Techniques for cardiac resynchronization therapy optimization, including echocardiography and device-based algorithms, currently lack multicenter data demonstrating long-term clinical benefit.
Does optimization of programmed parameters (AV and VV delays) improve clinical outcomes in patients receiving cardiac resynchronization therapy?
Current techniques for CRT optimization, including echocardiography and device-based algorithms, lack proven long-term clinical benefit and suffer from poor reproducibility.
One of the basic tenets of cardiac resynchronization therapy (CRT) is that optimization of programmed parameters is important to maximize the therapeutic response. Both atrioventricular (AV) and interventricular (VV) timing intervals have been suggested as potential methods to improve response rates. A variety of techniques have been described to determine the optimal AV and VV delays. Many of these methods have demonstrated acute hemodynamic benefits; however, multicenter data proving long-term clinical benefit have been lacking. Echocardiography-guided methods have been most commonly employed, but no technique has been shown to be superior. In fact, many of these techniques have poor reproducibility and are time-consuming. Device-based algorithms allow for a rapid, simplified approach to CRT optimization; however, their clinical value has also been called into question. This review will describe the different techniques for CRT optimization and evaluate their potential value and limitations.
Cuoco et al. (Wed,) conducted a review in Cardiac resynchronization therapy. Optimization of programmed parameters (AV and VV delays) was evaluated. Techniques for cardiac resynchronization therapy optimization, including echocardiography and device-based algorithms, currently lack multicenter data demonstrating long-term clinical benefit.
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