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ICE Guided CRT: Is there Evidence of Reverse Remodeling?
Antonio Rossillo1, Angelo B Ramondo1
1Cardiology Department, San Bortolo Hospital. Vicenza, Italy.
Insights
Identifying optimal candidates for cardiac resynchronization therapy (CRT) is crucial. Evaluating both electrical and mechanical delays, potentially with intracardiac echocardiography, may improve CRT efficacy in heart failure patients.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Cardiac resynchronization therapy (CRT) is a standard treatment for heart failure (HF) with impaired left ventricular (LV) function and wide QRS complex.
- A significant portion of eligible patients (over 30%) do not respond positively to CRT.
- Current methods like surface ECG and echocardiography are insufficient for identifying optimal CRT candidates.
Conclusions:
- A personalized strategy focusing on both electrical and mechanical dyssynchrony is recommended to optimize CRT benefits.
- Intracardiac echocardiography presents a promising tool for guiding CRT lead placement.
- Further large-scale randomized trials are necessary to confirm the benefits and cost-effectiveness of this advanced approach.
Abstract:
Cardiac resynchronization therapy (CRT) is an accepted treatment for patients with heart failure (HF), impaired left ventricular (LV) function, and a wide QRS complex. However, more than 30% of eligible patients fail to benefit from CRT. It is clearly necessary to define the characteristics of the best candidates for this therapy. To this end, surface ECG and echocardiography have been tested. Unfortunately, however, neither of these examinations has proved sufficiently able to identify the best patients. A tailored approach based on the evaluation of both electrical and mechanical delay to guide LV lead placement seems to be the most reasonable strategy in order to increase the efficacy of CRT therapy. The good preliminary data that have been published suggest that using intracardiac echocardiography to define the mechanical delay could be an interesting option. Moreover, at present it is the only option available that can enable intraprocedural evaluation of the mechanical activation sequence. Naturally, further randomized studies with larger populations should be performed in order to ascertain the real benefit of this approach and to evaluate whether it will outweigh the additional cost of this technology.
