18 research outputs found

    Fig 1 -

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    Electrogram (EGM) and electrocardiogram (ECG) of the three different settings: 1. optimized bi-ventricular-stimulation (BiV); 2. Physiological AV nodal conduction without triggered left ventricular pacing (tLVp-off); 3. TLVp algorithm turned on (tLVp-on) with physiological AV nodal conduction (a), and after premature ventricular contraction (PVC; b). (ECG–electrocardiogram, IEGM–internal electrogram, PVC—premature ventricular contraction, tLVp—triggered left ventricular pacing).</p

    QRS width (ecg) in the different CRT modes.

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    (BiV–biventricular pacing, LV—left ventricle, tLVp—triggered left ventricular pacing).</p

    Electrocardiographic and echocardiographic markers depending on the amount of QRS shortening by tLVp with regard to intrinsic QRS complex.

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    Electrocardiographic and echocardiographic markers depending on the amount of QRS shortening by tLVp with regard to intrinsic QRS complex.</p

    Fig 5 -

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    (A) QRS width; (B) Max. LV delay depending on the amount of QRS shortening by tLVp with regard to intrinsic QRS complex (BiV–biventricular pacing, LV—left ventricle, tLVp—triggered left ventricular pacing); n = 9 for ≤20ms, n = 8 for >20ms.</p

    Echocardiographic (echo) markers in the different CRT modes.

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    (A) 3D LVEF (echo); (B) Systolic dyssynchrony index (SDI; echo). (3D - 3-dimensional, BiV–biventricular pacing, LV—left ventricle, LVEF–left ventricular ejection fraction, tLVp—triggered left ventricular pacing).</p

    LV delay, measured by 2D strain (echo) in the different CRT modes.

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    Max. (BiV–biventricular pacing, LV—left ventricle, LVEF–left ventricular ejection fraction, tLVp—triggered left ventricular pacing).</p

    Fig 2 -

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    Sankey plot showing the number of eligible vectors before and after LVAD implantation using the ECG-based (A) and the device-based (B) S-ICD screening test. LVAD = left ventricular assist device.</p

    Baseline patient characteristics (n = 22).

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    BackgroundThe number of left ventricular assist devices (LVADs) implanted in patients with end-stage heart failure is increasing. In this patient cohort, subcutaneous implantable cardioverter defibrillators (S-ICDs) could be a promising alternative to transvenous ICDs due to lower infection rates and avoidance of venous access. However, eligibility for the S-ICD depends on ECG features that may be influenced by an LVAD. The aim of the present study was a prospective evaluation of S-ICD eligibility before and after LVAD implantation.MethodsThe study recruited all patients presenting at Hannover Medical School for LVAD implantation between 2016 and 2020. S-ICD eligibility was evaluated using the ECG-based and the device-based S-ICD screening test before and after LVAD implantation.ResultsTwenty-two patients (57.3 ± 8.7 years of age, 95.5% male) were included in the analysis. The most common underlying diseases were dilated cardiomyopathy (n = 16, 72.7%) and ischemic cardiomyopathy (n = 5, 22.7%). Before LVAD implantation 16 patients were found eligible for the S-ICD according to both screening tests (72.7%), but only 7 patients were eligible after LVAD, 31.8%; p = 0.05). Oversensing due to electromagnetic interference was observed in 6 patients (66.6%) found ineligible for S-ICD after LVAD implantation. A lower S wave amplitude in leads I (p = 0.009), II (p = 0.006) and aVF (p = 0.006) before LVAD implantation was associated with higher rate of S-ICD ineligibility after LVAD implantation.ConclusionLVAD implantation can impair S-ICD eligibility. Patients with lower S wave amplitude in leads I, II and aVF were more likely to be ineligible for S-ICD implantation after LVAD implantation. Thus, S-ICD therapy should be carefully considered in patients who are candidates for LVAD therapy.</div
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