[Acute hemodynamic effects]

Area of Science:

• Cardiology
• Medical Devices
• Heart Failure Management

Background:

• Advanced heart failure (HF) with left bundle branch block (LBBB) presents challenges for cardiac resynchronization therapy (CRT).
• Patient response to CRT can vary, necessitating personalized approaches.
• Previous studies indicate that QRS duration influences acute CRT effects.

Purpose of the Study:

• To evaluate the acute hemodynamic effects of different CRT stimulation modes (right, left, biventricular) in patients with LBBB and severe HF.
• To identify predictors of acute CRT response and assess long-term outcomes.
• To determine if pre-procedural hemodynamic testing can optimize CRT programming.

Main Methods:

• Patients with LBBB, severe HF, and QRS width >150 ms underwent various stimulation modes at different atrioventricular (AV) delays.
• Acute response was defined as a ≥10% increase in pulse pressure.
• One-year follow-up assessed changes in NYHA class, VO2peak, and left ventricular end-diastolic diameter.

Main Results:

• 88% of patients were acute responders, with significant improvements in pulse pressure and contractility.
• Atrio-left ventricular stimulation yielded higher pulse pressure increases in some patients compared to biventricular stimulation.
• One-year follow-up showed significant improvements in HF symptoms, exercise capacity, and reverse remodeling.

Conclusions:

• Hemodynamic testing before CRT is valuable for identifying acute non-responders.
• This testing can guide the selection of the optimal stimulation mode, site, and AV delay for CRT responders.
• Personalized CRT programming based on acute hemodynamic response can lead to significant long-term clinical benefits.