Michael R Gold1, Yinghong Yu2, Nicholas Wold2, John D Day3. 1. Medical University of South Carolina, Charleston, South Carolina. Electronic address: goldmr@musc.edu. 2. Boston Scientific Corporation, St. Paul, Minnesota. 3. Intermountain Heart Institute, Murray, Utah.
Abstract
BACKGROUND: Pacing at sites with late electrical activation or greater interventricular delay is associated with improvement in measures of cardiac resynchronization therapy (CRT) response, primarily reverse remodeling. However, little is known about whether such lead positions improve heart failure (HF) clinical outcomes. OBJECTIVE: The purpose of this study was to assess the association between interventricular electrical delay and HF clinical outcomes. METHODS: The Pacing Evaluation-Atrial SUpport Study was a multicenter randomized trial of patients undergoing CRT-defibrillator implantation. Interventricular delay was measured as the unpaced right ventricle-left ventricle (RV-LV) interval in sinus rhythm. The HF clinical composite score was the primary end point. In addition, the time to first HF hospitalization or death was measured and events were adjudicated by a blinded core laboratory. The cohort was divided at the median RV-LV interval into short (<67 ms) and long (≥67 ms) subgroups. In addition, receiver operating characteristic curves were constructed to identify the optimal cutoff of the RV-LV interval and spline analysis was performed to assess RV-LV interval as a continuous variable. RESULTS:A total of 1342 patients were included in this study. The clinical composite score at 1 year differed between groups, with more patients improving and fewer patients worsening in the long RV-LV group (P = .014). The time to first HF hospitalization or mortality also differed with a lower risk of an event in the long RV-LV group (hazard ratio 0.62; P = .002). Multivariate analysis showed that RV-LV time (hazard ratio 0.71; P = .038) and sex were independent predictors of this outcome. CONCLUSION: Baseline interventricular delay is a strong independent predictor of clinical response to CRT.
RCT Entities:
BACKGROUND: Pacing at sites with late electrical activation or greater interventricular delay is associated with improvement in measures of cardiac resynchronization therapy (CRT) response, primarily reverse remodeling. However, little is known about whether such lead positions improve heart failure (HF) clinical outcomes. OBJECTIVE: The purpose of this study was to assess the association between interventricular electrical delay and HF clinical outcomes. METHODS: The Pacing Evaluation-Atrial SUpport Study was a multicenter randomized trial of patients undergoing CRT-defibrillator implantation. Interventricular delay was measured as the unpaced right ventricle-left ventricle (RV-LV) interval in sinus rhythm. The HF clinical composite score was the primary end point. In addition, the time to first HF hospitalization or death was measured and events were adjudicated by a blinded core laboratory. The cohort was divided at the median RV-LV interval into short (<67 ms) and long (≥67 ms) subgroups. In addition, receiver operating characteristic curves were constructed to identify the optimal cutoff of the RV-LV interval and spline analysis was performed to assess RV-LV interval as a continuous variable. RESULTS: A total of 1342 patients were included in this study. The clinical composite score at 1 year differed between groups, with more patients improving and fewer patients worsening in the long RV-LV group (P = .014). The time to first HF hospitalization or mortality also differed with a lower risk of an event in the long RV-LV group (hazard ratio 0.62; P = .002). Multivariate analysis showed that RV-LV time (hazard ratio 0.71; P = .038) and sex were independent predictors of this outcome. CONCLUSION: Baseline interventricular delay is a strong independent predictor of clinical response to CRT.
Authors: Hye Bin Gwag; June Soo Kim; Kyoung-Min Park; Young Keun On; Seung-Jung Park Journal: J Interv Card Electrophysiol Date: 2021-03-27 Impact factor: 1.900
Authors: Josef Halamek; Pavel Leinveber; Ivo Viscor; Radovan Smisek; Filip Plesinger; Vlastimil Vondra; Jolana Lipoldova; Magdalena Matejkova; Pavel Jurak Journal: PLoS One Date: 2019-05-31 Impact factor: 3.240
Authors: Michael R Gold; Yinghong Yu; Jagmeet P Singh; Ulrika Birgersdotter-Green; Kenneth M Stein; Nicholas Wold; Timothy E Meyer; Kenneth A Ellenbogen Journal: Circ Arrhythm Electrophysiol Date: 2018-08
Authors: Anett Behon; Walter Richard Schwertner; Eperke Dóra Merkel; Attila Kovács; Bálint Károly Lakatos; Endre Zima; László Gellér; Valentina Kutyifa; Annamária Kosztin; Béla Merkely Journal: ESC Heart Fail Date: 2020-10-22