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Updated: Jul 7, 2026

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

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

Cardiac resynchronization therapy: "nonresponders" and "hyperresponders".

Philippe Castellant¹, Marjaneh Fatemi, Valerie Bertault-Valls

¹Department of Cardiology, Hôpital de la Cavale Blanche, Brest University Hospital, France.

|February 5, 2008

Summary

Some patients with dilated cardiomyopathy (DCM) experience complete recovery after cardiac resynchronization therapy (CRT), becoming "hyperresponders." This complete functional recovery was exclusively observed in patients with nonischemic DCM.

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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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Area of Science:

Cardiology
Heart Failure Management
Medical Device Therapy

Background:

Cardiac resynchronization therapy (CRT) is a standard treatment for heart failure in patients with dilated cardiomyopathy (DCM) and left bundle branch block.
A significant portion of patients (30%) do not respond to CRT, but the possibility of
hyper-response
or complete recovery has not been well-documented.

Purpose of the Study:

To identify and characterize patients with DCM who exhibit complete functional recovery and normalization of left ventricular function following CRT.
To investigate the concept of
hyper-responders
in the context of CRT.

Main Methods:

Prospective follow-up of 84 consecutive patients with DCM, left bundle branch block, and advanced heart failure (NYHA class III-IV) who received CRT.
Hyper-responders were defined by achieving both functional recovery and a left ventricular ejection fraction (LVEF) of 50% or greater.

Main Results:

Eleven patients (13%) were identified as hyper-responders within 6 to 24 months post-CRT.
Hyper-responders showed a significant increase in LVEF from 25% to 60% (P = .001).
Hyper-response was exclusively observed in patients with nonischemic DCM (18% of this subgroup vs. 0% of ischemic DCM patients, P = .05).

Conclusions:

Complete functional recovery, termed
hyper-response
is achievable in a subset of patients undergoing CRT for DCM.
The etiology of DCM is a key factor, with hyper-responders found solely among those with nonischemic DCM.
Left bundle branch block may be a causal factor in the development of DCM in the nonischemic subgroup.