title: Left ventricular wall motion analysis to guide management of CRT non-responders.
abstract: OBJECTIVE
  A discordant left ventricular (LV) lead position can be responsible for cardiac resynchronization therapy (CRT) non-response. In this study, tailored optimization of the individual LV wall motion was evaluated for the outcome in these patients.
  
  
  RESULTS
  Two hundred and forty-six CRT outpatients were screened for non-response due to a discordant LV lead. In 17 patients, three-dimensional data of fluoroscopic rotation scan and echocardiography were integrated to analyse the individual LV wall motion with respect to the LV lead position. Optimization was guided by the systolic dyssynchrony index (SDI) and LV ejection fraction (LVEF) during different interventricular (VV)-delay programming. If re-programming failed, implantation of a second LV lead was performed. A discordant or partly concordant LV lead position was found in nearly all patients (16/17, 94%), which contributed to an unchanged baseline amount of LV dyssynchrony with either CRT on or off (SDI 11.3 vs. 11.0%; P = 0.744). In the majority of patients, VV-delay re-programming achieved better resynchronization, 4/17 patients needed implantation of a second LV lead. After 3 months, significant improvement of NYHA functional class (1 class; P = 0.004), peak oxygen consumption (10 vs. 13 mL/min/kg; P = 0.008), LVEF (27 vs. 39%; P = 0.003), and SDI (11.0 vs. 5.8; P = 0.02) was observed. Clinical and echocardiographic responses were found in 77 and 59%, respectively, with even good results on long-term follow-up.
  
  
  CONCLUSIONS
  Tailored optimization of the individual LV wall motion can lead to significant clinical and echocardiographic improvements in previous CRT non-responders with a discordant LV lead position.
authors.affiliation: Department of Electrophysiology, University of Leipzig - Heart Center, Strümpellstrasse 39, 04229 Leipzig, Germany bettina.nitsche@googlemail.com.
authors.forename: Bettina
authors.initials: B
authors.lastname: Nitsche
authors.affiliation: Department of Electrophysiology, University of Leipzig - Heart Center, Strümpellstrasse 39, 04229 Leipzig, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Eitel
authors.affiliation: Department of Electrophysiology, University of Leipzig - Heart Center, Strümpellstrasse 39, 04229 Leipzig, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Bode
authors.affiliation: Department of Electrophysiology, University of Leipzig - Heart Center, Strümpellstrasse 39, 04229 Leipzig, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Wetzel
authors.affiliation: Department of Electrophysiology, University of Leipzig - Heart Center, Strümpellstrasse 39, 04229 Leipzig, Germany.
authors.forename: Sergio
authors.initials: S
authors.lastname: Richter
authors.affiliation: Department of Electrophysiology, University of Leipzig - Heart Center, Strümpellstrasse 39, 04229 Leipzig, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Döring
authors.affiliation: Department of Electrophysiology, University of Leipzig - Heart Center, Strümpellstrasse 39, 04229 Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.affiliation: Department of Electrophysiology, University of Leipzig - Heart Center, Strümpellstrasse 39, 04229 Leipzig, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.affiliation: Department of Electrophysiology, University of Leipzig - Heart Center, Strümpellstrasse 39, 04229 Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaspar
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D019560:Echocardiography, Three-Dimensional; D004867:Equipment Design; D004868:Equipment Failure; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D013318:Stroke Volume; D013599:Systole; D017211:Treatment Failure; D016277:Ventricular Function, Left
keywords: Cardiac resynchronization therapy; Discordant LV lead; Left ventricular wall motion; Non-response; Optimization; Real-time three-dimensional echocardiography