Optimizing outcomes from cardiac resynchronization therapy: what do recent data and insights say?
Felicity de Vere1,2, Nadeev Wijesuriya1,2, Sandra Howell1,2
1School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
Insights
Cardiac Resynchronization Therapy (CRT) improves heart failure (HF) outcomes for many, but non-responders exist. This review explores optimizing CRT and new therapies like AI and conduction system pacing for better heart failure management.
Area of Science:
- Cardiology
- Biomedical Engineering
- Heart Failure Management
Background:
- Cardiac Resynchronization Therapy (CRT) benefits approximately two-thirds of heart failure (HF) patients.
- A significant portion of patients remain non-responders to traditional CRT.
- Understanding and overcoming CRT non-response is crucial for improving patient outcomes.
Purpose of the Study:
- To review recent evidence on optimizing CRT outcomes.
- To evaluate if traditional CRT is still the best first-line therapy for electrical resynchronization in HF.
- To explore novel approaches for preempting and counteracting CRT non-response.
Main Methods:
- Systematic review of electronic literature searches (PubMed, Google Scholar).
- Focus on primary evidence published within the last five years.
- Analysis of traditional CRT optimization and emerging technologies.
Main Results:
- Evidence suggests refining patient selection and procedural techniques can preempt non-response.
- Post-implantation strategies can further optimize patient responses to CRT.
- Emerging technologies like AI-guided programming and conduction system pacing show promise.
Conclusions:
- Optimizing patient selection and procedural techniques are key to maximizing CRT effectiveness.
- Newer technologies, including AI and CSP, offer potential for personalized CRT and improved HF management.
- Continuous research is vital to enhance CRT outcomes and address non-response in heart failure patients.
Introduction:
Cardiac Resynchronization Therapy (CRT) is an effective treatment for heart failure (HF) in approximately two-thirds of recipients, with a third remaining CRT 'non-responders.' There is an increasing body of evidence exploring the reasons behind non-response, as well as ways to preempt or counteract it.
Areas Covered:
This review will examine the most recent evidence regarding optimizing outcomes from CRT, as well as explore whether traditional CRT indeed remains the best first-line therapy for electrical resynchronization in HF. We will start by discussing methods of preempting non-response, such as refining patient selection and procedural technique, before reviewing how responses can be optimized post-implantation. For the purpose of this review, evidence was gathered from electronic literature searches (via PubMed and GoogleScholar), with a particular focus on primary evidence published in the last 5 years.
Expert Opinion:
Ever-expanding research in the field of device therapy has armed physicians with more tools than ever to treat dyssynchronous HF. Newer developments, such as artificial intelligence (AI) guided device programming and conduction system pacing (CSP) are particularly exciting, and we will discuss how they could eventually lead to truly personalized care by maximizing outcomes from CRT.
