Cardiac resynchronization therapy optimization in nonresponders and incomplete responders using electrical dyssynchrony mapping.

Autor:	Brown CD; Minneapolis Heart Institute East, Allina Health, St. Paul, Minnesota., Burns KV; Minneapolis Heart Institute East, Allina Health, St. Paul, Minnesota., Harbin MM; Minneapolis Heart Institute East, Allina Health, St. Paul, Minnesota., Espinosa EA; Minneapolis Heart Institute East, Allina Health, St. Paul, Minnesota., Olson MD; Minneapolis Heart Institute East, Allina Health, St. Paul, Minnesota., Bank AJ; Minneapolis Heart Institute East, Allina Health, St. Paul, Minnesota; Cardiology Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota. Electronic address: Alan.Bank@allina.com.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2022 Dec; Vol. 19 (12), pp. 1965-1973. Date of Electronic Publication: 2022 Aug 05.
DOI:	10.1016/j.hrthm.2022.07.016
Abstrakt:	Background: Nonresponse to cardiac resynchronization therapy (CRT) occurs in ∼30%-50% of patients. There are no well-accepted clinical approaches for optimizing CRT in nonresponders. Objective: The purpose of this study was to demonstrate the effect of CRT optimization using electrical dyssynchrony mapping on left ventricular (LV) function, size, and dyssynchrony in selected patients with nonresponse/incomplete response to CRT. Methods: We studied 39 patients with underlying left bundle branch block or interventricular conduction delay who had an LV ejection fraction of ≤40% after receiving CRT and had significant electrical dyssynchrony. Electrical dyssynchrony was measured at multiple atrioventricular delays and interventricular delays. The QRS area between combinations of 9 anterior and 9 posterior electrograms (QRS area under the curve) was calculated, and cardiac resynchronization index (CRI) was defined as the percent change in QRS area under the curve compared to native conduction. Electrical dyssynchrony maps depicted CRI over the wide range of settings tested. Patients were programmed to an optimal device setting, and echocardiograms were recorded 5.9 ± 3.7 months postoptimization. Results: CRI increased from 49.4% ± 24.0% to 90.8% ± 10.5%. CRT optimization significantly improved LV ejection fraction from 31.8% ± 4.7% to 36.3% ± 5.9% (P < .001) and LV end-systolic volume from 108.5 ± 37.6 to 98.0 ± 37.5 mL (P = .009). Speckle-tracking measures of LV strain significantly improved by 2.4% ± 4.5% (transverse; P = .002) and 1.0% ± 2.6% (longitudinal; P = .017). Aortic to pulmonic valve opening time, a measure of interventricular dyssynchrony, significantly (P = .040) decreased by 14.9 ± 39.4 ms. Conclusion: CRT optimization of electrical dyssynchrony using a novel electrical dyssynchrony mapping technology significantly improves LV systolic function, LV end-systolic volume, and mechanical dyssynchrony. This methodology offers a noninvasive, practical clinical approach to treating nonresponders and incomplete responders to CRT. (Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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