HF
NYHA Indications of HF
class I (35%):
class II (35%):
class III (25%):
class IV (5%):
II: mild symptoms w ordinary exertion
III: moderate symptoms with less than ordinary exertion
IV: symptomatic at rest
CARE HF criteria and goal
-NYHA cl III-IV
-EF< or = to 35%
-QRS> 150ms
-NSR
-Enlarged LV end diastolic diameter(use echo to see)
Goal: compare optimal med therapy vs optimal med therapy w CRT-P (BIV pacing)
LV leads are placed in the __ (which sits in the ___) and these leads travels through the __
CS, AV groove on the posterior side of the heart, coronary veins
1 pro about using an A lead with an AF PT...
If we decided not to use an A lead, what would we need to bring
pro- could use RA lead in hopes of atrial remodeling and returning to NSR
If not used, we will need an IS-1 pin port plug to plug A hole
The #1 cause of ___ sided HF is ___ sided HF
right, left
CARE HF results
FIRST study demonstrating significant reduction in mortality in CRT-P PT's compared to opt med therapy...
saw reduced mortality and hosp and risk of complications, improved symptoms and QOL
The first LV leads were __polar bc the small size was advantageous. When using this type of lead, we could use a non traditional pacing configuration called __. Explain this configuration and its negative potential side effect.
How could we trouble shoot if this problem were to arise?
uni, extended bipolar
LV tip (cathode) to RV coil/ring (anode)
coil if integrated, ring if dedicated
Could lead to anodal stimulation which is when we capture at the anode rather than the cathode. We would have to reposition the lead, (later could be fix with electronic repositioning, aka changing the pacing vector).
The LV lead is typically inserted with access through the ____ on the __ side using a hemostatic introducer
subclavian vien, left
___ (acute or chronic) HF involves long term, gradual decline in LV function characterized by volume overload eventually leading to ventricular ___ (AKA change in shape/size)
chronic, remodeling
first trial to include non-ischemic DCM PTs and show CRT does work
COMPANION
benefits of bipolar/quadripolar leads as opposed to unipolar
-size and shape choices
-inc means of fixation/sstability (shape=wedge, side helix)
-INC # of PACING VECTORS
- good bc if threshold was high in one vector, we could try other options to find most optimal vector
-less lead repositioning
USually need a __ french sheath to access the CS
9
Example of HFrEF, AKA ___ (systolic or diastolic) HF: ______, and what it does to the heart
Example of HFpEF, AKA ___ (systolic or diastolic) HF: ______, and what it does to the heart
HFrEF is REDUCED EF, aka systolic HF. ie: dialted cardiomyopathy, which expands the left ventricle leaving the walls thin, stretched/enlarged and weak, in a basketball shape. Blood will fill the LV but not be able to be pumped out sufficiently, leading to EF< 40 %... (most common type of HF and calcium channel blockers are contraindicated, but ACE inhibitors, diuretics and digitalis treat)
HFpEF is PRESERVED EF, aka diastolic HF. ie: hypertrophic cardiomyopathy, which thickens and stiffens the LV wall. This decreases the amount of filling space in LV, but does not impact pumping ability so EF> 40%...
(treat with ACE inhibitors, calcium channel blockers, beta blockers, and eventually diuretics if needed)
MADIT- CRT criteria and goal
-EF< or = to 30%
-isch or non isch
- QRS> 0r = to 130ms
-NYHA I or II
Goal- compare CRT with ICD vs ICD alone
bipolar configuration vs reverse bipolar
LV tip cathode to LV ring anode
LV ring cathode to LV tip anode
Which company uses the worley cath which has an extra inner dilater to assist with lead placement. This is a good option if having trouble cannulating the CS
Abbott
primary cardiomyopathy:
secondary cardiomyopathy:
primary: no other condition led to weakened heart
secondary: caused by a previous medical condition like HTN, valve disease, CAD etc
MADIT CRT results
- improved EF bc LVEDV increased
-no diff in risk of death
- CRT reduced risk of HF events significantly (eso with QRS > 150)
true unipolar configuration
(couldnt do with early CRT-D device so had to use extended bipolar)
tip to can
how do you decide which shape/size LV lead and guide wires to use
based on anatomy of the PT's CS
ability to cannulate
physician preference