Intracardiac conduction time as a predictor of cardiac resynchronization therapy response: Results of the BIO|SELECT pilot study

Kyoko Soejima, Yusuke Kondo, Shingo Sasaki, Kazumasa Adachi, Ritsushi Kato, Nobuhisa Hagiwara, Tomoo Harada, Kengo Kusano, Fumiharu Miura, Itsuro Morishima, Kazuyasu Yoshitani, Akihiko Yotsukura, Manabu Fujimoto, Nobuhiro Nishii, Kenji Shimeno, Masatsugu Ohe, Hiroshi Tasaka, Hiroto Sasaki, Juergen Schrader, Kenji Ando

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Quadripolar left ventricular (LV) leads are capable of sensing and pacing the left ventricle from 4 different electrodes, which may potentially improve patient response to cardiac resynchronization therapy (CRT). Objective: We measured 3 different time intervals: right ventricular (RV)-sensed to LV-sensed during intrinsic rhythm (RVs-LVs), RV-paced to LV-sensed (RVp-LVs), and LV-paced to LV-sensed (LVp-LVs, between distal [LV1] and proximal pole on a quadripolar LV lead), and assessed their association with CRT response in terms of LV end-systolic volume (LVESV) and a composite benefit index (CBI) comprising LVESV, LV ejection fraction (LVEF), brain natriuretic peptide level, and NYHA class. Methods: A CRT-defibrillator system with quadripolar LV lead was implanted in 196 patients (mean age 69 years, mean LVEF 30%, left bundle-branch block [LBBB] 58%). Conduction intervals were measured before hospital discharge. At baseline and 7-month follow-up, echocardiographic and other components of CBI were determined. Results: The mean RVs-LV1s, RVp-LV1s, and LVp-LVs delays were 68 ± 38 ms, 132 ± 34 ms, and 99 ± 31 ms, respectively. From baseline to 7 months, LVESV decreased by 17.3% ± 28.6%. The RVs-LV1s interval correlated stronger with CBI (R2 = 0.12, P < .00001) than with LVESV change (R2 = 0.05, P = .006). In contrast, RVp-LV1s did not correlate and LVp-LVs correlated only weakly with CRT response. The subgroup of patients (44%) with LBBB and RVs-LV1s above the lower quartile (≥34 ms) showed the greatest response to CRT. Conclusion: The RVs-LVs interval during intrinsic rhythm is relevant for CRT success, whereas RVp-LVs and LVp-LVs intervals did not predict CRT response.

Original languageEnglish
Pages (from-to)588-596
Number of pages9
JournalHeart Rhythm O2
Volume2
Issue number6
DOIs
Publication statusPublished - Dec 2021

Keywords

  • Cardiac resynchronization therapy (CRT)
  • Composite benefit index
  • CRT response
  • Interventricular electrical delay
  • Left ventricular end-systolic volume
  • Quadripolar left ventricular lead

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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