Cessation of pacing in super‐responders of cardiac resynchronization therapy: A randomized controlled trial

Abstract

LVEF was significantly reduced in super-responders of CRT 6 months after cessation of pacing. Super-responders to CRT should receive continued, long-term pacing to preserve recovered LV function.

Discontinuation of Cardiac Resynchronization Therapy for Heart Failure Due to Dilated Cardiomyopathy in a 61-Year-Old Female “­Super-Responder” with Return of a Reduced Left Ventricular Ejection Fraction to Normal

“…Liang et al demonstrated that even super-responders sometimes exhibited a recurrence of electrical and mechanical remodeling after CRT discontinuation [ 5 ]; therefore, CRT should be continued when possible to promote these protective factors. In our patient, CRT was discontinued because of the high rate of battery consumption; however, this was a special case, and current evidence and guidelines do not recommend the discontinuation of CRT.…”

“…However, because of limited data, we cannot elucidate the mechanisms involved. Many studies and guidelines have recommended that CRT should be continued as long as possible [ 5 , 6 , 19 ] and discontinuation is not recommended. In this case, although CRT was discontinued, good results were achieved, and HF did not recur.…”

“…Patients are normally classified as either responders or nonresponders based on changes in the LVEF, LV size, and clinical symptoms, although unified definitions of CRT response and nonresponse have not yet been established [ 3 , 4 ]. Additionally, the concept of a CRT super-response has recently been introduced; this has been defined as an improvement in LVEF to >50% and/or a decrease in LV size of >25–30% by 6 months to 1 year after implantation [ 4 , 5 ]. Super-responders may also react differently to CRT discontinuation by exhibiting a rapid decrease in the LVEF and an increase in both mitral regurgitation (MR) and QRS complex width [ 6 , 7 ].…”

“…Some studies have reported that discontinuation of CRT results in a decline in cardiac function due to recurrence of remodeling, even in super-responders [ 5 , 6 ]; therefore, CRT should be continued as long as possible. Here, we report a case of dilated cardiomyopathy (DCM) treated with CRT and medication in which the patient, classified as a CRT super-responder, was able to successfully discontinue CRT.…”

Defining dyssynchrony: The ongoing search for cardiac resynchronization therapy “response”

“…Finally, while symptom improvement was the standard measure for most studies, there were patients who were "super responders" who actually developed improvement in their left ventricular ejection fraction after CRT, and it is difficult to predict which patients might receive this advantage. 5 As the data increasingly have shown that patients with LBBB are more likely to benefit from CRT compared to right bundle branch block or non-specific intraventricular conduction delays, most society guidelines require a true LBBB to meet a class I indication for CRT. 6,7 The difficulty with using LBBB as a metric for CRT candidacy is that defining it has been controversial.…”