Atrioventricular dyssynchrony from empiric device settings is common in cardiac resynchronization therapy and adversely impacts left ventricular morphology and function

Sinner, Gregory; Gupta, Vedant; Seratnahaei, Arash; Charnigo, Richard; Darrat, Yousef; Elayi, Samy Claude; Leung, Steve W.; Sorrell, Vincent L.

doi:10.1111/echo.13486

Cited by 4 publications

(3 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Doppler echocardiography-derived AV optimization has been associated with an improvement in both LV systolic function and presystolic MR. In brief, AV delay is programmed so that the end of atrial contraction is timed to coincide with the onset of ventricular contraction [62]. Because AV dyssynchrony is common and modifiable, Doppler echocardiography-guided AV optimization after CRT is warranted, particularly in nonresponders with a fused or truncated LV filling pattern [63].…”

Section: Av and Ventriculoventricular Time Intervalmentioning

confidence: 99%

Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach

et al. 2019

View full text Add to dashboard Cite

Since the first report on biventricular pacing in 1994, cardiac resynchronization therapy (CRT) has become standard for patients with advanced heart failure (HF) and ventricular conduction delay. CRT improves myocardial function by resynchronizing myocardial contraction, which results in reverse left ventricular remodeling and improves symptoms and clinical outcomes. Despite the accelerated development of CRT device technology and its increased application in treating HF patients, almost one-third of these patients do not respond to the therapy or gain any clinical benefit from device implantation. Over the last decade, multiple cardiac imaging modalities have provided a deeper understanding of myocardial pathophysiology, thereby improving HF treatment management. However, the optimal strategy for improving the CRT response remains debatable. This article provides an updated overview of the electropathophysiology of myocardial dysfunction in ventricular conduction delay and the diagnostic approaches involving the use of multiple modalities.

show abstract

Section: Av and Ventriculoventricular Time Intervalmentioning

confidence: 99%

Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach

et al. 2019

View full text Add to dashboard Cite

show abstract

“… 5 However, non‐optimal AVd/VVd programming has been shown to be frequent in real‐world CRT population, 8 adversely impacting on LV remodelling and outcomes. 9 Echo‐guided CRT optimization may therefore still have a place in the management of CRT patients inside a comprehensive CRT and HF programme. 5 , 10 Few data are available on the impact of such programme in contemporary unselected real‐life CRT population.…”

Section: Introductionmentioning

confidence: 99%

“…Despite promising results on acute haemodynamic parameters, the contrasting results of randomized clinical trials 6,7 led to low use of this time‐consuming technique in current practice and last European Heart Rhythm Association position paper states that current evidence does not strongly support the performance of routine AVd and VVd optimization in all patients receiving CRT 5 . However, non‐optimal AVd/VVd programming has been shown to be frequent in real‐world CRT population, 8 adversely impacting on LV remodelling and outcomes 9 . Echo‐guided CRT optimization may therefore still have a place in the management of CRT patients inside a comprehensive CRT and HF programme 5,10 .…”

Section: Introductionmentioning

confidence: 99%

Impact of cardiac resynchronization therapy optimization inside a heart failure programme: a real‐world experience

Moulin¹,

Hamon²,

Djouadi³

et al. 2022

ESC Heart Failure

View full text Add to dashboard Cite

AimsThis study sought to describe and evaluate the impact of a routine in-hospital cardiac resynchronization therapy (CRT) programme, including comprehensive heart failure (HF) evaluation and systematic echo-guided CRT optimization. Methods and results CRT implanted patients were referred for optimization programme at 3 to 12 months from implantation. The program included clinical and biological status, standardized screening for potential cause of CRT non-response and systematic echo-guided atrioventricular and interventricular delays (AVd and VVd) optimization. Initial CRT-response and improvement at 6 months post-optimization were assessed with a clinical composite score (CCS). Major HF events were tracked during 1 year after optimization. A total of 227 patients were referred for CRT optimization and enrolled (71 ± 11 years old, 77% male, LVEF 30.6 ± 7.9%), of whom 111 (48.9%) were classified as initial non-responders. Left ventricular lead dislodgement was noted in 4 patients (1.8%), and loss or ≤90% biventricular capture in 22 (9.7%), mostly due to arrhythmias. Of the 196 patients (86%) who could undergo echo-guided CRT optimization, 71 (36.2%) required VVd modification and 50/144 (34.7%) AVd modification. At 6 months post-optimization, 34.3% of the initial non-responders were improved according to the CCS, but neither AVd nor VVd echo-guided modification was significantly associated with CCS-improvement. After one-year follow-up, initial non-responders maintained a higher rate of major HF events than initial responders, with no significant difference between AVd/VVd modified or not. Conclusions Our study supports the necessity of a close, comprehensive and multidisciplinary follow-up of CRT patients, without arguing for routine use of echo-guided CRT optimization.

show abstract