What question did this study set out to answer?

To evaluate whether targeting left ventricular lead placement to the coronary sinus branch providing the highest acute hemodynamic response via invasive dP/dtmax improves reverse remodeling at 6 months.

January 22, 2021Heart Rhythm O2Open Access

A multicenter prospective randomized controlled trial of cardiac resynchronization therapy guided by invasive dP/dt

Q: What are the key findings of this study?

Guided CRT using invasive LV dP/dtmax to target left ventricular lead placement improved the rate of reverse remodeling compared to conventional CRT (73% vs 60%; P=0.02).

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Patients requiring cardiac resynchronization therapy (n=281). Intervention: Guided CRT using invasive LV dP/dtmax vs. Conventional CRT. Primary outcome: proportion of patients with a reduction in LV end-systolic volume (LVESV) of ≥15% at 6 months (p=.02).

Q: What does this research mean for the field?

Guided CRT using invasive LV dP/dtmax to target left ventricular lead placement improves the rate of reverse remodeling compared to conventional CRT. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Guided CRT using invasive LV dP/dtmax increases reverse remodeling by ~22% vs conventional CRT.

P=.02
n=281

Why the study?

No periprocedural metric has demonstrated improved cardiac resynchronization therapy outcomes in a multicenter setting.

Does invasive dP/dt-guided left ventricular lead placement improve the rate of reverse remodeling at 6 months in patients undergoing cardiac resynchronization therapy compared to conventional placement?

Key Points

To evaluate whether targeting left ventricular lead placement to the coronary sinus branch providing the highest acute hemodynamic response via invasive dP/dtmax improves reverse remodeling at 6 months.
Multicenter prospective randomized controlled trial involving 281 patients across 12 centers comparing invasive LV dP/dtmax-guided CRT lead placement to conventional CRT.
In the guided arm, LV dP/dtmax was measured during biventricular pacing to identify coronary sinus branches and target lead placement to the location yielding the highest acute hemodynamic response (AHR).
The primary endpoint was the proportion of patients demonstrating a reduction in left ventricular end-systolic volume (LVESV) of ≥15% at 6-month follow-up.
A significantly greater proportion of patients in the guided arm achieved a ≥15% reduction in LVESV at 6 months compared to the conventional arm (73% vs 60%, P = .02).
Patients achieving an AHR ≥10% were significantly more likely to achieve a ≥15% reduction in LVESV than those with an AHR <10% (84% vs 28%, P < 0.001).
Procedure duration (142 ± 39 minutes vs 104 ± 39 minutes, P < .001) and fluoroscopy duration (28 ± 15 minutes vs 20 ± 16 minutes, P = .002) were significantly longer in the pressure wire–guided group.

Study Design

Type

RCT (n=281)

Randomization

randomized

Multicenter

Yes

Structured PICO

Population

281 patients undergoing cardiac resynchronization therapy across 12 centers, mean age 70.8 ± 10.9 years, 54% with ischemic etiology.

Intervention

Guided cardiac resynchronization therapy (CRT) with left ventricular (LV) lead placement targeted to the coronary sinus branch generating the best acute hemodynamic response (AHR), determined by invasively measuring LV dP/dtmax during biventricular pacing.

Comparator

Conventional cardiac resynchronization therapy (CRT).

Outcome

Proportion of patients with a reduction in left ventricular end-systolic volume (LVESV) of ≥15% at 6 months.surrogate

Main Result

Absolute Event Rate: 73% vs 60%

p-value: p=.02

Invasive dP/dt-guided LV lead placement during CRT significantly improves the rate of echocardiographic reverse remodeling at 6 months compared to conventional placement, though it increases procedure and fluoroscopy times.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Supports dP/dt-guided LV lead placement in CRT despite longer procedures; extends randomized evidence for individualized optimization.

Cite This Study

Sohal et al. (2021) conducted an RCT in Patients requiring cardiac resynchronization therapy (n=281). Guided CRT using invasive LV dP/dtmax vs. Conventional CRT was evaluated on proportion of patients with a reduction in LV end-systolic volume (LVESV) of ≥15% at 6 months (p=.02). Guided CRT using invasive LV dP/dtmax to target left ventricular lead placement improved the rate of reverse remodeling compared to conventional CRT (73% vs 60%; P=0.02).

synapsesocial.com/papers/6a13dc7bf88db7183c5981f1 https://doi.org/10.1016/j.hroo.2021.01.005

Topics

HFrEF treatment Heart failure

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A multicenter prospective randomized controlled trial of cardiac resynchronization therapy guided by invasive dP/dt

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

A multicenter prospective randomized controlled trial of cardiac resynchronization therapy guided by invasive dP/dt

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider