Electrical dyssynchrony mapping and optimization of nonresponders in patients programmed with the adaptive cardiac...

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Devices

Background:

• Adaptive cardiac resynchronization therapy (aCRT) offers clinical benefits but has a significant nonresponder population.
• Identifying and optimizing therapy for nonresponders remains a clinical challenge.

Purpose of the Study:

• To quantify electrical synchrony in patients using aCRT.
• To assess the echocardiographic effects of optimizing aCRT in nonresponders and incomplete responders.

Main Methods:

• 125 patients programmed with aCRT were studied using novel electrical dyssynchrony mapping (EDM) technology.
• Electrical synchrony was quantified using the cardiac resynchronization index (CRI).
• EDM guided optimization of aCRT settings.

Main Results:

• CRI improved from 56%±29% at baseline aCRT to 92%±12% with EDM optimization (P<.001).
• Left ventricle (LV)-only aCRT showed higher baseline CRI than biventricular aCRT (62%±25% vs 48%±31%; P=.014).
• In 53 nonresponders optimized with EDM, significant improvements were observed in CRI, LV ejection fraction, volumes, and strain parameters.

Conclusions:

• EDM optimization significantly enhances electrical synchrony compared to standard aCRT programming (92% vs 56%).
• Optimizing aCRT in nonresponders leads to significant improvements in LV size and systolic function.
• This approach holds potential for converting CRT nonresponders into responders.