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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

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

Patients with non-ischaemic dilated cardiomyopathy and hyper-responders to cardiac resynchronization therapy:

Philippe Castellant1, Marjaneh Fatemi, Erwann Orhan

  • 1Département of Cardiology, Hôpital de la Cavale Blanche, Brest University Hospital, Bd Tanguy Prigent, 29609 Brest Cedex, France.

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
|February 26, 2009
PubMed

Insights

Cardiac resynchronization therapy (CRT) can significantly improve left ventricular (LV) function in some patients with non-ischaemic dilated cardiomyopathy (NIDCM) and left bundle branch block (LBBB). Approximately 21.5% of NIDCM patients achieve

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) can reverse left ventricular (LV) dysfunction in select patients with non-ischaemic dilated cardiomyopathy (NIDCM), left bundle branch block (LBBB), and severe heart failure.
  • Patients achieving substantial functional recovery are termed 'hyper-responders' and have been exclusively identified in NIDCM cohorts.

Purpose of the Study:

  • To determine the proportion of 'hyper-responders' among patients with NIDCM receiving CRT.
  • To identify potential baseline clinical profiles that predict CRT 'hyper-response' in NIDCM patients.

Main Methods:

  • Prospective follow-up of consecutive NIDCM patients (LV ejection fraction <35%, LV end-diastolic diameter >60 mm, LBBB, NYHA class III-IV) who received CRT.
  • 'Hyper-responders' were defined as achieving NYHA class I-II and LVEF ≥50% after at least 6 months of CRT.
  • Baseline clinical parameters were compared between 'hyper-responders' and non-hyper-responders.

Main Results:

  • Out of 51 NIDCM patients, 11 (21.5%) were identified as 'hyper-responders' post-CRT, showing a significant increase in LVEF (26% to 59%, P < 0.01).
  • The remaining 40 patients (78.5%) exhibited minimal functional improvement with a modest LVEF increase (21% to 26%, P = 0.03).
  • Baseline parameters in 'hyper-responders' were less severely deteriorated compared to non-responders, although no single discriminating factor was identified.

Conclusions:

  • A significant subset of NIDCM patients with LBBB experience complete functional recovery and normalized LV function after CRT.
  • The findings suggest LBBB might be a causative factor for DCM in these 'hyper-responder' patients.
  • No unique baseline predictor distinguished 'hyper-responders' from other patients, highlighting the need for further research into predictive markers.
Abstract

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