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[Acute hemodynamic effects].

J Vogt1, J Heintze, B Lamp

  • 1Kardiologische Klinik, Herz- und Diabeteszentrum NRW, Georgstr. 11, 32545 Bad Oeynhausen, Germany. akohlstaedt@hdz-nrw.de

Herzschrittmachertherapie & Elektrophysiologie
|April 13, 2005
PubMed
Summary
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Cardiac resynchronization therapy (CRT) effectively improves heart failure (HF) outcomes in patients with left bundle branch block (LBBB). Hemodynamic testing before CRT identifies non-responders and optimizes stimulation for responders.

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.

Related Experiment Videos

  • 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.