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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

Clinical and echocardiographic predictors of nonresponse to cardiac resynchronization therapy

Miriam Shanks1, Victoria Delgado, Arnold C T Ng

  • 1Department of Cardiology, Leiden University Medical Center, The Netherlands.

American Heart Journal
|March 12, 2011
PubMed

Insights

Up to 44% of heart failure patients do not respond to cardiac resynchronization therapy (CRT). Key predictors of nonresponse include ischemic heart failure, reduced baseline walk distance, less left ventricular dyssynchrony, and anterior LV lead placement.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF).
  • A significant percentage of patients (30-40%) do not respond to CRT.
  • Identifying nonresponse predictors is crucial for optimizing HF treatment.

Purpose of the Study:

  • To identify clinical and echocardiographic factors associated with nonresponse to CRT.
  • To evaluate determinants of CRT efficacy in advanced HF patients.

Main Methods:

  • 581 advanced HF patients undergoing CRT implantation were assessed.
  • Clinical and echocardiographic data were collected at baseline and 6 months.
  • Nonresponse was defined by lack of functional improvement, HF-related mortality, or insufficient LV volume reduction.

Main Results:

  • 44% of patients (254/581) were nonresponders at 6 months.
  • Nonresponders showed higher rates of male sex, ischemic cardiomyopathy, worse NYHA class, and shorter 6-minute walk distance.
  • Less baseline left ventricular (LV) dyssynchrony and anterior LV lead position were also associated with nonresponse.

Conclusions:

  • Ischemic HF etiology is a significant predictor of CRT nonresponse.
  • Shorter baseline 6-minute walk distance and less LV dyssynchrony independently predict nonresponse.
  • Anterior LV lead position is also an independent determinant of CRT nonresponse.
Abstract

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