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Optimal percentage of biventricular pacing to obtain CRT-response: how high is high enough
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Ana Fátima Esteves
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Ana Fátima Esteves; Leonor Parreira; Dinis Valbom Mesquita; Marta Ferreira Fonseca; José Maria Farinha; Antonio Pinheiro Cumena Candjondjo; Joana Silva Ferreira; Rui Antunes Coelho; Pedro Campos Amador; Artur Lopes; Nuno J. Fonseca; Rui Caria
Abstract
<p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:black"><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Background: The greatest benefit with cardiac resynchronization therapy (CRT) is achieved when biventricular pacing (BivP) percentage (%) is close to 100%. However, in some patients that goal can be challenging to obtain.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:black"><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Purpose: We sought to determine whether a lower BivP% could lead to similar outcomes in terms of CRT response and events, as compared with patients with BivP% more than 98%. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:black"><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Methods: Patients with CRT followed up in a remote-monitoring network were retrospectively analyzed. BivP% was assessed overtime and response to CRT was defined as an absolute increase in left ventricle (LV) ejection fraction (EF) >5% or a relative increase in LVEF >15% or an increase of LV end-diastolic volume (LVEDV) >15%. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:black"><span style="font-family:".SFUIText",serif"><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Low BivP% was defined as </span></span></span><span style="font-family:".SFUIText",serif"><span style="font-size:12.0pt"><span style="font-family:Symbol"><</span></span></span><span style="font-family:".SFUIText",serif"><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">98%. Clinical, echocardiographic data and all-cause death during follow-up were evaluated. Receiver operator characteristics (ROC) curve and area under the curve (AUC) were obtained to determine the discriminative power of BivP% as predictor of CRT response. Optimal cut-point value was obtained (Youden index) and patients were divided according to this value. Kaplan-Meyer survival function was used to compare survival in the different groups and the Log-rank test was used for comparison between the groups. </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:black"><span style="font-family:".SFUIText",serif"><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Results: 88 patients, 76% male, median age 73.5 (IQR 65.75-79.25) years had an implanted CRT device, with defibrillator capacity in 69%. Etiology was ischemic in 44% and idiopathic in 38% patients. 61% patients were under optimized medical therapy (OMT), 93% under beta-blockers and 39% were taking angiotensin receptor-neprilysin inhibitors (ARNI). Median LVEF before CRT was 27% (IQR 20.25-32) and median LVEDV was 201 mL (IQR 160-236.5).</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:black"><span style="font-family:".SFUIText",serif"><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">44 patients (50%) had low BivP% (median 91%, IQR 96-99) during follow-up, 55% due to atrial fibrillation (AF) and 52% due to frequent premature ventricular complexes (PVC). Atrioventricular (AV) node ablation was performed in 11 patients and AF ablation in 2 patients. After optimization of medical therapy, device programming and/or interventional procedures, we obtained a BivP >98% in 26 out of the 44 patients (59%). However, in 18 patients (20%) BivP% was <98% (median 95, IQR 92.25-96). 66% patients were CRT responders. Median follow-up was 36 (IQR 23.75-84) months. During follow-up, 11 (13%) patients were hospitalized for HF and mortality was 27% (24 patients). </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:black"><span style="font-family:".SFUIText",serif"><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Optimal cut-point value for predicting CRT response was 91% BivP% (AUC 0.644, p-value 0.047, 95% CI 0.496-0.792). The characteristics of the two groups didn’t differ significantly (Table). </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:black"><span style="font-family:".SFUIText",serif"><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Survival was significantly higher in patients with BivP% >91% (Log-rank 3.667, p-value 0.050) – Figure. </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:black"><span style="font-family:".SFUIText",serif"><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion: In this population, a biventricular pacing >91% was sufficient to achieve CRT-response and was associated with a better survival.</span></span></span></span></span></span></p>
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