Long-term follow-up after cardiac resynchronization therapy-optimization in a real-world setting: A single-center cohort study.
BACKGROUND
Suboptimal device programming is among the reasons for reduced response to cardiac resynchronization therapy (CRT). However, whether systematic optimization is beneficial remains unclear, particularly late after CRT implantation. The aim of this single-center cohort study was to assess the effect of systematic atrioventricular delay (AVD) optimization on echocardiographic and device parameters.


METHODS
Patients undergoing CRT optimization at the University Hospital Zurich between March 2011 and January 2013, for whom a follow-up was available, were included. AVD optimization was based on 12-lead electrocardiography (ECG) and echocardiographic left ventricular inflow characteristics. Parameters were assessed at the time of CRT optimization and follow-up, and were compared between patients with AVD optimization (intervention group) and those for whom no AVD optimization was deemed necessary (control group).


RESULTS
Eighty-one patients with a mean age of 64 ± 11 years were included in the analysis. In 73% of patients, AVD was deemed suboptimal and was changed accordingly. After a median follow-up time of 10.4 (IQR 6.2 to 13.2) months, the proportion of patients with sufficient biventricular pacing (> 97% pacing) was greater in the intervention group (78%) compared to controls (50%). Furthermore, AVD adaptation was associated with an improvement in interventricular mechanical delay (decrease of 6.6 ± 26.2 ms vs. increase of 4.3 ± 17.7 ms, p = 0.034) and intraventricular septal-to-lateral delay (decrease of 0.9 ± 48.1 ms vs. increase of 15.9 ± 15.7 ms, p = 0.038), as assessed by tissue Doppler imaging. Accordingly, a reduction was observed in mitral regurgitation along with a trend towards reduced left ventricular volumes.


CONCLUSIONS
In this "real-world" setting systematic AVD optimization was associated with beneficial effects regarding biventricular pacing and left ventricular remodeling. These data show that AVD optimization may be advantageous in selected CRT patients.
['Korach|Raphael|R|', 'Kahr|Peter C|PC|', 'Ruschitzka|Frank|F|', 'Steffel|Jan|J|', 'Flammer|Andreas J|AJ|', 'Winnik|Stephan|S|']
D000368:Aged D058406:Cardiac Resynchronization Therapy D015331:Cohort Studies D004452:Echocardiography D005500:Follow-Up Studies D006333:Heart Failure D006352:Heart Ventricles D006801:Humans D008875:Middle Aged D016896:Treatment Outcome
cardiac resynchronization therapy atrioventricular delay biventricular pacing left ventricular remodeling