Efficacy of Cardiac Resynchronization Therapy Using Automated Dynamic Optimization and Left Ventricular-only Pacing
10.3346/jkms.2019.34.e187
- Author:
Hye Bin GWAG
1
;
Youngjun PARK
;
Seong Soo LEE
;
June Soo KIM
;
Kyoung Min PARK
;
Young Keun ON
;
Seung Jung PARK
Author Information
1. Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
- Publication Type:Original Article
- Keywords:
Cardiac Resynchronization Therapy;
Automatic Optimization;
Left Ventricular Pacing
- MeSH:
Bundle-Branch Block;
Cardiac Resynchronization Therapy;
Death;
Electrocardiography;
Follow-Up Studies;
Heart Failure;
Heart Transplantation;
Humans;
Immunodeficiency Virus, Bovine
- From:Journal of Korean Medical Science
2019;34(27):e187-
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Although device-based optimization has been developed to overcome the limitations of conventional optimization methods in cardiac resynchronization therapy (CRT), few real-world data supports the results of clinical trials that showed the efficacy of automatic optimization algorithms. We investigated whether CRT using the adaptive CRT algorithm is comparable to non-adaptive biventricular (BiV) pacing optimized with electrocardiogram or echocardiography-based methods. METHODS: Consecutive 155 CRT patients were categorized into 3 groups according to the optimization methods: non-adaptive BiV (n = 129), adaptive BiV (n = 11), and adaptive left ventricular (LV) pacing (n = 15) groups. Additionally, a subgroup of patients (n = 59) with normal PR interval and left bundle branch block (LBBB) was selected from the non-adaptive BiV group. The primary outcomes included cardiac death, heart transplantation, LV assist device implantation, and heart failure admission. Secondary outcomes were electromechanical reverse remodeling and responder rates at 6 months after CRT. RESULTS: During a median 27.5-month follow-up, there was no significant difference in primary outcomes among the 3 groups. However, there was a trend toward better outcomes in the adaptive LV group compared to the other groups. In a more rigorous comparisons among the patients with normal PR interval and LBBB, similar patterns were still observed. CONCLUSION: In our first Asian-Pacific real-world data, automated dynamic CRT optimization showed comparable efficacy to conventional methods regarding clinical outcomes and electromechanical remodeling.
