Key result
Dynamic CRT algorithms yield ~2-fold higher echocardiographic response rates than echocardiography optimization.
Why the study?
Suboptimal device programming is frequent in non-responders to CRT, but the role of device optimization and the most appropriate technique remain unknown.
Does device optimization using dynamic algorithms improve echocardiographic and clinical outcomes compared to echocardiography or empirical settings in patients receiving cardiac resynchronization therapy?
Meta-Analysis (n=4,346)
Does device optimization using dynamic algorithms improve echocardiographic and clinical outcomes compared to echocardiography or empirical settings in patients receiving cardiac resynchronization therapy?
Dynamic algorithms offer a resource-friendly alternative to echocardiography for CRT optimization, providing significantly better echocardiographic response and clinical outcomes.
Answers are grounded in this paper and cite their sources.
May favor dynamic algorithms over echocardiography for CRT optimization; extends pooled evidence with clinical outcome gains.
AIMS: Suboptimal device programming is frequent in non-responders to cardiac resynchronization therapy (CRT). However, the role of device optimization and the most appropriate technique are still unknown. The aim of our study was to analyse the effect of different CRT optimization techniques within a network meta-analysis. METHODS: A systematic search was conducted on MEDLINE, Embase and CENTRAL for studies comparing outcomes with empirical device settings or optimization using echocardiography, static algorithms or dynamic algorithms. Studies investigating the effect of optimization in non-responders were also analysed. RESULTS: A total of 17 studies with 4346 patients were included in the quantitative analysis. Of the treatments and outcomes examined, a significant difference was found only between dynamic algorithms and echocardiography, with the former leading to a higher echocardiographic response rate [odds ratio (OR): 2.02, 95% confidence interval (CI) 1.21-3.35], lower heart failure hospitalization rate (OR: 0.75, 95% CI 0.57-0.99) and greater improvement in 6-minute walk test [mean difference (MD): 45.52 m, 95% credible interval (CrI) 3.91-82.44 m]. We found no significant difference between empirical settings, static algorithms and dynamic algorithms. Seven studies with 228 patients reported response rates after optimization in non-responders. Altogether, 34.3%-66.7% of initial non-responders showed improvement after optimization, depending on response criteria. CONCLUSIONS: At the time of CRT implantation, dynamic algorithms may serve as a resource-friendly alternative to echocardiographic optimization, with similar or better mid-term outcomes. However, their superiority over empirical device settings needs to be investigated in further trials. For non-responders, CRT optimization should be considered, as the majority of patients experience improvement.
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Zsigmond et al. (2024) conducted a meta-analysis in Heart failure (Cardiac resynchronization therapy) (n=4,346). Dynamic algorithms (DYNs) vs. Echocardiography, static algorithms, or empirical settings was evaluated on Echocardiographic response rate (OR 2.02, 95% CI 1.21-3.35). Dynamic algorithms significantly increased the echocardiographic response rate compared to echocardiography optimization in patients receiving cardiac resynchronization therapy (OR 2.02).
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