Journal article
Impact of cardiac resynchronization therapy optimization inside a heart failure programme: a real-world experience
ESC Heart Failure, Vol.9(5), pp.3101-3112
10/2022
DOI: 10.1002/ehf2.14043
PMCID: PMC9715781
PMID: 35748123
Abstract
This study sought to describe and evaluate the impact of a routine in-hospital cardiac resynchronization therapy (CRT) programme, including comprehensive heart failure (HF) evaluation and systematic echo-guided CRT optimization.
CRT implanted patients were referred for optimization programme at 3 to 12 months from implantation. The program included clinical and biological status, standardized screening for potential cause of CRT non-response and systematic echo-guided atrioventricular and interventricular delays (AVd and VVd) optimization. Initial CRT-response and improvement at 6 months post-optimization were assessed with a clinical composite score (CCS). Major HF events were tracked during 1 year after optimization. A total of 227 patients were referred for CRT optimization and enrolled (71 ± 11 years old, 77% male, LVEF 30.6 ± 7.9%), of whom 111 (48.9%) were classified as initial non-responders. Left ventricular lead dislodgement was noted in 4 patients (1.8%), and loss or ≤90% biventricular capture in 22 (9.7%), mostly due to arrhythmias. Of the 196 patients (86%) who could undergo echo-guided CRT optimization, 71 (36.2%) required VVd modification and 50/144 (34.7%) AVd modification. At 6 months post-optimization, 34.3% of the initial non-responders were improved according to the CCS, but neither AVd nor VVd echo-guided modification was significantly associated with CCS-improvement. After one-year follow-up, initial non-responders maintained a higher rate of major HF events than initial responders, with no significant difference between AVd/VVd modified or not.
Our study supports the necessity of a close, comprehensive and multidisciplinary follow-up of CRT patients, without arguing for routine use of echo-guided CRT optimization.
Details
- Title: Subtitle
- Impact of cardiac resynchronization therapy optimization inside a heart failure programme: a real-world experience
- Creators
- Thibaut Moulin - Department of Cardiology, FHU SENEC, AP-HP, University Hospital Henri Mondor, Créteil, FranceDavid Hamon - Department of Cardiology, FHU SENEC, AP-HP, University Hospital Henri Mondor, Créteil, FranceKamila Djouadi - Department of Cardiology, FHU SENEC, AP-HP, University Hospital Henri Mondor, Créteil, FranceThomas D'Humières - Université Paris-Est CréteilNathalie Elbaz - Department of Cardiology, FHU SENEC, AP-HP, University Hospital Henri Mondor, Créteil, FranceMadjid Boukantar - Department of Cardiology, FHU SENEC, AP-HP, University Hospital Henri Mondor, Créteil, FranceCéline Zerbib - Department of Cardiology, FHU SENEC, AP-HP, University Hospital Henri Mondor, Créteil, FranceSégolène Rouffiac - Department of Cardiology, FHU SENEC, AP-HP, University Hospital Henri Mondor, Créteil, FranceTarvinder S Dhanjal - University of WarwickLaura Ernande - Department of Physiology, FHU SENEC, AP-HP, University Hospital Henri Mondor, Créteil, FranceGeneviève Derumeaux - Université Paris-Est CréteilEmmanuel Teiger - Department of Cardiology, FHU SENEC, AP-HP, University Hospital Henri Mondor, Créteil, FranceThibaud Damy - Department of Cardiology, FHU SENEC, AP-HP, University Hospital Henri Mondor, Créteil, FranceNicolas Lellouche - Department of Cardiology, FHU SENEC, AP-HP, University Hospital Henri Mondor, Créteil, France
- Resource Type
- Journal article
- Publication Details
- ESC Heart Failure, Vol.9(5), pp.3101-3112
- DOI
- 10.1002/ehf2.14043
- PMID
- 35748123
- PMCID
- PMC9715781
- NLM abbreviation
- ESC Heart Fail
- ISSN
- 2055-5822
- eISSN
- 2055-5822
- Language
- English
- Date published
- 10/2022
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984691517402771
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