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How to improve the rate of responders with cardiac resynchronisation therapy?

Aiming for better response rates in CRT

Up to one third of patients implanted with CRT today are non-responders. In this session, the speakers presented various aspects of improving CRT response.


Dr Marsan (Pavia, IT) reviewed the role of echo in patient selection for CRT. In view of the disappointing results of the recent PROSPECT trial, new methods of assessing left ventricular (LV) dyssynchrony are being looked at, such as speckle tracking imaging and real time 3D echo, both claiming more than 80% sensitivity and specificity for CRT response.

Dr Van de Veire (Leiden, NL) reviewed the topic of preprocedural imaging techniques. Currently, echo is the most useful tool to assess dyssynchrony, MRI is best used for scar imaging and CT is starting to be used for venous anatomy. The use of a combination of these modalities, as well as the future development of a single modality that will assess all three elements (future MRI?) is crucial for the improvement of CRT response rates.

Localization of the LV and maybe right ventricular (RV) leads are key elements of response to CRT. Dr Lozano reviewed the topic of lead implantation and localization, with special emphasis on new methods for selection of the best pacing sites. He also described the use of novel techniques (such as the Stereotaxis as well as NavX) to reach these target sites while reducing the amount of contrast and X-ray exposure.

Post implantation, AV and VV delay optimization are often used in CRT patients. However, there are still many unanswered question regarding these techniques, as reviewed by Dr De Sutter (Ghent, BE). These questions include, amongst others, the best method for optimization, whether all patients should undergo optimization, what is the added value of VV optimization on top of AV delay optimization, whether optimization should be done at rest or during exercise, etc. We are still in search of a quick and easy method for optimization.

Dr Leclercq (Rennes, FR) presented the various methods of device based follow-up of CHF patients including invasive pressure and thoracic impedance monitoring and the potential benefit of home monitoring as a tool for CHF patient management


CRT still has a relatively high non-response rate. We probably need a single modality that will provide us with a combined pre-implantation information on venous anatomy, mechanical function and viability to improve our results. Post implantation optimization and monitoring will further improve the response rate. 




How to improve the rate of responders with cardiac resynchronisation therapy?

Notes to editor

This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.