Introduction: Biventricular (BV) pacing is an established therapy for heart failure (HF) patients with intraventricular conduction delay, but not all patients improved clinically. We investigated the ...interventricular delay (IVD) by means of the transesophageal left ventricular posterior wall potential (LVPWP).
Materials and methods, and Results: A total of 18 HF patients (age 62±9 years; 15 males) with NYHA class 3.1±0.3, LV ejection fraction 22±7%, left bundle branch block and a QRS duration (QRSD) of 171±27 ms were analyzed using transesophageal LVPWP before implantation of a BV pacing device. The median follow up was 14±14 months. In 14 responders, IVD was 81±25 ms with a QRSD/IVD ratio of 2.2±0.3 with reclassification of NYHA class 3.1±0.3 to 2.0±0.5 (p<0.001) and an increase in LV ejection fraction from 22±7% to 36±11% (p=0.001) during long-term BV pacing. In four non-responders, transesophageal IVD was significantly smaller at 30±11 ms (p=0.001).
Conclusion: Transesophageal IVD may be a useful method to detect responders to BV pacing. Transesophageal LVPWP may be a simple and useful technique to detect clinical responders to BV pacing in HF patients.
Einleitung: Die biventrikuläre (BV) Stimulation ist eine etablierte Therapie bei Patienten mit Herzinsuffizienz (HF) und intraventrikulärem Leitungsdelay, aber nicht alle Patienten verbessern sich klinisch. Wir haben das interventrikuläre Delay (IVD) mit dem transösophagealen linksventrikulären Potenzial der posterioren Wand (LVPWP) untersucht.
Material und Methode und Ergebnisse: Elf HF-Patienten (Alter 62±9 Jahre; 15 Männer) mit NYHA Klasse 3,1±0,3, LV Ejektionsfraktion 22±7%, Linksschenkelblock und QRS-Dauer (QRSD) 171±27 ms wurden mit dem transösophagealen LVPWP vor Implantation eines BV Schrittmachers analysiert. Der Median der Nachuntersuchung betrug 14±14 Monate. Bei 14 Respondern betrug das IVD 81±25 ms mit einem QRSD/IVD Verhältnis von 2,2±0,3. Es verbesserte sich die NYHA Klasse von 3,1±0,3 auf 2,0±0,5 (p<0,001) und erhöhte sich die LV Ejektionsfraktion von 22±7 auf 36±11% (p=0,001) während der BV Stimulation über lange Zeit. Bei 4 Nonrespondern war das transösophageale IVD signifikant geringer mit 30±11 ms (p=0,001).
Schlussfolgerung: Das transösophageale IVD stellt möglicherweise eine brauchbare Methode zur Erkennung von Respondern für die BV Stimulation dar. Das transösophageale LVPWP ist möglicherweise eine einfache und brauchbare Technik zur Erkennung von klinischen Respondern für die BV Stimulation bei HF-Patienten.
Introduction: The purpose of this study was to evaluate termination of atrial flutter (AFL) by directed rapid transesophageal atrial pacing (TAP) with and without simultaneous transesophageal ...echocardiography (TEE) performed using a novel TEE tube electrode.
Materials and methods, and Results: A total of 16 AFL patients (age 63±12 years; 13 males) with mean AFL cycle length of 224±24 ms (n=12) and mean ventricular cycle length of 448±47 ms (n=12) were analyzed using either an esophageal TO electrode (n=10) or a novel TEE tube electrode consisting of a tube with four hemispherical electrodes that is pulled over the echo probe (n=6). AFL could be terminated by directed rapid TAP using an esophageal TO electrode, leading to induction of atrial fibrillation (AF) (n=6), induction of AF and spontaneous conversion to sinus rhythm (SR) (n=3), and with conversion to SR (n=1). AFL could also be terminated by directed rapid TAP using the TEE tube electrode, with induction of AF (n=3) or induction of AF and spontaneous conversion to SR (n=3).
Conclusion: AFL can be terminated by directed rapid TAP with hemispherical electrodes with and without simultaneous TEE. TAP with the directed TEE tube electrode is a safe, simple, and useful method for terminating AFL.
Einleitung: Die Terminierung von Vorhofflattern (AFL) mit gerichteter hochfrequenter transösophagealer Vorhofstimulation (TAP) wurde mit und ohne simultane transösophageale Echokardiographie (TEE) mit einer neuen TEE-Schlauchelektrode evaluiert.
Material und Methode und Ergebnisse: 16 AFL Patienten (Alter 63±12 Jahre; 13 Männer) mit einer mittleren AFL-Periodendauer von 224±24 ms (n=12) und einer mittleren ventrikulären Periodendauer von 448±47 ms (n=12) wurden mittels Ösophaguselektrode „TO” (n=10) oder neuer „TEE-Schlauchelektrode”, die aus einem Schlauch mit 4 halbkugelförmigen Elektroden besteht und über die Echokardiographiesonde gezogen wird (n=6), analysiert. AFL konnte mit gerichteter hochfrequenter TAP und TO-Elektrode durch Induktion von Vorhofflimmern (AF) (n=6), Induktion von AF mit spontaner Konversion in den Sinusrhythmus (SR) (n=3) und Konversion in den SR (n=1) terminiert werden. AFL konnte mit gerichteter hochfrequenter TAP und TEE-Schlauchelektrode durch Induktion von AF (n=3) und Induktion von AF mit spontaner Konversion in den SR (n=3) terminiert werden.
Schlussfolgerung: AFL kann durch gerichtete hochfrequente TAP mit halbkugelförmigen Elektroden mit und ohne simultane TEE terminiert werden. TAP mit der gerichteten TEE-Schlauchelektrode ist eine sichere, einfache und praktikable Methode zur Terminierung von AFL.
To evaluate the therapeutic significance of noninvasive transesophageal pacing for termination of tachycardias the method of rapid atrial or ventricular transesophageal pacing was used in 233 ...patients with different tachycardiac arrhythmias. We were able to terminate atrial flutter in 136 of 162 patients by transesophageal rapid atrial stimulation (conversion to sinus rhythm in 75 cases, induction of atrial fibrillation in 61 cases). Atrial tachycardias were interrupted in 17 of 23 patients (sinus rhythm in 11 cases, atrial fibrillation in six cases). AV reciprocating/AV nodal supraventricular reentry tachycardias were terminated in 62 of 63 patients (sinus rhythm in 58 cases, atrial fibrillation in four cases). By transesophageal rapid ventricular pacing ventricular tachycardias could be terminated in ten of 15 patients. The success rate of transesophageal pacing was influenced by the pacing rate, by the type of tachycardiac arrhythmia inclusive by the type of atrial flutter and by the tachycardia's cycle length. Because the success rates are comparable with invasive technique and the procedure is simpler, the noninvasive transesophageal antitachycardiac pacing should be respected as the method of the first choice in patients with supraventricular tachycardias.
Introduction: Cardiogenic shock due to myocardial infarction or heart failure entails a
reduction in end organ perfusion. Patients who cannot be stabilized with inotropes and who experience ...increasing circulatory failure are in need of an extracorporeal mechanical support system.
Today, small, percutaneously implantable cardiac assist devices are available and might be a solution
to reduce mortality and complications. A temporary, ventricular, continuous flow propeller pump
using magnetic levitation (Impella®) has been approved for that purpose. Methods and Study Design: JenaMACS (Jena Mechanical Assist Circulatory Support) is a monocenter, proof-of-concept
study to determine whether treatment with an Impella CP® leads to improvement of hemodynamic
parameters in patients with cardiogenic shock requiring extracorporeal, hemodynamic support. The
primary outcomes of JenaMACS are changes in hemodynamic parameters measured by pulmonary
artery catheterization and changes in echocardiographic parameters of left and right heart function
before and after Impella® implantation at different support levels after 24 h of support. Secondary
outcome measures are hemodynamic and echocardiographic changes over time as well as clinical
endpoints such as mortality or time to hemodynamic stabilization. Further, laboratory and clinical safety endpoints including severe bleeding, stroke, neurological outcome, peripheral ischemic
complications and occurrence of sepsis will be assessed. JenaMACS addresses essential questions of
extracorporeal, mechanical, cardiac support with an Impella CP® device in patients with cardiogenic
shock. Knowledge of the acute and subacute hemodynamic and echocardiographic effects may help
to optimize therapy and improve the outcome in those patients. Conclusion: The JenaMACS study
will address essential questions of extracorporeal, mechanical, cardiac support with an Impella CP®
assist device in patients with cardiogenic shock. Knowledge of the acute and subacute hemodynamic
and echocardiographic effects may help to optimize therapy and may improve outcome in those
patients. Ethics and Dissemination: The protocol was approved by the institutional review board and
ethics committee of the University Hospital of Jena. Written informed consent will be obtained from
all participants of the study. The results of this study will be published in a renowned international
medical journal, irrespective of the outcomes of the study. Strengths and Limitations: JenaMACS is
an innovative approach to characterize the effect of additional left ventricular mechanical unloading
during cardiogenic shock via a minimally invasive cardiac assist system (Impella CP®) 24 h after
onset and will provide valuable data for acute interventional strategies or future prospective trials.
However, JenaMACS, due to its proof-of-concept design, is limited by its single center protocol, with
a small sample size and without a comparison group.
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