Impact of paced left ventricular dyssynchrony on left ventricular reverse remodeling after cardiac resynchronization therapy

Anais Gauthey*, Erik Willemen, Joost Lumens, Sylvain Ploux, Pierre Bordachar, Philippe Ritter, Frits W. Prinzen, Sibille Lejeune, Anne-Catherine Pouleur, Quentin Garnir, Sebastien Marchandise, Christophe Scavee, Aurelien Wauters, Jean-Benoit Le Polain De Waroux

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Introduction: We investigated whether pacing-induced electrical dyssynchrony at the time of cardiac resynchronization therapy (CRT) device implantation was associated with chronic CRT response. Methods and Results: We included a total of 69 consecutive heart failure patients who received a CRT device. Left (LVp-RVs) and right (RVp-LVs) pacing-induced interlead delays were measured intraoperatively and used to determine if there was paced left ventricular (LV) dyssynchrony, defined as present when LVp-RVs is larger than RVp-LVs. CRT response was defined as a reduction in LV end-systolic volume ≥15%, 6 months after implantation. Paced left ventricular dyssynchrony (PLVD) was associated with ischemic cardiomyopathy (ICM) (χ 2: 8; P =.005) but not with QRS morphology nor with pacing lead positions. In a univariate analysis, PLVD (odds ratio [OR], 6.53; 95% confidence interval [CI], 2.2-18.9; P =.001), atypical left bundle branch block (LBBB) (OR, 3.3; 95% CI, 1.2-9.4; P =.022), and ICM (OR, 5.2; 95% CI, 1.6-17; P =.006) were associated with nonresponse. In a multivariate analysis, both PLVD (OR, 9.74; 95% CI, 2.8-33.9; P <.0001) and atypical LBBB (OR, 5.6; 95% CI, 1.5-20.3; P =.009) were independently associated with nonresponse. Adding PLVD to a model based on QRS morphology provided a significant and meaningful incremental value to predict LV reverse remodeling after CRT (χ 2 to enter: 8; P <.005). Computer simulations corroborate these findings by showing that, while intrinsic electrical dyssynchrony is a prerequisite, the level of pacing-induced dyssynchrony modulates acute CRT response. Conclusion: In addition to the intrinsic electrical substrate, PLVD is strongly associated with less LV reverse remodeling, demonstrating that measuring the electrical substrate during pacing has additional value for prediction of CRT response in an already well-selected patient population.

Original languageEnglish
Pages (from-to)494-502
Number of pages9
JournalJournal of Cardiovascular Electrophysiology
Volume31
Issue number2
DOIs
Publication statusPublished - Feb 2020

Keywords

  • cardiac resynchronization therapy
  • heart failure
  • interventricular delay
  • left bundle branch block
  • reverse remodeling
  • HEART-FAILURE
  • PATIENT SELECTION
  • ELECTRICAL DELAY
  • GUIDELINES

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