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Cardiac resynchronization therapy (CRT) represents an increasingly recommended solution to alleviate symptomatology and improve the quality of life in individuals with dilated cardiomyopathy (DCM) and heart failure (HF) with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal medical therapy (OMT). However, this therapy does have the desired results all cases, in that sometimes low sensing and high voltage stimulation are needed to obtain some degree of resynchronization, even in the case of perfectly placed cardiac pacing leads. Our study aims to identify whether there is a relationship between several transthoracic echocardiographic (TTE) parameters characterizing left ventricular (LV) performance, especially strain results, and sensing and pacing parameters. Between 2020–2021, CRT was performed to treat persistent symptoms in 48 patients with a mean age of 64 (53.25–70) years, who were diagnosed with DCM and HFrEF, and who were still symptomatic despite OMT. We documented statistically significant correlations between global longitudinal strain, posterolateral strain, and ejection fraction and LV sensing (r = 0.65, 0.469, and 0.534, respectively, p < 0.001) and LV pacing parameters (r = −0.567, −0.555, and −0.363, respectively, p < 0.001). Modern imaging techniques, such as TTE with cardiac strain, are contributing to the evaluation of patients with HFrEF, increasing the chances of CRT success, and allowing physicians to anticipate and plan for case management. [ABSTRACT FROM AUTHOR]

We report the case of a 58-year-old man with ischemic dilated cardiomyopathy and a history of left ventricle geometrical reconstruction after apical aneurysm resection, treated by cardiac resynchronization therapy with the use of a single-pass VDD defibrillator lead. The intervention and fluoroscopy time were prolonged by a difficult left ventricle lead placement, but the VDD lead contributed to time saving. Pacing and sensing thresholds as well as pacing and shock impedances were within normal limits. The benefits were important in terms of left ventricle systolic function and heart failure symptomatology after preexcitation of the left ventricle by 20 milliseconds. Adding cardiac resynchronization therapy to left ventricle reconstruction seems to have a beneficial effect especially after optimizing the pacing parameters, to counteract the effects of the residual scar. On the other hand, implantation of triple chamber cardiac devices is a challenging intervention. Obtaining an efficient cardiac resynchronization and primary sudden cardiac death prevention with two leads instead of three is feasible and it brings an important gain in terms of time saving and infection risk lowering. Data in the literature concerning these two issues is scarce. [ABSTRACT FROM AUTHOR]

A variety of parameters has been proposed in left ventricular (LV) asynchrony evaluation. Echocardiography was performed in 95 patients with non-ischemic dilated cardiomyopathy (DCM). Global myocardial index (GMI) and time to peak systolic velocity (Ts) was measured from the beginning of the QRS complex to the peak myocardial systolic velocity. Absolute difference in Ts between any two of the four basal LV segments, absolute difference in Ts between any two of the six basal LV segments, absolute difference in Ts between any 2 of the 12 (6 basal and 6 mid) LV segments, and standard deviation of Ts of the 12 (6 basal and 6 mid) LV segments were derived. A composite score was calculated combining the above four dyssynchrony parameters. All GMI differed significantly among dyssynchrony groups. The area under ROC-curve to detect patients with all four criteria of dyssynchrony was 0.94 for GMI (100% sensitivity, 90% specificity). In conclusion, GMI could be used as simple index to detect LV desynchronization in DCM. [ABSTRACT FROM AUTHOR]

Background: Onset of atrial fibrillation (AF) in patients with heart failure (HF) is usually associated with a high occurrence of cardiovascular complications. E/(E'×S') ratio (E=early diastolic transmitral velocity, E'=early mitral annular diastolic velocity and S'=systolic mitral annulus velocity) has been shown to reflect left ventricular filling pressure., Objective: We investigate whether E/(E'×S') could be a predictor of new-onset AF in patients with HF., Methods: We analyzed 113 consecutive hospitalized patients with HF, in sinus rhythm, after appropriate medical treatment. Patients with histories of AF, inadequate echocardiographic images, congenital heart disease, paced rhythm, significant primary valvular disease, acute coronary syndrome, coronary revascularization during follow-up, severe pulmonary disease or renal failure were not included. E/(E'×S') was determined using the average of septal and lateral mitral annular velocities. The primary study end-point was the new-onset AF., Results: During the follow-up period (35.7±11.2 months), 33 patients (29.2%) developed AF. Mean E/(E'×S') was 3.09±1.12 in these patients, while it was 1.72±1.34 in the other patients (p<0.001). The optimal E/(E'×S') cut-off to predict new-onset AF was 2.2 (88% sensitivity, 77% specificity). There were 64 patients (56.6%) with E/(E'×S')<2.2 and 49 (43.4%) with E/(E'×S')>2.2. New-onset AF was higher in patients with E/(E'×S')>2.2 than in patients with E/(E'×S')<2.2 [29 (59.1%) versus 4 (6.2%), p<0.001]. On multivariate Cox analysis including the variables that predicted AF on univariate analysis, E/(E'×S') was the only independent predictor of new-onset AF (hazard ratio=2.26, 95% confidence interval=1.25-4.09, p=0.007)., Conclusion: In patients with HF, E/(E'×S') seems to be a good predictor of new-onset AF.

Background: The electroanatomical substrate of dilated atria is characterised by increased non-uniform anisotropy and macroscopic slowing of conduction, which promote reentrant circuits., Aim: To analyse the relationship between electrophysiological properties of atria and echocardiographic markers of dilatation and increased filling pressure., Methods: The study group consisted of 79 patients without structural heart disease, aged 53+/-22 years, who were referred for electrophysiological study. In order to examine the atrial electrophysiological characteristics we studied interatrial conduction time (iaCT), double potentials and fragmented atrial activity during premature stimulation of the high right atrium (HRA). The analysed parameters included: duration of atrial activity, baseline iaCT (iaCTb) between HRA and distal coronary sinus (CS), iaCT during HRA pacing S1S1 600 ms (iaCTS1), maximum prolongation of iaCT during S2 and S3 delivery (iaCTS2, iaCTS3). We also calculated the decremental index (DI)=iaCT S3- iaCTS1/iaCTS1%. The following echocardiographic parameters were assessed: left atrial (LA) dimensions, surface (LAs), volume using ellipse formula (LAv), right surface (RAs), total atrial surface (TAs=LAs+RAs), and global myocardial index (GMI)., Results: Patients were divided into two groups. Group 1 consisted of 37 patients with evidence of slow atrial conduction (atrial fragmentation/iaCTb>80 ms/DI>50%/double atrial potentials), whereas group 2 was composed of 42 patients without slow conduction properties. There were no significant differences concerning age, body mass index or LA parasternal dimensions between the groups. Thirty-seven patients, of whom 32 were from group 1, had documented episodes of paroxysmal atrial fibrillation. GMI, LAs, LAv and TAs values were significantly higher in patients from group 1 than in group 2 subjects. A statistically significant linear correlation between iaCTb and TAs (r=0.52 p <0.0001)/LAv (r=0.38 p <0.0001) was found. There was also a trend toward a correlation between DI and TAs., Conclusion: This study supports the role of stretch and dilated atria in electrophysiological changes which occur in structurally normal hearts. The iaCT value may be indirectly and non-invasively evaluated using echocardiographic measurements.