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Updated: Aug 26, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Effect of cardiac resynchronization therapy on left atrial reverse remodeling and spontaneous echo contrast
Ahmet Vural1, Aysen Ağaçdiken, Dilek Ural
1Department of Cardiology, Kocaeli University Medical Faculty, Kocaeli, Turkey. drahmetvural@superonline.com
Insights
Cardiac resynchronization therapy (CRT) improves left atrial remodeling and function. CRT significantly reduces spontaneous echo contrast (SEC) frequency and intensity, enhancing atrial health in heart failure patients.
Area of Science:
- Cardiology
- Medical Devices
- Echocardiography
Background:
- Cardiac resynchronization therapy (CRT) is known to induce reverse remodeling in the left ventricle.
- However, its long-term effects on left atrial remodeling, including spontaneous echo contrast (SEC), remain incompletely understood.
Purpose of the Study:
- To investigate the long-term impact of CRT on left atrial reverse remodeling.
- To evaluate changes in left atrial total emptying fraction (LATEF) and the frequency and intensity of SEC following CRT.
Main Methods:
- Twenty patients with systolic heart failure and left bundle-branch block received biventricular pacemakers.
- Transthoracic and transesophageal echocardiography were performed pre-implantation and at 1 and 6 months post-implantation.
Main Results:
- CRT led to significant progressive decline in left atrial volumes, indicating reverse remodeling.
- Left atrial total emptying fraction (LATEF) increased significantly from baseline (33%) to 6 months (41%).
- Spontaneous echo contrast (SEC) frequency decreased from 90% to 45% at 6 months, with a significant reduction in intensity.
Conclusions:
- Long-term CRT effectively promotes atrial reverse remodeling.
- CRT improves left atrial emptying function and significantly reduces the presence and intensity of atrial spontaneous echo contrast.
- These findings suggest CRT offers substantial benefits for left atrial function and structure in heart failure patients.
Abstract:
Recent studies revealed reverse remodeling in left ventricle with cardiac resynchronization therapy (CRT). However, effects on left atrial remodeling, left atrial total emptying fraction and left atrial spontaneous echo contrast (SEC) have not been adequately evaluated. The aim of this study was to investigate the long-term changes in SEC, left atrial reverse remodeling, and left atrial total emptying fraction after CRT. Twenty patients with systolic heart failure and complete left bundle-branch block underwent implantation of biventricular pacemaker devices. Transthoracic and transesophageal echocardiography were performed one week before and one and six months after pacemaker implantation. After biventricular pacemaker implantation, significant clinical improvement was observed in all patients. Left atrial maximal and minimal volumes showed a significant progressive decline after CRT (reverse remodeling). Left atrial total emptying ejection fraction (LATEF) was 33 +/- 19% at baseline and increased to 37 +/- 10% and 41 +/- 11% at the 1st and 6th months respectively (p = 0.01 and p = 0.04). SEC was detected in 18 of 20 patients (90%) at the beginning of the study. After six months SEC disappeared in 5 patients and frequency of SEC reduced to 45%. Decrease in the intensity of the SEC was also statistically significant (at the 1st and 6th months; p = 0.001 and p < 0.001 respectively). Long-term CRT results in atrial reverse remodeling, increases LATEF, and reduces both frequency and intensity of atrial SEC.
