ABSTRACT
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
ABSTRACT
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
Subject(s)
Cardiac Resynchronization Therapy , Heart Failure , Child , Humans , Bundle of His , Treatment Outcome , Cardiac Conduction System Disease , Cardiac Resynchronization Therapy/methods , Heart Failure/therapy , Electrocardiography/methodsSubject(s)
Bradycardia , Prostheses and Implants , Humans , Bradycardia/diagnosis , Electrocardiography, AmbulatorySubject(s)
American Heart Association , Cardiology , Advisory Committees , Bradycardia , Humans , Societies , United StatesSubject(s)
Bradycardia , Cardiac Conduction System Disease , Cardiac Resynchronization Therapy/methods , Cardiac Surgical Procedures , Cardiovascular Agents/pharmacology , Electrophysiologic Techniques, Cardiac/methods , Quality of Life , American Heart Association , Bradycardia/etiology , Bradycardia/physiopathology , Bradycardia/therapy , Cardiac Conduction System Disease/etiology , Cardiac Conduction System Disease/physiopathology , Cardiac Conduction System Disease/therapy , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/methods , Heart Rate/drug effects , Heart Rate/physiology , Humans , Patient Care Management/methods , Patient Selection , Practice Guidelines as Topic , United StatesSubject(s)
Bradycardia , Cardiac Conduction System Disease , Cardiac Resynchronization Therapy/methods , Cardiac Surgical Procedures , Cardiovascular Agents/pharmacology , Electrophysiologic Techniques, Cardiac/methods , Quality of Life , American Heart Association , Bradycardia/etiology , Bradycardia/physiopathology , Bradycardia/therapy , Cardiac Conduction System Disease/etiology , Cardiac Conduction System Disease/physiopathology , Cardiac Conduction System Disease/therapy , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/methods , Heart Rate/drug effects , Heart Rate/physiology , Humans , Patient Care Management/methods , Patient Selection , United StatesSubject(s)
Bradycardia/diagnosis , Cardiac Conduction System Disease/diagnosis , Adrenergic beta-Agonists/therapeutic use , Algorithms , Bradycardia/genetics , Bradycardia/therapy , Bronchodilator Agents/therapeutic use , Calcium Channel Blockers/therapeutic use , Cardiac Conduction System Disease/genetics , Cardiac Conduction System Disease/therapy , Cardiotonic Agents/therapeutic use , Electrocardiography/methods , Genetic Testing/methods , HumansSubject(s)
Bradycardia/diagnosis , Cardiac Conduction System Disease/diagnosis , Adrenergic beta-Antagonists/therapeutic use , Arrhythmias, Cardiac/etiology , Bradycardia/complications , Bradycardia/epidemiology , Bradycardia/therapy , Cardiac Conduction System Disease/complications , Cardiac Conduction System Disease/epidemiology , Cardiac Conduction System Disease/therapy , Electrocardiography , Electrophysiological Phenomena , Epilepsy/complications , Heart Diseases/complications , Heart Diseases/congenital , Humans , Myocardial Infarction/complications , Quality of LifeSubject(s)
Cardiac Resynchronization Therapy Devices , Defibrillators, Implantable , Heart Diseases , Quality of Life , Remote Sensing Technology/methods , Telemedicine , Cardiac Resynchronization Therapy/methods , Cardiac Resynchronization Therapy/psychology , Cardiac Resynchronization Therapy/standards , Consensus , Disease Management , Heart Diseases/classification , Heart Diseases/diagnosis , Heart Diseases/therapy , Humans , International Cooperation , Quality Improvement , Randomized Controlled Trials as Topic , Telemedicine/instrumentation , Telemedicine/methodsABSTRACT
BACKGROUND: Because as many as 46% of implantable cardioverter defibrillator (ICD) patients experience clinical symptoms of shock anxiety, this randomized controlled study evaluated the efficacy of adapted yoga (vs usual care) in reducing clinical psychosocial risks shown to impact morbidity and mortality in ICD recipients. METHODS: Forty-six participants were randomized to a control group or an 8-week adapted yoga group that followed a standardized protocol with weekly classes and home practice. Medical and psychosocial data were collected at baseline and follow-up, then compared and analyzed. RESULTS: Total shock anxiety decreased for the yoga group and increased for the control group, t(4.43, 36), P < 0.0001, with significant differences between these changes. Similarly, consequential anxiety decreased for the yoga group but increased for the control group t(2.86,36) P = 0.007. Compared to the control, the yoga group had greater overall self-compassion, t(-2.84,37), P = 0.007, and greater mindfulness, t(-2.10,37) P = 0.04, at the end of the study. Exploratory analyses utilizing a linear model (R(2) = 0.98) of observed device-treated ventricular (DTV) events revealed that the expected number of DTV events in the yoga group was significantly lower than in the control group (P < 0.0001). Compared to the control, the yoga group had a 32% lower risk of experiencing device-related firings at end of follow-up. CONCLUSIONS: Our study demonstrated psychosocial benefits from a program of adapted yoga (vs usual care) for ICD recipients. These data support continued research to better understand the role of complementary medicine to address ICD-specific stress in cardiac outcomes.
