title: Septal flash predicts cardiac resynchronization therapy response in patients with permanent atrial fibrillation.
abstract: OBJECTIVE
  Patients with heart failure (HF) as well as atrial fibrillation (AF) have suboptimal response to cardiac resynchronization therapy (CRT). Identification of mechanical abnormalities, amenable to correction with CRT, might improve the selection of candidates and CRT efficiency. We evaluated whether abnormal septal motion, assessed by the presence of septal flash (SF) is related to CRT response in patients with AF.
  
  
  RESULTS
  Ninety-four CRT patients with AF were included. Echocardiography was performed in all subjects at baseline and at 12-month follow-up. Abnormal septal motion was defined by the presence of SF (early septal inward/outward motion within the isovolumic contraction period/QRS duration). Response to CRT was defined as a reduction (>15%) of the end-systolic volume of the left ventricle (LV). Univariate and multivariate analyses were performed to identify the predictors of CRT response. The mean age was 69 ± 8 years, 79% were males, and 59% of patients responded to CRT. Cardiovascular death was 14.4% and all-cause mortality was 16.5% during follow-up. Patients with SF at baseline that was acutely corrected by CRT were significantly more likely to respond than patients without SF. Baseline SF was an independent predictor of CRT response (OR 5.24; 95% CI 1.95-14.11).
  
  
  CONCLUSIONS
  Abnormal septal motion, assessed by the presence of SF, is a mechanism amenable to CRT correction. Its correction is associated with a higher likelihood of CRT response in HF patients with long-standing AF. This could improve the selection of candidates to CRT in a subgroup with particularly poor response and long-term prognosis.
authors.affiliation: Cardiology Department, Hospital Clínic, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain Cardiovascular Disease Division, Pontificia Universidad Católica de Chile, Santiago, Chile msitges@clinic.ub.es lgabrielli@med.puc.cl.
authors.forename: L
authors.initials: L
authors.lastname: Gabrielli
authors.affiliation: Cardiology Department, Hospital Clínic, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Marincheva
authors.affiliation: ICREA-Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Bijnens
authors.affiliation: Cardiology Department, Hospital Clínic, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Doltra
authors.affiliation: Cardiology Department, Hospital Clínic, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Tolosana
authors.affiliation: Cardiology Department, Hospital Clínic, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Borràs
authors.affiliation: Cardiology Department, Hospital Clínic, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Castel
authors.affiliation: Cardiology Department, Hospital Clínic, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Berruezo
authors.affiliation: Cardiology Department, Hospital Clínic, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Brugada
authors.affiliation: Cardiology Department, Hospital Clínic, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Mont
authors.affiliation: Cardiology Department, Hospital Clínic, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain msitges@clinic.ub.es lgabrielli@med.puc.cl.
authors.forename: M
authors.initials: M
authors.lastname: Sitges
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Atrial fibrillation; Cardiac resynchronization therapy; Heart failure; Septal flash