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Strategies to improve outcomes in patients with cardiac resynchronisation therapy

Ahsan, SYZ; (2013) Strategies to improve outcomes in patients with cardiac resynchronisation therapy. Doctoral thesis , UCL (University College London).

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Abstract

Cardiac Resynchronisation Therapy (CRT) is an important adjunctive treatment for selected heart failure (HF) patients. With increasing numbers of devices being implanted, strategies to improve outcome in CRT patients are paramount. These were explored in three separate studies. Firstly, a retrospective cohort study of all CRT procedures (n=490) was undertaken to identify the incidence and type of early (≤ 90 days) and late complication (> 90 days) in different CRT populations. Overall, complication rates were low (early 9.4%; late 6.1%) and the LV lead remained stable over long-term follow up. Compared to patients with HF with ischaemic aetiology, patients with idiopathic dilated cardiomyopathy had an increased risk of complications (OR 2.76, 95%CI 1.04-7.31, p=0.04). Secondly, the use of simple infection control measures to reduce cardiac device infection (CDI) rates were explored. A retrospective audit (2004-2007, n=2779 procedures), introduction of an infection control protocol (November 2007) and a prospective audit (2007-2009 n=981 procedures) identified that CDI within 1-year of procedure reduced from 1.3% to 0.6% due to the new protocol, with an estimated cost saving of £132,190 per-year. Finally, a prospective study to explore the acute haemodynamic response (AHR) to CRT using single and multi-site pacing from within a single coronary sinus (CS) branch was performed (n=28). Major intra- and inter-individual variations in the 5 maximum rate of change in LV pressure (LV dP/dt max), depending on the LV pacing site(s), were noted. Selecting the best LV pacing configuration resulted in an increase in AHR of 9.9% compared to conventional biventricular pacing and an absolute increase of 36.3% from baseline. This study is the first to evaluate multi-site pacing from within a single CS tributary and supports an individually tailored approach to CRT. The findings from these studies inform potential strategies to improve patient outcomes in a growing CRT population.

Type: Thesis (Doctoral)
Title: Strategies to improve outcomes in patients with cardiac resynchronisation therapy
Language: English
Additional information: Permission for digitisation not received.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
URI: https://discovery.ucl.ac.uk/id/eprint/1398307
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