Cardiac Resynchronization Therapy 3 скачать в хорошем качестве

Cardiac Resynchronization Therapy 3

Description at: https://johnsonfrancis.org/profession... Continuation on cardiac resynchronization therapy. Phrenic nerve stimulation with LV lead and more. Phrenic nerve stimulation with LV lead in CRT: First response is to try another vein. Another way is to try bipolar stimulation, deeper in a vein. Stimulation deeper in a vein can produce ventricular ectopy, which usually resolves in a few days. Bipolar stimulation is less likely to produce phrenic nerve stimulation. Direct diaphragmatic stimulation should also be considered, rather than phrenic nerve stimulation. Another method is to go in for an epicardial implantation. During surgery, it is possible to pull the phrenic nerve away and even anchor it a different site. While checking for diaphragmatic pacing during epicardial pacing, muscle relaxants should be withdrawn prior to checking for diaphragmatic stimulation. Same applies to implantation in the cath lab under general anaesthesia. Reverse remodeling of left ventricle with CRT: A substudy of MADIT-CRT trial evaluated the alterations in cardiac size and function echocardiographically in those who received CRT with an ICD. The study involved over 1800 patients who were randomly assigned to CRT plus an ICD or an ICD alone, in a 3:2 ratio. Echocardiographic data at baseline and at 1 year was available for about 1400 patients. The combo device (CRT + ICD) group had greater improvements in LV end-diastolic volume index, LV end-systolic volume index, LV ejection fraction, left atrial volume index and RV fractional area change. The P value was less than 0.001 for all the parameter comparisons. 40% reduction of risk of death or heart failure was noted with every 10% decrease in LV end diastolic volume at one year. Reverse remodeling with CRT reduces life threatening ventricular arrhythmias: There have been some reports of whether the altered sequence of ventricular depolarization with CRT can be arrhythmogenic. Investigators of MADIT-CRT in a sub study analyzed whether this is true in their study patients. They grouped the subjects into three – those with 25% or more reduction in LV end systolic volume at one year compared with baseline, those with less than 25% reductions and those who received only ICD and not CRT-D. The first group was the CRT responders and the second one CRT non responders. The highest rates of ventricular tachyarrhythmias (including ventricular tachycardia, ventricular fibrillation, and ventricular flutter) was highest in the non-responders (28%) and lowest in the responders (12%). The ICD only group had an intermediate value of 21%. This was for the cumulative probability of first ventricular tachyarrhythmia at two years after the initial assessment. Multivariate analysis showed a 55% risk reduction between CRT responders and ICD only patients, while the difference was not significant between non responders and ICD only patients. The authors concluded that reverse remodeling with CRT is associated with a significant risk reduction for life threatening ventricular arrhythmias. Please have a look at my blog post for some more data on CRT like LV endocardial pacing for CRT, volume status monitoring in CRT, trial of CRT for high operative risk functional MR and CRT in children with congenital heart disease and heart failure.