Cardiac resynchronisation therapy optimisation strategies: systematic classification, detailed analysis, minimum standards and a roadmap for development and testing

S M Afzal Sohaib, Zachary I. Whinnett, Kenneth A. Ellenbogen, Christoph Stellbrink, T Alexander Quinn, Margot D. Bogaard, Pierre Bordachar, Berry M van Gelder, Irene E van Geldorp, Cecilia Linde, Mathias Meine, Frits W Prinzen, Robert G Turcott, Henry M Spotnitz, Dan Wichterle, Darrel P. Francis, International Working Group on Quantitative Optimization:

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

In this article an international group of CRT specialists presents a comprehensive classification system for present and future schemes for optimising CRT. This system is neutral to the measurement technology used, but focuses on little-discussed quantitative physiological requirements. We then present a rational roadmap for reliable cost-effective development and evaluation of schemes. A widely recommended approach for AV optimisation is to visually select the ideal pattern of transmitral Doppler flow. Alternatively, one could measure a variable (such as Doppler velocity time integral) and "pick the highest". More complex would be to make measurements across a range of settings and "fit a curve". In this report we provide clinicians with a critical approach to address any recommendations presented to them, as they may be many, indistinct and conflicting. We present a neutral scientific analysis of each scheme, and equip the reader with simple tools for critical evaluation. Optimisation protocols should deliver: (a) singularity, with only one region of optimality rather than several; (b) blinded test-retest reproducibility; (c) plausibility; (d) concordance between independent methods; and (e) transparency, with all steps open to scrutiny. This simple information is still not available for many optimisation schemes. Clinicians developing the habit of asking about each property in turn will find it easier to win now down the broad range of protocols currently promoted. Expectation of a sophisticated enquiry from the clinical community will encourage optimisation protocol-designers to focus on testing early (and cheaply) the basic properties that are vital for any chance of long term efficacy.

Original languageEnglish
Pages (from-to)118-31
Number of pages14
JournalInternational Journal of Cardiology
Volume170
Issue number2
DOIs
Publication statusPublished - 10 Dec 2013

Keywords

  • Cardiac Resynchronization Therapy
  • Heart Conduction System
  • Heart Failure
  • Humans
  • Models, Cardiovascular
  • Reproducibility of Results
  • Ultrasonography
  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Review

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