title: Association between frequent cardiac resynchronization therapy optimization and long-term clinical response: a post hoc analysis of the Clinical Evaluation on Advanced Resynchronization (CLEAR) pilot study.
abstract: OBJECTIVE
  The long-term clinical value of the optimization of atrioventricular (AVD) and interventricular (VVD) delays in cardiac resynchronization therapy (CRT) remains controversial. We studied retrospectively the association between the frequency of AVD and VVD optimization and 1-year clinical outcomes in the 199 CRT patients who completed the Clinical Evaluation on Advanced Resynchronization study.
  
  
  RESULTS
  From the 199 patients assigned to CRT-pacemaker (CRT-P) (New York Heart Association, NYHA, class III/IV, left ventricular ejection fraction <35%), two groups were retrospectively composed a posteriori on the basis of the frequency of their AVD and VVD optimization: Group 1 (n = 66) was composed of patients 'systematically' optimized at implant, at 3 and 6 months; Group 2 (n = 133) was composed of all other patients optimized 'non-systematically' (less than three times) during the 1 year study. The primary endpoint was a composite of all-cause mortality, heart failure-related hospitalization, NYHA functional class, and Quality of Life score, at 1 year. Systematic CRT optimization was associated with a higher percentage of improved patients based on the composite endpoint (85% in Group 1 vs. 61% in Group 2, P < 0.001), with fewer deaths (3% in Group 1 vs. 14% in Group 2, P = 0.014) and fewer hospitalizations (8% in Group 1 vs. 23% in Group 2, P = 0.007), at 1 year.
  
  
  CONCLUSIONS
  These results further suggest that AVD and VVD frequent optimization (at implant, at 3 and 6 months) is associated with improved long-term clinical response in CRT-P patients.
authors.affiliation: Isala Klinieken, Zwolle, The Netherlands. p.p.h.m.delnoy@isala.nl
authors.forename: Peter Paul
authors.initials: PP
authors.lastname: Delnoy
authors.forename: Philippe
authors.initials: P
authors.lastname: Ritter
authors.forename: Herbert
authors.initials: H
authors.lastname: Naegele
authors.forename: Serafino
authors.initials: S
authors.lastname: Orazi
authors.forename: Hanna
authors.initials: H
authors.lastname: Szwed
authors.forename: Igor
authors.initials: I
authors.lastname: Zupan
authors.forename: Kinga
authors.initials: K
authors.lastname: Goscinska-Bis
authors.forename: Frederic
authors.initials: F
authors.lastname: Anselme
authors.forename: Maria
authors.initials: M
authors.lastname: Martino
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D017677:Age Distribution; D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000401:mortality* / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010865:Pilot Projects; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Atrioventricular delay; Cardiac resynchronization therapy optimization frequency; Echocardiography; Interventricular delay; Long-term clinical response; SonR™