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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

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Atrial reverse remodelling is associated with outcome of cardiac resynchronization therapy

Mariëlle Kloosterman1, Michiel Rienstra1, Bart A Mulder1

  • 1Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, Groningen RB 9700, The Netherlands.

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
|January 1, 2016
PubMed

Insights

Atrial reverse remodelling improves cardiac resynchronization therapy (CRT) outcomes. Patients without atrial or ventricular remodelling had the worst prognosis, highlighting its prognostic value.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) is a key treatment for heart failure.
  • Atrial remodelling can impact CRT efficacy.
  • Prognostic markers for CRT response are crucial.

Purpose of the Study:

  • To investigate the prognostic significance of atrial reverse remodelling (ARR) in patients undergoing CRT.
  • To determine if ARR influences long-term outcomes after CRT.

Main Methods:

  • Retrospective analysis of 365 patients receiving CRT at University Medical Centre Groningen.
  • ARR defined as ≥10% reduction in left atrial volume index at 6 months.
  • CRT success defined as ventricular reverse remodelling (≥15% LVESV reduction).
  • Primary endpoint: all-cause mortality or heart failure hospitalizations.

Main Results:

  • Patients with no ARR and no ventricular reverse remodelling had the worst outcomes (HR 3.1, P=0.006).
  • Outcomes for patients with ARR alone were comparable to those with both ARR and ventricular reverse remodelling (HR 2.0, P=0.21).
  • Mean follow-up was 2.0 ± 1.0 years, with 49 deaths.

Conclusions:

  • Absence of both atrial and ventricular reverse remodelling is associated with the poorest prognosis after CRT.
  • Atrial reverse remodelling alone is linked to improved left ventricular diastolic filling and comparable outcomes to combined remodelling.
  • Assessing atrial reverse remodelling offers valuable prognostic information for CRT outcomes.
Abstract

Keywords:
Cardiac resynchronization therapyDiastolic dysfunctionLeft atrial volumeOutcomeReverse remodelling

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