Improvement of Reverse Remodeling Using Electrocardiogram Fusion-Optimized Intervals in Cardiac Resynchronization...

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Devices

Background:

• The clinical benefit of optimizing atrioventricular (AV) and interventricular (VV) intervals in cardiac resynchronization therapy (CRT) remains debated.
• Previous studies indicate short-term hemodynamic improvements, but mid-term randomized data comparing electrocardiogram (ECG)-guided optimization with nominal settings are limited.

Purpose of the Study:

• To compare patient response to CRT using fusion-optimized AV and VV intervals versus standard nominal settings.
• To evaluate the impact of ECG-guided optimization on left ventricular (LV) remodeling and clinical outcomes at 12-month follow-up.

Main Methods:

• 180 patients with left bundle branch block undergoing CRT were randomized to fusion-optimized intervals (FOI) or nominal settings.
• In the FOI group, AV and VV intervals were optimized to achieve the narrowest QRS width via fusion with intrinsic conduction.
• Clinical response and LV remodeling (defined by LV end-systolic volume reduction) were assessed at 12 months.

Main Results:

• FOI significantly shortened baseline QRS duration more than nominal settings (-56.55 ms vs. -37.81 ms, p=0.025).
• A greater proportion of patients in the FOI group achieved LV reverse remodeling (74% vs. 53%, p=0.026).
• No significant difference was found in clinical response rates between the FOI and nominal settings groups (61% vs. 53%, p=0.24).

Conclusions:

• Device optimization using fusion-optimized intervals (FOI) leads to superior left ventricular remodeling compared to nominal settings in CRT patients.
• ECG-guided optimization of AV and VV intervals is an effective strategy for improving CRT device performance and patient outcomes.
• The BEST trial demonstrates the mid-term benefits of ECG optimization in CRT.