Association between frequent cardiac resynchronization therapy optimization and long-term clinical response: a post hoc analysis of the Clinical Evaluation on Advanced Resynchronization (CLEAR) pilot study

Peter Paul Delnoy, Philippe Ritter, Herbert Naegele, Serafino Orazi, Hanna Szwed, Igor Zupan, Kinga Goscinska-Bis, Frederic Anselme, Maria Martino, Luigi Padeletti, Peter Paul Delnoy, Philippe Ritter, Herbert Naegele, Serafino Orazi, Hanna Szwed, Igor Zupan, Kinga Goscinska-Bis, Frederic Anselme, Maria Martino, Luigi Padeletti

Abstract

Aims: The long-term clinical value of the optimization of atrioventricular (AVD) and interventricular (VVD) delays in cardiac resynchronization therapy (CRT) remains controversial. We studied retrospectively the association between the frequency of AVD and VVD optimization and 1-year clinical outcomes in the 199 CRT patients who completed the Clinical Evaluation on Advanced Resynchronization study.

Methods and results: From the 199 patients assigned to CRT-pacemaker (CRT-P) (New York Heart Association, NYHA, class III/IV, left ventricular ejection fraction <35%), two groups were retrospectively composed a posteriori on the basis of the frequency of their AVD and VVD optimization: Group 1 (n = 66) was composed of patients 'systematically' optimized at implant, at 3 and 6 months; Group 2 (n = 133) was composed of all other patients optimized 'non-systematically' (less than three times) during the 1 year study. The primary endpoint was a composite of all-cause mortality, heart failure-related hospitalization, NYHA functional class, and Quality of Life score, at 1 year. Systematic CRT optimization was associated with a higher percentage of improved patients based on the composite endpoint (85% in Group 1 vs. 61% in Group 2, P < 0.001), with fewer deaths (3% in Group 1 vs. 14% in Group 2, P = 0.014) and fewer hospitalizations (8% in Group 1 vs. 23% in Group 2, P = 0.007), at 1 year.

Conclusion: These results further suggest that AVD and VVD frequent optimization (at implant, at 3 and 6 months) is associated with improved long-term clinical response in CRT-P patients.

Keywords: Atrioventricular delay; Cardiac resynchronization therapy optimization frequency; Echocardiography; Interventricular delay; Long-term clinical response; SonR™.

Figures

Figure 1
Figure 1
Kaplan–Meier representation of time to first event for the combined secondary endpoint of death for all cause or hospitalization for heart failure in the systematically optimized Group 1 and the non-systematically optimized Group 2.

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