How to improve response to cardiac resynchronization therapy?

Czech version

Authors: J. Lukl
Authors‘ workplace: I. interní klinika Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Jan Lukl, CSc.
Published in: Vnitř Lék 2009; 55(9): 808-811
Category: 80th Birthday - prof. MUDr. Miloš Štejfa, DrSc., FESC

Overview

Cardiac resynchronization therapy decreases mortality and rehospitalization for heart failure. However, around 30% of patients do not respond to this therapy. The paper analyses factors, with a possible impact on the response to this therapy. It is a left ventricular lead proximity to the left ventricle segment with the latest activity, presence and size of postinfarction scar and a percentage of fully captured paced beats. Methods of optimalization of these factors are described as well as circumstances, under which some patients should be indicated for cardiosurgical lead implantation or if a cardiac resynchronization therapy should be ommited.

Key words:
cardiac resynchronization therapy – responders – postinfartion scar – atrial fibrillation

Sources

1.Turley AJ, Raja SG, Salhiyyah K et al. Does cardiac resynchronization therapy improve survival and quality of life in patients with end-stage heart failure? Interact Cardiovasc Thorac Surg 2008; 7: 1141–1146.

2. Chung ES, Leon AR, Tavazzi L et al. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation 2008; 117: 2608–2616.

3. Burkhoff D, Oikawa RY, Sagawa K. Influence of pacing site on canine left ventricular contraction. Am J Physiol 1986; 251: H428–H435.

4. Park RC, Little WC, O’Rourke RA. Effect of alteration of left ventricular activation sequence on the left ventricular end-systolic pressure-volume relation in closed-chest dogs. Circ Res 1985; 57: 706–717.

5. Owen CH, Esposito DJ, Davis JW et al. The effects of ventricular pacing on left ventricular geometry, function, myocardial oxygen consumption, and efficiency of contraction in conscious dogs. Pacing Clin Electrophysiol 1998; 21: 1417–1429.

6. Murphy RT, Sigurdsson G, Mulamalla Set al. Tissue synchronization imaging andoptimal left ventricular pacing site in car-diac resynchronization therapy. Am J Cardiol 2006; 97: 1615–1621.

7. Macías A, Gavira JJ, Castaño S et al. Left ventricular pacing site in cardiac resynchronization therapy: clinical follow-up and predictors of failed lateral implant. Eur J Heart Fail 2008: 10: 421–427.

8. Murphy RT, Sigurdsson G, Mulamalla Set al. Tissue synchronization imaging and optimal left ventricular pacing site in cardiac resynchronization therapy. Am J Cardiol 2006; 97: 1615–1621.

9. Becker M, Kramann R, Franke A et al. Impact of left ventricular lead position in cardiac resynchronization therapy on left ventricular remodelling. A circumferential strain analysis based on 2D echocardiography. Eur Heart J 2007; 28: 1211–1220.

10. Ypenburg C, van Bommel RJ, Delgado V et al. Optimal left ventricular lead position predicts reverse remodeling and survival after cardiac resynchronization therapy. J Am Coll Cardiol 2008; 52: 1402–1409.

11. Becker M, Hoffmann R, Schmitz F et al. Relation of optimal lead positioning as defined by three-dimensional echocardiography to long-term benefit of cardiac resynchronization. Am J Cardiol 2007; 100: 1671–1676.

12. van de Veire NR, Marsan NA, Schuijf JD et al. Noninvasive imaging of cardiac venous anatomy with 64-slice multi-slice computed tomography and noninvasive assessment of left ventricular dyssynchrony by 3-dimensional tissue synchronization imaging in patients with heart failure scheduled for cardiac resynchronization therapy. Am J Cardiol 2008; 101: 1023–1029.

13. 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.

14. White JA, Yee R, Yuan X et al. Delayed enhancement magnetic resonance imaging predicts response to cardiac resynchronization therapy in patients with intraventricular dyssynchrony. J Am Coll Cardiol 2006; 48: 1953–1960.

15. Ypenburg C, Roes SD, Bleeker GB et al. Effect of total scar burden on contrast-enhanced magnetic resonance imaging on response to cardiac resynchronization therapy. Am J Cardiol 2007; 99: 657–660.

16. Chalil S, Foley PW, Muyhaldeen SA et al. Late gadolinium enhancement-cardiovascular magnetic resonance as a predictor of response to cardiac resynchronization therapy in patients with ischaemic cardiomyopathy. Europace 2007; 9: 1031–1037.

17. Riedlbauchová L, Brunken R, Jaber WA et al. The impact of myocardial viability on the clinical outcome of cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2009; 20: 50–57.

18. Yokokawa M, Tada H, Toyama T et al. Magnetic resonance imaging is superior to cardiac scintigraphy to identify nonresponders to cardiac resynchronization therapy. Pacing Clin Electrophysiol 2009; 32 (Suppl 1): S57–S62.

19. Mele D, Agricola E, Galderisi M et al. Echocardiographic myocardial scar burden predicts response to cardiac resynchronization therapy in ischemic heart failure. J Am Soc Echocardiogr 2009; 22: 702–708.

20. Jansen AH, Bracke F, van Dantzig JM et al. The influence of myocardial scar and dyssynchrony on reverse remodeling in cardiac resynchronization therapy. Eur J Echocardiogr 2008; 9: 483–488.

21. Bleeker GB, Kaandorp TA, Lamb HJ et al. Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation. 2006; 113: 969–976.

22. van de Veire NR, Schuijf JD, De Sutter J et al. Non-invasive visualization of the cardiac venous system in coronary artery disease patients using 64-slice computed tomography. J Am Coll Cardiol 2006; 48: 1832–1838.

23. Arzola-Castaner D, Taub C et al. Left ventricular lead proximity to an akinetic segment and impact on outcome of cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2006; 17: 623–627.

24. 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.

25. 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.

26. Bristow MR, Saxon LA, Boehmer J et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140–2150.

27. Young JB, Abraham WT, Smith AL et al. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. JAMA 2003; 289: 2685–2694.

28. Tolosana JM, Hernandez Madrid A, Brugada J. Comparison of benefits and mortality in cardiac resynchronization therapy in patients with atrial fibrillation versus patients in sinus rhythm (Results of the Spanish Atrial Fibrillation and Resynchronization [SPARE] Study). Am J Cardiol 2008; 102: 444–449.

29. Gasparini M, Auricchio A, Regoli FJ et al. Four-year efficacy of cardiac resynchronization therapy on exercise tolerance and disease progression: the importance of performing atrioventricular junction ablation in patients with atrial fibrillation. J Am Coll Cardiol 2006; 48: 734–743.

30. Gasparini M, Auricchio A, Metra M et al. Long-term survival in patients undergoing cardiac resynchronization therapy: the importance of performing atrio-ventricular junction ablation in patients with permanent atrial fibrillation. Eur Heart J 2008; 29: 1644–1652.

31. Kamath GS, Cotiga D, Koneru JN et al. The utility of 12-lead Holter monitoring in patients with permanent atrial fibrillation for the identification of nonresponders after cardiac resynchronization therapy. J Am Coll Cardiol 2009; 53: 1050–1055.

32. Indik JH. Spontaneous conversion of atrial fibrillation in the setting of biventricular pacing. Cardiol Rev 2004; 12: 1–2.

33. Hoppe UC, Casares JM, Eiskjaer H et al. Effect of cardiac resynchronization on the incidence of atrial fibrillation in patients with severe heart failure. Circulation 2006; 114: 18–25.

34. Khan MN, Jaïs P, Cummings J et al. Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med 2008; 359: 1778–1785.