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Cardiac resynchronisation therapy: non responders or non progressors?

ESC Congress 2010

Heart Failure (HF)

It is well established that cardiac resynchronisation therapy (CRT) reduces hospitalization and improves the quality of life of patients with severe systolic heart failure. On the other hand, we also know that about 30% of patients fulfilling the criteria for CRT implantation do not benefit from the therapy as much as expected on the basis of clinical trials.

The session “Cardiac resynchronization therapy: non responders or non progressors?” focused on patients with less than optimal response to CRT.
In the first lecture Prof. Gasparini from Rozzano, Italy presented an excellent summary of the indications of CRT. In addition, he gave us valuable hints about how to avoid selecting the wrong patients. The problematic patient groups are those with large myocardial infarction, atrial fibrillation, narrow QRS complex and those with extremely low left ventricular ejection fraction.

In the second lecture Prof. Fernandez Lozanne from Madrid, Spain discussed the importance of correct LV lead placement. He emphasized that lead placement to an infarcted area is likely to result in failure of the therapy. He also pointed out that in many cases, we will have to choose a less than optimal place for LV pacing because of phrenic nerve stimulation. He said that new lead designs may solve this problem.

As a natural continuation to the previous prsentations Prof. Oto from Ankara, Turkey reminded us that some of the non-responders may improve markedly if the device is programmed correctly. According to him, the most important parameters to take into account in programming the CRT device are A-V delay and the delay between right and left ventricular pacing. He emphasized that the optimal values change over time, which makes frequent monitoring and reprogramming of the device necessary.

Last but not least Prof. Leclercq from Rennes, France discussed future developments in CRT. It may be that in the future, we will have devices that are capable of automatically adjusting their settings to match the changing hemodynamic situation.

In summary, the session provided an excellent summary on how to identify patients who are likely not to benefit from CRT therapy, and how to improve the success of the therapy by correct lead placement and programming of the device.




Cardiac resynchronisation therapy: non responders or non progressors?

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.