title: Automatic optimization of cardiac resynchronization therapy using SonR-rationale and design of the clinical trial of the SonRtip lead and automatic AV-VV optimization algorithm in the paradym RF SonR CRT-D (RESPOND CRT) trial.
abstract: Although cardiac resynchronization therapy (CRT) is effective in most patients with heart failure (HF) and ventricular dyssynchrony, a significant minority of patients (approximately 30%) are non-responders. Optimal atrioventricular and interventricular delays often change over time and reprogramming these intervals might increase CRT effectiveness. The SonR algorithm automatically optimizes atrioventricular and interventricular intervals each week using an accelerometer to measure change in the SonR signal, which was shown previously to correlate with hemodynamic improvement (left ventricular [LV] dP/dtmax). The RESPOND CRT trial will evaluate the effectiveness and safety of the SonR optimization system in patients with HF New York Heart Association class III or ambulatory IV eligible for a CRT-D device. Enrolled patients will be randomized in a 2:1 ratio to either SonR CRT optimization or to a control arm employing echocardiographic optimization. All patients will be followed for at least 24 months in a double-blinded fashion. The primary effectiveness end point will be evaluated for non-inferiority, with a nested test of superiority, based on the proportion of responders (defined as alive, free from HF-related events, with improvements in New York Heart Association class or improvement in Kansas City Cardiomyopathy Questionnaire quality of life score) at 12 months. The required sample size is 876 patients. The two primary safety end points are acute and chronic SonR lead-related complication rates, respectively. Secondary end points include proportion of patients free from death or HF hospitalization, proportion of patients worsened, and lead electrical performance, assessed at 12 months. The RESPOND CRT trial will also examine associated reverse remodeling at 1 year.
authors.affiliation: Hospital Clinic, University of Barcelona, Barcelona, Spain. Electronic address: jbrugada@clinic.ub.es.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.affiliation: Coburg Hospital, Coburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.affiliation: Isala Kliniken, Zwolle, The Netherlands.
authors.forename: Peter Paul
authors.initials: PP
authors.lastname: Delnoy
authors.affiliation: Careggi University Hospital, Florence, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.affiliation: University of Oklahoma, Oklahoma City, OK.
authors.forename: Dwight
authors.initials: D
authors.lastname: Reynolds
authors.affiliation: University Hospital of Bordeaux, Pessac, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ritter
authors.affiliation: Sorin CRM SAS, Clamart, France.
authors.forename: Alberto
authors.initials: A
authors.lastname: Borri-Brunetto
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
mesh_terms: D000465:Algorithms; D058406:Cardiac Resynchronization Therapy / Q000592:standards*; D004562:Electrocardiography; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D016896:Treatment Outcome