Electrophysiology and Cardiac Pacing Unit, Monaldi Hospital, Naples.
Published: March 2020
AI Article Synopsis
Article Abstract
Background: Cardiac resynchronization therapy (CRT) is an established treatment in patients with heart failure and prolonged QRS duration. A biventricular device is implanted to achieve faster activation and more synchronous contraction of the ventricles. Despite the convincing effect of CRT, 30-40% of patients do not respond. We decided to investigate the role of multipoint pacing (MPP) in a selected group of patients with right ventricle (RV)-to-left ventricle (LV) intervals less than 80 ms that do not respond to traditional CRT.
Methods: We will enrol 248 patients in this patient-blinded, observational, clinical study aiming to investigate if MPP could decrease LV end-systolic volume (ESV) in patients with RV-to-LV interval less than 80 ms. MPP will be activated ON at implant in patients with RV-to-LV delay less than 80 ms and OFF in RV-to-LV at least 80 ms. At follow-up the activation of MPP will be related to CRT response. The primary study endpoint will be the responder rate at 6 months, defined as a decrease in LV ejection fraction, LV end-diastolic volume, LV end-systolic volume (LVESV) at least 15% from baseline. Secondary outcomes include 12 months relative percentage reduction in LVESV and a combined clinical outcome measure of response to CRT defined as the patient being alive, no hospitalization due to heart failure, and experiencing an improvement in New York Heart Association functional class (Composite-Score).
Conclusion: Reducing the nonresponder rate continues to be an important goal for CRT.If an increase in reverse remodelling can be achieved by MPP, this study supports the conduct of larger trials investigating the role of MPP on clinical outcomes in selected patients treated, right now, only with traditional CRT.
Trial Registration: ClinicalTrials.gov, NCT02713308. Registered on 18 March 2016.
- The study investigates the effectiveness of a new ECG technique called CineECG, which visualizes heart electrical activity, in improving cardiac resynchronization therapy (CRT) for patients who don't respond well to standard treatments.
- Researchers analyzed CineECG data from 15 patients with heart conditions under different pacing settings and found that specific movement directions in the heart's electrical signals correlate with better immediate heart performance (measured as dP/dt max).
- The results indicate that the direction of the ST-T segment during repolarization can predict a significant improvement in heart function during CRT, suggesting that CineECG could help optimize treatment plans for patients.
Cardiac resynchronization therapy (CRT) using biventricular (BIV) pacing is aimed at heart failure patients but some don't respond; MultiPoint Pacing (MPP) might offer better results for these non-responders.
In a study with 3724 patients treated with BIV, 1639 were identified as non-responders and some were randomized to MPP or continued BIV pacing.
Results showed MPP led to better outcomes with a 33% success rate in reducing heart failure events compared to 23.5% in BIV, and MPP also resulted in fewer hospitalizations for heart failure.
Background: Studies have reported that female sex predicts superior cardiac resynchronization therapy (CRT) response. One theory is that this association is related to smaller female heart size, thus increased relative dyssynchrony at a given QRS duration (QRSd). Our objective was to investigate the mechanisms of sex-specific CRT response relating to heart size, relative dyssynchrony, cardiomyopathy type, QRS morphology, and other patient characteristics.
Although cardiac resynchronization therapy (CRT) reduces morbidity and mortality and reverses left ventricular (LV) remodeling in heart failure patients with LV electrical dyssynchrony, induced proarrhythmia has been reported. The mechanism of CRT-induced proarrhythmia remains under debate. In this case report, a description of how LV pacing induced polymorphic ventricular tachycardia immediately after the initiation of CRT has been reported.
