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Heart Failure in Adult Congenital Heart Disease
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Andrew Constantine, Ana Barradas-Pires, Isma Rafiq, Justyna Rybicka, Michael A. Gatzoulis, Konstantinos Dimopoulos
Cardiac resynchronization therapy (CRT) is recommended for patients with acquired HF on optimal medical therapy, based on symptoms, systemic ventricular function, evidence of electrical dyssynchrony, and the absence of atrial fibrillation.95 In this population, there is mounting evidence of improvements in exercise capacity, quality of life, ventricular function, and survival.96,97 CRT placement, particularly when an ICD is being planned, may provide additional benefit to some ACHD patients, but strong evidence is lacking. Access to the coronary sinus or one of its ventricular branches may be hampered or precluded by anomalous position of the coronary sinus, or previous surgery.
Anesthesia Monitoring and Management
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Capillary refill time (CRT) is a visual indication of perfusion. Normally, it should be less than 2.5 seconds; a prolonged CRT (> 3 seconds) is indicative of poor perfusion and low cardiac output.
Assessing and responding to sudden deterioration in the adult
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
To assess CRT, cutaneous pressure is exerted on the person’s fingertip for 5 s and released. The finger should be held at heart level or just above and the pressure should be enough to cause blanching (Resuscitation Council 2021a). The test indicates capillary perfusion. Normally, CRT is less than 2 s. Situations where CRT is increased include shock, dehydration, aortic aneurysm, aortic occlusion, cardiac tamponade, hypothermia and Raynaud’s syndrome.
Global article collection: essential reads from around the world
Published in Journal of Medical Economics, 2022
Mihajlo Jakovljevic, Chia Jie Tan, Nathorn Chaiyakunapruk, Guilherme Silva Julian, Kei Long Cheung, Mickael Hiligsmann, Brian Godman, Sylvia Opanga, Paul A. Scuffham, Michael Gregg
AdaptResponse itself is the largest trial conducted amongst randomized cardiac resynchronization therapy (CRT) interventional global trials in this area (ClinicalTrials.gov Identifier: NCT02205359) with an estimated patient enrollment of 3,700 participants. In their findings, the authors note that CRT improves cardiac performance and consequently reduces morbidity and mortality. Distinctive added value of the AdaptivCRT algorithm lies in its ability to improve response rates and hemodynamic optimization of CRT pacing. The use of post-hoc analysis proved significant in reducing the risk of all-cause readmission. Furthermore, the economic evaluation indicates incremental gains in the average patient survival and quality-of-life associated with cost savings. The authors have also carefully designated all core methodological limitations, with the main one simply being a lack of maturity of the data. However, this will come in time as the AdaptResponse trial’s estimated study completion date is September 2024. These pilot findings were published in October 2020, 4 years prior to final outcomes being determined.
Cost-effectiveness analysis of implantable cardiac devices in patients with systolic heart failure: a US perspective using real world data
Published in Journal of Medical Economics, 2020
Dhvani Shah, Xiaoxiao Lu, Victoria F. Paly, Stelios I. Tsintzos, Damian M. May
Cardiac resynchronization therapy (CRT) devices are a specific type of cardiac pacemaker used to re-establish electrical and mechanical coordination of the left and right ventricles. These devices are known as CRT-pacemakers (CRT-P). Implantable cardioverter defibrillators (ICDs) are used to provide therapies, such as defibrillation or anti-tachycardia pacing, to treat life-threatening arrhythmias associated with sudden cardiac death. The American College of Cardiology Foundation (ACCF)/AHA Guidelines for the management of HF make recommendations for the use of ICDs and CRT for patients with HFrEF conditional on specific clinical characteristics and manifestations such as ischemic/non-ischemic heart disease, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, QRS duration and presence of left bundle-branch block (LBBB)8. Modern types of CRT devices combine both the functionality of a CRT-P and that of an ICD and these are referred to as CRT-defibrillators (CRT-D). The relative benefit of these devices has been well established, but is understood to vary based on multiple patient characteristics9,10.
Multisite pacing and myocardial scars: a computational study
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Mohammad Albatat, Jacob Bergsland, Hermenegild Arevalo, Hans Henrik Odland, Samuel Wall, Joakim Sundnes, Ilangko Balasingham
Heart failure (HF) is a serious medical condition affecting more than 26 million people worldwide (Savarese and Lund 2017). In approximately one-quarter of HF patients a defect in the conduction system contributes to the HF, resulting in asynchronous ventricular activation and reduced cardiac pumping efficiency (Thom and Kannel 1997). The aim of cardiac resynchronization therapy (CRT) is to use controlled pacing to produce synchronous contraction of both ventricles (Abraham et al. 2002). CRT devices consist of subcutaneously implanted pacemaker cans containing control units and battery source, connected to three or more leads with sensing and pacing electrodes implanted in the right atrium, right- and left ventricles (RA, RV and LV) through an endovascular or direct surgical approach. In selected patients, CRT improves the cardiac pumping efficacy and relieves HF symptoms (Abraham and Hayes 2003), but 30% of cases do not respond to CRT due to a suboptimal stimulation pattern of the LV (Auricchio and Prinzen 2011). Multisite pacing (MSP) may increase CRT response by inserting LV lead(s) in additional location(s) to obtain: (1) improved stimulation pattern and (2) synchronization of a larger part of the LV.