A multicenter prospective randomized controlled trial of cardiac resynchronization therapy guided by invasive dP/dt
Background: No periprocedural metric has demonstrated improved cardiac resynchronization therapy (CRT) outcomes in a multicenter setting. Objective: We sought to determine if left ventricular (LV) lead placement targeted to the coronary sinus (CS) branch generating the best acute hemodynamic respons...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-02-01
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| Series: | Heart Rhythm O2 |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501821000076 |
| _version_ | 1798035584422248448 |
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| author | Manav Sohal, MBBS Shoaib Hamid, MD Giovanni Perego, MD Paolo Della Bella, MD Shaumik Adhya, MD John Paisey, MD Tim Betts, MD Ravi Kamdar, MD Pier Lambiase, MD Francisco Leyva, MD Janet M. McComb, MD Jonathan Behar, MD Thomas Jackson, MD Simon Claridge, MD Vishal Mehta, MD Mark Elliott, MD Steven Niederer, PhD Reza Razavi, MD C. Aldo Rinaldi, MD, FHRS |
| author_facet | Manav Sohal, MBBS Shoaib Hamid, MD Giovanni Perego, MD Paolo Della Bella, MD Shaumik Adhya, MD John Paisey, MD Tim Betts, MD Ravi Kamdar, MD Pier Lambiase, MD Francisco Leyva, MD Janet M. McComb, MD Jonathan Behar, MD Thomas Jackson, MD Simon Claridge, MD Vishal Mehta, MD Mark Elliott, MD Steven Niederer, PhD Reza Razavi, MD C. Aldo Rinaldi, MD, FHRS |
| author_sort | Manav Sohal, MBBS |
| collection | DOAJ |
| description | Background: No periprocedural metric has demonstrated improved cardiac resynchronization therapy (CRT) outcomes in a multicenter setting. Objective: We sought to determine if left ventricular (LV) lead placement targeted to the coronary sinus (CS) branch generating the best acute hemodynamic response (AHR) results in improved outcomes at 6 months. Methods: In this multicenter randomized controlled trial, patients were randomized to guided CRT or conventional CRT. Patients in the guided arm had LV dP/dtmax measured during biventricular (BIV) pacing. Target CS branches were identified and the final LV lead position was the branch with the best AHR and acceptable threshold values. The primary endpoint was the proportion of patients with a reduction in LV end-systolic volume (LVESV) of ≥15% at 6 months. Results: A total of 281 patients were recruited across 12 centers. Mean age was 70.8 ± 10.9 years and 54% had ischemic etiology. Seventy-three percent of patients in the guided arm demonstrated a reduction in LVESV of ≥15% at 6 months vs 60% in the conventional arm (P = .02). Patients with AHR ≥ 10% were more likely to demonstrate a reduction of ESV ≥ 15% (84% of patients with an AHR ≥10% vs 28% with an AHR <10%; P < 0.001). Procedure duration and fluoroscopy times were longer in the pressure wire–guided arm (104 ± 39 minutes vs 142 ± 39 minutes; P < .001 and 20 ±16 minutes vs 28 ± 15 minutes; P = .002). Conclusions: AHR determined by invasively measuring LV dP/dtmax during BIV pacing predicts reverse remodeling 6 months after CRT. Patients in whom LV dP/dtmax was used to guide LV lead placement demonstrated better rates of reverse remodeling. |
| first_indexed | 2024-04-11T21:00:11Z |
| format | Article |
| id | doaj.art-6d92c1569ac34e2fa9e3c585e2ea24fd |
| institution | Directory Open Access Journal |
| issn | 2666-5018 |
| language | English |
| last_indexed | 2024-04-11T21:00:11Z |
| publishDate | 2021-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj.art-6d92c1569ac34e2fa9e3c585e2ea24fd2022-12-22T04:03:32ZengElsevierHeart Rhythm O22666-50182021-02-01211927A multicenter prospective randomized controlled trial of cardiac resynchronization therapy guided by invasive dP/dtManav Sohal, MBBS0Shoaib Hamid, MD1Giovanni Perego, MD2Paolo Della Bella, MD3Shaumik Adhya, MD4John Paisey, MD5Tim Betts, MD6Ravi Kamdar, MD7Pier Lambiase, MD8Francisco Leyva, MD9Janet M. McComb, MD10Jonathan Behar, MD11Thomas Jackson, MD12Simon Claridge, MD13Vishal Mehta, MD14Mark Elliott, MD15Steven Niederer, PhD16Reza Razavi, MD17C. Aldo Rinaldi, MD, FHRS18Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom; King’s College London, London, United Kingdom; Address reprint requests and correspondence: Dr Manav Sohal, Cardiology Clinical Academic Group, St. George’s Hospital, Blackshaw Rd, London SW17 0QT, UK.Queen Elizabeth Hospital, London, United KingdomOspedale Auxologico, Milan, ItalyOspedale San Raffaele, Milan, ItalyGuy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom; Medway Maritime Hospital, Gillingham, United KingdomRoyal Bournemouth Hospital, Bournemouth, United KingdomJohn Radcliffe Hospital, Oxford, United KingdomCroydon University Hospital, London, United KingdomThe Heart Hospital, London, United Kingdom; Barts Heart Centre, London, United KingdomQueen Elizabeth Hospital, Birmingham, United KingdomFreeman Hospital, Newcastle, United KingdomKing’s College London, London, United KingdomKing’s College London, London, United KingdomKing’s College London, London, United KingdomKing’s College London, London, United KingdomKing’s College London, London, United KingdomKing’s College London, London, United KingdomKing’s College London, London, United KingdomGuy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom; King’s College London, London, United KingdomBackground: No periprocedural metric has demonstrated improved cardiac resynchronization therapy (CRT) outcomes in a multicenter setting. Objective: We sought to determine if left ventricular (LV) lead placement targeted to the coronary sinus (CS) branch generating the best acute hemodynamic response (AHR) results in improved outcomes at 6 months. Methods: In this multicenter randomized controlled trial, patients were randomized to guided CRT or conventional CRT. Patients in the guided arm had LV dP/dtmax measured during biventricular (BIV) pacing. Target CS branches were identified and the final LV lead position was the branch with the best AHR and acceptable threshold values. The primary endpoint was the proportion of patients with a reduction in LV end-systolic volume (LVESV) of ≥15% at 6 months. Results: A total of 281 patients were recruited across 12 centers. Mean age was 70.8 ± 10.9 years and 54% had ischemic etiology. Seventy-three percent of patients in the guided arm demonstrated a reduction in LVESV of ≥15% at 6 months vs 60% in the conventional arm (P = .02). Patients with AHR ≥ 10% were more likely to demonstrate a reduction of ESV ≥ 15% (84% of patients with an AHR ≥10% vs 28% with an AHR <10%; P < 0.001). Procedure duration and fluoroscopy times were longer in the pressure wire–guided arm (104 ± 39 minutes vs 142 ± 39 minutes; P < .001 and 20 ±16 minutes vs 28 ± 15 minutes; P = .002). Conclusions: AHR determined by invasively measuring LV dP/dtmax during BIV pacing predicts reverse remodeling 6 months after CRT. Patients in whom LV dP/dtmax was used to guide LV lead placement demonstrated better rates of reverse remodeling.http://www.sciencedirect.com/science/article/pii/S2666501821000076Acute hemodynamic responseCardiac resynchronization therapyHeart failureLV reverse remodelingTargeted lead placement |
| spellingShingle | Manav Sohal, MBBS Shoaib Hamid, MD Giovanni Perego, MD Paolo Della Bella, MD Shaumik Adhya, MD John Paisey, MD Tim Betts, MD Ravi Kamdar, MD Pier Lambiase, MD Francisco Leyva, MD Janet M. McComb, MD Jonathan Behar, MD Thomas Jackson, MD Simon Claridge, MD Vishal Mehta, MD Mark Elliott, MD Steven Niederer, PhD Reza Razavi, MD C. Aldo Rinaldi, MD, FHRS A multicenter prospective randomized controlled trial of cardiac resynchronization therapy guided by invasive dP/dt Heart Rhythm O2 Acute hemodynamic response Cardiac resynchronization therapy Heart failure LV reverse remodeling Targeted lead placement |
| title | A multicenter prospective randomized controlled trial of cardiac resynchronization therapy guided by invasive dP/dt |
| title_full | A multicenter prospective randomized controlled trial of cardiac resynchronization therapy guided by invasive dP/dt |
| title_fullStr | A multicenter prospective randomized controlled trial of cardiac resynchronization therapy guided by invasive dP/dt |
| title_full_unstemmed | A multicenter prospective randomized controlled trial of cardiac resynchronization therapy guided by invasive dP/dt |
| title_short | A multicenter prospective randomized controlled trial of cardiac resynchronization therapy guided by invasive dP/dt |
| title_sort | multicenter prospective randomized controlled trial of cardiac resynchronization therapy guided by invasive dp dt |
| topic | Acute hemodynamic response Cardiac resynchronization therapy Heart failure LV reverse remodeling Targeted lead placement |
| url | http://www.sciencedirect.com/science/article/pii/S2666501821000076 |
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