Clinical Epidemiology and Ageing

Impact of cardiac resynchronization therapy optimization inside a heart failure programme: a real-world experience.

Moulin T, Hamon D, Djouadi K, d'Humières T, Elbaz N, Boukantar M, Zerbib C, Rouffiac S, Dhanjal TS, Ernande L, Derumeaux G, Teiger E, Damy T, Lellouche N ESC Heart Fail. 2022;9(5):3101-3112.

AIMS: 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.

METHODS AND RESULTS: 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.

CONCLUSIONS: 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.

MeSH terms: Aged; Aged, 80 and over; Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Echocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Treatment Outcome
DOI: 10.1002/ehf2.14043