An analysis of defibrillation and cardiac resynchronization therapy strategies in patients with failing systemic right ventricles

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dc.contributor.advisorMorgan, John Men_ZA
dc.contributor.authorMichael, Kevin Aen_ZA
dc.date.accessioned2014-07-28T13:32:19Z
dc.date.available2014-07-28T13:32:19Z
dc.date.issued2007en_ZA
dc.descriptionIncludes bibliographical references (leaves 52-56).
dc.description.abstractThe expanding application of cardiac resynchronization (CRT) and implantable cardioverter-defibrillator therapy (lCD) to include patients with congenital heart disease requires careful evaluation of selection criteria and unconventional adaptive strategies to ensure clinical efficacy. A single centre prospective analysis of adults post atrial redirection surgery (Mustard operation) for dextro-transposition of the great arteries (d-TGA) presenting with systemic right ventricular (sRV) dysfunction and at risk of sudden cardiac death (SCD). All patients ( mean age 25 years, range 18-35) with varying functional disability{New York Heart Association (NYHA) II-III} receiving ICDs ± concomitant CRT were evaluated. Total follow-up period was 24 months. A patient individualized approach was used for device implantation. Endocardial, epicardial and transthoracic defibrillation strategies were examined in 5 consecutive cases. A hybridized form of CRT was employed in two patients. Only one patient demonstrated response to therapy while the other deteriorated during biventricular pacing (BVP). This prompted a novel approach to CRT using noncontact mapping (NCM) and acute intra-arterial blood pressure response to guide endocardialsRV lead placement in a single patient. The ejection fraction increased from 23 -33% within 1week post procedure and clinical improvement was sustained after 6-months follow-up. Application of CRT II CD therapy to patients with sRV dysfunction requires individualized and adaptive strategies to overcome anatomical constraints. This study represents a chronological and evolutionary account of these measures.en_ZA
dc.identifier.apacitationMichael, K. A. (2007). <i>An analysis of defibrillation and cardiac resynchronization therapy strategies in patients with failing systemic right ventricles</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Cardiology. Retrieved from http://hdl.handle.net/11427/2827en_ZA
dc.identifier.chicagocitationMichael, Kevin A. <i>"An analysis of defibrillation and cardiac resynchronization therapy strategies in patients with failing systemic right ventricles."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Cardiology, 2007. http://hdl.handle.net/11427/2827en_ZA
dc.identifier.citationMichael, K. 2007. An analysis of defibrillation and cardiac resynchronization therapy strategies in patients with failing systemic right ventricles. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Michael, Kevin A AB - The expanding application of cardiac resynchronization (CRT) and implantable cardioverter-defibrillator therapy (lCD) to include patients with congenital heart disease requires careful evaluation of selection criteria and unconventional adaptive strategies to ensure clinical efficacy. A single centre prospective analysis of adults post atrial redirection surgery (Mustard operation) for dextro-transposition of the great arteries (d-TGA) presenting with systemic right ventricular (sRV) dysfunction and at risk of sudden cardiac death (SCD). All patients ( mean age 25 years, range 18-35) with varying functional disability{New York Heart Association (NYHA) II-III} receiving ICDs ± concomitant CRT were evaluated. Total follow-up period was 24 months. A patient individualized approach was used for device implantation. Endocardial, epicardial and transthoracic defibrillation strategies were examined in 5 consecutive cases. A hybridized form of CRT was employed in two patients. Only one patient demonstrated response to therapy while the other deteriorated during biventricular pacing (BVP). This prompted a novel approach to CRT using noncontact mapping (NCM) and acute intra-arterial blood pressure response to guide endocardialsRV lead placement in a single patient. The ejection fraction increased from 23 -33% within 1week post procedure and clinical improvement was sustained after 6-months follow-up. Application of CRT II CD therapy to patients with sRV dysfunction requires individualized and adaptive strategies to overcome anatomical constraints. This study represents a chronological and evolutionary account of these measures. DA - 2007 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2007 T1 - An analysis of defibrillation and cardiac resynchronization therapy strategies in patients with failing systemic right ventricles TI - An analysis of defibrillation and cardiac resynchronization therapy strategies in patients with failing systemic right ventricles UR - http://hdl.handle.net/11427/2827 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/2827
dc.identifier.vancouvercitationMichael KA. An analysis of defibrillation and cardiac resynchronization therapy strategies in patients with failing systemic right ventricles. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Cardiology, 2007 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/2827en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Cardiologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherCardiologyen_ZA
dc.titleAn analysis of defibrillation and cardiac resynchronization therapy strategies in patients with failing systemic right ventriclesen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMPhilen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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