Long-term follow-up after cardiac resynchronization therapy-optimization in a real-world setting: A single-center
Raphael Korach1, Peter C Kahr1, Frank Ruschitzka1
1University Heart Center, Cardiology, University Hospital Zurich, Switzerland.
Insights
Systematic atrioventricular delay (AVD) optimization improved biventricular pacing and cardiac remodeling in cardiac resynchronization therapy (CRT) patients. This approach may benefit selected CRT recipients, enhancing device effectiveness.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Suboptimal device programming can reduce response to cardiac resynchronization therapy (CRT).
- The benefit of systematic atrioventricular delay (AVD) optimization, especially late after CRT implantation, remains unclear.
Purpose of the Study:
- To assess the impact of systematic atrioventricular delay (AVD) optimization on echocardiographic and device parameters in CRT patients.
- To evaluate the effectiveness of AVD optimization in a real-world clinical setting.
Main Methods:
- A single-center cohort study included patients undergoing CRT optimization.
- Atrioventricular delay (AVD) optimization was guided by 12-lead ECG and echocardiographic left ventricular inflow characteristics.
- Patients were compared between an intervention group (AVD optimization) and a control group (no optimization).
Main Results:
- 73% of patients required AVD adjustment, with 78% achieving sufficient biventricular pacing post-optimization versus 50% in controls.
- AVD optimization correlated with improved interventricular mechanical delay and intraventricular septal-to-lateral delay.
- Mitral regurgitation decreased, and left ventricular volumes showed a trend toward reduction.
Conclusions:
- Systematic AVD optimization demonstrated positive effects on biventricular pacing and left ventricular remodeling in CRT patients.
- These findings suggest that AVD optimization can be advantageous for selected CRT recipients.
- The study supports the utility of AVD optimization in improving CRT outcomes.
Background:
Suboptimal device programming is among the reasons for reduced response to cardiac resynchronization therapy (CRT). However, whether systematic optimization is beneficial remains unclear, particularly late after CRT implantation. The aim of this single-center cohort study was to assess the effect of systematic atrioventricular delay (AVD) optimization on echocardiographic and device parameters.
Methods:
Patients undergoing CRT optimization at the University Hospital Zurich between March 2011 and January 2013, for whom a follow-up was available, were included. AVD optimization was based on 12-lead electrocardiography (ECG) and echocardiographic left ventricular inflow characteristics. Parameters were assessed at the time of CRT optimization and follow-up, and were compared between patients with AVD optimization (intervention group) and those for whom no AVD optimization was deemed necessary (control group).
Results:
Eighty-one patients with a mean age of 64 ± 11 years were included in the analysis. In 73% of patients, AVD was deemed suboptimal and was changed accordingly. After a median follow-up time of 10.4 (IQR 6.2 to 13.2) months, the proportion of patients with sufficient biventricular pacing (> 97% pacing) was greater in the intervention group (78%) compared to controls (50%). Furthermore, AVD adaptation was associated with an improvement in interventricular mechanical delay (decrease of 6.6 ± 26.2 ms vs. increase of 4.3 ± 17.7 ms, p = 0.034) and intraventricular septal-to-lateral delay (decrease of 0.9 ± 48.1 ms vs. increase of 15.9 ± 15.7 ms, p = 0.038), as assessed by tissue Doppler imaging. Accordingly, a reduction was observed in mitral regurgitation along with a trend towards reduced left ventricular volumes.
Conclusions:
In this "real-world" setting systematic AVD optimization was associated with beneficial effects regarding biventricular pacing and left ventricular remodeling. These data show that AVD optimization may be advantageous in selected CRT patients.
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