Skip to main content
SpringerLink
Log in

Optimizing cardiac resynchronization therapy

  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Cardiac resynchronization therapy (CRT) improves clinical outcome and survival in advanced heart failure. However, some patients do not respond clinically or show improvement in left ventricular function. Our focus has turned to why such “nonresponders” exist. Follow-up of CRT has led to several explanations, varying by individual patient, and has shown the importance of device programming in CRT in heart failure. The failing heart displays delayed contraction in the ventricle, also referred to as mechanical dyssynchrony. Simply pacing both ventricles simultaneously might not be adequate to optimize systolic function. Individually tailoring the atrioventricular (AV) timing can improve left ventricular filling and cardiac output, and adjusting the interventricular (VV) pacing delay has also been shown to improve hemodynamics. Increasing evidence regarding AV and VV optimization is emerging. This article reviews the current data on optimization, including the physiology, numerous approaches, and current issues.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Cazeau S, Leclercq C, Lavergne T, et al.: Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001, 344:873–880.

    Article  PubMed  CAS  Google Scholar 

  2. Abraham WT, Fisher WG, Smith AL, et al.: Cardiac resynchronization in chronic heart failure. N Engl J Med 2002, 346:1845–1853.

    Article  PubMed  Google Scholar 

  3. Linde C, Leclercq C, Rex S, et al.: Long-term benefits of biventricular pacing in congestive heart failure: results from the Multisite Stimulation in Cardiomyopathy (MUSTIC) study. J Am Coll Cardiol 2002, 40:111–118.

    Article  PubMed  Google Scholar 

  4. Cleland JG, Daubert JC, Erdmann E, et al.: The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005, 352:1539–1549.

    Article  PubMed  CAS  Google Scholar 

  5. Yu CM, Fung JW, Zhang Q, et al.: Tissue Doppler imaging is superior to strain rate imaging and postsystolic shortening on the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy. Circulation 2004, 110:66–73.

    Article  PubMed  Google Scholar 

  6. Bader H, Garrigue S, Lafitte S, et al.: Intra-left ventricular electromechanical asynchrony. A new independent predictor of severe cardiac events in heart failure patients. J Am Coll Cardiol 2004, 43:248–256.

    Article  PubMed  Google Scholar 

  7. Butter C, Auricchio A, Stellbrink C, et al.: Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation 2001, 104:3026–3029.

    Article  PubMed  CAS  Google Scholar 

  8. Wang P, Kramer A, Estes NA 3rd, et al.: Timing cycles for biventricular pacing. Pacing Clin Electrophysiol 2002, 25:62–75.

    Article  PubMed  Google Scholar 

  9. Auricchio A, Stellbrink C, Block M, et al.: Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. The Pacing Therapies for Congestive Heart Failure Study Group. The Guidant Congestive Heart Failure Research Group. Circulation 1999, 99:2993–3001.

    PubMed  CAS  Google Scholar 

  10. Jansen AH, Bracke FA, van Dantzig JM, et al.: Correlation of echo-Doppler optimization of atrioventricular delay in cardiac resynchronization therapy with invasive hemodynamics in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 2006, 97:552–557.

    Article  PubMed  Google Scholar 

  11. Kerlan JE, Sawhney NS, Waggoner AD, et al.: Prospective comparison of echocardiographic atrioventricular delay optimization methods for cardiac resynchronization therapy. Heart Rhythm 2006, 3:148–154.

    Article  PubMed  Google Scholar 

  12. Bax JJ, Abraham T, Barold SS, et al.: Cardiac resynchronization therapy: part 2—issues during and after device implantation and unresolved questions. J Am Coll Cardiol 2005, 46:2168–2182.

    Article  PubMed  Google Scholar 

  13. Auricchio A, Ding J, Spinelli JC, et al.: Cardiac resynchronization therapy restores optimal atrioventricular mechanical timing in heart failure patients with ventricular conduction delay. J Am Coll Cardiol 2002, 39:1163–1169.

    Article  PubMed  Google Scholar 

  14. Ritter PH, Dibb JC, Lelievre T: Quick determination of the optimal AV delay at rest in patients paced in DDD mode for complete AV block [abstract]. Eur J CPE 1994, 4:A163.

    Google Scholar 

  15. Meluzin J, Novak M, Mullerova J, et al.: A fast and simple echocardiographic method of determination of the optimal atrioventricular delay in patients after biventricular stimulation. Pacing Clin Electrophysiol 2004, 27:58–64.

    Article  PubMed  Google Scholar 

  16. Sawhney NS, Waggoner AD, Garhwal S, et al.: Randomized prospective trial of atrioventricular delay programming for cardiac resynchronization therapy. Heart Rhythm 2004, 1:562–567.

    Article  PubMed  Google Scholar 

  17. Perego GB, Chianca R, Facchini M, et al.: Simultaneous vs. sequential biventricular pacing in dilated cardiomyopathy: an acute hemodynamic study. Eur J Heart Fail 2003, 5:305–313.

    Article  PubMed  Google Scholar 

  18. van Gelder BM, Bracke FA, Meijer A, et al.: Effect of optimizing the VV interval on left ventricular contractility in cardiac resynchronization therapy. Am J Cardiol 2004, 93:1500–1503.

    Article  PubMed  Google Scholar 

  19. Kurzidim K, Reinke H, Sperzel J, et al.: Invasive optimization of cardiac resynchronization therapy: role of sequential biventricular and left ventricular pacing. Pacing Clin Electrophysiol 2005, 28:754–761.

    Article  PubMed  Google Scholar 

  20. Bordachar P, Lafitte S, Reuter S, et al.: Echocardiographic parameters of ventricular dyssynchrony validation in patients with heart failure using sequential biventricular pacing. J Am Coll Cardiol 2004, 44:2157–2165.

    Article  PubMed  Google Scholar 

  21. Mortensen PT, Sogaard P, Mansour H, et al.: Sequential biventricular pacing: evaluation of safety and efficacy. Pacing Clin Electrophysiol 2004, 27:339–345.

    Article  PubMed  Google Scholar 

  22. Sogaard P, Egeblad H, Pedersen AK, et al.: Sequential versus simultaneous biventricular resynchronization for severe heart failure: evaluation by tissue Doppler imaging. Circulation 2002, 106:2078–2084.

    Article  PubMed  Google Scholar 

  23. Turner MS, Bleasdale RA, Vinereanu D, et al.: Electrical and mechanical components of dyssynchrony in heart failure patients with normal QRS duration and left bundlebranch block: impact of left and biventricular pacing. Circulation 2004, 109:2544–2549.

    Article  PubMed  Google Scholar 

  24. Bleeker GB, Schalij MJ, Molhoek SG, et al.: Relationship between QRS duration and left ventricular dyssynchrony in patients with end-stage heart failure. J Cardiovasc Electrophysiol 2004, 15:544–549.

    PubMed  Google Scholar 

  25. Yu CM, Lin H, Zhang Q, Sanderson JE: High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 2003, 89:54–60.

    Article  PubMed  Google Scholar 

  26. Phillips KP, Harberts DB, Johnston LP, O’Donnell D: Left ventricular resynchronization predicted by individual performance of right and left ventricular pacing: a study on the impact of sequential biventricular pacing on ventricular dyssynchrony. Heart Rhythm 2007, 4:147–153.

    Article  PubMed  Google Scholar 

  27. Vanderheyden M, De Backer T, Rivero-Ayerza M, et al.: Tailored echocardiographic interventricular delay programming further optimizes left ventricular performance after cardiac resynchronization therapy. Heart Rhythm 2005, 2:1066–1072.

    Article  PubMed  Google Scholar 

  28. Leon AR, Abraham WT, Brozena S, et al.: Cardiac resynchronization with sequential biventricular pacing for the treatment of moderate-to-severe heart failure. J Am Coll Cardiol 2005, 46:2298–2304.

    Article  PubMed  Google Scholar 

  29. Baker JH, Turk K, Pires LA, et al.: Optimization of interventricular delay in biventricular pacing: results from the RHYTHM ICD V-V Optimization Phase study [abstract]. Heart Rhythm 2005, 2:S205–S206.

    Article  Google Scholar 

  30. De Lurgio D, Boehmer J, Higgins S, et al.: Simultaneous biventricular pacing with optimized atrioventricular delay results in more reverse remodelling versus other resynchronization modalities in DECREASE-HF [abstract]. J Card Fail 2007, 13(Suppl 2):S141.

    Google Scholar 

  31. Burri H, Sunthorn H, Shah D, Lerch R: Optimization of device programming for cardiac resynchronization therapy. Pacing Clin Electrophysiol 2006, 29:1416–1425.

    Article  PubMed  Google Scholar 

  32. O’Donnell D, Nadurata V, Hamer A, et al.: Long-term variations in optimal programming of cardiac resynchronization therapy devices. Pacing Clin Electrophysiol 2005, 28(Suppl 1):S24–S26.

    Article  PubMed  Google Scholar 

  33. Scharf C, Li P, Muntwyler J, et al.: Rate-dependent AV delay optimization in cardiac resynchronization therapy. Pacing Clin Electrophysiol 2005, 28:279–284.

    Article  PubMed  Google Scholar 

  34. Gold MR, Niazi I, Giudici M, et al.: A new automated algorithm for optimizing AV delay to improve global LV contractile function with cardiac resynchronization therapy [abstract]. Heart Rhythm 2005, 2:S287.

    Article  Google Scholar 

  35. Meine M, Min X, Paris M, Park E: An intracardiac EGM method for VV optimization during cardiac resynchronization therapy [abstract]. Heart Rhythm 2006, 3:S63.

    Article  Google Scholar 

  36. Porterfield JG, Porterfield LM, Baker JH, et al.: Device based intracardiac delay optimization vs. echo in ICD patients [abstract]. Europace 2006, 8(Suppl 1):176.

    Google Scholar 

  37. Scharf C, Attenhofer Jost CH: Concepts and questions in programming cardiac resynchronization devices. Heart Rhythm 2005, 2:1073–1075.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Ohio State University Heart Center, 473 West 12th Avenue, Suite 200 DHLRI, Columbus, OH, 43210, USA

    Ayesha Hasan

Authors
  1. Ayesha Hasan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ayesha Hasan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hasan, A. Optimizing cardiac resynchronization therapy. Curr Heart Fail Rep 5, 38–43 (2008). https://doi.org/10.1007/s11897-008-0007-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-008-0007-z

Keywords

Search

Navigation