Betablockers and ivabradine titration guided by routine exercise tests led to drug strategy changes in 42% of patients with fusion CRT pacing to maintain constant fusion pacing.
Cohort (n=64)
Does beta-blocker and ivabradine titration guided by systematic exercise tests optimize drug management in patients with fusion CRTP?
Routine exercise testing and titration of beta-blockers and ivabradine based on PR interval helps maintain constant fusion pacing in patients with LV-only fusion CRTP.
Background: Betablockers (BB)/ivabradine titration in fusion CRT pacing (CRTP) is understudied. Aim: To assess drug optimization using systematic exercise tests (ET) in fusion CRTP with preserved atrioventricular conduction (AVc). Methods: Changes in drug management were assessed during systematic follow-ups in CRTP patients without right ventricle lead. Shorter AVc (PR interval) allowed BB up-titration, while longer AVc needed BB down-titration, favoring ivabradine. Constant fusion pacing was the goal to improve outcomes. Results: 64 patients, 62.5 ± 9.5 y.o divided into three groups: shorter PR (<160 ms), normal (160−200 ms), longer (200−240 ms); follow-up 59 ± 26 months. Drugs were titrated in case of: capture loss due to AVc shortening (14%), AVc lengthening (5%), chronotropic incompetence (11%), maximum tracking rate issues (9%), brady/tachyarrhythmias (8%). Interventions: BB up-titration (78% shorter PR, 19% normal PR, 5% longer PR), BB down-titration (22% shorter PR, 14% normal PR), BB exclusion (16% longer PR), adding/up-titration ivabradine (22% shorter PR, 19% normal PR, 5% longer PR), ivabradine down-titration (22% shorter PR, 3% normal PR), ivabradine exclusion (11% normal PR, 5% longer PR). Drug strategy was changed in 165 follow-ups from 371 recorded (42% patients). Conclusions: BBs/ivabradine titration and routine ET during follow-ups in patients with fusion CRTP should be a standard approach to maximize resynchronization response. Fusion CRTP showed a positive outcome with important LV reverse remodeling and significant LVEF improvement in carefully selected patients.
Văcărescu et al. (Wed,) conducted a cohort in Fusion CRT pacing with preserved atrioventricular conduction (n=64). Betablockers and ivabradine titration guided by exercise tests was evaluated on Changes in drug management. Betablockers and ivabradine titration guided by routine exercise tests led to drug strategy changes in 42% of patients with fusion CRT pacing to maintain constant fusion pacing.
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