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How to pre-select responders to cardiac resynchronisation therapy?

ESC Congress Report

  • CRT-P not to be neglected as an alternative to CRT-D.
  • Conventional data interpretation may need to be challenged.

View the Slides from this session in ESC Congress 365

This session was informative and addressed the controversial issue concerning patient selection for CRT in a lively and provocative fashion.

John CLELAND (London, GB) provided an overview of the data with an interpretation that placed greater weight on QRS duration than on QRS morphology. He challenged the conventional emphasis on the importance of a left bundle branch configuration and presented data to support this relatively controversial viewpoint. He also argued in favour of the wider use of CRT-P devices and questioned the necessity of the defibrillator component in many patients receiving a CRT-D.

Giuseppe Boriani  (Bologna, IT) presented a more conventional viewpoint as an electrophysiologist and clearly demonstrated the impact of a conduction defect on the pattern of left ventricular contraction as seen with sophisticated mapping techniques. The value of the tools used by EP specialists in selecting appropriate patients and predicting response was convincing. In contrast to the previous speaker, he argued for the use of CRT-D in most patients satisfying CRT criteria.

Darrel Francis (London, GB), as expected, challenged the way we interpret data. Though some elegant but simple explained mathematical principles, he questioned the way we incorporate the normal variation in data and demonstrated how this variation affects our determination of correlations. The process was logical and fascinating and made the audience question some of the basic principles that we usually assume to be correct. The same data set can lead to very different interpretations dependent on on the details of the analytic approach. It was both an amusing and informative presentation.

Finally, Antonis Manolis (Glyfada-Athens, GR) spoke directly to the clinicians. It was obvious that he has vast experience in this field an implanter and his recommendations were extremely clear and direct. He covered a large volume of trial data but managed to present it in a fashion that was rapidly digested by the audience. His talk represented a practical users manual with useful hints and covered not only selection but the essential practical details that are so essential to successful implantation and delivery of device therapy.




How to pre-select responders to cardiac resynchronisation therapy?

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.