Significance of effective cardiac resynchronization therapy pacing for clinical responses: An analysis based on the effective cardiac resynchronization therapy algorithm

Satoshi Oka; Nobuhiko Ueda; Kohei Ishibashi; Takashi Noda; Yuichiro Miyazaki; Akinori Wakamiya; Keiko Shimamoto; Kenzaburo Nakajima; Tsukasa Kamakura; Mitsuru Wada; Yuko Inoue; Koji Miyamoto; Satoshi Nagase; Takeshi Aiba; Hideaki Kanzaki; Chisato Izumi; Kengo Kusano

doi:10.1016/j.hrthm.2023.06.005

Significance of effective cardiac resynchronization therapy pacing for clinical responses: An analysis based on the effective cardiac resynchronization therapy algorithm

Heart Rhythm. 2023 Sep;20(9):1289-1296. doi: 10.1016/j.hrthm.2023.06.005. Epub 2023 Jun 10.

Authors

Satoshi Oka¹, Nobuhiko Ueda², Kohei Ishibashi³, Takashi Noda³, Yuichiro Miyazaki¹, Akinori Wakamiya³, Keiko Shimamoto³, Kenzaburo Nakajima³, Tsukasa Kamakura³, Mitsuru Wada¹, Yuko Inoue³, Koji Miyamoto³, Satoshi Nagase³, Takeshi Aiba³, Hideaki Kanzaki³, Chisato Izumi³, Kengo Kusano¹

Affiliations

¹ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
² Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: rabbitueda2003@ncvc.go.jp.
³ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.

PMID: 37307884
DOI: 10.1016/j.hrthm.2023.06.005

Abstract

Background: High percent ventricular pacing maximizes cardiac resynchronization therapy (CRT) response. An effective CRT algorithm classifies each left ventricular (LV) pace as effective or ineffective on the basis of the detection of QS or QS-r morphology on the electrogram; however, the relationship between percent effective CRT pacing (%e-CRT) and responses is unclear.

Objective: We aimed to clarify the association between %e-CRT and clinical outcomes.

Methods: Of the 136 consecutive CRT patients, 49 using the adaptive and effective CRT algorithm with percent ventricular pacing > 90% were evaluated. The primary and secondary outcomes were heart failure (HF) hospitalization and prevalence of CRT responders, defined as patients with an improvement in LV ejection fraction of ≥10% or a reduction in LV end-systolic volume of ≥15% after CRT device implantation, respectively.

Results: We divided the patients into the effective group (n = 25) and the less effective group (n = 24) by the median value of %e-CRT (97.4% [93.7%-98.3%]). During the median follow-up period of 507 days (interquartile range 335-730 days), the effective group had a significantly lower risk of HF hospitalization than the less effective group as revealed by Kaplan-Meier analysis (log-rank, P = .016). Univariate analysis revealed %e-CRT ≥ 97.4% (hazard ratio 0.12; 95% confidence interval 0.01-0.95; P = .045) as a predictor of HF hospitalization. The effective group had a higher prevalence of CRT responders than the less effective group (23 [92%] vs 9 [38%]; P < .001). Univariate analysis revealed that %e-CRT ≥ 97.4% (odds ratio 19.20; 95% confidence interval 3.63-101.00; P < .001) was a predictor of CRT response.

Conclusion: High %e-CRT is associated with high CRT responder prevalence and low HF hospitalization risk.

Keywords: Atrial fibrillation; Biventricular pacing; Cardiac resynchronization therapy; Effective pacing; Heart failure; QRS duration.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Algorithms
Cardiac Resynchronization Therapy Devices
Cardiac Resynchronization Therapy*
Heart Failure* / diagnosis
Heart Failure* / therapy
Humans
Treatment Outcome