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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
Limited response to cardiac resynchronization therapy in patients with concomitant right ventricular dysfunction
Paul B Tabereaux1, Harish Doppalapudi, G Neal Kay
1Department of Medicine, Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA.
Journal of Cardiovascular Electrophysiology
|October 23, 2009
Summary
Right ventricular dysfunction (RVD) significantly reduces the likelihood of positive response to cardiac resynchronization therapy (CRT) in heart failure patients. RVD is also linked to poorer survival rates following CRT implantation.
Area of Science:
- Cardiology
- Heart Failure Management
- Electrophysiology
Background:
- Left ventricular dysfunction (LVD) and dyssynchrony are common indications for cardiac resynchronization therapy (CRT).
- Right ventricular dysfunction (RVD) is a known predictor of reduced survival in LVD patients, but its impact on CRT response was unclear.
Purpose of the Study:
- To investigate the influence of RVD on the clinical effectiveness of CRT.
- To determine if RVD is associated with a lack of response to CRT.
Main Methods:
- Retrospective analysis of 130 patients with LVD who received CRT implantable cardioverter-defibrillators (ICDs).
- RVD was defined as a right ventricular ejection fraction <0.40.
- Lack of CRT response included mortality, heart transplantation, LV assist device, no NYHA class improvement, or hospice care.
Main Results:
- 59.2% of patients (77/130) showed no response to CRT.
- RVD was present in 56% of non-responders (P=0.02).
- RVD, female gender, and elevated serum creatinine were independently associated with decreased odds of CRT response (adjusted ORs 0.34, 0.36, and 0.25, respectively).
- Patients with RVD had significantly lower survival post-CRT (log rank P=0.01).
Conclusions:
- Right ventricular dysfunction is a strong predictor of poor clinical response to CRT in heart failure patients with LVD.
- RVD should be a key consideration when evaluating patients for CRT candidacy.
- Identifying RVD may help personalize CRT treatment strategies and improve patient outcomes.
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