The importance of increased percentage of biventricular pacing to improve clinical outcomes in patients receiving cardiac resynchronization therapy

Gasparini, Maurizio; Galimberti, Paola; Ceriotti, Carlo

doi:10.1097/hco.0b013e32835b0b17

Cited by 14 publications

(6 citation statements)

References 13 publications

(7 reference statements)

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“…Loss of biventricular pacing can occur as a result of a long AVD due to intrinsic atrioventricular conduction. In such patients, shortening of AVD may increase the degree of biventricular pacing [24][25][26]. In the present study, patients in whom the AVD was changed Taken together, the present findings support the role of systematic AVD optimization to achieve the highest possible percentage of biventricular stimulation and improve hemodynamic parameters.…”

Section: A High Percentage Of Biventricular Pacing Is Associated Withsupporting

confidence: 80%

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Long-term follow-up after cardiac resynchronization therapy-optimization in a real-world setting: A single-center cohort study

et al. 2021

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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 singlecenter 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.

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Section: A High Percentage Of Biventricular Pacing Is Associated Withsupporting

confidence: 80%

“…CRT patients [24]. Koplan et al [25] demonstrated that the greatest benefit in reduction of HF hospitalization and all-cause mortality was achieved with a biventricular pacing above 92%.…”

Section: A High Percentage Of Biventricular Pacing Is Associated Withmentioning

confidence: 99%

Long-term follow-up after cardiac resynchronization therapy-optimization in a real-world setting: A single-center cohort study

et al. 2021

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“…The biventricular pacing percentage was determined as the average delivery of biventricular pacing percentage throughout the follow-up time at the last available device interrogation. Two groups were selected as representing high ($97%) and low (<97%) biventricular pacing, on the basis of a recent literature review and results from the MADIT-CRT trial evaluating the cutoff point of biventricular pacing efficacy on HF/death and death (5,8,12). The likelihood of receiving low biventricular pacing (defined as <97%) was raised with increasing burden of ectopic beats at baseline (Figures 2 and 3).…”

Section: Device Programming and Interrogationmentioning

confidence: 99%

“…The margin of success associated with implantation of a CRT device, however, relies on the capability to effectively deliver biventricular pacing, and even minor reductions in biventricular pacing can diminish the beneficial effects of CRT (3)(4)(5)(6)(7)(8).…”

mentioning

confidence: 99%

Association Between Frequency of Atrial and Ventricular Ectopic Beats and Biventricular Pacing Percentage and Outcomes in Patients With Cardiac Resynchronization Therapy

Ruwald

Mittal

Ruwald

et al. 2014

Journal of the American College of Cardiology

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Relatively low frequencies of ectopic beats (≥0.1%) dramatically increase the probability of low biventricular pacing (<97%), with reduced CRT efficacy by less reverse remodeling and higher risk of HF/death and VTA. This supports pre-implantation Holter monitoring of patients selected for CRT for optimal outcome. (MADIT-CRT: Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy; NCT00180271).

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“…It is important to highlight that differences in pacing delivery may impact patient outcomes. For example, analyses have also shown that reductions in percentage of pacing can impact outcomes, including heart failure hospitalizations and mortality 15,28. More detailed results from the Adaptive CRT trial specifically quantified the incremental benefit for each percentage point increase in %LV pacing 23.…”

Section: Discussionmentioning

confidence: 99%

<p>Heart failure hospitalization reduction and cost savings achieved by improved delivery of effective biventricular pacing: economic implications of the OLE study under the US setting</p>

Hernández‐Madrid¹,

Lu²,

Tsintzos³

et al. 2019

CEOR

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Background: The hOLter for Efficacy analysis (OLE) study demonstrated that current device pacing diagnostics overestimate the amount of cardiac resynchronization therapy (CRT) pacing that effectively stimulates the cardiac tissue. Sub-optimal pacing increases mortality, hospitalizations, and associated health-care costs. We sought to estimate the expected number of hospital admissions due to heart failure (HF) and its respective financial impact in patients with maximized effective pacing versus conventional pacing. Methods: A Markov model was developed to project HF hospitalizations and quantify the costs that could be avoided if pacing was maximally effective. OLE data were used to inform the prevalence of ineffective pacing among CRT patients and and average loss of pacing by causes. Adaptive CRT trial data quantified the reduction in underlying hospitalization risk by increasing effective pacing delivered. Survival was informed by a meta-analysis of 5 randomized clinical trials. Costs were analyzed from a US payer perspective. Results: Projected average hospitalizations totaled 4.58 over a lifetime horizon for CRT patients with conventional pacing. Maximizing effective pacing delivery was projected to avoid 1.83 HF admissions/patient over the lifetime. This equates to a savings of 40% (US$22,802) compared with conventional pacing from the Medicare perspective. In a sensitivity analysis, CRT with effective pacing was projected to provide cost savings in all scenarios. Conclusions: Maximized effective pacing leads to a lower number of HF hospitalizations, thus allowing significant cost offsets in the US setting.

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The importance of increased percentage of biventricular pacing to improve clinical outcomes in patients receiving cardiac resynchronization therapy

Abstract: Every effort should be made in all patients receiving CRT to approach 100% BIV pacing by a correct device programming, a correct pharmacologic regimen and atrioventricular nodal ablation in atrial fibrillation patients.

Cited by 14 publications

References 13 publications

Long-term follow-up after cardiac resynchronization therapy-optimization in a real-world setting: A single-center cohort study

Long-term follow-up after cardiac resynchronization therapy-optimization in a real-world setting: A single-center cohort study

Association Between Frequency of Atrial and Ventricular Ectopic Beats and Biventricular Pacing Percentage and Outcomes in Patients With Cardiac Resynchronization Therapy

<p>Heart failure hospitalization reduction and cost savings achieved by improved delivery of effective biventricular pacing: economic implications of the OLE study under the US setting</p>

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