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Lunati M, Magenta G, Cattafi G, et al. Clinical Relevance Of Systematic CRT Device Optimization. J Atr Fibrillation. 2014;7(2):1077doi: 10.4022/jafib.1077.
Lunati, M., Magenta, G., Cattafi, G., Moreo, A., Falaschi, G., Contardi, D., & Locati, E. (2014). Clinical Relevance Of Systematic CRT Device Optimization. Journal of atrial fibrillation, 7(2), 1077. https://doi.org/10.4022/jafib.1077
Lunati, Maurizio, et al. "Clinical Relevance Of Systematic CRT Device Optimization." Journal of atrial fibrillation vol. 7,2 (2014): 1077. doi: https://doi.org/10.4022/jafib.1077
Lunati M, Magenta G, Cattafi G, Moreo A, Falaschi G, Contardi D, Locati E. Clinical Relevance Of Systematic CRT Device Optimization. J Atr Fibrillation. 2014 Aug 31;7(2):1077. doi: 10.4022/jafib.1077. eCollection 2014. PMID: 27957096; PMCID: PMC5135253.
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J Atr Fibrillation. 2014 Aug 31;7(2):1077. doi: 10.4022/jafib.1077. eCollection 2014.

Clinical Relevance Of Systematic CRT Device Optimization.

Journal of atrial fibrillation

Maurizio Lunati, Giovanni Magenta, Giuseppe Cattafi, Antonella Moreo, Giacomo Falaschi, Danilo Contardi, Emanuela Locati

Affiliations

  1. "A. De Gasperis" Cardiothoracic and Vascular Department, Niguarda-Ca' Granda Hospital, Milan, Italy.
  2. SORIN Group Italia S.r.l., Milan, Italy.

PMID: 27957096 PMCID: PMC5135253 DOI: 10.4022/jafib.1077

Abstract

Cardiac Resynchronization Therapy (CRT) is known as a highly effective therapy in advanced heart failure patients with cardiac dyssynchrony. However, still one third of patients do not respond (or sub-optimally respond) to CRT. Among the many contributors for the high rate of non-responders, the lack of procedures dedicated to CRT device settings optimization (parameters to regulate AV synchrony and VV synchrony) is known as one of the most frequent. The most recent HF/CRT Guidelines do not recommend to carry-out optimization procedures in every CRT patient; they simply state those procedures "could be useful in selected patients", even though their role in improving response has not been proven. Echocardiography techniques still remain the gold-standard reference method to the purpose of CRT settings optimization. However, due to its severe limitations in the routine of CRT patients management (time and resource consuming, scarce reproducibility, inter and intra-operator dependency), echocardiography optimization is widely under-utilized in the real-world of CRT follow-up visits. As a consequence, device-based techniques have been developed to by-pass the need for repeated echo examinations to optimize CRT settings. In this report the available device-based optimization techniques onboard on CRT devices are shortly reviewed, with a specific focus on clinical outcomes observed in trials comparing these methods vs. clinical practice or echo-guided optimization methods. Particular emphasis is dedicated to hemodynamic methods and automaticity of optimization algorithms (making real the concept of "ambulatory CRT optimization"). In fact a hemodynamic-based approach combined with a concept of frequent re-optimization has been associated - although retrospectively - with a better clinical outcome on the long-term follow-up of CRT patients. Large randomized trials are ongoing to prospectively clarify the impact of automatic optimization procedures.

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