Echocardiography reveals acute response to cardiac resynchronization therapy

In his PhD, Stian Balnagown Ross has found novel, acute parameters that can predict the response to cardiac resynchronization therapy in patients with heart failure.


MAIN RESULTS:

  1. Vectorcardiographic guided non-lateral left ventricular lead placement predicts acute haemodynamic response to cardiac resynchronization therapy.

  2. Premature septal contractions predict acute haemodynamic improvement in cardiac resynchronization therapy.
  3. Lead motion does not predict acute response to cardiac resynchronization therapy.

THESIS DEFENCE:

Thesis: Cardiac resynchronization therapy – Acute response parameters
Candidate: Stian Balnagown Ross
Time: February 7, 2020 at 13:15
Place: Oslo University Hospital, Rikshospitalet A: Seminar room A3.3067
Link to university website


SUMMARY:

(1) Changes in 3D electrocardiography under biventricular pacing could predict acute response to cardiac resynchronization therapy (CRT) in heart failure patients with non-lateral left ventricular lead position. In these patients, vectorcardiographic assessment of QRS area seems to be a useful non-invasive tool, and acute hemodynamic responses were observed despite a shorter left ventricular electrical delay than the recommended cut-off value.

In the study, 26 heart failure patients had at CRT device implanted with continuous registration of left ventricular pressure. 12 of them responded acutely to the treatment, and their ECG parameters were compared to the non-responders’.

(3) A pattern of premature septal contraction indicative of dyssynchrony could be an excellent marker of acute hemodynamic response to CRT. Ross and colleagues assessed three distinct septal contraction patterns with echocardiography in 38 candidates for CRT. The 27 patients with this contraction pattern generally had acute systolic, diastolic and electrical improvements under biventricular pacing. The 11 patients with normally timed septal contractions did not.

(2) The motion of the pacemaker leads does not seem to provide valuable information regarding acute cardiac resynchronization therapy response. The researchers derived surrogates for contractility from three-dimensional lead motion analysis, but these surrogates could not discriminate between acute haemodynamic responders and non-responders. 18 of 27 patients with heart failure in this study had an acute hemodynamic response to CRT.


REFERENCES:

(1) Ross, S., Odland, H. H., Aranda, A., Edvardsen, T., Gammelsrud, L. O., Haland, T. F., Cornelussen, R., Hopp, E., & Kongsgaard, E. (2018). Cardiac resynchronization therapy when no lateral pacing option exists: vectorcardiographic guided non-lateral left ventricular lead placement predicts acute hemodynamic response. Ep Europace20(8), 1294-1302.

(2) Ross, S., Odland, H. H., Fischer, T., Edvardsen, T., Gammelsrud, L. O., Haland, T. F.,  & Kongsgaard, E. (2018). Contractility surrogates derived from three-dimensional lead motion analysis and prediction of acute haemodynamic response to CRT. Open heart5(2), e000874.

(3) Ross, S., Nestaas, E., Kongsgaard, E., Odland, H. H., Haland, T. F., Hopp, E., Haugaa, K. H., & Edvardsen, T. (2020). Septal contraction predicts acute haemodynamic improvement and paced QRS width reduction in cardiac resynchronization therapy. European Heart Journal-Cardiovascular Imaging.