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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
[Factors associated with efficacy of cardiac resynchronization therapy for patients with congestive heart failure]
Hao-Ying Shi1, Wei Jin, Fang Wang
1Department of Cardiology, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China.
Insights
Cardiac resynchronization therapy (CRT) is effective for heart failure, but less so for patients with atrial fibrillation. For sinus rhythm patients, QRS duration, LV pre-ejection time, and pulmonary systolic pressure predict CRT response.
Area of Science:
- Cardiology
- Heart Failure Management
- Cardiac Electrophysiology
Background:
- Congestive heart failure (CHF) affects millions globally, with cardiac resynchronization therapy (CRT) offering a treatment option.
- Identifying predictors of CRT response is crucial for optimizing patient selection and outcomes.
Purpose of the Study:
- To evaluate the efficacy of CRT in patients with CHF.
- To identify factors predicting responder versus non-responder status to CRT.
Main Methods:
- Fifty-three CHF patients (sinus rhythm and atrial fibrillation) received CRT.
- Echocardiography and tissue Doppler imaging assessed response 6 months post-implantation.
- Clinical response: improved NYHA class; Echocardiographic response: reduced LV end-systolic volume or increased LVEF.
Main Results:
- Overall clinical and echocardiographic response rates were 75% and 69.8%, respectively.
- Atrial fibrillation patients showed significantly lower echocardiographic response rates (45.5%) compared to sinus rhythm patients (76.2%).
- In sinus rhythm patients, wider QRS duration, lower pulmonary systolic pressure, and prolonged left ventricular pre-ejection time predicted better CRT response.
Conclusions:
- CRT response is diminished in CHF patients with atrial fibrillation compared to those with sinus rhythm.
- QRS duration, left ventricular pre-ejection time, and pulmonary systolic pressure are valuable predictors of CRT response in sinus rhythm patients.
Objective:
The efficacy of cardiac resynchronization therapy (CRT) in patients with congestive heart failure and the potential factors associated with responder or nonresponder were investigated.
Methods:
Fifty three patients with congestive heart failure (42 with sinus rhythm and 11 with atrial fibrillation) underwent CRT were enrolled in this study. Conventional echocardiography and tissue Doppler imaging were performed in each patient before implantation and 6 month post implantation. Clinical response was defined as improvement of one NYHA functional class and echocardiographic response was defined as a reduction in LV end-systolic volume by > 15% or an increase of absolute value of LVEF > 5%.
Results:
The clinical response rate was 75% and echocardiographic response rate was 69.8% during 6 month follow-up. The echocardiographic response rate for patients with atrial fibrillation was lower than that for patients with sinus rhythm (45.5% vs. 76.2%, P < 0.05). In patients with sinus rhythm, higher response rate was seen in patients with widen QRS duration, lower pulmonary systolic pressure and prolonged left ventricular pre-ejection time (LVPT) while response rate was not affected by LVEF, left ventricular volume, NYHA functional class and intra-ventricular dyssynchrony.
Conclusions:
Response rate to CRT was lower in patients with atrial fibrillation compared to patients with sinus rhythm. In patients with sinus rhythm, QRS duration, LVPT and pulmonary systolic pressure were useful parameters to predict the response to CRT.
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