Document Type
Article
Publication Title
Circ Arrhythm Electrophysiol
Abstract
BACKGROUND: The role of atrioventricular optimization (AVO) to improve cardiac resynchronization therapy outcomes remains controversial. Previous post hoc analyses of a multicenter trial showed that measures of electrical dyssynchrony (right ventricular-left ventricular [LV] or LV electrical delay durations) are associated with patients who benefit from AVO.
METHODS: This was a global, multicenter, prospective, randomized trial of de novo cardiac resynchronization therapy implant patients with an right ventricular-LV duration ≥70 ms to determine whether AVO results in greater reverse remodeling. Patients were randomized 1:1 for either an AVO algorithm (SmartDelay) that determines atrioventricular delay and pacing chamber, biventricular or LV only, or a fixed atrioventricular delay of 120 ms with biventricular pacing. Paired echocardiograms performed at baseline and 6 months were evaluated. The primary end point was echocardiographic cardiac resynchronization therapy response, defined dichotomously as a >15% reduction in LV end-systolic volume.
RESULTS: A total of 310 patients (n=120 women) were randomized and had completed 6 months of follow-up. The echocardiographic cardiac resynchronization therapy response rate did not statistically differ between the groups (SmartDelay, 74.8%; fixed, 67.7%;
CONCLUSIONS: Analysis of reverse remodeling parameters demonstrated that AVO via SmartDelay, relative to the nonoptimized fixed atrioventricular delay comparator group, improved absolute and relative changes in LV function in patients with longer right ventricular-LV duration.
REGISTRATION: URL: https://www.
CLINICALTRIALS: gov; Unique identifier: NCT03089281.
First Page
011714
Last Page
011714
DOI
10.1161/CIRCEP.122.011714
Publication Date
6-1-2023
Recommended Citation
Gold, Michael R; Ellenbogen, Kenneth A; Leclercq, Christophe; Lowy, Jonathan; Rials, Seth J; Shoda, Morio; Tomassoni, Gery; Issa, Ziad; Sarrazin, Jean-Francois; Jennings, John M; Nair, Devi G; Wold, Nicholas; Yong, Patrick; Harbin, Michelle M; Stein, Kenneth M; and Auricchio, Angelo, "Effects of Atrioventricular Optimization on Left Ventricular Reverse Remodeling With Cardiac Resynchronization Therapy: Results of the SMART-CRT Trial." (2023). Heart and Vascular Articles. 21.
https://scholarlyworks.ohiohealth.com/heart-vascular-articles/21