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Efficacy of Cardiac Resynchronization Therapy Using Automated Dynamic Optimization and Left Ventricular-only Pacing.

Authors
  • Gwag, Hye Bin1
  • Park, Youngjun2
  • Lee, Seong Soo2
  • Kim, June Soo2
  • Park, Kyoung Min2
  • On, Young Keun2
  • Park, Seung Jung3
  • 1 Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. , (North Korea)
  • 2 Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. , (North Korea)
  • 3 Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. [email protected] , (North Korea)
Type
Published Article
Journal
Journal of Korean medical science
Publication Date
Jul 15, 2019
Volume
34
Issue
27
Identifiers
DOI: 10.3346/jkms.2019.34.e187
PMID: 31293111
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Although device-based optimization has been developed to overcome the limitations of conventional optimization methods in cardiac resynchronization therapy (CRT), few real-world data supports the results of clinical trials that showed the efficacy of automatic optimization algorithms. We investigated whether CRT using the adaptive CRT algorithm is comparable to non-adaptive biventricular (BiV) pacing optimized with electrocardiogram or echocardiography-based methods. Consecutive 155 CRT patients were categorized into 3 groups according to the optimization methods: non-adaptive BiV (n = 129), adaptive BiV (n = 11), and adaptive left ventricular (LV) pacing (n = 15) groups. Additionally, a subgroup of patients (n = 59) with normal PR interval and left bundle branch block (LBBB) was selected from the non-adaptive BiV group. The primary outcomes included cardiac death, heart transplantation, LV assist device implantation, and heart failure admission. Secondary outcomes were electromechanical reverse remodeling and responder rates at 6 months after CRT. During a median 27.5-month follow-up, there was no significant difference in primary outcomes among the 3 groups. However, there was a trend toward better outcomes in the adaptive LV group compared to the other groups. In a more rigorous comparisons among the patients with normal PR interval and LBBB, similar patterns were still observed. In our first Asian-Pacific real-world data, automated dynamic CRT optimization showed comparable efficacy to conventional methods regarding clinical outcomes and electromechanical remodeling. © 2019 The Korean Academy of Medical Sciences.

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