Abstract 3784: New Algorhythm for Pacing With Optimal Fusion During Cardiac Resynchronization Therapy Induces Extensive Reverse-Remodeling in Heart Failure Patients With Normal Atrio-Ventricular Conduction and Concordant Left Ventricular Lead Position
Objective: To test long term effects of CRT with optimal fusion as determined by a new non-invasive algorhythm.
Background: Acutely CRT with fusion is superior to pure biventricular pacing in HF patients without AV block. Achieving non-invasively optimal fusion as well as its long term effects are not known.
Methods: We evaluated patients with HF, wide QRS, normal PR interval, significant LV dyssynchrony (time difference in peak septal wall to postero-lateral wall strain >130 msec by speckle-tracking radial strain) and concordant LV lead position. Using LV transmural conduction time determined during LV pacing and the interval from atrial sensing to the beginning of QRS determined during intrinsic rhythm (ODO), the AV and VV intervals where set to achieve optimal fusion. Patients were assessed after 1 week, 3 month, 6 month and 1 year clinically, by echocardiography and with biochemical markers (NT-proBNP, inflammatory markers).
Results: There were 40 patients (21 males, 17 ischemic). In 100% of the patients there was a rapid and significant clinical improvement (table 1⇓). There were no HF hospitalizations or deaths in this cohort. There was an immediate and persistent reduction in LV asynchrony, which was associated with an important and progressive improvement in LV systolic function and extensive LV reverse remodeling (table 1⇓). There was also a significant reduction of the serum levels of NT-proBNP and inflammatory markers.
Conclusions: CRT with fusion achieved non-invasively in patients with normal AV conduction and concordant LV lead position eliminates LV asynchrony and produces a super-response during long-term CRT, almost normalizing LV function.