Cardiac Resynchronization Therapy in Heart Failure in Sub-Saharan Africa Environment: Experience of the Principal Hospital of Dakar (Senegal)

Background: Heart failure is a major public health challenge in sub-Saharan Africa. In patients with chronic Heart Failure and cardiac desynchrony, studies have suggested that cardiac resynchronization, can improve cardiac function and the quality of life of patients. However, in Sub-Saharan Africa, very few studies have been done on cardiac resynchronization which is in its infancy. The aim of this study is to report the local data from our hospital. Method: It was a transversal, descriptive and analytical study conducted from November 2019 to September 2022 at the Cardiology Department of the Principal Hospital of Dakar. Results: Twelve patients were implanted for Cardiac Resynchronization Therapy (CRT). The sex ratio was 8 males/4 females. The average age was 67 ± 11 years. Ten patients had non-ischemic heart disease and the two others had ischemic one. All of them had NYHA III or IV scores before CRT. The Quality of Life (QOL) was judged as poor by all of the patients. The average duration of QRS was 156 ± 9 ms. 27.9% ± 5% was the mean Left Ventricular ejection fraction (LVEF). Complications occur in 3/12 patients (25%). It was one CS vein dissection, one micro LV lead dislodgement and one phrenic nerve stimulation. Nine patients, who were considered as responders, had an improvement of QOL and NYHA, the LVEF increased and the end-diastolic dimension, and the duration of the QRS interval all decreased. Two patients do not respond and one (1) who had permanent atrial fibrillation, was a secondary responder after an atrioventricular junction ablation. Conclusion: Cardiac resynchronization is a therapy that improves the QOL of patients, the LVEF and reduces the duration of the QRS interval. However, this procedure is not without risk of complications. In sub-Saharan Africa, the major challenge is to improve the financial accessibility of this therapy for the population.

Echocardiographic Evaluation of Qiangxin Decoction Combined with Cardiac Resynchronization Therapy for Patients with Chronic Heart Failure

OBJECTIVE: To explore the echocardiographic evaluation of patients with chronic heart failure (CHF) after Qiangxin Decoction combined with cardiac resynchronization therapy. METHODS: A total of 140 CHF patients admitted to our hospital were randomly divided into combined group (Qiangxin Decoction and cardiac resynchronization, n = 70) and routine group (cardiac resynchronization, n = 70), and they were treated for 2 courses (16 weeks), with 8 weeks as a course. The improvement of heart function classification (HYHA) was observed before and after treatment, and the therapeutic effects were evaluated according to the improvement of heart function classification (markedly effective, effective, invalid, and worsening). The traditional Chinese medicine (TCM) diagnostic criteria was the main symptoms (0 to 6 points), secondary symptoms (0 to 3 points), tongue picture (0 to 1 point) and pulse condition (0 to 1 point), and the higher the score was, the more obvious the symptoms were. The left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF) and cardiac output (CO) were observed and recorded according to the heart color ultrasound before and after treatment. And the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to evaluate the life quality before and after treatment, and the highest score of the scale was 105 points. The higher the score was, the obvious the symptoms were, and the worse the life quality was. And the adverse reactions were recorded in the 2 groups. RESULTS: After the treatment, the total effective rate in the routine group was significantly lower than that in the combined group (75.71% vs . 94.30%), and there was statistically significant difference (P < 0.05). After the treatment, the TCM syndrome score in the routine group was higher than that in the combined group ((14.37±3.59) points vs.(10.53±3.11) points), and there was statistically significant difference (P < 0.05). After the treatment, the levels of LVEDD and LVESD in the routine group were higher than those in the combined group, and there were statistically significant differences (P < 0.05). The levels of LVEF and CO in the routine group were lower than those in the combined group, and there were statistically significant differences (P < 0.05). After the treatment, the score of MLHFQ scale in the routine group was higher than that in the combined group ((57.38±8.53) points vs.(46.39±7.14) points), and there was statistically significant difference (P < 0.05). CONCLUSION: Qiangxin Decoction combined with cardiac resynchronization therapy has good echocardiographic evaluation in patients with chronic heart failure.

Predictors of super-response to cardiac resynchronization therapy： the significance of heart failure medication, pre-implant left ventricular geometry and high percentage of biventricular pacing

BackgroundSuper 应答者(SR ) 被定义为在心脏的再同步治疗(CRT ) 以后显示出关键心脏的功能改进的病人。这研究的目的是在 CRT.MethodsThis 学习注册了从 2010 ～ 2014 在时期期间经历了 CRT 的 201 个病人以后，识别并且验证 SR 的预言者。临床并且 echocardiographic 评估在 CRT 和 6 个月前被进行在以后。有在纽约心协会(NYHA ) 的减少的病人功能的班 1，在左室的结束收缩的体积(LVESV ) 的减少 15% ，并且最后的左室的喷射部分(LVEF ) 当经历了 CRT 的 201 个病人的 SRs.Results29% 作为 SR 被识别， 45% 被分类。在基线， SR 有显著地更小的左 atrial 直径(男孩) ， LVESV，左室的结束心脏舒张的体积(LVEDV ) 和比 non-super-responders (non-SRs ) 的更高的 LVEF。用变换血管收缩素的酶禁止者或血管收缩素受体 blockers (ACEI/ARB ) 的病人的百分比比 non-SRs 在 SR 是更高的。大多数 SR 有 Biventricular (BiV ) 在 CRT 以后在比 98% 六个月大的百分比上踱步。在 multivariate 逻辑回归分析， SR 的独立预言者是更低的 LVEDV [奇怪的比率(或) ：0.93；信心间隔(CI ) ：0.90-0.97 ] ， ACEI/ARB 的使用(或：0.33；CI：0.13-0.82 ) 并且比 98% 大的 BiV 踱步百分比(或：0.29；CI：0.16-0.87 ) 有 ACEI/ARB 和更少 ectatic 的更好的依从的 .ConclusionPatients 在 CRT 前的室的几何学趋于有成为 SR 的更大的可能性。BiV 踱步的更高的百分比为成为 SR 是必要的。

Cardiac resynchronization therapy for heart failure induced by left bundle branch block after transcatheter closure of ventricular septal defect

有先天的心疾病的一个 54 岁的女病人让一个坚持的完全的左捆分支由 Amplatzer 室的氏族的缺点 occluder 在闭合以后堵住三个月。九个月以后，病人受不了胸悲痛，心跳，并且在每日的活动，和她的 6-min 散步距离出汗显著地减少了(155 &#x000a0； m ) 。她显示出的 echocardiography 与 37% 的左室的喷射部分增加了左室的结束心脏舒张的直径。她一个星期在收到的心脏的再同步治疗以后显著地减少的症状。她没在每日的活动有症状，并且她的回响显示出 46% 和 53% 的左室的喷射部分。而且，左室的结束心脏舒张的直径减少了在心脏的再同步治疗以后的 6 和 10 个月，和 6-min 散步距离显著地增加了。在有室的氏族的缺点 Amplatzer occluder 的 transcatheter 闭合能在左室的收缩功能导致左室的增大和重要减少以后，这个盒子表明了那坚持的完全的左捆分支块九个月。心脏的再同步治疗减少了左室的结束心脏舒张的直径和增加的左室的喷射部分，从而改进病人的心工作。

Cardiac resynchronization therapy in the elderly heart failure patient

Ms. BP is an 83 year old white female with a long history of congestive heart failure (HF). She is now symptomatic with minimal exertion, has a left ventricular ejection fraction (LVEF) of 20%. Her CHF is due to hypertension (HTN) plus coronary artery disease (CAD) and she is on angiotensin converting enzyme inhibitor (ACEI), furosemide, digoxin,spironolactone, low dose beta blocker and nitrates. Her beta-natriuretic peptide (BNP) in clinic is 3030 pg/ml, heart rate (HR) 100, blood pressure (BP) 89/43.

High sensitivity C-reactive protein and cardfiac resynchronization therapy in patients with advanced heart failure

C 反应的蛋白质(hsCRP ) 与先进的征兆的心失败(HF ) 在病人铺平收到心脏的再同步治疗(CRT ) 的高敏感的预示的值上的 BackgroundThe 数据是少见的。现在的学习的目的 232 个 CRT 病人是与左室颠倒在六月 CRT 以及长期的 outcome.MethodsA 以后改变调查浆液 hsCRP 层次的协会全部的被包括。对 hsCRP 价值，临床的地位和 echocardiographic 数据的评价在基线并且在六月 CRT 以后被执行。长期的后续为 HF.ResultsDuring 包括了所有原因死亡和住院 31.3 &#x000b1 的吝啬的后续经期；31.5 个月，提高的 hsCRP (&#x0003e；3 mg/L ) 与重要 2.39 褶层增加在 CRT 以前被联系(P = 0.006 ) 在死亡或 HF 住院的风险。在 6 月的后续，对 CRT 作出回应的病人显示出重要减小或维持在 hsCRP 层次低(-0.5 &#x000b1；4.1 mg/L 减小) 与非应答者相比(1.7 &#x000b1；6.1 mg/L 增加， P = 0.018 ) 。与 6 月的 hsCRP 层次在被减少或仍然保持低的病人相比， 6 月的 hsCRP 层次在被增加或坚持说高度的病人经历了随后的死亡或 HF 住院的显著地更高的风险(木头等级 P &#x0003c；0.001 ) 。 echocardiographic 改进在6月的 hsCRP 层次在被减少或在6月的 hsCRP 层次在谁被提起或坚持说 high.ConclusionsOur 调查结果表明了基线的那大小与那些相比仍然保持低的病人之中也更好，当为及时潜力的预示的标记冒险层化和随后的适当治疗，后续 hsCRP 层次可能是有用的在有经历 CRT 的先进 HF 的病人的策略。

Does ‘super-responder’ patients to cardiac resynchronization therapy still have indications for neuro-hormonal antagonists? Evidence from long-term follow-up in a single center

Background Whether cardiac resynchronization therapy super-responders (CRT-SRs) still have indications for neuro-hormonal antagonists or not remains uninvestigated.Methods We reviewed clinical data from 376 patients who underwent CRT implantation in Fuwai Hospital from 2009 to 2015 and followed up to 2017.CRT-SRs were defined by an improvement of the New York Heart Association functional class and left ventricular ejection fraction to ≥ 50% in absolute values at 6-month follow-up.All CRT-SRs were assigned into two groups on the basis of whether persistently receiving neuro-hormonal antagonists (NHA)(defined as angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers and β-blockers) after 6-month follow-up and then we compared long-term outcome.Results A total of 60 patients met criteria for super-response.One of thirteen (7.7%) CRT-SRs without NHA had all-cause death,which also occurred in 2 of 47 (4.3%) in CRT-SRs with NHA (P = 0.526).However,3 of 13 (23.1%) CRT-SRs without NHA had heart failure (HF) hospitalization,1 of 47 (2.1%) CRT-SRs with NHA had this endpoint (P = 0.040).Besides,subgroup analysis indicated that,for ischemic etiology group,CRT-SRs receiving NHA had considerably lower incidence of HF hospitalization than those without NHA (0 vs.75%,P = 0.014),which was not observed in non-ischemic etiology group (2.6% vs.0,P = 1.000) during long-term follow-up.Conclusions Our study found that for ischemic etiology,compared with CRT-SRs with NHA,CRT-SRs without NHA were associated with a higher risk of HF hospitalization.However,for non-ischemic etiology,we found that CRT-SRs with NHA or without NHA at follow-up were associated with similar outcomes,which needed further investigation by prospective trials.

Effect of serum γ-glutamyltranferase and albumin levels on the response to cardiac resynchronization therapy in the elderly

Background Several liver function tests have been identified as predictors of hospitalization for heart failure(HF) and death in patients with chronic HF. The relationship between serum γ-glutamyltranferase(GGT) and albumin(SA) levels with the response to cardiac resynchronization therapy(CRT) has not been reliably determined. The aim of the study was to evaluate the impact of liver function tests on the results of CRT in the elderly. Methods Baseline GGT and SA were assessed before CRT device implantation in the elderly(> 70-year-old) patients. The endpoints were:(1) CRT response defined as > 5% left ventricular ejection fraction improvement and no hospitalization for HF or cardiovascular death;(2) hospitalizations;and(3) mortality. Results Eighty of 138(58%) included patients were responders at nine months. Compared to responders, the SA levels were not significantly different(35.1 ± 5.4 vs. 33.6 ± 5.5 g/L, P = 0.103);but the GGT levels, higher(81.6 ± 69.3 vs. 54.7 ± 49.6 U/L, P = 0.013) in non-responders to CRT. GGT level was independently associated with non-response to CRT(P < 0.001, OR = 0.17;95% CI: 0.08–0.38, P < 0.001). GGT cut-off value ≥ 55 U/L was highly predictive of non-response [AUC = 0.65, 64% Sensitivity, 69% Specificity(95% CI: 0.56–0.74)]. GGT ≥ 55 U/L was also associated with higher risk of hospitalization for atrial fibrillation(AF)(95% vs. 83%, P = 0.024). Both SA and GGT had no impact on overall(P = 0.220, P = 0.723) mortality. Conclusions Higher level of GGT is an independent predictor of non-response to CRT in patients over age 70 years and is associated with higher risk of hospitalization for AF. Baseline serum levels of albumin and GGT and have no impact on mortality in elderly patients undergoing CRT.

The value of serum metabolomics analysis in predicting the response to cardiac resynchronization therapy

Objective To construct a prediction model based on metabolic profiling for predicting the response to cardiac resynchronization therapy(CRT).Methods Peripheral venous(PV)and coronary sinus(CS)blood samples were collected from 25 patients with heart failure(HF)at the time of CRT implantation,and PV blood samples were obtained from ten healthy controls.The serum samples were analyzed by liquid chromatography-mass spectrometry(LC-MS).As per the clinical and echocardiographic assessment at the 6-month follow-up,the HF patients were categorized as CRT responders and non-responders.Results HF patients had altered serum metabolomic profiles that were significantly different from those of the healthy controls.Differential metabolites were also observed between CRT responders and non-responders.A prediction model for CRT response(CRT-Re)was constructed using the concentration levels of the differential metabolites,L-arginine and taurine.The optimal cutoff value of the CRT-Re model was found to be 0.343 by ROC analysis(sensitivity,88.2%;specificity,87.5%;Area under curve(AUC)=0.897,P=0.002).The concentration levels of the differential metabolites,L-arginine and lysyl-gamma-glutamate,in PV serum were significantly correlated with that in CS serum(r=0.945 and 0.680,respectively,all P<0.001).Conclusions Our results suggest that serum-based metabolic profiling may be a potential complementary screening tool for predicting the outcome of CRT.

Left univentricular pacing for cardiac resynchronization therapy using rate-adaptive atrioventricular delay

ObjectiveTo 评估左 univentricular (爱)用率适应的心房与心室的延期( RAAVD )为心脏的再同步治疗( CRT )踱步追踪生理的心房与心室的延期( AVD )的算法有充血的心失败( CHF )的 72 个病人全部的 .MethodsA 被使随机化到 RAAVD 爱踱步对标准 biventricular ( BiV )在 1 踱步：1 比率。Echocardiography 被用来为两个组优化 AVD。顺序的 BiV 踱步的效果并且爱与优化 A-V (正确 atrio-LV ) 踱步用一个 RAAVD 算法的延期被比较。在在五心率( HR )的铅 V1 的 S/R 比率的标准差( SD )分割( R 定义为追踪的索引的 S/R -SD5),，被用来为追踪生理的 AVD.ResultsThe QRS 复杂持续时间评估 RAAVD 算法的精确性( 132 瑮慲慣摲慩??????椠瑮慲慣摲慩???????

The role of electrocardiography in the elaboration of a new paradigm in cardiac resynchronization therapy for patients with nonspecific intraventricular conduction disturbance

心脏的再同步治疗(CRT ) 与左捆分支块(磅) 仅仅在病人与有利结果被联系模式并且在有 QRS 持续时间 &#x0003e 的病人；150 ms，在有有 120-150 的 QRS 持续时间的 non-LBBB 模式的病人， ms 通常不是有益的。在为 QRS 持续时间调整以后， QRS 形态学不再是对 CRT 的临床的反应的一个决定因素。与主流的看法相对照，我们假设了在有 non-LBBB 和 120-150 ms 的 QRS 持续时间的病人的相反的 CRT 结果不由于 QRS 形态学自己，但是到在这亚群的更少的 dyssynchrony 和相反的耐心的特征，例如更多的 ischemic 病原学和男病人的更大的流行与有磅模式的病人相比。进一步，当前的 CRT 技术被设计与磅模式消除在病人在场的 dyssynchrony 并且对不恰当与 non-LBBB 在病人消除 dyssynchrony 模式。我们也假设了那 electrocardiography 可以也关于 interventricular 和左 intraventricular dyssynchrony 和近似地点的存在提供信息最近激活左室(LV ) 区域。到这个目的，我们设计了新 ECG 标准估计 interventricular 和 LV intraventricular dyssynchrony 和最近的激活的 LV 区域的近似地点。我们的初步的数据证明在有骚乱(NICD ) 模式可能在从那的一个遥远的地点的 nonspecific intraventricular 传导的病人的最近的激活的 LV 区域与磅模式在病人介绍，它可能与 NICD 模式为病人要求一种新奇 CRT 技术的发明。新 interventricular 和 LV intraventricular dyssynchrony ECG 标准和一种潜在的新奇 CRT 技术的申请可能减少在有 NICD 的病人的当前高的 nonresponder 率模式。

The Temporal Relation between Cardiomyopathy and LBBB and Response to Cardiac Resynchronization Therapy:Case Series and Literature Review

Background:Left bundle branch block(LBBB)-induced cardiomyopathy has been proposed,but the association between LBBB and cardiac resynchronization therapy(CRT)response remains unclear and practical criteria for selecting CRT candidates are needed.Methods:One hundred and seventeen consecutive heart failure patients were reviewed,24 of whom received CRT.Only two patients had a clear temporal relation between cardiomyopathy and LBBB.Results:Compared with the patient with“cardiomyopathy-induced LBBB,”the patient with“LBBB-induced cardiomyopathy”had higher left ventricular(LV)wall thickness,higher LV wall thickening rate,higher peak circumferential strain,and longer peak circumferential strain delay.The LV deformation patterns in the two patients were obviously distinct on cardiovascular magnetic resonance tissue tracking.During follow-up,the patient with LBBB-induced cardiomyopathy had a good response to CRT(LV ejection fraction 23 before CRT vs.30%at 6 months vs.29 at 12 months vs.32%at 18 months;LV end-diastolic diameter 77 mm before CRT vs.66 mm at 6 months vs.62 mm at 12 months vs.63 mm at 18 months),and the other patient had no response to CRT(LV ejection fraction 29 before CRT vs.29%at 6 months vs.26 at 12 months vs.22%at 24 months;LV end-diastolic diameter 85 mm before CRT vs.88 mm at 6 months vs.85 mm at 12 months vs.84 mm at 24 months).Conclusion:The temporal relation between cardiomyopathy and LBBB could be a determinant for CRT response.Cardiovascular magnetic resonance tissue tracking may be a useful tool to identify the chronological order and a principal consideration for selecting candidates for CRT.Larger prospective clinical trials are needed to study the prevalence of,time course of,and risk factors for LBBB-induced cardiomyopathy.

Role of nuclear cardiology for guiding device therapy in patients with heart failure

Heart failure is a dynamic condition with high morbidity and mortality and its prognosis should be reassessed frequently, particularly in patients for whom critical treatment decisions may depend on the results of prognostication. In patients with heart failure, nuclear cardiology techniques are useful to establish the etiology and the severity of the disease, while fewer studies have explored the potential capability of nuclear cardiology to guide cardiac resynchronization therapy(CRT) and to select patients for implantable cardioverter defibrillators(ICD). Left ventricular synchrony may be assessed by radionuclide angiography or gated singlephoton emission computed tomography myocardial perfusion scintigraphy. These modalities have shown promise as predictors of CRT outcome using phase analysis. Combined assessment of myocardial viability and left ventricular dyssynchrony is feasible using positron emission tomography and could improve conventional response prediction criteria for CRT. Preliminary data also exists on integrated positron emission tomography/computed tomography approach for assessing myocardial viability, identifying the location of biventricular pacemaker leads, and obtaining left ventricular functional data, including contractile phase analysis. Finally, cardiac imaging with autonomic radiotracers may be useful in predicting CRT response and for identifying patients at risk for sudden cardiac death, therefore potentially offering a way to select patients for both CRT and ICD therapy. Prospective trials where imaging is combined with image-test driven therapy are needed to better define the role of nuclear cardiology for guiding device therapy in patients with heart failure.

Cardiac resynchronization therapy: Dire need for targeted left ventricular lead placement and optimal device programming

Cardiac resynchronization therapy(CRT) effected via biventricular pacing has been established as prime therapy for heart failure patients of New York Heart Association functional class Ⅱ, Ⅲ and ambulatory Ⅳ, reduced left ventricular(LV) function, and a widened QRS complex. CRT has been shown to improve symptoms, LV function, hospitalization rates, and survival. In order to maximize the benefit from CRT and reduce the number of non-responders, consideration should be given to target the optimal site for LV lead implantation away from myocardial scar and close to the latest LV site activation; and also to appropriately program the device paying particular attention to optimal atrioventricular and interventricular intervals. We herein review current data related to both optimal LV lead placement and device programming and their effects on CRT clinical outcomes.

Cardiac resynchronization therapy in acute pulmonary edema: A case report

We are reporting a case of 71-year old lady with a dual chamber demand pacemaker,who developed acute pulmonary edema due to an acute left ventricular(LV)dysfunction and worsening in mitral valve regurgitation after atrioventricular nodal ablation for uncontrolled atrial fibrillation.This was attributed to right ventricular apical pacing leading to LV dyssynchronization.Patient dramatically improved within 12-24 h after upgrading her single chamber pacemaker to biventricular pacing.Our case demonstrates that biventricular pacing can be an effective modality of treatment of acute congestive heart failure.In particular,it can be used when it is secondary to LV dysfunction and severe mitral regurgitation attributed to significant dyssynchrony created by right ventricular pacing in patients with atrioventricular nodal ablation for chronic atrial fibrillation.

Implant Electrical Characteristics Predict Response to Cardiac Resynchronization Therapy

Background: The optimal site for left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) remains uncertain. Intra-procedural measures for predicting response to CRT have shown mixed results. Hypothesis: This study analyzed intracardiac electrogram (IEGM) characteristics at implant and assessed patients’ response rates (RR) to CRT. Methods: Forty-one consecutive patients undergoing CRT were enrolled. Medically optimized patients in sinus rhythm, with ejection fraction (EF) 34 were included. Right ventricular (RV) leads were positioned mid-septum. LV leads were targeted to the latest mechanical activation on echocardiography. IEGMs were measured, assessing intrinsic RV-to-LV delay (int RV-LV), RV-paced delay (RVp-LV), and LV-paced delay (LVp-RV). The difference between LVp-RV and RVp-LV was recorded as delta-LV. Response was defined as improvement of EF > 10%, reduction in LVEDD > 15% and improvement of ≥1 NYHA class. Results: Overall RR was 79%. LV leads were placed in the target location in 91%. Int RV-LV was 101 ± 14 ms in responders;78 ± 11 ms in non-responders (p 100 had a RR of 87%;int RV-LV 40 ms had a RR of 56%;delta-LV < 40 ms had a RR of 85%. There was no significant correlation between lead position, DI, QRS duration or EF and IEGM measurements. Conclusions: IEGM measures at implant are easily obtained. Significant intrinsic electrical delay and shorter delta-LV both predict response, even when LV leads are implanted in the targeted mechanically-delayed segment. These assessments of electrical dyssynchrony may be used to determine optimal lead positions and response to CRT.

Exercise Training Post Cardiac Resynchronization Therapy Improves Exercise Tolerance and Quality of Life

Background: Cardiac resynchronization therapy (CRT) results in improved morbidity, mortality, symptoms, quality of life (QOL) and exercise capacity, in appropriate chronic heart failure (CHF) patients. Moreover, combined exercise training (ET) and CRT maximize these improvements in these patients. The study evaluated the effect of ET on these patients in terms of QOL, functional class, exercise capacity and left ventricular ejection fraction (LVEF). Results: There were significant improvements in the QOL, functional class, exercise capacity, and LVEF compared with the Control Group. Comparison of both groups confirmed the cumulative effects of ET with CRT. The QOL improved by the end of training in the exercise group (p = 0.001), compared to the Control Group (p = 0.850). NYHA functional class improved significantly in the Exercise Group (p = 0.013). Percent-predicted peak oxygen consumption (VO2 peak) had significantly improved in the trained (p < 0.001) versus the untrained CRT Group (p= 0.596). There was a mean percent rise of the ejection fraction from 39.2 ± 12.86 to 44.40% ± 14.42% in the Exercise Group compared to a non-significant change in the Control Group. Conclusion: ET in resynchronized CHF patients is feasible and further enhances QOL and exercise tolerance in addition to the improvements seen after CRT. The study therefore recommends for the prescription of ET after implantation in order to maximize the expected benefit.

Predicting patient response to cardiac resynchronization therapy by gated SPECT myocardial perfusion imaging

Introduction Heart failure(HF)is widely prevalent(> 6 million cases)and rapidly growing(> 0.6 million new cases annually)in the United States.Although the prevalence of HF in China is less than that in the United States,the total number of HF patients in China exceeds 4 million.

Biventricular pacing for treating heart failure in children: A case report and review of the literature

BACKGROUND Cardiac resynchronization therapy(CRT) can be used as an escalated therapy to improve heart function in patients with cardiac dysfunction due to long-term right ventricular pacing. However, guidelines are only targeted at adults. CRT is rarely used in children.CASE SUMMARY This case aimed to implement biventricular pacing in one child with heart failure who had a left ventricular ejection fraction < 35% at 4 years after implantation of an atrioventricular sequential pacemaker due to atrioventricular block.Postoperatively, echocardiography showed atrial sensing ventricular pacing and QRS wave duration of 120-130 ms, and cardiac function significantly improved after upgrading pacemaker.CONCLUSION Patients whose cardiac function is deteriorated to a level to upgrade to CRT should be upgraded to reverse myocardial remodeling as soon as possible.