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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Impact of baseline left ventricular volume on left ventricular reverse remodeling after cardiac resynchronization

Xavier Galloo1, Jan Stassen2, Kensuke Hirasawa3

  • 1Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.

Heart Rhythm
|February 20, 2022
PubMed

Insights

Cardiac resynchronization therapy (CRT) benefits patients with severe left ventricular (LV) dilatation, improving survival. Significant LV reverse remodeling and better outcomes occur regardless of baseline LV volumes.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Left ventricular (LV) dilatation can impede reverse remodeling following cardiac resynchronization therapy (CRT).
  • Understanding the influence of baseline LV volumes is crucial for optimizing CRT outcomes.

Purpose of the Study:

  • To assess the impact of baseline LV volumes on LV reverse remodeling post-CRT.
  • To determine if LV reverse remodeling after CRT is associated with improved long-term survival.

Main Methods:

  • 864 patients were stratified into quintiles based on baseline LV end-diastolic volume indexed for body surface area (LVEDVi).
  • LV reverse remodeling was defined as a ≥15% reduction in LV end-systolic volume at 6-month follow-up.
  • Long-term mortality rates were compared across LVEDVi quintiles and between patients with/without LV reverse remodeling.

Main Results:

  • Patients with larger baseline LVEDVi exhibited worse survival post-CRT.
  • 10-year survival was significantly better in patients achieving LV reverse remodeling (48.7%) versus those who did not (33.9%).
  • Significant LV reverse remodeling occurred across all LVEDVi quintiles, with superior survival observed in remodeling patients irrespective of baseline LV volume.

Conclusions:

  • Significant LV reverse remodeling and superior survival post-CRT are achievable even in patients with severe baseline LV dilatation.
  • Cardiac resynchronization therapy should not be withheld due to severe LV dilatation, as positive remodeling and survival benefits can still be realized.
Abstract

Keywords:
Cardiac resynchronization therapyHeart failureLeft ventricular reverse remodelingLeft ventricular volumeSurvival

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