Moulin, Thibaut, Hamon, David, Djouadi, Kamila, D'Humieres, Thomas, Elbaz, Nathalie, Boukantar, Madjid, Zerbib, Céline, Rouffiac, Segolene, Dhanjal, Tarvinder, Ernande, Laura, Derumeaux, Geneviève, Teiger, Emmanuel, Damy, Thibaud and Lellouche, Nicolas (2022) Impact of cardiac resynchronization therapy optimization inside a heart failure programme : a real‐world experience. ESC Heart Failure, 9 (5). pp. 3101-3112. doi:10.1002/ehf2.14043 ISSN 2055-5822.

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Abstract

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.

Item Type:	Journal Article
Subjects:	Q Science > QP Physiology R Medicine > RC Internal medicine R Medicine > RJ Pediatrics
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Cardiac pacing, Congestive heart failure, Congestive heart failure -- Patients, Implantable cardioverter-defibrillators, Heart failure -- Treatment, Echocardiography , Atrioventricular node
Journal or Publication Title:	ESC Heart Failure
Publisher:	John Wiley & Sons Ltd
ISSN:	2055-5822
Official Date:	20 November 2022
Dates:	Date Event 20 November 2022 Published 24 June 2022 Available 3 June 2022 Accepted
Volume:	9
Number:	5
Page Range:	pp. 3101-3112
DOI:	10.1002/ehf2.14043
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	21 November 2022
Date of first compliant Open Access:	22 November 2022

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