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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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Cardiac resynchronization therapy in left ventricular hypertrabeculation/non-compaction and myopathy.

Claudia Stöllberger¹, Gerhard Blazek, Elisabeth Bucher

¹2. Medizinische Abteilung, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030 Wien, Osterreich. claudia.stoellberger@chello.at

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology

|November 22, 2007

Summary

Cardiac resynchronization therapy (CRT) improved functional capacity in all patients with left ventricular hypertrabeculation/non-compaction (LVHT) and heart failure. However, systolic function improved in only half, suggesting comorbidities like myopathy impact CRT response.

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Area of Science:

Cardiology
Electrophysiology
Heart Failure Research

Background:

Left ventricular hypertrabeculation/non-compaction (LVHT) is a rare congenital cardiomyopathy.
The efficacy of cardiac resynchronization therapy (CRT) in LVHT patients with heart failure remains poorly understood.
Comorbidities, particularly neuromuscular disorders, may influence treatment outcomes in these patients.

Purpose of the Study:

To evaluate the response to cardiac resynchronization therapy (CRT) in patients diagnosed with left ventricular hypertrabeculation/non-compaction (LVHT) and heart failure.
To investigate the impact of comorbidities, such as myopathy, on CRT outcomes in this specific patient population.

Main Methods:

Retrospective analysis of 8/102 patients with diagnosed LVHT who underwent CRT implantation.
Neurological investigations were performed, with a focus on identifying myopathy.
Assessment of clinical improvement (NYHA class), left ventricular dimensions, and systolic function (fractional shortening) during a mean follow-up of 39 months.

Main Results:

All patients demonstrated improvement in New York Heart Association (NYHA) functional class by at least one class.
Left ventricular end-diastolic diameter decreased in most patients, with significant reductions (>30%) in two.
Left ventricular systolic function, measured by fractional shortening, increased substantially in half of the patients.
Seven out of eight patients had an identified myopathy.
Two patients died during the follow-up period.

Conclusions:

Biventricular pacing via CRT leads to functional capacity improvement in all LVHT patients with heart failure and myopathy.
Systolic function improvement was observed in approximately half of the patients.
The suboptimal response to CRT in some LVHT patients may be attributed to patient selection criteria or the presence of comorbidities, especially neuromuscular disorders.