT during diastolic relaxation. Finally, the method is applied to two clinical cases and one control, demonstrating that increased residual AT during diastole provides a potential novel index for delineating healthy and pathological cases.
- Published
- 2011
48. Elimination of phrenic nerve stimulation occurring during CRT: follow-up in patients implanted with a novel quadripolar pacing lead
- Author
-
C. Aldo Rinaldi, Anoop Shetty, Paresh A. Mehta, Julian Bostock, and Mark Squirrel
- Subjects
Adult ,Aged, 80 and over ,Male ,Pacemaker, Artificial ,Phrenic nerve stimulation ,Ventricular lead ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Middle Aged ,Electrodes, Implanted ,Cardiac Resynchronization Therapy ,Phrenic Nerve ,Young Adult ,nervous system ,Physiology (medical) ,Anesthesia ,medicine ,Humans ,In patient ,Female ,Cardiology and Cardiovascular Medicine ,Lead (electronics) ,business ,Aged - Abstract
Phrenic nerve stimulation (PNS) occurs at follow-up in approximately 20% of patients with bipolar leads. The quadripolar Quartet model 1458Q (St. Jude Medical, Sylmar, CA, USA) left ventricular lead (LV) has four electrodes (one distal tip and three ring) capable of ten different pacing vectors which may allow reprogramming to eliminate PNS.Forty patients underwent attempted CRT-D implantation between October 2009 and October 2010 with the Quartet lead. Pacing parameters, lead position, complications and presence of PNS were collected at implant, pre-discharge and at 3 and 6 months follow-up.A quadripolar LV lead was successfully implanted in 95% (38/40) of patients. During follow-up, one patient (3%) had a lead displacement requiring reposition. LV pacing parameters remained stable at 6 months follow-up (mean threshold 1.3 V at 0.6 ms and impedance 948 Ω). PNS at the time of implant was observed in 12 patients (32%) all of which were overcome by using the additional vectors available on the quadripolar LV lead or by repositioning the lead at the time of index implant. During 6 months follow-up there were five (13%) cases of PNS, all of which were successfully treated by reprogramming to a different vector. No cases required reintervention, surgical epicardial lead placement, or that lead be turned off.The quadripolar Quartet lead is associated with a high implant success rate, stable pacing parameters and a low displacement rate during the first 6 months after implant. The ten LV pacing vectors available with this lead allowed PNS and capture threshold problems to be overcome at implant, and importantly at follow-up, thus obviating the need for lead reposition.
- Published
- 2011
49. Adverse response to cardiac resynchronisation therapy in patients with septal scar on cardiac MRI preventing a septal right ventricular lead position
- Author
-
C. Aldo Rinaldi, Senthil Kirubakaran, Anoop Shetty, Reza Razavi, Stam Kapetanakis, Simon G. Duckett, Jaswinder Gill, Gerry Carr-White, Julian Bostock, and Matthew Ginks
- Subjects
Cardiomyopathy, Dilated ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Doppler echocardiography ,Risk Assessment ,Cardiac Resynchronization Therapy ,Cohort Studies ,03 medical and health sciences ,Cicatrix ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Confidence Intervals ,Heart Septum ,Odds Ratio ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Ventricular remodeling ,Aged ,Retrospective Studies ,Analysis of Variance ,Ischemic cardiomyopathy ,medicine.diagnostic_test ,Ventricular Remodeling ,business.industry ,Myocardium ,Magnetic resonance imaging ,Stroke Volume ,Stroke volume ,Middle Aged ,equipment and supplies ,medicine.disease ,Magnetic Resonance Imaging ,Heart septum ,Echocardiography, Doppler ,Treatment Outcome ,Heart failure ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Myocardial scar is an adverse factor when considering which patients are likely to respond to cardiac resynchronisation therapy (CRT). We hypothesized that septal scarring on magnetic resonance imaging (MRI) may be associated with a poor outcome from CRT, which may relate to the inability to place the right ventricular (RV) lead in the septum.Fifty patients (ejection fractions, 25 ± 8%; 45 men, 62.8 ± 14 years; 26 dilated cardiomyopathy; and 24 ischaemic cardiomyopathy (ICM)) receiving CRT underwent delayed enhancement cardiac MRI to assess location and burden of myocardial scar. Acute hemodynamic response (AHR) was evaluated at implant with a pressure wire in the left ventricular (LV) cavity. LV remodelling was determined by reduction in LV end-systolic volume at 6 months.The presence of ICM with septal scar was associated with a poor acute and chronic response to CRT. This was predominantly due to a worse response in patients with septal scar. Patients without septal scar had a better AHR with a 26.7 ± 28.9% rise in LV dP/dt (max) from baseline vs. -2.8 ± 14.5% for patients with septal scar (P = 0.01) with Biventricular (BIV) pacing. A greater proportion remodelled (56% vs. 20% (P = 0.02)). Furthermore, only 33% of patients with septal scar had an RV septal lead compared with 66% with no septal scar (P = 0.03).The presence of septal scar was associated with a poor acute and chronic response to CRT. This may relate to the inability to achieve a RV septal lead placement.
- Published
- 2011
50. Real-Time Cardiac MR Anatomy and Dyssynchrony Overlay for Guidance of Cardiac Resynchronization Therapy Procedures: Clinical Results Update
- Author
-
Anoop Shetty, Tobias Schaeffter, Reza Razavi, C. Aldo Rinaldi, Gerry Carr-White, Simon G. Duckett, YingLiang Ma, and Kawal Rhode
- Subjects
Coronary Vein ,medicine.medical_specialty ,Haemodynamic response ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Cardiac chamber ,Internal medicine ,medicine ,Cardiology ,Radiology ,Implant ,Lead Placement ,Lead (electronics) ,business ,Coronary sinus - Abstract
Optimal left ventricular (LV) lead placement via the coronary sinus (CS) is a critical factor in defining response to cardiac resynchronization therapy (CRT). Using novel MR image acquisition, segmentation, overlay and registration software we set out to guide lead placement by avoiding scar and targeting the LV region with the latest mechanical activation. We previously reported clinical results for 7 patients and now present updated results. 17 patients underwent cardiac magnetic resonance (CMR) scans. 3D whole heart images were segmented to produce high-fidelity anatomical models of the cardiac chambers and coronary veins. Four-chamber and short-axis cine images were processed using Tomtec software to give a 16-segment time volume-dyssynchrony map. In patients with myocardial scar, the Gadolinium late enhancement images were manually segmented and registered to the anatomical model along with the dyssynchrony map. The 3 latest mechanically acti- vated segments with
- Published
- 2011
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