IMPROVED ELECTRICAL SYNCHRONY BY CARDIAC RESYNCHRONIZATION THERAPY REPROGRAMMING AND ECHOCARDIOGRAPHIC RESPONSE IN PATIENTS WITH EXISTING DEVICES
CCC ePoster Library. AlTurki A. 10/26/19; 280512; 277
Dr. Ahmed AlTurki
Dr. Ahmed AlTurki
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Abstract
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BACKGROUND: Whether reprogramming of cardiac resynchronization therapy (CRT) to increase electrical synchrony translates into echocardiographic improvement remains unclear. SyncAV is an algorithm that has been developed to lead to fusion of the triple wavefronts: intrinsic, right ventricular (RV)-paced, and left ventricular (LV)-paced which improves electrical synchrony. We aimed to assess whether programming with SyncAV is associated with an increase in left ventricular ejection fraction (LVEF), a decrease in the severity of mitral regurgitation (MR) and an increase in functional capacity compared to existing CRT programming in patients with existing devices.

METHODS AND RESULTS: Consecutive patients at a single tertiary care center with a previously implanted CRT device with SyncAV algorithm were evaluated. All patients with chronically implanted CRT with SyncAV algorithm underwent routine ECG-based SyncAV optimization during their next regular device clinic visit. This analysis only included patients who able to be programmed to the SyncAV algorithm (i.e. in sinus rhythm with intrinsic AV conduction at implant) All patients included in the study fulfilled criteria for CRT implantation as per Canadian Cardiovascular Society guideline recommendations. Echocardiography was performed and NYHA functional class was assessed prior to and 6 months after SyncAV optimization. Results: Of 64 consecutive, potentially eligible patients who underwent assessment, 34 patients who were able to undergo SyncAV programming were included. The mean age was 74±9 years, 41% were female and 59% had ischemic cardiomyopathy. The mean intrinsic conduction QRSd was 152±25 ms with existing CRT programming and 138±23 ms with SyncAV programming. At 6-month follow-up, SyncAV optimization was associated with a significant increase in left ventricular ejection fraction (mean LVEF 36.5%±13.3% versus 30.9%±13.3%; P < 0.001) as well as a reduction in the severity of MR (mean MR grade 0.5±1.0 versus 0.9±1.0; P < 0.001) compared to existing CRT programming. There was no difference in NYHA functional class.

CONCLUSION: Atrio-ventricular delay optimization using SyncAV significantly improved LVEF and mitral regurgitation severity in patients with existing CRT devices and programing. Further studies are needed to assess if SycnAV is associated with better clinical outcomes and to identify which patients are likely to derive benefit.
BACKGROUND: Whether reprogramming of cardiac resynchronization therapy (CRT) to increase electrical synchrony translates into echocardiographic improvement remains unclear. SyncAV is an algorithm that has been developed to lead to fusion of the triple wavefronts: intrinsic, right ventricular (RV)-paced, and left ventricular (LV)-paced which improves electrical synchrony. We aimed to assess whether programming with SyncAV is associated with an increase in left ventricular ejection fraction (LVEF), a decrease in the severity of mitral regurgitation (MR) and an increase in functional capacity compared to existing CRT programming in patients with existing devices.

METHODS AND RESULTS: Consecutive patients at a single tertiary care center with a previously implanted CRT device with SyncAV algorithm were evaluated. All patients with chronically implanted CRT with SyncAV algorithm underwent routine ECG-based SyncAV optimization during their next regular device clinic visit. This analysis only included patients who able to be programmed to the SyncAV algorithm (i.e. in sinus rhythm with intrinsic AV conduction at implant) All patients included in the study fulfilled criteria for CRT implantation as per Canadian Cardiovascular Society guideline recommendations. Echocardiography was performed and NYHA functional class was assessed prior to and 6 months after SyncAV optimization. Results: Of 64 consecutive, potentially eligible patients who underwent assessment, 34 patients who were able to undergo SyncAV programming were included. The mean age was 74±9 years, 41% were female and 59% had ischemic cardiomyopathy. The mean intrinsic conduction QRSd was 152±25 ms with existing CRT programming and 138±23 ms with SyncAV programming. At 6-month follow-up, SyncAV optimization was associated with a significant increase in left ventricular ejection fraction (mean LVEF 36.5%±13.3% versus 30.9%±13.3%; P < 0.001) as well as a reduction in the severity of MR (mean MR grade 0.5±1.0 versus 0.9±1.0; P < 0.001) compared to existing CRT programming. There was no difference in NYHA functional class.

CONCLUSION: Atrio-ventricular delay optimization using SyncAV significantly improved LVEF and mitral regurgitation severity in patients with existing CRT devices and programing. Further studies are needed to assess if SycnAV is associated with better clinical outcomes and to identify which patients are likely to derive benefit.
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