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Distribution of esophageal interventricular conduction delays in CRT patients and healthy subjects
(2015)
Cardiac resynchronization therapy (CRT) is an established class I level A biventricular pacing therapy in chronic heart failure patients with left bundle branch block and reduced left ventricular ejection fraction, but not all patients improved clinically. Purpose of the study was to evaluate electrical interatrial conduction delay (IACD) to interventricular conduction delay (IVCD) ratio with focused transesophageal left atrial and left ventricular electrocardiography.
Methods: Thirty eight chronic heart failure patients (age 63.4±10.2 years; 3 females, 35 males) with New York Heart Association (NYHA) functional class 3.0±0.2 and 171.71±36.17ms QRS duration were analysed using posterior left atrial and left ventricular transesophageal electrocardiography with hemispherical electrodes before CRT. Electrical IACD was measured between onset of P-wave in the surface ECG and onset of left atrial signal. Electrical IVCD was measured between onset of QRS complex in the surface ECG and onset of left ventricular signal.
Results: Electrical IACD and IVCD could be evaluated by transesophageal left atrial and left ventricular electrocardiography in all heart failure patients with correlation to 1.18±0.92 IACD-IVCD-ratio (r=-0.57, P<0.001; r=0.66, P<0.001). There were 32 CRT responder with reduction of NYHA class from 3.0±0.22 to 1.97±0.31 (P<0.001) during 16.5±18.9 month CRT with 75.19±33.49ms IACD, 78.91±24.73ms IVCD, 1.04±0.66 IACD-IVCD-ratio and correlation between IACD and IACDIVCD- ratio (r=0.84, P<0.001). There were 6 CRT nonresponder with no reduction of NYHA class from 3.0±0.3 to 2.9±0.5 during 14.3±13.7 month biventricular pacing, 50.0±28.26ms IVCD (P=0.014), 1.92±1.65 IACD-IVCD-ratio (P=0,029) and correlation between 67.0±24.9ms IACD and IACD-IVCD-ratio (r=0.85, P=0.031).
Conclusions: Focused transesophageal left atrial and left ventricular electrocardiography can be utilized to analyse electrical IACD and IVCD in heart failure patients. IACDIVDC- ratio may be a useful parameter to evaluate electrical left cardiac desynchronization in heart failure patients.
Introduction: Despite lots of developments in the last years, radiofrequency ablation of rhythm diseases is a safe but still complex procedure that requires special experience and expertise of the physicians and biomedical engineers. Thus, there is a need of special trainings to become familiar with the different equipment and to explain several effects that can be observed during clinical routine.
Methods: The Offenburg University of Applied Sciences offers a biomedical engineering study path specialized in the fields of cardiology, electrophysiology and cardiac electronic implants. It`s Peter Osypka Institute for Pacing and Ablation provides teaching following the slogan “Learning by watching, touching and adjusting”. It conducts lots of trainings for students as well as young physicians interested in electrophysiology and radiofrequency ablation.
Results: In-vitro trainings will be provided using the Osypka HAT 200 and HAT300s, Stockert EPshuttle and SmartAblate system as well as the Boston EPT-1000XP and Maestro 3000 and the Radionics RFG-3E cardiac radio frequency ablation generators. All of them require different handling as well as special accessories like catheter connection cables or boxes and back plates. The participants will be trained in the setup of temperature, power and cut-off impedance dependent on different ablation catheters. Furthermore troubleshooting in hard- and software is part of the program. Performing procedures in pork or animal protein and using physiological saline solution to simulate the blood flow, they can study the influence of contact force and impedance on lesion geometry etc. and to avoid adverse effects like “plops”. Lots of catheter types are available: 4mm tip, 8mm standard and gold tip, open and closed irrigated tip ablation catheters of different companies. The experiments will be completed by measuring the lesion size dependent on the used catheter type and ablation settings.
Conclusion: In-vitro training in radiofrequency ablation is a challenge for biomedical engineering students and young physicians.
Special implant connection module was developed to combine full features of two commercial heart rhythm simulators, ARSI-4 and Intersim II, into a master-slave teaching system. Seven workstations were equipped with the Carelink and Homemonitoring remote patient monitoring systems. This combination enables in-vitro training of physicians, nurses and students in pace-maker and defibrillator measurements during implantation and individual programming in the follow-up. Thus, extended sets of arrhythmias and electrode problems can be used to simulate problems and their solutions in a wide range of the clinical routine.