Key result
In a real-world cohort of 170 heart failure patients, the majority presented with suboptimal CRT device settings, including 53.3% requiring shortening of sensed AV delays, highlighting the need for expert device follow-up.
Why the study?
What proportion of CHF patients with CRT devices require programming adjustments at follow-up in a real-world setting?
Observational (n=170)
No
What proportion of CHF patients with CRT devices require programming adjustments at follow-up in a real-world setting?
A substantial proportion of heart failure patients with CRT devices have suboptimal settings at their first post-operative consultation, highlighting the need for expert device follow-up.
Real-world CRT optimization frequently requires parameter adjustments; leaves open whether standardized protocols improve outcomes in prospective trials.
BACKGROUND: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients suffering from chronic heart failure (CHF). Optimal device programming is crucial for maximum patient benefit. The goal of the present study was to assess device settings from CHF patients undergoing CRT optimization in a "real world" setting, and to delineate parameters most frequently requiring adjustment. METHODS: All patients who underwent CRT device implantation in the Cardiology Clinicat the University Hospital Zurich between January 2011 and September 2012 and in whom follow-up was available were included in this analysis. RESULTS: A total of 170 CHF patients were included in this analysis. True biventricular pacing was present in 44% of all patients, while QRS fusion was detected in 49.9%. The majority of the patients presented with suboptimal atrioventricular (AV) delays requiring adjustment. AV delays were therefore shortened due to the presence of QRS fusion in 53.3% and 38.1% of patients (sAV and pAV, respectively) or prolonged because of truncation of the A wave in the left ventricular inflow pulse wave Doppler measurement (17.5% and 28.4% for sAV and pAV, respectively). In contrast, interventricular delay (VV delay) was rarely changed (11.9%). CONCLUSIONS: In our "real world" cohort, a substantial proportion of patients presented to their first post-operative consultation with suboptimal device settings. Our data indicate that the opportunity to optimize device settings is frequently wasted in the "real world", underlining the necessity for expert device follow-up to deliver optimal care to this challenging group of heart failure patients.
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Steffel et al. (2013) conducted an observational in Chronic heart failure (n=170). Comprehensive CRT device optimization was evaluated on Sensed AV delay requiring shortening. In a real-world cohort of 170 heart failure patients, the majority presented with suboptimal CRT device settings, including 53.3% requiring shortening of sensed AV delays, highlighting the need for expert device follow-up.
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