Key result
Acute interruption of cardiac resynchronization therapy in long-term responders significantly increased left ventricular end-systolic volume (P=0.02) and worsened mitral regurgitation (P=0.01).
Why the study?
Does acute interruption of cardiac resynchronization therapy worsen LV function and dyssynchrony in long-term responders?
Observational (n=35)
Does acute interruption of cardiac resynchronization therapy worsen LV function and dyssynchrony in long-term responders?
p-value: p=0.02 for LVESV, 0.01 for MR
Acute interruption of CRT in long-term responders worsens LV function and mitral regurgitation without significantly worsening LV dyssynchrony, highlighting the need for uninterrupted therapy.
Acute CRT interruption may worsen LVESV and MR in responders; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Responders to cardiac resynchronization therapy (CRT) have greater left ventricular (LV) dyssynchrony than nonresponders prior to CRT. AIM: We conducted this study to see whether the long term responders have more worsening of LV dyssynchrony and LV function on acute interruption of CRT. MATERIALS AND METHODS: We identified 22 responders and 13 nonresponders who received CRT as per standard criteria for 23.73 +/- 7.9 months (median 24.5 months). We assessed the acute change in LV function, mitral regurgitation (MR) and compared LV dyssynchrony in CRT on and off modes. RESULTS: On turning off CRT, there was no significant worsening of LV dyssynchrony in both responders and nonresponders. The dyssynchrony measurements by SPWMD, TDI and 3D echocardiography did not correlate significantly. LVESV increased (p = 0.02) and MR (p = 0.01) worsened in CRT-off mode in responders only without significant change in LVEF or LV dimensions. DISCUSSION AND CONCLUSION: In long-term responders to CRT, there is alteration in the function of remodeled LV with acute interruption of CRT, without significant worsening of LV dyssynchrony. The role of different echocardiographic parameters in the assessment of LV dyssynchrony remains controversial. Even after long-term CRT reversely remodels the LV, the therapy needs to be continued uninterrupted for sustained benefits.
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Kuppahally et al. (2009) conducted an observational in Heart failure with cardiac resynchronization therapy (n=35). Acute interruption of cardiac resynchronization therapy vs. CRT-on mode was evaluated on Acute change in LV function, mitral regurgitation, and LV dyssynchrony (p=0.02 for LVESV, 0.01 for MR). Acute interruption of cardiac resynchronization therapy in long-term responders significantly increased left ventricular end-systolic volume (P=0.02) and worsened mitral regurgitation (P=0.01).
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