Does haemodynamic testing with different stimulation modes identify acute responders and optimal settings in patients with severe HF and LBBB?
Haemodynamic testing before CRT helps identify acute nonresponders and optimize stimulation mode, site, and AV delay, which is associated with significant clinical and echocardiographic improvements at 1 year.
Aims Several studies on the acute effect of cardiac resynchronization in patients with advanced heart failure (HF) and left bundle branch block (LBBB) have shown that left and biventricular stimulation increase pulse pressure and contractility, while patients with a QRS complex 150 ms underwent right, left and biventricular stimulation at different AV delays. Acute response was defined as 10% pulse pressure increase. 165 of 188 patients (88%) in sinus rhythm (47 women, mean age 62.5 10 years, ejection fraction 238%, NYHA class 3.10.3) were regarded acute responders. 10% of 103 patients with dilated cardiomyopathy and 16.5% of 79 patients with coronary artery disease were considered nonresponders. 29 patients (81%) with two posterolateral veins were acute responders with 10 of them (33%) being responders in only one vein. 54 patients had an atrio-left ventricular pulse pressure increase of 10.710.6%, 9.86.4% in 48 patients with atrio-biventricular stimulation. At one-year follow-up, heart failure had significantly improved from NYHA class 3.10.4 to 2.10.7 (P < 0:0001), VO 2 peak from 12.72.8 to 15.93.6 ml/min/kg. Left ventricular enddiastolic diameter being an indicator of reverse remodelling decreased from 80.510.5 to 73.313 (P < 0:0001). Conclusion Haemodynamic testing before CRT allows the identification of acute nonresponders as well as the best mode and site of stimulation and the optimal atrioventricular delay in responders.
J. Vogt (Sun,) studied this question.
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