Key result
Optimization using electrical dyssynchrony mapping significantly improved the cardiac resynchronization index compared to baseline adaptive CRT settings (92% vs 56%; P<0.001).
Why the study?
Although adaptive CRT provides clinical benefit, a significant number of patients remain nonresponders.
Does optimization using electrical dyssynchrony mapping improve electrical synchrony and echocardiographic parameters in patients programmed with adaptive CRT?
Observational (n=125)
Does optimization using electrical dyssynchrony mapping improve electrical synchrony and echocardiographic parameters in patients programmed with adaptive CRT?
Absolute Event Rate: 92% vs 56%
p-value: p=<.001
Optimization of CRT settings using electrical dyssynchrony mapping significantly improves electrical synchrony and echocardiographic parameters in patients who are nonresponders to the adaptive CRT algorithm.
EDM optimization was associated with better LV function in aCRT nonresponders; leaves open whether gains improve clinical outcomes.
BACKGROUND: The adaptive cardiac resynchronization therapy (CRT) (aCRT) algorithm provides an important clinical benefit. However, a significant number of patients are nonresponders. OBJECTIVES: The goals of this study were to quantify electrical synchrony in patients programmed with aCRT and to assess the echocardiographic effects of optimization in CRT nonresponders and incomplete responders. METHODS: We studied 125 patients programmed with aCRT and measured electrical synchrony at multiple device settings using novel electrical dyssynchrony mapping (EDM) technology. Electrical synchrony was quantified as cardiac resynchronization index (CRI), a measure that analyzes areas between multiple pairs of anterior and posterior electrograms and calculates synchrony normalized to native rhythm. RESULTS: CRI improved from baseline aCRT settings to optimal settings on the basis of EDM (56%±29% vs 92%±12%; P<.001). Patients programmed with left ventricle (LV)-only aCRT (group 1, n=68 [54%]) had a higher CRI (62%±25% vs 48%±31%; P=.014) than did patients programmed with biventricular aCRT (group 2, n=57 [46%]). In group 1 and group 2, optimal CRI during sequential biventricular (92%±13% and 93%±9%, respectively) and LV-only (92%±6% and 91%±7%, respectively) pacing was significantly (P<.001) higher than CRI at baseline aCRT setting. In a subset of 53 nonresponders optimized using EDM, there were significant improvements in CRI (37%±25%; P<.0001), LV ejection fraction (6.2%±6.6%; P<.0001), end-diastolic volume (9.5±28.2 mL; P=.015), end-systolic volume (13.4±24.9 mL; P<.001), and transverse (1.5%±4.4%; P=.014), longitudinal (1.0%±2.5%; P=.003), and circumferential (2.6%±8.5%; P=.047) strain. CONCLUSION: Electrical synchrony improves 56% with CRT using aCRT programming and 92% with EDM optimization. Optimization of aCRT-programmed nonresponders results in significant improvements in LV size and systolic function, offering the possibility of converting CRT nonresponders into responders.
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Bank et al. (2024) conducted an observational in Heart failure with adaptive cardiac resynchronization therapy (n=125). Electrical dyssynchrony mapping (EDM) optimization vs. Baseline aCRT settings was evaluated on Cardiac resynchronization index (CRI) (p=<.001). Optimization using electrical dyssynchrony mapping significantly improved the cardiac resynchronization index compared to baseline adaptive CRT settings (92% vs 56%; P<0.001).
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