Design and results of aCRT MID-Q study: Adoption of adaptive CRT in patients with normal AV conduction and moderately wide left bundle branch block

Yamasaki, Hiro; Sekiguchi, Yukio; Gosho, Masahiko; Nogami, Akihiko; Aonuma, Kazutaka; Investigators, aCRT Mid-Q

doi:10.1016/j.jjcc.2019.08.003

Cited by 5 publications

(2 citation statements)

References 18 publications

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“…A substudy of the aCRT trial revealed that patients with a high percentage of adaptive LV pacing showed better clinical improvement and PQ intervals than patients within the normal range [ 31 ]. The mechanism of benefit in this patient cohort was speculated to be “fusion” of the excitation from LV pacing with intrinsic conduction propagating through the still preserved His-Purkinje system [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of adaptive left bundle branch–optimized cardiac resynchronization therapy: a single centre experience

Feng

Yang

Zhao

et al. 2022

BMC Cardiovasc Disord

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Background Adaptive cardiac resynchronization therapy (aCRT) is associated with improved clinical outcomes. Left bundle branch area pacing (LBBAP) has shown encouraging results as an alternative option for aCRT. A technique that can be accomplished effectively using LBBAP combined with coronary venous pacing (LOT-aCRT). We aimed to assess the feasibility and outcomes of LOT-aCRT. Methods LOT-aCRT, capable of providing two pacing modes, LBBAP alone or LBBAP combined with LV pacing, was attempted in patients with CRT indications. Patients were divided into two groups: those with LBBAP and LV pacing (LOT-aCRT) and those with conventional biventricular pacing (BVP-aCRT). Results A total of 21 patients were enrolled in the study (10 in the LOT-aCRT group, 11 in the BVP-aCRT group). In the LOT-aCRT group, the QRS duration (QRSd) via BVP was narrowed from 158.0 ± 13.0 ms at baseline to 132.0 ± 4.5 ms (P = 0.019) during the procedure, and further narrowed to 123.0 ± 5.7 ms (P < 0.01) via LBBAP. After the procedure, when LOT-aCRT implanted and worked, QRSd was further changed to 121.0 ± 3.8 ms, but the change was not significant (P > 0.05). In the BVP-aCRT group, BVP resulted in a significant reduction in the QRSd from 176.7 ± 19.7 ms at baseline to 133.3 ± 8.2 ms (P = 0.011). However, compared with LOT-aCRT, BVP has no advantage in reducing QRSd and the difference was statistically significant (P < 0.01). During 9 months of follow-up, patients in both groups showed improvements in the LVEF and NT-proBNP levels (all P < 0.01). However, compared with BVP-aCRT, LOT-aCRT showed more significant changes in these parameters (P < 0.01). Conclusions The study demonstrates that LOT-aCRT is clinically feasible in patients with systolic heart failure and LBBB. LOT-aCRT was associated with significant narrowing of the QRSd and improvement in LV function.

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Section: Discussionmentioning

confidence: 99%

Effects of adaptive left bundle branch–optimized cardiac resynchronization therapy: a single centre experience

Feng

Yang

Zhao

et al. 2022

BMC Cardiovasc Disord

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“…Theoretically, the adverse effects of RV pacing based on the induced electrical/mechanical dyssynchrony could be more critical in patients with rEF; therefore, CRT may be more beneficial in those patients. However, the mean baseline QRS duration was relatively narrower in DG patients; therefore, this could be one of the reasons for their insufficient response to CRT [15] .…”

Section: Mechanical Response To Crt; Upgrade Vs De Novo Crt In Patients With Av Blockmentioning

confidence: 96%

Clinical outcomes of upgrade to versus de novo cardiac resynchronization therapy in mild heart failure patients with atrioventricular block

Kanai

Daigo

Shoda

et al. 2022

Journal of Cardiology

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Emergent role of dynamic optimization in cardiac resynchronization therapy: Systematic review and network meta‐analysis

Zsigmond,

Masszi,

Ehrenberger

et al. 2024

ESC Heart Failure

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AimsSuboptimal device programming is frequent in non‐responders to cardiac resynchronization therapy (CRT). However, the role of device optimization and the most appropriate technique are still unknown. The aim of our study was to analyse the effect of different CRT optimization techniques within a network meta‐analysis.MethodsA systematic search was conducted on MEDLINE, Embase and CENTRAL for studies comparing outcomes with empirical device settings or optimization using echocardiography, static algorithms or dynamic algorithms. Studies investigating the effect of optimization in non‐responders were also analysed.ResultsA total of 17 studies with 4346 patients were included in the quantitative analysis. Of the treatments and outcomes examined, a significant difference was found only between dynamic algorithms and echocardiography, with the former leading to a higher echocardiographic response rate [odds ratio (OR): 2.02, 95% confidence interval (CI) 1.21–3.35], lower heart failure hospitalization rate (OR: 0.75, 95% CI 0.57–0.99) and greater improvement in 6‐minute walk test [mean difference (MD): 45.52 m, 95% credible interval (CrI) 3.91–82.44 m]. We found no significant difference between empirical settings, static algorithms and dynamic algorithms. Seven studies with 228 patients reported response rates after optimization in non‐responders. Altogether, 34.3%–66.7% of initial non‐responders showed improvement after optimization, depending on response criteria.ConclusionsAt the time of CRT implantation, dynamic algorithms may serve as a resource‐friendly alternative to echocardiographic optimization, with similar or better mid‐term outcomes. However, their superiority over empirical device settings needs to be investigated in further trials. For non‐responders, CRT optimization should be considered, as the majority of patients experience improvement.

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Design and results of aCRT MID-Q study: Adoption of adaptive CRT in patients with normal AV conduction and moderately wide left bundle branch block

Cited by 5 publications

References 18 publications

Effects of adaptive left bundle branch–optimized cardiac resynchronization therapy: a single centre experience

Effects of adaptive left bundle branch–optimized cardiac resynchronization therapy: a single centre experience

Clinical outcomes of upgrade to versus de novo cardiac resynchronization therapy in mild heart failure patients with atrioventricular block

Emergent role of dynamic optimization in cardiac resynchronization therapy: Systematic review and network meta‐analysis

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