Interventricular Electrical Delay Is Predictive of Response to Cardiac Resynchronization Therapy
Michael R Gold1, Jagmeet P Singh2, Kenneth A Ellenbogen3
1Medical University of South Carolina, Charleston, South Carolina, USA.
JACC. Clinical Electrophysiology
|May 16, 2018
Summary
Increased interventricular electrical delay, measured by the right ventricle-left ventricle (RV-LV) interval, is linked to better outcomes in cardiac resynchronization therapy (CRT). This finding suggests RV-LV delay can predict improved remodeling and quality of life in heart failure patients receiving CRT.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) benefits heart failure patients, but non-response remains a challenge.
- Traditional LV lead placement has limited efficacy; pacing at sites with late electrical activation improves CRT response.
- Interventricular electrical delay is hypothesized to be associated with improved CRT outcomes.
Purpose of the Study:
- To evaluate the relationship between interventricular electrical delay (RV-LV interval) and patient outcomes.
- To determine if RV-LV delay predicts response to cardiac resynchronization therapy.
- To analyze the impact of RV-LV delay on left ventricular remodeling and quality of life.
Main Methods:
- A prospective substudy of the SMART-AV trial involving 419 patients undergoing CRT implantation.
- Measurement of the unpaced right ventricle-left ventricle (RV-LV) interval in sinus rhythm.
- Echocardiographic assessment of LV volumes and ejection fraction, and quality of life questionnaires at baseline and 6 months post-CRT.
Main Results:
- Significant increases in left ventricular (LV) volumes, ejection fraction, and quality of life (QOL) were observed with prolonged RV-LV delay.
- LV end-systolic volume response rates increased from 30% to 75% with increasing RV-LV delay (p < 0.001).
- Patients in the highest RV-LV delay quartile showed a 5.98-fold increased odds of reverse remodeling response (p < 0.001).
Conclusions:
- Baseline interventricular electrical delay is a powerful independent predictor of CRT response.
- Prolonged RV-LV delay is associated with improved reverse remodeling and quality of life outcomes.
- RV-LV interval measurement can optimize CRT patient selection and improve treatment efficacy.
Keywords:
cardiac resynchronization therapyheart failureinterventricular delayleft ventricular reverse remodelingoutcomesMore Related Videos
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