Biventricular pacing set-up optimization to maximize cardiac resynchronization benefit – current options

Česká verzia

Authors: D. Marek
Authors place of work: I. interní klinika – kardiologická FN Olomouc
Published in the journal: Kardiol Rev Int Med 2014, 16(2): 95-101
Category: Cardiology Review

Summary

Cardiac resynchronization therapy (CRT) improves the quality of life and/ or haemodynamic parameters only in 2/ 3 of heart failure patients with a biventricular pacemaker implanted. In the rest of these patients (non‑responders), further refinement of pacing parameters is provided. This atrioventricular delay (AVD) and ventriculoventricular delay (VVD) optimization may help to improve cardiac performance in some of them. Echocardiography is widely used to assess the effect of AVD and VVD programming. The diastolic filling pattern, the length of the diastole, stroke volume/ cardiac output, ejection fraction, LV dP/ dT and LV contraction synchrony by tissue Doppler or speckle tracking are the most frequent criteria used for optimization. Whilst all these variables are proved to demonstrate an instant effect of AVD/ VVD optimization in selected groups of CRT patients, neither a randomized study nor a meta‑analysis showed any long‑term benefit in the CRT population. This article describes the theoretical concept of optimization, certain methodological problems and unresolved issues in CRT optimization and evidence in literature already published. Optimization options are summarized in current guidelines but an individual approach is recommended in non‑responders.

Keywords:
cardiac resynchronization therapy – atrioventricular delay – ventriculoventricular delay – echocardiography – optimization

Zdroje

1. Mullens W, Grimm RA, Verga T et al. Insights from a cardiac resynchronization optimization clinic as part of a heart failure disease management program. J Am Coll Cardiol 2009; 53: 765– 773. doi: 10.1016/ j.jacc.2008.11.024.

2. Bertini M, Delgado V, Bax JJ et al. Why, how and when do we need to optimize the setting of cardiac resynchronization therapy? Europace 2009; 11 (Suppl 5): v46– v57. doi: 10.1093/ europace/ eup275.

3. Bax JJ, Abraham T, Barold SS et al. Cardiac resynchronization therapy: Part 2– issues during and after device implantation and unresolved questions. J Am Coll Cardiol 2005; 46: 2168– 2182.

4. Auricchio A, Ding J, Spinelli JC et al. Cardiac resynchronization therapy restores optimal atrioventricular mechanical timing in heart failure patients with ventricular conduction delay. J Am Coll Cardiol 2002; 39: 1163– 1169.

5. Taha N, Zhang J, Ranjan R et al. Biventricular Pacemaker Optimization Guided by Comprehensive Echocardiography‑ Preliminary Observations Regarding the Effects on Systolic and Diastolic Ventricular Function and Third Heart Sound. J Am Soc Echocardiogr 2010; 23: 857– 866. doi: 10.1016/ j.echo.2010.04.022.

6. Sogaard P, Egeblad H, Pedersen AK et al. Sequential versus simultaneous biventricular resynchronization for severe heart failure: evaluation by tissue Doppler imaging. Circulation 2002; 106: 2078– 2084.

7. Meluzín J, Novák M, Müllerová J et al. A fast and simple echocardiographic method of determination of the optimal atrioventricular delay in patients after biventricular stimulation. Pacing Clin Electrophysiol 2004; 27: 58– 64.

8. Abraham WT, Fisher WG, Smith AL et al. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002; 346: 1845– 1853.

9. Cleland JG, Daubert JC, Erdmann E et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005; 352: 1539– 1549.

10. Ellims AH, Pfluger H, Elsik M et al. Utility of cardiac magnetic resonance imaging, echocardiography and electrocardiography for the prediction of clinical response and long‑term survival following cardiac resynchronisation therapy. Int J Cardiovasc Imaging 2013; 29: 1303– 1311. doi: 10.1007/ s10554– 013– 0215– 9.

11. Ellenbogen KA, Gold MR, Meyer TE et al. Primary results from the SmartDelay determined AV optimization: a comparison to other AV delay methods used in cardiac resynchronization therapy (SMART‑ AV) trial: a randomized trial comparing empirical, echocardiography‑ guided, and algorithmic atrioventricular delay programming in cardiac resynchronization therapy. Circulation 2010; 122: 2660– 2668. doi: 10.1161/ CIRCULATIONAHA.110.992552.

12. Ritter P, Delnoy PP, Padeletti L et al. A randomized pilot study of optimization of cardiac resynchronization therapy in sinus rhythm patients using a peak endocardial acceleration sensor vs. standard methods. Europace 2012; 14: 1324– 1333. doi: 10.1093/ europace/ eus059.

13. Bristow MR, Saxon LA, Boehmer J et al. Cardiac‑ resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140– 2150.

14. Gasparini M, Steinberg JS, Arshad A et al. Resumption of sinus rhythm in patients with heart failure and permanent atrial fibrillation undergoing cardiac resynchronization therapy: a longitudinal observational study. Eur Heart J 2010; 31: 976– 983. doi: 10.1093/ eurheartj/ ehp572.

15. Hauck M, Bauer A, Voss F et al. Effect of cardiac resynchronization therapy on conversion of persistent atrial fibrillation to sinus rhythm. Clin Res Cardiol 2009; 98: 189– 194. doi: 10.1007/ s00392- 008- 0740- z.

16. Ritter P, Padeletti L, Gillio‑ Meina L et al. Determination of the optimal atrioventricular delay in DDD pacing. Comparison between echo and peak endocardial acceleration measurements. Europace 1999; 1: 126– 130.

17. Rafie R, Naqvi TZ. Echocardiography‑ guided biventricular pacemaker optimization: role of echo Doppler in hemodynamic assessment and improvement. Expert Rev Cardiovasc Ther 2012; 10: 859– 874. doi: 10.1586/ erc.12.68.

18. Bordachar P, Lafitte S, Reuter S et al. Echocardiographic parameters of ventricular dyssynchrony validation in patients with heart failure using sequential biventricular pacing. J Am Coll Cardiol 2004; 44: 2157– 2165.

19. Risum N, Sogaard P, Hansen TF et al. Comparison of Dyssynchrony Parameters for VV‑ Optimization in CRT Patients. Pacing Clin Electrophysiol 2013; 36: 1382– 1390. doi: 10.1111/ pace.12203.

20. Gold MR, Niazi I, Giudici M et al. Acute hemodynamic effects of atrial pacing with cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2009; 20: 894– 900. doi: 10.1111/ j.1540- 8167.2009.01460.x.

21. Kamath GS, Cotiga D, Koneru JN et al. The utility of 12– lead Holter monitoring in patients with permanent atrial fibrillation for the identification of nonresponders after cardiac resynchronization therapy. J Am Coll Cardiol 2009; 53: 1050– 1055. doi: 10.1016/ j.jacc.2008.12.022.

22. Padeletti L, Muto C, Maounis T et al. Atrial fibrillation in recipients of cardiac resynchronization therapy device: 1‑year results of the randomized MASCOT trial. Am Heart J 2008; 156: 520– 526. doi: 10.1016/ j.ahj.2008.04.013.

23. Auger D, Hoke U, Bax JJ et al. Effect of atrioventricular and ventriculoventricular delay optimization on clinical and echocardiographic outcomes of patients treated with cardiac resynchronization therapy: a meta‑analysis. Am Heart J 2013; 166: 20– 29. doi: 10.1016/ j.ahj.2013.03.021.

24. Brignole M, Auricchio A, Baron‑ Esquivias G et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013; 34: 2281– 2329. doi: 10.1093/ eurheartj/ eht150.