title: Optimizing the programation of cardiac resynchronization therapy devices in patients with heart failure and left bundle branch block.
abstract: This study was conducted to investigate the clinical impact of cardiac resynchronization device optimization. A series of 100 consecutive patients received cardiac resynchronization therapy. In the first 49 patients, an empirical atrioventricular delay of 120 ms was set, with simultaneous biventricular stimulation (interventricular [VV] interval=0 ms). In the next 51 patients, systematic atrioventricular optimization was performed. VV optimization was also performed, selecting 1 VV delay: right or left ventricular preactivation (+30 or -30 ms) or simultaneous (VV interval=0 ms), according to the best synchrony obtained by tissue Doppler-derived wall displacement. At follow-up, patients who were alive without cardiac transplantation and showed improvement of >or=10% in the distance walked in the 6-minute walking test were considered responders. There were no differences between the 2 groups at baseline. Left ventricular ejection fraction improved in the 2 groups, but left ventricular cardiac output improved only in the optimized group. At 6 months, patients with optimized devices walked slightly further in the 6-minute walking test (497+/-167 vs 393+/-123 m, p<0.01), with no differences in New York Heart Association functional class or quality of life compared with nonoptimized patients. Overall, the number of nonresponders were similar in the 2 groups (27% vs 23%, p=NS). In conclusion, the echocardiographic optimization of cardiac resynchronization devices provided a slight incremental clinical benefit at midterm follow-up. Simple and rapid methods to routinely optimize the devices are warranted.
authors.affiliation: Thorax Clinic Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: Bàrbara
authors.initials: B
authors.lastname: Vidal
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.forename: Alba
authors.initials: A
authors.lastname: Marigliano
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Ernesto
authors.initials: E
authors.lastname: Díaz-Infante
authors.forename: Manel
authors.initials: M
authors.lastname: Azqueta
authors.forename: David
authors.initials: D
authors.lastname: Tamborero
authors.forename: José María
authors.initials: JM
authors.lastname: Tolosana
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.forename: Félix
authors.initials: F
authors.lastname: Pérez-Villa
authors.forename: Carles
authors.initials: C
authors.lastname: Paré
authors.forename: Lluís
authors.initials: L
authors.lastname: Mont
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002037:Bundle-Branch Block / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002302:Cardiac Output; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017147:Defibrillators, Implantable; D018619:Echocardiography, Doppler, Pulsed; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D013318:Stroke Volume; D020257:Ventricular Remodeling