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Usefulness of Hemodynamic Device-Based Optimization in Heterogeneous Patients Implanted with Cardiac Resynchronization Therapy Defibrillator

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Abstract

Optimization of the atrioventricular (AV) and interventricular (VV) timings of the CRT is the most supposed correctable variable to improve the rate of CRT responder. The aim of the present study has been to evaluate if there is a specific subgroup of patients who can actually benefit the most from a hemodynamic optimization of AV. This is a prospective, observational single-center study that enrolled consecutive patients with clinical indication for CRT; all patients were implanted with CRT-D devices with SonR technology, able to automatically adjust AV and VV delay on a weekly basis. Among 57 patients, 39 (69%) showed a LVESV reduction > 15%. The SonR was able to modify the pacing parameters, but an increase of left atrial diameter was associated to a reduced AV variability, suggesting that an impaired left atrial function could potentially reduce the ability of the SonR algorithm to adjust the correct timing of pacing.

Patients with respectively a high (A) and low (B) AV timing variability, among several parameters that could potentially influence the AV timing, only left atrial dimensions demonstrated a significant impact. In fact an increase of left atrial diameter was associated to a reduced AV variability, suggesting that an impaired left atrial function could potentially reduce the ability of the SonR algorithm to adjust the correct timing of pacing.

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Authors and Affiliations

  1. Ospedale San Giovanni Bosco, Via Filippo Maria Briganti, 255, 80144, Naples, Italy

    Gregorio Covino, Mario Volpicelli & Paolo Capogrosso

  2. HT MED, II Traversa Coste Agnano, 18, 80078, Pozzuoli, Italy

    Carmine Ciardiello

Authors
  1. Gregorio Covino
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  2. Mario Volpicelli
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  3. Carmine Ciardiello
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  4. Paolo Capogrosso
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Correspondence to Carmine Ciardiello.

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The authors declare that they have no conflict of interest.

Human and Animal Rights

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation and with the Helsinki declaration of 1975, as revisited in 2000.

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Associate Editor Sunil Kapur oversaw the review of this article

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Covino, G., Volpicelli, M., Ciardiello, C. et al. Usefulness of Hemodynamic Device-Based Optimization in Heterogeneous Patients Implanted with Cardiac Resynchronization Therapy Defibrillator. J. of Cardiovasc. Trans. Res. 13, 938–943 (2020). https://doi.org/10.1007/s12265-020-10004-9

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  • DOI: https://doi.org/10.1007/s12265-020-10004-9

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