516 Index. Cannulation, CS ostium, 38 Cardiac resynchronization, defined, 322

Transcription

1 Index Activity sensor, 258 Afterdepolarizations, 351 Alerts (CRT advances), patient, Algorithms CRT-related, 188 AF, atrial refractory sensing, 189, atrial tachyarrhythmia therapies, AV and VV delay, automatic optimizati on of, 193 LVCM, 193 ventricular resynchronization restoration in special situations, ventricular triggered mode, 193 defibrillation testing, pacing, Angiography, shepherd s hook, 42 Anodal capture, defined, 336 See also LV capture; RV capture Anodal stimulation, 249, Anode-limited battery, 181 Antibradycardia pacing, CRT and, 129 See also Pacing Antitachycardia pacing (ATP) after CRT, 470 atrial, 194 CRT-related algorithms, 194 ventricular therapies programming in CRTD, See also Atrial fibrillation (AF); Ventricular tachyarrhythmias APAF trial, 11 Apical RV pacing, Apnea, 187 Arrhythmias AF, , after CRT, atrial, , ventricular, 499, Atrial arrhythmias, , See also Antitachycardia pacing (ATP); Atrial fibrillation (AF); Atrial tachyarrhythmias; Ventricular arrhythmias Atrial enlargement, left, 442 Atrial fibrillation (AF), 9 11 after CRT, chronic pacing requiring, CRT upgrade and, CRT and, 113 device memory functions, 186 devices programming aspects, impact of AF incidence, issues and, loss aspects, paroxysmal, permanent, RV pacing after AV nodal ablation for, ventricular resynchronization restoration in special situations, V-V programming in patients with permanent, 244 See also Antitachycardia pacing (ATP); Defibrillation threshold testing (DFT); Ventricular tachyarrhythmias Atrial oversensing, , 393 See also Atrial undersensing; Nonresponders; Ventricular oversensing Atrial pacing competitive, 300 CRT nonresponders management and, noncompetitive (NCAP), 300 rate modulated single-chamber (AAIR), 70 single-chamber (AAI), 70 See also Antitachycardia pacing (ATP); Biventricular pacing; Ventricular pacing Atrial preventive pacing, 194 Atrial refractory (AR) period, 189, Atrial sensing late (intraatrial conduction delay), 444 oversensing, , 393 refractory sensing, 189,

2 516 Index undersensing, 393 See also Ventricular sensing Atrial shocks, 195 Atrial tachyarrhythmias with rapid ventricular conduction, See also Atrial arrhythmias; Ventricular tachyarrhythmias therapies, Atrial tachycardia (AT), 300 See also Ventricular tachycardia (VT) Atrial tracking recovery algorithm, 191 Atrial undersensing, 355, 393 See also Atrial oversensing Automatic adjusting sensitivity (AAS) sensing, 379 Automatic device-based optimization, V-V delay and, 249 Automatic gain control (AGC) sensing, 379 Automatic left ventricular threshold measurement, Automatic optimization, 193, , See also AV optimization Automatic sensitivity control, 312 See also Ventricular tachycardia (VT) AV (atrioventricular) nodal ablation for AF, programmability, 246 resynchronization, AV block (AVB), 9 10, 355, AV conduction correction, CRT loss aspects, , 365 LV pacing for, prolonged, test, 215 See also Ventricular fusion beats with native conduction AV delay automatic optimization, 193, , CRT device programming and, CRT nonresponders management and, during exercise, 289 echocardiography after CRT implantation and, optimal, 219, 246 programming, prolonged, 318 See also Ventricular conduction delay; VV delay AV dyssynchrony, 148, 167 See also Interventricular dyssynchrony AV interval, 254, 256, 343 See also AV delay; V-V interval AV optimization, 217, , , Battery (CRT device hardware technology), Bifocal RV pacing, see Dual site RV pacing BIOPACE study, 10 Bipolar leads, 330, 379 Biventricular ATP, Biventricular capture, See also LV capture; RV capture Biventricular devices, 269, 290, See also Biventricular Pacemakers; Implanted cardioverter defibrillator (ICD) Biventricular pacemakers anodal stimulation in, CRT electrocardiogram during, electrocardiogram during CRT and, 429, electrocardiographic follow-up of, interventricular V-V timing effect on ECG of, Biventricular pacing, defibrillation testing in, monochamber RV pacing upgrading to, upgrading to triple ventricular pacing, with conventional DDD pacemaker, 453 See also Atrial pacing Biventricular stimulation, , See also Stimulation BLOCK HF trial, 10 Buddy wire technique, 42 Cannulation, CS ostium, 38 Cardiac resynchronization, defined, 322 See also CRT Cardiac surgical approach for LV lead placement, Cardiomyopathy, See also under Dilated cardiomyopathy (DCM) CARE-HF trial, 3, 5, 8, , atrial arrhythmias and, 498 atrial fibrillation and CRT, 113 benefits from CRT, 108 CRT-D versus CRT-P study, extension phase of, ICD versus CRT and, 112 if CRT without ICD reduce all-cause mortality but not sudden death?, 459 mortality and, , 110 NYHA classes, 118 QRS duration and morphology in CRT, 114 recurrent HF and, 511

3 Index 517 ventricular tachyarrhythmias after CRT, 459 Catheters (LV leads advances), guiding, Cathode-limited battery, 181 Central venous oxygen saturation, Chronic pacing requiring atrial fibrillation patients, CRT upgrade and, Clinical practice guidelines, CRT, 4 Color-coded TDI, See also Pulsed-wave TDI COMPANION trial, 3, 5, 63 64, 95 97, , , 108, , 114, 118, 300, , 459, 499 Competitive atrial pacing, Conduction delay, 442 See also AV delay Conduction test, 215 Congestive heart failure (CHF), 70, 177, 276 See also Heart disease; Heart failure (HF) CONTAK CD trial, 8, 12, , 114, 118, 125, , 381, 388, 403, 460 Contractility, myocardial, 264 Coronary sinus, inability to cannulate, 411 Coronary stenting, 49 Coronary venoplasty, Coronary venous system ; LV pacing absent or inaccessible target veins, 38 39, 411 active fixation leads in, 48, 50 ECG patterns from, 429 tortuosity, 411 CRT (cardiac resynchronization therapy) advances, , algorithms, antibradycardia pacing patients and, 129 arrhythmias issues, atrial fibrillation (AF) and, 10 11, 113 automatic optimization of AV and VV delay (CRT advances), 193 AV block and, 9 10 AV programmability, 246 benefits, CARE-HF trial, clinical practice guidelines, 4 complications, 112, 382 conventional approach, device and lead related issues, device hardware technology, device memory functions, devices programming, for disordered electrical timing, electrocardiogram during, functional (secondary) MR and, functional MR reduction and, guidelines, 4 5 hardware systems, heart failure (HF) and, 8 10, , hemodynamic sensors and, 253 ICD versus, 111 interventricular interval programmability, , 244, intraventricular conduction delay and, IVCD and, 12 latency aspects, LBBB and, 389 lead dislodgment and loss of, loss, see CRT loss for LV dysfunctioning patients, 30 LVEF parameters, 118 nonconventional and alternative approach, NYHA classes, 118 optimal stimulation site, importance of achieving, in patients with narrow QRS, 11 possible future expansion of indications, 8 proarrhythmia, QRS duration and morphology in, RBBB and, research, current directions in, 5 8 reverse LV remodeling, 327 right bundle branch block and, 12 sensor-driven, trials, see CRT trials upgrade, see CRT upgrades venous stenosis, V-V interval programmability, , See also CRT-D; CRT-P; Echocardiography; Nonresponders; Responders CRT-D (CRT with a defibrillator), 10 CRT trials and, dedicated, 379 device programming, , 317 DFT testing in, nondedicated, 377 phrenic nerve stimulation, 373 programming ventricular therapies in, sensors, 253 ventricular arrhythmias and, 499 ventricular double-counting, 377, 379 ventricular oversensing, ventricular pacing inhibition, 379 versus CRT pacing only (CRT-P), See also CRT-P systems CRT loss AF, atrial oversensing,

4 518 Index atrial tachyarrhythmias with rapid ventricular conduction, causes and corrective actions, differential LV capture threshold rise, 369, due to lead dislodgment, 40 41, 374 due to LV capture threshold rise, 40 frequent ventricular premature beats (VPDs), 366, 369 phrenic nerve stimulation, pseudo-atrial undersensing, related to pacing operation, related to ventricular activation, 360, , 366, 369 T wave, prevention of pacing on, 360 CRT pacing algorithms and functions in, alone/only, 63 conventional, nonconventional and alternative, sites, See also Atrial Pacing; CRT-P systems; LV pacing; RV pacing CRT-P systems CRT trials and, 101, 103 dedicated, 379 device programming, nondedicated, 377 phrenic nerve stimulation, 373 ventricular arrhythmias and, 499 ventricular double-counting, ventricular oversensing, 375 ventricular pacing inhibition, 379 versus CRT-D, See also CRT pacing; CRT-D; Pacemakers CRT trials atrial fibrillation and, 113 benefits, CARE-HF, , , 108, COMPANION, 96 97, , , 108, 114 CONTAK CD, , 114, 125 CRT-D, CRT-P, 101, 103 DAVID trial, 118 designs, 107 entry criteria for previous randomized clinical trials, 112 established evidence from clinical studies, future scope, , HOBIPACE, 125, 127 ICD versus CRT, 111 Leiden, 125 long-term efficacy, 108, 111 LVEF parameters, 118 LV pacing sites and, MASCOT trial, 113 MIRACLE, 97, , 108, 114, mortality, MUSTIC, 96, 105, , 113 nonresponders versus responders, 111 number needed to treat (NNT), 112 NYHA classes and, 118 observational studies, 107 past and present evidence, , PATH-CHF, 105 QRS duration and morphology in, 114 RAFT, 111 SCD-HeFT, 111 CRT upgrades chronic pacing requiring atrial fibrillation patients and, CRT-ICD, 87 CRT utility and current guidelines, 69 dual chamber pacemakers and, 86 incorporating or abandoning components from older system, 86 indications and clinical implications, paced QRS, in patients with prior RV pacing, RV pacing, 70 71, 74 75, 86 strategies, technical, CS ostium, inability to localize or cannulate, Data, 187 DAVID trial, 9, 118 Dedicated CRTP/D systems with univentricular sensing, 379 See also Ventricular double-counting Defibrillation, 269, See also Atrial fibrillation (AF); Implanted cardioverter defibrillator (ICD) Defibrillation energy requirement (DER), 270 Defibrillation testing, See also Upper Limit of vulnerability (ULV) testing Defibrillation threshold testing (DFT), algorithms, in CRT-D devices, 274, 275 efficacy testing, one-shock, 273, 274 Defibrillator, 105 See also CRT-D; Implanted cardioverter defibrillator (ICD) Delayed afterdepolarizations (DAD), 351 DESIRE trial, 8 Diaphragmatic stimulation,

5 Index 519 Differential LV capture threshold rise, 40, See also Ventricular activation related CRT loss Dilated cardiomyopathy (DCM), 139 HF and, abnormal electrical timing in, , idiopathic cardiomyopathy and, 141, 144 LBBB in, 318, 345 LV dysfunction, 141, 144 new cause of, 140 nonischemic (NDCM), 139, patients selection and methods, 140 that could be cured, results long-term follow-up of patients with LVEF> 50%, 141 LV dysfunction reversal, 141, 144 population, 140 study design, 140 Doppler echocardiographic indices, 217 Doppler imaging, tissue, see tissue Doppler imaging (TDI) Double-counting, ventricular, see ventricular double-counting Dual chamber pacemakers, CRT upgrade and, 86 Dual-chamber pacing (DDD) modes, 70, 256, 333 See also RV pacing Dual-chamber pacing, 28, 70, 256, 453 See also Apical RV pacing Dual-site RV pacing, DVIR mode, 333 Dyssynchrony atrioventricular, 148, 167 detection for CRT response prediction, 149 index, 8 interventricular, 148 LV, 149 measures and echocardiography, 7 QRSd limitations in assessing, 390, 391 ventricular mechanical, 412, 413 Early afterdepolarizations (EAD), 351, 463 Echocardiography See also Echocardiography after CRT implantation; Echocardiography before CRT implantation; Electrocardiography (ECG) AV optimization using, CRT and, 114, 117 Doppler indices, 217 dyssynchrony measures and, 7 ECG versus, 6 8 indices, 6, 217 LV latency and, 229, 232 M-mode, 150 patient follow-up and, 8 RT3DE, 158, 160 sophisticated, 389 strain (rate) imaging, techniques for selecting CRT responders, three-dimensional, 158, 160 tissue doppler imaging, 150, tissue synchronization imaging (TSI), 156 Echocardiography after CRT implantation AV delay programming, AV resynchronization programming, device programming, electrocardiogram during CRT interventricular delay programming, interventricular resynchronization programming, intraventricular resynchronization programming, long term considerations, refractory heart failure after initial improvement with CRT, 177 short-term considerations, therapy effectiveness AV dyssynchrony, 167 interventricular dyssynchrony, intraventricular dyssynchrony, 168, See also Echocardiography before CRT implantation Echocardiography before CRT implantation, 147 CRT benefits, LV dyssynchrony detection for CRT response prediction, 149 LV lead placement and, 161 scar tissue, presence and localization of, See also Echocardiography after CRT implantation; Electrocardiogram during CRT EF, see Ejection fraction Ejection fraction, 65, 66, 69, 108, 111, 497 Electrical timing CRT for, in HF, abnormal, , improved pumping function, Electrocardiogram during CRT, 425, 429, , biventricular pacing with conventional DDD pacemaker and, 453 ECG patterns from coronary venous system, 429 excercise, 452 interatrial conduction delay, 442 intraatrial conduction delay, latency and, 452 long-term ECG changes, 444

6 520 Index LV pacing and, RV pacing and, ventricular fusion beats with native conduction, See also Biventricular pacemakers; Echocardiography after CRT implantation; Echocardiography before CRT implantation; Electrocardiography (ECG) Electrocardiography (ECG) CRT programming considerations, during exercise, 452 follow-up of biventricular pacemakers, leadless, 197 versus echocardiography for patient selection, 6 8 See also Echocardiography; Electrocardiogram during CRT Electrodes (CRT hardware system), Electronic repositioning, 40, 374 Endless loop tachycardia (CRT device memory functions), 186 Endocardial LV pacing, transvenous, Epicardial approach for LV lead placement, surgical, minimal thoracotomy, 18 robotically assisted, VATS, 18 See also Transseptal approach for LV lead placement Exercise AV delay during, 289 CRT devices programming aspects, CRT electrocardiogram during, 452 hemodynamics, 254 mean daily physical activity (MDPA) index, optimal V-V interval and, 247 Finger photoplethysmography (FPPG), Fluid index, 486 See also Intrathoracic impedance FPPG, see Finger photoplethysmography Frequent ventricular premature beats (VPDs), 366, 369 See also Ventricular activation related CRT loss Functional MR, 11 12, , 511 Functions (CRT devices), pacing, FVT, 352 Guidelines, CRT, 4 5 Guiding catheters (LV lead advances), Hardware systems (CRT) leads and electrodes, LV polarity confirgurations, 330 pulse generators, Heart disease less advanced, 123, 128 severity, CRT-D versus CRT-P study, 65 trials, 128 See also Heart failure (HF) Heart failure (HF), 3 after CRT, BLOCK HF trial, 10 CARE-HF trial, 5, COMPANION trial, 96 97, congestive (CHF), 70, 177, 276 DCM-associated abnormal electrical timing in, device memory functions, CRT, 187 hemodynamic sensors, mild, 9 10 MIRACLE trial, 97 monitoring (hemodynamic sensors), mortality, MUSTIC trial, 96 prevention and CRT, prevention in NYHA class II patients, 8 9 recurrent, refractory, 177 sensors use for detecting, 266 See also Heart failure hospitalization (HFH); Hemodynamic sensors Heart failure exacerbation prediction, See also Intrathoracic impedance Heart failure hospitalization (HFH), 133, intrathoracic impedance advances and, 482 prevention, 257 QRS duration and, 133 Heart rate variability (HRV), , 475 CRT effect on, device-based, 480 prognostic value in CRT, 478, 480 time domain analysis, Hemodynamic monitoring invasive, 340 noninvasive, See also AV optimization Hemodynamic sensors, 253 Clinical apsects, 257 HFH prevention, 257 HF monitoring and, prerequisites for, 257 role in HF devices, 253 sensor-driven CRT, types

7 Index 521 activity, 258 CVO 2, HRV, myocardial contractility, 264 PEA, 264 pulmonary fluid content, 262, 264 RV pressures, See also Heart failure (HF) High LV stimulation thresholds, HOBIPACE (Homburg Biventricular Pacing Evaluation) study, 30, 125, 127 ICD, see Implanted cardioverter defibrillator (ICD) Idiopathic cardiomyopathy, 141, 144 See also Cardiomyopathy; Dilated cardiomyopathy (DCM) Impedance, intrathoracic, see intrathoracic impedance Implanted cardioverter defibrillator (ICD), 63 biventricular, 269 CRT-D and, 65 CRT-ICD upgrade aspects, 87 CRT versus, 111 defibrillation testing, if CRT and ICD reduce mortality (ventricular tachyarrhythmias after CRT)?, if CRT without ICD reduce mortality (ventricular tachyarrhythmias after CRT)?, 459 one-shock DFT testing, ventricular therapies programming in CRTD, Implied TARP, 357 Indices of disease progression, CRT research and, 6 InSync trial, , 353 ; V-V interval Integrated bipolar (IBP) leads, 379 Interatrial conduction delay, 442 See also Electrocardiogram during CRT; Intraatrial conduction delay; Intraventricular conduction delay (IVCD) Interventricular delay (IVD), 29, , See also Heart failure (HF) Interventricular dyssynchrony, 148, See also Echocardiography after CRT implantation Interventricular interval, Interventricular refractory period, See also Ventricular tachycardia (VT) Interventricular resynchronization, See also Echocardiography after CRT implantation Interventricular timing, Interventricular ventricular refractory period (IVRP), 357 Interventricular V-V timing, biventricular pacemakers and, Intraatrial conduction delay, See also Interatrial conduction delay; Intraventricular conduction delay (IVCD) Intramural delay, prolonged, 322 See also Electrical timing Intrathoracic impedance, See also Heart disease; Heart failure (HF) Intraventricular conduction delay (IVCD), 12, 123 Intraventricular delay, prolonged, See also Electrical timing Intraventricular dyssynchrony, 168, , See also Dyssynchrony Intraventricular resynchronization, See also Echocardiography after CRT implantation Invasive hemodynamic monitoring, 340 See also AV optimization; Noninvasive hemodynamic monitoring Late atrial sensing, 444 See also Atrial sensing; Intraatrial conduction delay Latency CRT electrocardiogram during, 452 defined, 225, 226 left ventricular (LV), 227, 229, 232 pacing rate and output, effect of, right venticular (RV), 226 ; RV pacing Lead active fixation pacing, 48, 50 bipolar polarity configuration, 330 connectors (CRT device hardware technology), dislodgment, 40 41, 374 See also CRT loss; Ventricular activation related CRT loss and electrodes, unipolar polarity configuration, 330 Leadless ECG, 197 Left atrial enlargement, 442 Left bundle branch block (LBBB) CRT and, 389 CRT responders and, 390 in DCM, 139, 318, 345 induced cardiomyopathy, 139, 140 NDCM and, 346 See also Right bundle branch block (RBBB) Left interventricular septal pacing, 23

8 522 Index Left ventricular capture management (LVCM), 193 Left ventricular end diastolic dimension (LVEDD), 8 Left ventricular protection period (LVPP), 360 Leiden trial, 125, 130, 460 Loop tachycardia (CRT device memory functions), endless, 186 Low Energy Safety Study (LESS), Lower rate programming, 496 LV (left ventricular) AF and, dysfunction, 30, 125, 127, 141, 144 function monitoring in pacemaker patients, HF and, 9 10 mitral regurgitation (MR) and, 11 remodeling, reverse, 327 to RV conduction test, 215 See also RV (right ventricular) LV capture, 40, 215, 314, , , 373 See also RV capture LVCM (left ventricular capture management), 193, LV dyssynchrony, 134, 149 See also Dyssynchrony LVEDD (left ventricular end diastolic dimension), 8 LVEF (LV ejection fraction) AF and, CRT trials and, 118 NYHA class III and moderate depression of, RV pacing and, 134 LV end systolic volume (LVESD), 27 LVESD (LV end systolic volume), 27 LV latency, 227, 229, 232 ; RV pacing LV lead advances, diaphragmatic stimulation and, 313 failures, 504 guiding catheters, implantation, 313 LV lead placement cardiac surgical approach for, echocardiography before CRT implantation and, 161 factors limiting optimal, lead connectors, 183 LV septal pacing approach, 23 obstacles to achieving conventional transvenous, suboptimal, 409 subxiphoid videopericardioscopic device approach, 23 surgical epicardial approach, transseptal approach, transvenous, ; RV lead placement LV only ATP, See also CRT-D (CRT with a defibrillator) LV only stimulation, See also Nonresponders LV oversensing, 375 See also Ventricular oversensing LV pacing, 30 ; RV pacing Conventional CRT and, 37 diaphragmatic stimulation and, electrocardiogram during CRT and, latency, 225, 227 negative QRS complex during, 429 nonconventional and alternative CRT approach, nonresponders management and, 400, optimal CRT response and, 35 36, 400, , for prolonged AV conduction correction, sensor-driven rate adaptation in CRT, 254 sites, 27 29, 35 36, 117, 118 transcutaneous or transvenous access to pericardial space for, 55 using telescoping sheaths, LV polarity configuration leads, 330 LVPP (left ventricular protection period), 360 LV stimulation, 39 40, 400, , See also Stimulation LV threshold, 39 40, MADIT trial, 9, 71, 118, 128 MASCOT trial, 113 Mean daily physical activity (MDPA) index, See also Exercise Medtronic Impedance Diagnostics in Heart Failure Patients Trial (MIDHeFT), 262 Memory functions (CRT device), MIDHeFT trial, 262 Minimal thoracotomy approach, 18 Minithoracotomy, 18 MIRACLE-ICD trial, 9, 105, , 381, 441, 460 MIRACLE trial, 6, 12, 97, , 108, 110, 114, 386, 388, 441, 459, 511 Mitral regurgitation (MR), 11 12, , 511 M-mode echocardiography, 150 See also Echocardiography

9 Index 523 Mode switching (CRT device memory functions), inappropriate, 186 Monochamber RV pacing, See also RV pacing Morbidity and mortality in HF, CRT trials and, Mortality comparison, CARE-HF versus COMPANION trials, 101 CRT impact on, in HF, VT CRT, MOST trial, 71 MUSTIC (Multisite Stimulation in Cardiomyopathies) trial, 107, 108, 459, 96, 105 MUSTIC AF trial, 10, 113, 302, 459, 498 Myocardial contractility, 264 Myocardial electrophysiology, disturbed See also Ventricular tachyarrhythmias Clinical evidence, 463, experimental considerations, 463 Nerve stimulation, phrenic, See also Ventricular activation related CRT loss New York Heart Association, see NYHA classes Noncapture, See also LV capture Noncompetitive atrial pacing (NCAP), 300 Nondedicated CRTP/D systems with Y-adaptors, See also Ventricular double-counting Noninvasive hemodynamic monitoring, See also AV optimization; Invasive hemodynamic monitoring Nonischemic DCM (NDCM), , Nonresponders, 385 biventricular stimulation and, LV lead placement aspects, LV only stimulation, management, 392 atrial oversensing aspects of, 393 atrial pacing role, atrial undersensing aspects of, 393 LV lead placmenent, 410 LV pacing, 400, , noncapture aspects of, 393, 394 optimal CRT response aspects, 400, patient-related causes of nonresponse, 394 patient-system interface related causes of nonresponse, 394 system-related causes of nonresponse, ventricular conduction delay role, 398 ventricular oversensing aspects of, 393 patients selection optimization aspects for reducing, 385 baseline QRS duration, clinical characteristics, 386 prolonged QRS duration, ventricular mechanical dyssynchrony absence, See also Responders Number needed to treat (NNT), 112 NYHA class class III IV, 3, 5, class III patients with LVEF moderate depression, class II patients, 8 9, , CRT and, 118 defibrillation testing and, One-shock DFT testing, See also Defibrillation threshold testing (DFT) OPSITE trial, 302 Optimal AV delay, 219, 246 Optimal pacing sites, 27 28, 31 32, Optimal stimulation site, importance of achieving, Optimal V-V interval, , 249 Optimization, 193, , , Paced AV (SAV), 395 See also Atrial pacing Paced QRS, frontal place axis of, 433 Paced QRSd, 71 72, 433 Pacemaker-mediated tachycardia (PMT), 382, Pacemakers biventricular, 429, , CRT upgrade aspects and, DDD, 453 upgrading of conventional, See also Pacing Pacemaker syndrome, 28 See also Apical RV pacing Pacing algorithms and functions in CRT devices, antibradycardia, 129 antitachycardia, 470 atrial antitachycardia pacing (ATP), 194 atrial preventive pacing, 194 biventricular, 30, 31 CRT programming considerations, 333 dual-chamber, 28

10 524 Index modes, 333 monochamber RV, related CRT loss, triple ventricular, upgrading in ICD patients with ventricular tachyarrhythmias, 461 See also CRT pacing; LV pacing; Pacemakers; RV pacing Pacing outputs (CRT programming considerations), Pacing sites LV, 27 30, optimal, 27 28, RV, 28 30, 32 Paroxysmal AF, Paroxysmal atrial arrhythmias, PATH-CHF trial, 105, 118, 386, 403 Patient alerts (CRT advances), PAVE trial, 10, Peak endocardial acceleration (PEA) sensor, 264 Percutaneous coronary intervention (PCI) guide, 41 Permanent AF (CRT devices programming aspects), 302, Phrenic nerve stimulation (PNS), ventricular activation related CRT loss, See also CRT loss CRT issues, 502 Physical activity, see excercise Post ventricular atrial blanking (PVAB), Postventricular atrial refractory period (PVARP), 189, , , 297, , 310, 355, See also Total atrial refractory period (TARP) Premature ventricular complexes (PVCs), Pressures, RV, Primary prevention patients (ventricular therapies programming in CRTD), 352 Proarrhythmia, , 462 AV, 246 interventricular interval, , V-V interval, , , , 249 See also Arrhythmias; Ventricular oversensing Programmability Programming biventricular capture loss, detection of, CRT-D, , 317, 350 CRT-P, diaphragmatic stimulation, during excercise, initial device programming, 284 pacing outputs (CRT programming considerations), 337, 339 paroxysmal AF and, permanent AF and, 302, PVCs, slow ventricular tachycardia (VT), upper rate programming, 290, , Prolonged atrioventricular (AV) delay, 318 See also AV delay; Electrical timing Prolonged AV conduction correction, LV pacing for, Prolonged QRS duration (QRSd), 318 Prolonged ventricular conduction, 318, PROSPECT trial, 8, 114, 162 Pseudo-atrial undersensing, 355 See also Atrial undersensing Pulmonary fluid content, 262, 264 Pulsed-wave TDI, 155 See also Color-coded TDI Pumping function, CRT for improved, Puncture, transseptal, 50 QRS CRT in patients with narrow, 11 negative, 429 paced QRS complex during RV pacing, 425, 426 ventricular fusion and, 438 QRS duration (QRSd) CRT nonresponders and, CRT responders and, heart failure hospitalization (HFH) and, 133 morphology in CRT and, normal, 392 paced, 71 72, 433 prolonged, 318 See also Electrical timing QS configuration in lead (biventricular pacemakers), QuickOpt algorithm, 218 RAFT trial, 111 Rapid ventricular conduction, 360 See also Ventricular conduction Rapid ventricular response (RVR), 361 Rate adaptation in CRT, Rate modulated dual-chamber pacing (DDDR), 70, 256 Rate modulated single chamber atrial pacing (AAIR), 70 Rate modulated single chamber ventricular pacing (VVIR), 71 Real-time 3D (RT3DE) echocardiography, 158

11 Index 525 Recurrent heart failure (HF) after CRT, See also Heart Disease; Heart failure (HF) Reference impedance, 486 See also Intrathoracic impedance Refractory heart failure after initial improvement with CRT, 177 Regurgitation, functional (secondary) mitral, Remodeling, reverse LV, 327 Remote control (CRT advances), Respirophasic oversensing, 379 See also Ventricular oversensing Responders, 385 echocardiographic techniques, QRSd and, See also Nonresponders Resynchronization/defibrillation for Advanced Heart Failure Trial (RAFT), 111 Reverse LV remodeling, 327 REVERSE trial, 9, 128 Right bundle branch block (RBBB), 12 See also Left bundle branch block (LBBB) CRT and, QRS duration and morphology in CRT, Robotically assisted LV epicardial lead implantation, RV capture, See also LV capture RV conduction test, LV to, 215 RV lead placement, , 438 RV only ATP, RV oversensing, 375 See also Ventricular oversensing RV pacing, 9 10 AAI, 70 after AV nodal ablation for AF, apical, conventional pacemaker patients, 133 CRT and, 12, 30, 70 71, 73 80, 86 dual-chamber pacing (DDD) modes, 70 dual site, electrocardiogram during CRT and, latency during, 226 LV dyssynchrony measurement, 134 LVEF and LV dyssynchrony measurement, 134 monochamber, negative QRS complex during, 429 QRSd aspects, 71, 72 sensor-driven rate adaptation in CRT, 254 sites, 28, 29, 32 VVIR, 71 RV pressures, R-wave, See also Electrocardiogram during CRT Scar tissue, See also Echocardiography before CRT implantation SCD-HeFT trial, 111, 499 Secondary prevention patients (ventricular therapies programming in CRTD), 352 Sensed AV (SAV), 395 See also Atrial pacing Sensor-driven CRT, Septal to posterior wall motion delay (SPWMD), 150 Sequential biventricular stimulation, Shepherd s hook renal angiography, 42 Single-chamber atrial pacing (AAI), 70 Single-shock defibrillation, biventricular ICDs and, 269 Sleep apnea monitoring, 187 Slow ventricular tachycardia (VT), Stenoses, 411 Stents, coronary, Stimulation anodal, biventricular, in biventricular pacemakers, LV only, phrenic nerve, 39 40, thresholds, LV, 39, 40 Strain (rate) imaging, Suboptimal LV lead placement, avoiding or correcting, 409 Subthreshold LVp event, 217 Subxiphoid videopericardioscopic device, 23 Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), 111 Sudden death, 459 Suprathreshold LVp event, 217 Surgical approach for LV lead placement ; LV pacing Cardiac, epicardial approach, SVT, Tachyarrhythmia after CRT, 458, device memory functions, CRT, 187 therapies (CRT-related algorithms), atrial, ventricular, 187, See also Arrhythmias Tachycardia endless loop, 186 pacemaker-mediated (PMT), 382,

12 526 Index Telemonitoring (CRT advances), Telescoping sheaths, LV pacing using, Therapies, with rapid ventricular conduction, Thoracoscopy (VATS), video-assisted, 18 Thoracotomy, mini, 18 Three-dimensional echocardiography, 158, 160 Threshold measurement, LV, Time domain analysis, See also Heart rate variability (HRV) Tissue doppler imaging (TDI), 8 9, 114, 150, color-coded, pulsed-wave, 155 Tissue synchronization imaging (TSI), 156 Tortuosity, coronary venous, 411 Total atrial refractory period (TARP), 290, , 357 See also Postventricular atrial refractory period (PVARP) Transcutaneous access to pericardial space for LV pacing, 55 Transmural dispersion of repolarization (TDR), 462, 467 Transseptal approach for LV lead placement, Transseptal puncture, 50 Transvenous access to pericardial space for LV pacing, 55 Transvenous endocardial LV pacing, Transvenous LV lead placement obstacles absent or seemingly inaccessible target veins, CRT loss, CS ostium, inability to localize or cannulate, high LV stimulation thresholds, phrenic nerve stimulation, Triple site pacing, 336 Triple ventricular pacing, biventricular pacing upgrading to, True bipolar (TBP) leads, 379 T-wave, 360 See also CRT loss; Pacing Unipolar polarity configuration leads, 330 Univentricular sensing, 379 See also Ventricular double-counting Upper limit of vulnerability (ULV), 277 Upper rate behavior in biventricular devices, 290, response, Wenckebach, 295, Upper rate programming (CRT device programming), 496 VDD mode, CRT programming considerations, 333 Venoplasty, 85 Venous stenosis, VENTAK CHF trial, , , 403, 460 Ventricular activation related CRT loss, , 369 See also CRT loss; Ventricular conduction Ventricular arrhythmias, CRT issues and, 499, See also Arrhythmias Ventricular conduction, , 398 See also Ventricular activation related CRT loss Ventricular double-counting aspects, resolving dedicated CRTP/D systems with univentricular sensing, 379 nondedicated CRTP/D systems with Y-adaptors, Ventricular fusion beats with native conduction electrocardiogram during CRT and, first-degree AV block influence, fusion with spontaneous ventricular activation, 441 Ventricular mechanical dyssynchrony absence, CRT nonresponders and, Ventricular oversensing CRT nonresponse and, 393 double counting aspects, LV and RV, 375 respirophasic oversensing and, 379 ventricular pacing inhibition and, 379 VT detection interval, 377 See also Atrial oversensing; Atrial undersensing Ventricular pacing, 379 ; RV pacing Ventricular premature beats (VPDs), 366 Ventricular rate regulation (VRR), 363, Ventricular resynchronization, , , Ventricular safety pacing (VSP), 369 Ventricular sense response (VSR), 366, Ventricular sensing See also Atrial sensing; Ventricular oversensing Univentricular sensing, 379 VSR, 366, Ventricular tachyarrhythmias after CRT,

13 Index 527 device memory functions, CRT, 187 See also Atrial tachyarrhythmias; Ventricular tachycardia (VT) Ventricular tachycardia (VT), , 352, 377 See also Atrial tachycardia (AT); Ventricular oversensing Ventricular therapies, , Ventricular triggered mode, 193 VF (ventricular fibrillation), Video-assisted thoracoscopy (VATS), 18 Videopericardioscopic device, subxiphoid, 23 VV delay, 193, 241, 249 See also AV delay; V-V timing VVI mode, 333 V-V interval, , 246 anodal stimulation, 249 clinical considerations, clinical studies, InSync III clinical study, optimal V-V interval, , 249 in patients with permanent AF, 244 See also AV interval; VV delay VVIR mode, 333 V-V optimization, 218 V-V timing automatic optimization, , biventricular pacemakers and, CRT, 346, See also VV delay Wenckebach upper rate response, 295, Y-adaptors, See also Ventricular double-counting