Heart failure & cardiomyopathies
Optimization of pacing for patients receiving ineffective cardiac resynchronization therapy
Authors' conclusion
i-CRT occurred early, and the maximum i-CRT was high among patients with latency or pseudo-fusion. Optimization of atrioventricular or interventricular delay improved i-CRT and shortened the QRS duration.
Study context
- Population
- Patients receiving cardiac resynchronization therapy (CRT) assessed with EffectivCRT, 2018–2024
- Participants
- 225 consecutive patients
- Exposure
- High %ineffective CRT (i-CRT) vs others; AV or VV delay optimization
- High %i-CRTn = 36
- Outcome
- Characteristics of high %i-CRT and efficacy of pacing optimization; CRT response (LVEF improved ≥10% and/or LV end-systolic volume reduced ≥15%)
Methodological detailsconsecutive patients
- Consecutive patients
Main finding
As reported in the abstract
P = 0.003
- High %i-CRT prevalence: 36 patients
- 16%
- Predominant cause pseudo-fusion or latency: 13 patients
- 36%
Observational data: associations, not effects.
Further findings
Predominant cause of high %i-CRT
- Pseudo-fusion or latency
- 13 patients [36%]
Time to maximum i-CRT and maximum i-CRT, pseudo-fusion or latency vs other causes (high %i-CRT subgroup)
- Shorter time from CRT initiation to maximum i-CRT with pseudo-fusion or latency
- P = 0.012
- Higher maximum i-CRT with pseudo-fusion or latency
- P < 0.001
%i-CRT after AV or interventricular delay optimization (10 patients)
- %i-CRT improved from 64.6% (IQR 39.3%-87.5%) to 6.4% (IQR 1.8%-32.0%)
- P = 0.005
- n = 10
QRS duration after AV or interventricular delay optimization (10 patients)
- QRS duration shortened from 165 ± 31 ms to 138 ± 21 ms
- P = 0.003
- n = 10
Conversion of initial nonresponders to CRT responders after optimization
- Initial nonresponders converted to CRT responders
- 3 of 7
Original publication
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