Improved acute haemodynamic response to cardiac resynchronization therapy using multipoint pacing cannot solely be explained by better resynchronization

Engels, Elien B.; Vis, Annemijn; Rees, Bianca D. van; Marcantoni, Lina; Zanon, Francesco; Vernooy, Kevin; Prinzen, Frits W.

doi:10.1016/j.jelectrocard.2018.07.011

Cited by 10 publications

(9 citation statements)

References 18 publications

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“…Over the last two decades, CRT has become a well-established treatment for heart failure patients with reduced ejection fraction, who are symptomatic despite full medical therapy, as stated in the European and American guidelines [ 13 , 14 ]. Despite its significant effect in controlling patients’ symptoms, reducing hospitalisation, and improving survival, almost one third of patients remain limited by HF symptoms due to impaired LV function and fluid retention [ 5 , 6 ]. One of the cardiac function disturbances such patients are limited by is atrial arrhythmia, which is known to be related to LA size enlargement and which could also decrease in CRT responders [ 7 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…This limited clinical improvement urged researchers and clinicians to identify other therapeutic potentials that could alleviate symptoms in such patients [3], particularly those requiring cardiac resynchronisation therapy (CRT) [4]. Despite being considered the best treatment for symptomatic HF patients on full medical therapy, one third of subjects receiving CRT do not respond [5,6]. Responders to CRT treatment have shown strong evidence for improved cardiac performance and also a benefit of reducing atrial arrhythmia, which has been interpreted on the basis of reverse remodelling of the left atrium (LA) [7].…”

Section: Introductionmentioning

confidence: 99%

“…Despite being considered the best treatment for symptomatic HF patients on full medical therapy, one third of subjects receiving CRT do not respond [ 5 , 6 ]. Responders to CRT treatment have shown strong evidence for improved cardiac performance and also a benefit of reducing atrial arrhythmia, which has been interpreted on the basis of reverse remodelling of the left atrium (LA) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Left atrial volume index predicts response to cardiac resynchronisation therapy: a systematic review and meta-analysis

2020

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Introduction: In responders, cardiac resynchronisation therapy (CRT) results in improved left ventricular (LV) function and reduced atrial arrhythmia. The aim of this meta-analysis was to assess the potential relationship between the left atrium (LA) volume and CRT response. Material and methods: We systematically searched all electronic databases up to August 2018 in order to select clinical trials and observational studies that assessed the predictive value of LA volume index (LAVI) of CRT response. Left ventricular end-systolic volume (LVESV) reduction ≥ 15 ml and/ or LV ejection fraction (EF) increase ≥ 10% were the documented criteria for positive CRT response. Results: A total of 2191 patients recruited in 10 studies with mean follow-up duration of 10.5 months were included in this meta-analysis. The pooled analysis showed that CRT responders had lower baseline LAVI compared to non-responders, with a weighted mean difference (WMD) of-5.89% (95% CI:-9.47 to-3.22, p < 0.001). At follow-up, LAVI fell in the CRT responders (WMD-4.36%, 95% CI:-3.54 to-5.17, p < 0.001) compared to non-responders (WMD 1.45 %, 95% CI:-0.75 to 3.65, p = 0.20). The mean change of LAVI in the CRT responders was related to the fall in LVESV, β =-1.02 (-1.46 to-0.58), p < 0.001 and the increase in LVEF, β = 2.02 (1.86 to 4.58), p = 0.001. A baseline LAVI < 34 ml/m 2 predicted CRT response with summary sensitivity 0.80% (0.53-0.95), specificity 0.74% (0.53-0.89), and odds ratio > 11. Conclusions: Baseline LAVI predicts CRT response, and its reduction reflects devise-related LA remodelling. These results emphasis the role of LAVI assessment as an integral part of cardiac function response to CRT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Left atrial volume index predicts response to cardiac resynchronisation therapy: a systematic review and meta-analysis

2020

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“…In acute hemodynamic measurements in typical LBBB patients, an adjunct benefit over conventional BIV pacing was proven at any site, but after optimization of BIV, MPP was not always superior. Thus, primarily the optimization of the LV pacing site is of greater relevance than MPP itself [ 49 , 50 •, 51 ].…”

Section: Finding the Optimal LV Lead Positionmentioning

confidence: 99%

Optimal CRT Implantation—Where and How To Place the Left-Ventricular Lead?

Butter

Georgi

Stockburger³

2021

Curr Heart Fail Rep

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Purpose of Review Cardiac resynchronization therapy (CRT) represents a well-established and effective non-pharmaceutical heart failure (HF) treatment in selected patients. Still, a significant number of patients remain CRT non-responders. An optimal placement of the left ventricular (LV) lead appears crucial for the intended hemodynamic and hence clinical improvement. A well-localized target area and tools that help to achieve successful lead implantation seem to be of utmost importance to reach an optimal CRT effect. Recent Findings Recent studies suggest previous multimodal imaging (CT/cMRI/ECG torso) to guide intraprocedural LV lead placement. Relevant benefit compared to empirical lead optimization is still a matter of debate. Technical improvements in leads and algorithms (e.g., multipoint pacing (MPP), adaptive algorithms) promise higher procedural success. Recently emerging alternatives for ventricular synchronization such as conduction system pacing (CSP), LV endocardial pacing, or leadless pacing challenge classical biventricular pacing. Summary This article reviews current strategies for a successful planning, implementation, and validation of the optimal CRT implantation. Pre-implant imaging modalities offer promising assistance for complex cases; empirical lead positioning and intraoperative testing remain the cornerstone in most cases and ensure a successful CRT effect.

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“…Heart failure (HF) is a clinical syndrome that is becoming a major public health problem worldwide because of its increasing incidence and prevalence as well as its related morbidity and mortality [1]. Despite its failure in about one-third of treated patients, cardiac resynchronization therapy (CRT) still remains the best treatment for symptomatic HF patients on full medical therapy [2,3].…”

Section: Introductionmentioning

confidence: 99%

Improved Left Atrial Function in CRT Responders: A Systematic Review and Meta-Analysis

Bytyçi

Bajraktari

Lindqvist

et al. 2020

JCM

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Cardiac resynchronization therapy (CRT) is associated with reverse left atrial (LA) remodeling. The aim of this meta-analysis was to assess the relationship between clinical response to CRT and LA function changes. We conducted a systematic search of all electronic databases up to September 2019 which identified 488 patients from seven studies. At (mean) 6 months follow-up, LA systolic strain and emptying fraction (EF) were increased in CRT responders, with a −5.70% weighted mean difference (WMD) [95% confidence interval (CI) −8.37 to −3.04, p < 0.001 and a WMD of −8.98% [CI −15.1 to −2.84, p = 0.004], compared to non-responders. The increase in LA strain was associated with a fall in left ventricle (LV) end-systolic volume (LVESV) r = −0.56 (CI −0.68 to −0.40, p < 0.001) and an increase in the LV ejection fraction (LVEF) r = 0.58 (CI 0.42 to 0.69, p < 0.001). The increase in LA EF correlated with the fall in LVESV r = −0.51 (CI −0.63 to −0.36, p < 0.001) and the increase in the LVEF r = 0.48 (CI 0.33 to 0.61, p = 0.002). The increase in LA strain correlated with the increase in the LA EF, r = 0.57 (CI 0.43 to 0.70, p < 0.001). Thus, the improvement of LA function in CRT responders reflects LA reverse remodeling and is related to its ventricular counterpart.

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Improved acute haemodynamic response to cardiac resynchronization therapy using multipoint pacing cannot solely be explained by better resynchronization

Cited by 10 publications

References 18 publications

Left atrial volume index predicts response to cardiac resynchronisation therapy: a systematic review and meta-analysis

Left atrial volume index predicts response to cardiac resynchronisation therapy: a systematic review and meta-analysis

Optimal CRT Implantation—Where and How To Place the Left-Ventricular Lead?

Improved Left Atrial Function in CRT Responders: A Systematic Review and Meta-Analysis

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