Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing
Background: Betablockers (BB)/ivabradine titration in fusion CRT pacing (CRTP) is understudied. Aim: To assess drug optimization using systematic exercise tests (ET) in fusion CRTP with preserved atrioventricular conduction (AVc). Methods: Changes in drug management were assessed during systematic f...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-04-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/12/5/1096 |
| _version_ | 1797500472314036224 |
|---|---|
| author | Cristina Vacarescu Constantin-Tudor Luca Horea Feier Dan Gaiță Simina Crișan Alina-Gabriela Negru Stela Iurciuc Emilia-Violeta Goanță Cristian Mornos Mihai-Andrei Lazăr Caius-Glad Streian Diana-Aurora Arnăutu Vladiana-Romina Turi Dragos Cozma |
| author_facet | Cristina Vacarescu Constantin-Tudor Luca Horea Feier Dan Gaiță Simina Crișan Alina-Gabriela Negru Stela Iurciuc Emilia-Violeta Goanță Cristian Mornos Mihai-Andrei Lazăr Caius-Glad Streian Diana-Aurora Arnăutu Vladiana-Romina Turi Dragos Cozma |
| author_sort | Cristina Vacarescu |
| collection | DOAJ |
| description | Background: Betablockers (BB)/ivabradine titration in fusion CRT pacing (CRTP) is understudied. Aim: To assess drug optimization using systematic exercise tests (ET) in fusion CRTP with preserved atrioventricular conduction (AVc). Methods: Changes in drug management were assessed during systematic follow-ups in CRTP patients without right ventricle lead. Shorter AVc (PR interval) allowed BB up-titration, while longer AVc needed BB down-titration, favoring ivabradine. Constant fusion pacing was the goal to improve outcomes. Results: 64 patients, 62.5 ± 9.5 y.o divided into three groups: shorter PR (<160 ms), normal (160–200 ms), longer (200–240 ms); follow-up 59 ± 26 months. Drugs were titrated in case of: capture loss due to AVc shortening (14%), AVc lengthening (5%), chronotropic incompetence (11%), maximum tracking rate issues (9%), brady/tachyarrhythmias (8%). Interventions: BB up-titration (78% shorter PR, 19% normal PR, 5% longer PR), BB down-titration (22% shorter PR, 14% normal PR), BB exclusion (16% longer PR), adding/up-titration ivabradine (22% shorter PR, 19% normal PR, 5% longer PR), ivabradine down-titration (22% shorter PR, 3% normal PR), ivabradine exclusion (11% normal PR, 5% longer PR). Drug strategy was changed in 165 follow-ups from 371 recorded (42% patients). Conclusions: BBs/ivabradine titration and routine ET during follow-ups in patients with fusion CRTP should be a standard approach to maximize resynchronization response. Fusion CRTP showed a positive outcome with important LV reverse remodeling and significant LVEF improvement in carefully selected patients. |
| first_indexed | 2024-03-10T03:03:22Z |
| format | Article |
| id | doaj.art-e6a9d565b6f64bacbda099420b81f150 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T03:03:22Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-e6a9d565b6f64bacbda099420b81f1502023-11-23T10:39:16ZengMDPI AGDiagnostics2075-44182022-04-01125109610.3390/diagnostics12051096Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT PacingCristina Vacarescu0Constantin-Tudor Luca1Horea Feier2Dan Gaiță3Simina Crișan4Alina-Gabriela Negru5Stela Iurciuc6Emilia-Violeta Goanță7Cristian Mornos8Mihai-Andrei Lazăr9Caius-Glad Streian10Diana-Aurora Arnăutu11Vladiana-Romina Turi12Dragos Cozma13Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, RomaniaBackground: Betablockers (BB)/ivabradine titration in fusion CRT pacing (CRTP) is understudied. Aim: To assess drug optimization using systematic exercise tests (ET) in fusion CRTP with preserved atrioventricular conduction (AVc). Methods: Changes in drug management were assessed during systematic follow-ups in CRTP patients without right ventricle lead. Shorter AVc (PR interval) allowed BB up-titration, while longer AVc needed BB down-titration, favoring ivabradine. Constant fusion pacing was the goal to improve outcomes. Results: 64 patients, 62.5 ± 9.5 y.o divided into three groups: shorter PR (<160 ms), normal (160–200 ms), longer (200–240 ms); follow-up 59 ± 26 months. Drugs were titrated in case of: capture loss due to AVc shortening (14%), AVc lengthening (5%), chronotropic incompetence (11%), maximum tracking rate issues (9%), brady/tachyarrhythmias (8%). Interventions: BB up-titration (78% shorter PR, 19% normal PR, 5% longer PR), BB down-titration (22% shorter PR, 14% normal PR), BB exclusion (16% longer PR), adding/up-titration ivabradine (22% shorter PR, 19% normal PR, 5% longer PR), ivabradine down-titration (22% shorter PR, 3% normal PR), ivabradine exclusion (11% normal PR, 5% longer PR). Drug strategy was changed in 165 follow-ups from 371 recorded (42% patients). Conclusions: BBs/ivabradine titration and routine ET during follow-ups in patients with fusion CRTP should be a standard approach to maximize resynchronization response. Fusion CRTP showed a positive outcome with important LV reverse remodeling and significant LVEF improvement in carefully selected patients.https://www.mdpi.com/2075-4418/12/5/1096fusion CRT pacingexercise testbetablockerivabradine optimization |
| spellingShingle | Cristina Vacarescu Constantin-Tudor Luca Horea Feier Dan Gaiță Simina Crișan Alina-Gabriela Negru Stela Iurciuc Emilia-Violeta Goanță Cristian Mornos Mihai-Andrei Lazăr Caius-Glad Streian Diana-Aurora Arnăutu Vladiana-Romina Turi Dragos Cozma Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing Diagnostics fusion CRT pacing exercise test betablocker ivabradine optimization |
| title | Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing |
| title_full | Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing |
| title_fullStr | Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing |
| title_full_unstemmed | Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing |
| title_short | Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing |
| title_sort | betablockers and ivabradine titration according to exercise test in lv only fusion crt pacing |
| topic | fusion CRT pacing exercise test betablocker ivabradine optimization |
| url | https://www.mdpi.com/2075-4418/12/5/1096 |
| work_keys_str_mv | AT cristinavacarescu betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT constantintudorluca betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT horeafeier betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT dangaita betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT siminacrisan betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT alinagabrielanegru betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT stelaiurciuc betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT emiliavioletagoanta betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT cristianmornos betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT mihaiandreilazar betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT caiusgladstreian betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT dianaauroraarnautu betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT vladianarominaturi betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing AT dragoscozma betablockersandivabradinetitrationaccordingtoexercisetestinlvonlyfusioncrtpacing |