Key result
Unequivocal proof of the clinical benefit brought by optimization of AV and VV intervals in cardiac resynchronization therapy is still lacking, though finger plethysmography appears promising.
Why the study?
Does optimization of pacing intervals improve clinical and echocardiographic outcomes in patients with heart failure undergoing cardiac resynchronization therapy?
Does optimization of pacing intervals improve clinical and echocardiographic outcomes in patients with heart failure undergoing cardiac resynchronization therapy?
There is currently no unequivocal evidence that routine optimization of CRT pacing intervals provides significant clinical benefit over empirical settings, highlighting the need for more robust, reproducible methods like finger plethysmography.
Evidence does not support routine AV/VV optimization in CRT; leaves open validation of finger plethysmography.
U osob s chronickĂ˝m srdeÄnĂm selhĂĄnĂm pĹi vĂ˝znamnĂŠ systolickĂŠ dysfunkci levĂŠ komory a prodlouĹženĂŠm komplexu QRS slouŞà srdeÄnĂ resynchronizaÄnĂ lĂŠÄba (SRL) k nĂĄpravÄ synchronicity depolarizace myokardu. MĂra zlepĹĄenĂ klinickĂŠho stavu a echokardiografickĂŠho nĂĄlezu po jejĂm zavedenĂ vĹĄak zĂĄvisĂ na rĹŻznĂ˝ch parametrech - strukturĂĄlnĂch zmÄnĂĄch myokardu, poruchĂĄch nitrokomorovĂŠho vedenĂ a umĂstÄnĂ stimulaÄnĂch elektrod. K individualizaci lĂŠÄby lze na implantovanĂ˝ch SRL pĹĂstrojĂch nastavit rĹŻznĂŠ parametry, z nichĹž nejdĹŻleĹžitÄjĹĄĂ jsou AV a VV intervaly. AÄkoliv jejich optimalizace byla pĹedmÄtem rozsĂĄhlĂ˝ch klinickĂ˝ch studiĂ, nepochybnĂ˝ dĹŻkaz o prospÄĹĄnosti optimalizace tÄchto intervalĹŻ stĂĄle chybĂ. NejÄastÄji se k hodnocenĂ optimalizace pouĹžĂvĂĄ echokardiografie a metody zaloĹženĂŠ na intrakardiĂĄlnĂ elektrokardiografii. KvĹŻli nedostatkĹŻm ve statistickĂŠm zpracovĂĄnĂ vĹĄak nelze oznaÄit nÄkterou z metod jako referenÄnĂ nebo pouĹžitelnou v kaĹždodennĂ klinickĂŠ praxi. Echokardiografie je zatĂĹžena znaÄnou variabilitou vĂ˝sledkĹŻ, jejichĹž kvalita je navĂc silnÄ zĂĄvislĂĄ na zkuĹĄenosti vyĹĄetĹujĂcĂho. Optimalizace na podkladÄ intrakardiĂĄlnĂch elektrokardiogramĹŻ zatĂm neprokĂĄzala jasnÄ lepĹĄĂ vĂ˝sledky neĹž empirickĂŠ nastavenĂ pĹĂstroje. SlibnÄjĹĄĂ metodou se zatĂm jevĂ hodnocenĂ hemodynamiky prstovou pletysmografiĂ, neboĹĽ zĂskanĂĄ data jsou vysoce reproducibilnĂ a nezĂĄvislĂĄ na erudici vyĹĄetĹujĂcĂho. ZatĂm vĹĄak chybÄjĂ randomizovanĂŠ multicentrickĂŠ dvojitÄ zaslepenĂŠ studie s prstovou pletysmografiĂ, kterĂŠ by zhodnotily vĂ˝znam tĂŠto metody v optimalizaci SRL. MÄĹenĂ informaÄnĂho obsahu jakĂ˝chkoliv dat tĂ˝kajĂcĂch se optimalizace SRL, analĂ˝za jejich reproducibility a vĹĄeobecnĂŠ pouĹžĂvĂĄnĂ konfidenÄnĂch intervalĹŻ by mohly tĂŠĹž pomoci nalĂŠzt dalĹĄĂ pouĹžitelnĂŠ metody. PĹi hodnocenĂ vĂ˝sledkĹŻ je Äasto nezbytnĂĄ ĂşzkĂĄ spoluprĂĄce se statistikem.
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Ulč et al. (2013) conducted a review in Heart failure with left ventricular systolic dysfunction and prolonged QRS complex. Optimization of pacing intervals (AV and VV) vs. Empirical settings was evaluated. Unequivocal proof of the clinical benefit brought by optimization of AV and VV intervals in cardiac resynchronization therapy is still lacking, though finger plethysmography appears promising.
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