1. Optimal percentage of biventricular pacing to obtain CRT response: how high is high enough
- Author
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Leonor Parreira, José Farinha, N Fonseca, Rui Caria, Alessandra Santos Lopes, R Coelho, Pedro Amador, Dinis Mesquita, Marta Fonseca, A Pinheiro, AF Esteves, and Jorge Ferreira
- Subjects
medicine.medical_specialty ,Ejection fraction ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Ischemia ,Atrial fibrillation ,medicine.disease ,Log-rank test ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Funding Acknowledgements Type of funding sources: None. Background The greatest benefit with cardiac resynchronization therapy (CRT) is achieved when biventricular pacing (BivP) percentage (%) is close to 100%. However, in some patients that goal can be challenging to obtain. Purpose Determine whether a lower BivP% could lead to similar CRT response and events, as compared with patients with BivP% >98%. Methods Patients with CRT followed up in a remote-monitoring network were retrospectively analyzed. BivP% was assessed and response to CRT was defined as an absolute increase in left ventricle ejection fraction (LVEF) >5% or a relative increase in LVEF >15%. Low BivP% was defined as Results 88 patients, 76% male, median age 73.5 (IQR 65.75-79.25) years were included. A CRT-D was implanted in 69%. Etiology was ischemic in 44%. 93% were under beta-blockers. Median LVEF before CRT was 27% (IQR 20.25-32). 44 patients (50%) had low BivP% (median 91%, IQR 96-99), 55% due to atrial fibrillation and 52% due to frequent premature ventricular complexes. After optimization of medical therapy, device programming and/or interventional procedures, we obtained a BivP >98% in 26 out of the 44 patients (59%). However, in 18 patients (20%) BivP% was Optimal cut-point value for predicting CRT response was 91% BivP% (AUC 0.644, p-value 0.047, 95% CI 0.496-0.792). The characteristics of the two groups didn’t differ significantly (Table). Survival was significantly higher in patients with BivP% >91% (Log-rank 3.667, p-value 0.050) – Figure. Conclusion In this population, BivP% >91% was sufficient to achieve CRT-response and was associated with a better survival. BivP% 91%(n = 84)p-valueAge in years, median (IQR)72.50 (70.50-73.75)74.00 (65.00-80.00)0.666CRT-D, n (%)3 (75.0)58 (69.0)0.999Ischemic cardiopathy, n (%)3 (75.0)35 (41.7)0.311LVEF before CRT, median (IQR)27 (19-39)27 (20-32)0.795Beta-blockers, n (%)4 (100.0)78 (95.1)0.999Abstract Figure.
- Published
- 2021