10 results on '"Charlotte Stephansen"'
Search Results
2. Electrically guided versus imaging-guided implant of the left ventricular lead in cardiac resynchronization therapy: a study protocol for a double-blinded randomized controlled clinical trial (ElectroCRT)
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Charlotte Stephansen, Anders Sommer, Mads Brix Kronborg, Jesper Møller Jensen, Kirsten Bouchelouche, and Jens Cosedis Nielsen
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Heart failure ,Cardiac resynchronization therapy ,CRT ,Left ventricular ejection fraction ,LVEF ,Electrical mapping ,Medicine (General) ,R5-920 - Abstract
Abstract Background Cardiac resynchronization therapy (CRT) is an established treatment in patients with heart failure and prolonged QRS duration where a biventricular pacemaker is implanted to achieve faster activation and more synchronous contraction of the left ventricle (LV). Despite the convincing effect of CRT, 30–40% of patients do not respond. Among the most important correctable causes of non-response to CRT is non-optimal LV lead position. Methods We will enroll 122 patients in this patient-blinded and assessor-blinded, randomized, clinical trial aiming to investigate if implanting the LV lead guided by electrical mapping towards the latest LV activation as compared with imaging-guided implantation, causes an excess increase in left ventricular (LV) ejection fraction (LVEF). The patients are randomly assigned to either the intervention group: preceded by cardiac computed tomography of the cardiac venous anatomy, the LV lead is placed according to the latest LV activation in the coronary sinus (CS) branches identified by systematic electrical mapping of the CS at implantation and post-implant optimization of the interventricular pacing delay; or patients are assigned to the control group: placement of the LV lead guided by cardiac imaging. The LV lead is targeted towards the latest mechanical LV activation as identified by echocardiography and outside myocardial scar as identified by myocardial perfusion (MP) imaging. The primary endpoint is change in LVEF at 6-month follow up (6MFU) as compared with baseline measured by two-dimensional echocardiography. Secondary endpoints include relative percentage reduction in LV end-systolic volume, all-cause mortality, hospitalization for heart failure, and a clinical combined endpoint of response to CRT at 6MFU defined as the patient being alive, not hospitalized for heart failure, and experiencing improvement in NYHA functional class or/and > 10% increase in 6-minute walk test. Discussion We assume an absolute increase in LVEF of 12% in the intervention group versus 8% in the control group. If an excess increase in LVEF can be achieved by LV lead implantation guided by electrical mapping, this study supports the conduct of larger trials investigating the impact of this strategy for LV-lead implantation on clinical outcomes in patients treated with CRT. Trial registration ClinicalTrials.gov, NCT02346097. Registered on 12 January 2015. Patients were enrolled between 16 February 2015 and 13 December 2017.
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- 2018
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3. Cardiac computed tomography-verified right ventricular lead position and outcomes in cardiac resynchronization therapy
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Daniel Benjamin Fyenbo, Anders Sommer, Charlotte Stephansen, Bjarne Linde Nørgaard, Mads Brix Kronborg, Jens Kristensen, Christian Gerdes, Henrik Kjærulf Jensen, Jesper Møller Jensen, and Jens Cosedis Nielsen
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Heart Failure ,Cardiac resynchronization therapy ,Cardiac computed tomography ,Ventricular Remodeling ,Heart Ventricles ,Right ventricular lead position ,Cardiac Resynchronization Therapy ,Treatment Outcome ,Left ventricular reverse remodeling ,Physiology (medical) ,Clinical outcomes ,Humans ,Cardiology and Cardiovascular Medicine ,Tomography - Abstract
PURPOSE: To evaluate the association between different right ventricular (RV) lead positions as assessed by cardiac computed tomography (CT) and echocardiographic and clinical outcomes in patients receiving cardiac resynchronization therapy (CRT).METHODS: We reviewed patient records of all 278 patients included in two randomized controlled trials (ImagingCRT and ElectroCRT) for occurrence of heart failure (HF) hospitalization or all-cause death (primary endpoint) during long-term follow-up. Outcomes were compared between RV lead positions using adjusted Cox regression analysis. Six months after CRT implantation, we estimated left ventricular (LV) reverse remodeling by measuring LV end-systolic and end-diastolic volumes by echocardiography. Changes from baseline to 6 months follow-up were compared between RV lead positions. Device-related complications were recorded at 6-month follow-up.RESULTS: During median (interquartile range) follow-up of 4.7 (2.9-7.1) years, the risk of meeting the primary endpoint was similar for patients with non-apical vs. apical RV lead position (adjusted hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.54-1.12, p = 0.17) and free wall vs. septal RV lead position (adjusted HR 1.03, 95% CI 0.72-1.47, p = 0.86). Changes in LV ejection fraction and dimensions were similar with the different RV lead positions. We observed no differences in device-related complications relative to the RV lead position.CONCLUSIONS: In patients receiving CRT, the risk of HF hospitalization or all-cause death during long-term follow-up, and LV remodeling and incidence of device-related complications after 6 months are not associated with different anatomical RV lead position as assessed by cardiac CT.
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- 2022
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4. Reproducibility and repeatability of identifying the latest electrical activation during mapping of coronary sinus branches in CRT recipients
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Mads Brix Kronborg, Jens Kristensen, Jens Cosedis Nielsen, Charlotte Stephansen, and Christian Gerdes
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medicine.medical_treatment ,Heart Ventricles ,Cardiac resynchronization therapy ,cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,medicine ,Humans ,In patient ,030212 general & internal medicine ,repeatability ,Vein ,Lead (electronics) ,reproducibility ,Coronary sinus ,Heart Failure ,Reproducibility ,coronary sinus ,business.industry ,left ventricular lead ,electrocardiograms ,Coronary Sinus ,Reproducibility of Results ,Repeatability ,Confidence interval ,medicine.anatomical_structure ,Treatment Outcome ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
INTRODUCTION: Studies have shown an association between the outcome in cardiac resynchronization therapy (CRT) and longer interventricular delay at the site of the left ventricular (LV) lead. Targeted LV lead placement at the latest electrically activated segment increases LV function further as compared with standard treatment. We aimed to determine reproducibility and repeatability of identifying the latest electrically activated segment during mapping of all available coronary sinus (CS) branches in patients receiving CRT.METHODS: We included 35 patients who underwent CRT implantation with protocolled mapping guided LV lead implantation aiming for the site of the latest electrical activation. Three different doctors experienced in electrophysiology and implantation of CRT devices independently measured time interval from the local bipolar right ventricular (RV) electrogram (EGM) to the local unipolar LV EGM at all mapped sites (RV-LV). The segment with the latest electrical activation was defined as the target segment (TS) and the CS tributary containing TS was defined as the target vein (TV). Weighted κ statistics with 95% confidence intervals were computed to assess intra- and interobserver agreement for TS and TV.RESULTS: We mapped 258 segments within 131 veins. Weighted κ values for repeatability were 0.85 (0.81-0.89) for TS and 0.92 (0.89-0.93) for TV, and weighted κ values of interobserver agreement ranged from 0.70 (0.61-0.73) to 0.80 (0.76-0.83) for TS and 0.73 (0.64-0.78) to 0.86 (0.83-0.89) for TV among all three observers.CONCLUSION: The reproducibility and repeatability of identifying the latest electrically activated segment during mapping of all available CS branches in patients receiving CRT range from good to very good.
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- 2020
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5. Reproducibility and repeatability of identifying latest electrical activation during mapping of coronary sinus branches in CRT recipients
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Charlotte Stephansen, Mads Brix Kronborg, Christian Gerdes, Jens Kristensen, and Jens Cosedis Nielsen
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Reproducibility ,Cohen's kappa ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,medicine ,Repeatability ,Nuclear medicine ,business ,Lead (electronics) ,Coronary sinus ,Kappa ,Confidence interval - Abstract
Introduction: Studies have shown an association between outcome in cardiac resynchronization therapy (CRT) and longer interventricular delay at the site of the left ventricular (LV) lead. Targeted LV lead placement at the latest electrically activated segment increases LV function further as compared with standard treatment. We aimed to determine reproducibility and repeatability of identifying latest electrically activated segment during mapping of all available CS branches in patients receiving CRT. Methods: We included 35 patients who underwent CRT implantation with protocolled mapping guided LV lead implantation aiming for the site of latest electrical activation. Three different doctors experienced in electrophysiology and implantation of CRT devices independently measured time interval from the local bipolar right ventricular (RV) electrogram (EGM) to the local unipolar LV EGM at all mapped sites (RV-LV). The segment with the latest electrical activation was defined as target segment (TS) and the CS tributary containing TS was defined as target vein (TV). Weighted Kappa statistics with 95% confidence intervals were computed to assess intra-and inter-observer agreement for TS and TV. Results: We mapped 258 segments within 131 veins. Weighted kappa values for repeatability were 0.85 (0.81-0.89) for TS and 0.92 (0.89-0.93) for TV, and weighted kappa values of inter-observer agreement ranged from 0.70 (0.61-0.73) to 0.80 (0.76-0.83) for TS and 0.73 (0.64-0.78) to 0.86 (0.83-0.89) for TV among all three observers. Conclusion: The reproducibility and repeatability of identifying latest electrically activated segment during mapping of all available CS branches in patients receiving CRT ranges from good to very good.
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- 2020
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6. Reproducibility of measuring QRS duration and implications for optimization of interventricular pacing delay in cardiac resynchronization therapy
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Christian Gerdes, Jens Kristensen, Anders Sommer, Mads Brix Kronborg, Jesper Møller Jensen, Charlotte Stephansen, Christoffer Tobias Witt, and Jens Cosedis Nielsen
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SELECTION ,Male ,QRS duration ,medicine.medical_treatment ,ACCURACY ,cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,ELECTROCARDIOGRAM ,Severity of Illness Index ,Cardiac Resynchronization Therapy ,Cohort Studies ,Electrocardiography ,0302 clinical medicine ,Cause of Death ,Medicine ,030212 general & internal medicine ,Intraobserver Variation ,Prospective Studies ,CANDIDATES ,Observer Variation ,Limits of agreement ,Age Factors ,General Medicine ,Middle Aged ,Survival Rate ,Echocardiography ,Interobserver Variation ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Intraobserver reproducibility ,optimization ,BUNDLE-BRANCH BLOCK ,medicine.medical_specialty ,Bundle-Branch Block ,Cardiac resynchronization therapy ,Risk Assessment ,Lower limit ,03 medical and health sciences ,QRS complex ,Sex Factors ,ECG-guided ,Physiology (medical) ,Internal medicine ,Humans ,Aged ,Heart Failure ,Reproducibility ,business.industry ,Reproducibility of Results ,Original Articles ,observer variation ,interventricular pacing delay ,business - Abstract
BACKGROUND: QRS narrowing after CRT is a predictor of patient outcome. Further narrowing can be obtained by interventricular pacing delay (VVd) optimization, raising interest to inter and intraobserver variation in manual measurements of QRS duration.METHODS: (a) Variation in intrinsic rhythm QRS duration in CRT patients with LBBB: In 40 intrinsic 12-lead ECGs, six observers measured QRS duration defined as widest QRS in any lead. In 20 of these ECGs, two observers repeated the measurements. (b) Variation in paced QRS duration at different VVd settings and agreement in selecting the narrowest QRS: In 20 CRT patients, five paced ECGs were recorded at different VVds. The most frequently selected VVd(s) estimated to cause the narrowest QRS in each patient defined the optimal VVd. Two observers repeated the measurements and VVd selections.RESULTS: Absolute interobserver difference in measured QRS duration in intrinsic rhythm ECGs was mean 2 ms, range (-40; 40 ms), mean limits of agreement (LoA): -21; 25 ms. Absolute interobserver difference in measured QRS duration in paced ECGs was mean 3 ms, range (-50; 60 ms), mean LoA: -20; 27 ms. There was no difference in LoA between intrinsic and paced QRS duration (lower limit p = 0.68; upper limit p = 0.44). The optimal VVd was included in 17/20 (85%) of the VVd selections by six observers. Interobserver variation was comparable with the intraobserver variation.CONCLUSIONS: Interobserver variation and intraobserver variation in manually measured paced and intrinsic rhythm QRS duration are clinically acceptable and comparable in a cohort of CRT patients. Inter and intraobserver reproducibility for selecting the optimal VVd is good and warrants manual VVd optimization for QRS narrowing in CRT.
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- 2018
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7. Longer inter-lead electrical delay is associated with response to cardiac resynchronization therapy in patients with presumed optimal left ventricular lead position
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Bjarne L. Nørgaard, Christian Gerdes, Jens Kristensen, Mads Brix Kronborg, Anders Sommer, Jens Cosedis Nielsen, Charlotte Stephansen, and Steen Hvitfeldt Poulsen
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,law.invention ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,QRS complex ,Myocardial perfusion imaging ,0302 clinical medicine ,Randomized controlled trial ,law ,Physiology (medical) ,Internal medicine ,Odds Ratio ,Journal Article ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Cardiac Resynchronization Therapy Devices ,Prospective Studies ,Lead (electronics) ,Aged ,Aged, 80 and over ,Heart Failure ,medicine.diagnostic_test ,Ventricular End-Systolic Volume ,Ventricular Remodeling ,business.industry ,Myocardial Perfusion Imaging ,Stroke Volume ,Odds ratio ,Middle Aged ,Logistic Models ,Treatment Outcome ,Echocardiography ,Multivariate Analysis ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Electrophysiologic Techniques, Cardiac - Abstract
Aims: In a randomized trial of cardiac resynchronization therapy (CRT), a presumed optimal left ventricular (LV) lead position close to the latest mechanically activated non-scarred myocardium was achieved in 98% of patients by standard implantation. We evaluated whether inter-lead electrical delay (IED) was associated with response to CRT in these patients.Methods and results: We prospectively included 160 consecutive patients undergoing CRT. Pre-implant speckle-tracking echocardiography radial strain and 99mTc myocardial perfusion imaging determined the latest mechanically activated non-scarred myocardial segment. We measured procedural IED as the time interval between sensed signals in right ventricular and LV lead electrograms. All patients had LV pacing site concordant or adjacent to the latest mechanically activated non-scarred segment verified by cardiac computed tomography. Response to CRT was defined as ≥15% reduction in LV end-systolic volume at 6 months follow-up. Selecting a practical IED cut-off value of 100 ms, more patients with long IED than patients with short IED responded to CRT (87 vs. 68%; P = 0.004). In multivariate logistic regression analysis, IED ≥100 ms remained associated with CRT response after adjusting for baseline characteristics, including QRS duration and scar burden [odds ratio 3.19 (1.24-8.17); P = 0.01]. Categorizing IED by tertiles, CRT response improved with longer IED (P = 0.03). Comparable response rates were observed in patients with a concordant and adjacent LV lead position.Conclusion: A longer IED was associated with more pronounced LV reverse remodelling response in CRT recipients with a presumed optimal LV lead position concordant or adjacent to the latest mechanically activated non-scarred segment.
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- 2018
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8. 532Association between right ventricular paced QRS width and response to cardiac resynchronization therapy
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Christian Gerdes, Jens Kristensen, Charlotte Stephansen, Jc. Nielsen, Mads Brix Kronborg, and Anders Sommer
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medicine.medical_specialty ,Qrs width ,business.industry ,Physiology (medical) ,Internal medicine ,medicine.medical_treatment ,Cardiology ,medicine ,Cardiac resynchronization therapy ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
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9. P335Intra-procedural QRS shortening and response to cardiac resynchronization therapy
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Jens Kristensen, Christian Gerdes, Jc. Nielsen, Anders Sommer, Mads Brix Kronborg, and Charlotte Stephansen
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medicine.medical_specialty ,QRS complex ,business.industry ,Physiology (medical) ,Internal medicine ,medicine.medical_treatment ,medicine ,Cardiac resynchronization therapy ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
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10. P1003interventricular delay in cardiac resynchronization therapy: inter observer agreement when aiming for the narrowest paced QRS-complex
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Ct. Witt, Jc. Gerdes, Charlotte Stephansen, Jens Kristensen, Mb. Kronborg, and Jc. Nielsen
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medicine.medical_specialty ,QRS complex ,business.industry ,Inter observer agreement ,Physiology (medical) ,Internal medicine ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
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