Adaptive Cardiac Resynchronization Therapy Effect on Electrical Dyssynchrony (aCRT-ELSYNC): A randomized controlled trial

Kazi T. Haq, PhD; Nichole M. Rogovoy, BS; Jason A. Thomas, BS; Christopher Hamilton, BA; Katherine J. Lutz, MD; Ashley Wirth, BS; Aron B. Bender, MD; David M. German, MD, MPH; Ryle Przybylowicz, MD; Peter van Dam, PhD; Thomas A. Dewland, MD, FHRS; Khidir Dalouk, MD; Eric Stecker, MD, FHRS; Babak Nazer, MD; Peter M. Jessel, MD, FHRS; Karen S. MacMurdy, MD, FHRS; Ignatius Gerardo E. Zarraga, MD, FHRS; Bassel Beitinjaneh, MD; Charles A. Henrikson, MD, MPH, FHRS; Merritt Raitt, MD, FHRS; Cristina Fuss, MD; Maros Ferencik, MD, PhD, MCR; Larisa G. Tereshchenko, MD, PhD, FHRS, CCDS

Heart Rhythm O2 (Aug 2021)

Adaptive Cardiac Resynchronization Therapy Effect on Electrical Dyssynchrony (aCRT-ELSYNC): A randomized controlled trial

Kazi T. Haq, PhD,
Nichole M. Rogovoy, BS,
Jason A. Thomas, BS,
Christopher Hamilton, BA,
Katherine J. Lutz, MD,
Ashley Wirth, BS,
Aron B. Bender, MD,
David M. German, MD, MPH,
Ryle Przybylowicz, MD,
Peter van Dam, PhD,
Thomas A. Dewland, MD, FHRS,
Khidir Dalouk, MD,
Eric Stecker, MD, FHRS,
Babak Nazer, MD,
Peter M. Jessel, MD, FHRS,
Karen S. MacMurdy, MD, FHRS,
Ignatius Gerardo E. Zarraga, MD, FHRS,
Bassel Beitinjaneh, MD,
Charles A. Henrikson, MD, MPH, FHRS,
Merritt Raitt, MD, FHRS,
Cristina Fuss, MD,
Maros Ferencik, MD, PhD, MCR,
Larisa G. Tereshchenko, MD, PhD, FHRS, CCDS

Affiliations

Kazi T. Haq, PhD: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
Nichole M. Rogovoy, BS: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
Jason A. Thomas, BS: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; University of Washington, Seattle, Washington
Christopher Hamilton, BA: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
Katherine J. Lutz, MD: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
Ashley Wirth, BS: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
Aron B. Bender, MD: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; University of California Los Angeles, Los Angeles, California
David M. German, MD, MPH: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
Ryle Przybylowicz, MD: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
Peter van Dam, PhD: Peacs BV, Arnhem, the Netherlands
Thomas A. Dewland, MD, FHRS: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; University of California San Francisco, San Francisco, California
Khidir Dalouk, MD: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
Eric Stecker, MD, FHRS: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
Babak Nazer, MD: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
Peter M. Jessel, MD, FHRS: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
Karen S. MacMurdy, MD, FHRS: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
Ignatius Gerardo E. Zarraga, MD, FHRS: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
Bassel Beitinjaneh, MD: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
Charles A. Henrikson, MD, MPH, FHRS: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
Merritt Raitt, MD, FHRS: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
Cristina Fuss, MD: Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
Maros Ferencik, MD, PhD, MCR: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
Larisa G. Tereshchenko, MD, PhD, FHRS, CCDS: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Address reprint requests and correspondence: Dr Larisa G. Tereshchenko, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN62, Portland, OR 97239.

Journal volume & issue: Vol. 2, no. 4
pp. 374 – 381

Abstract

Read online

Background: Adaptive cardiac resynchronization therapy (aCRT) is known to have clinical benefits over conventional CRT, but the mechanisms are unclear. Objective: Compare effects of aCRT and conventional CRT on electrical dyssynchrony. Methods: A prospective, double-blind, 1:1 parallel-group assignment randomized controlled trial in patients receiving CRT for routine clinical indications. Participants underwent cardiac computed tomography and 128-electrode body surface mapping. The primary outcome was change in electrical dyssynchrony measured on the epicardial surface using noninvasive electrocardiographic imaging before and 6 months post-CRT. Ventricular electrical uncoupling (VEU) was calculated as the difference between the mean left ventricular (LV) and right ventricular (RV) activation times. An electrical dyssynchrony index (EDI) was computed as the standard deviation of local epicardial activation times. Results: We randomized 27 participants (aged 64 ± 12 years; 34% female; 53% ischemic cardiomyopathy; LV ejection fraction 28% ± 8%; QRS duration 155 ± 21 ms; typical left bundle branch block [LBBB] in 13%) to conventional CRT (n = 15) vs aCRT (n = 12). In atypical LBBB (n = 11; 41%) with S waves in V5-V6, conduction block occurred in the anterior RV, as opposed to the interventricular groove in strict LBBB. As compared to baseline, VEU reduced post-CRT in the aCRT (median reduction 18.9 [interquartile range 4.3–29.2 ms; P = .034]), but not in the conventional CRT (21.4 [-30.0 to 49.9 ms; P = .525]) group. There were no differences in the degree of change in VEU and EDI indices between treatment groups. Conclusion: The effect of aCRT and conventional CRT on electrical dyssynchrony is largely similar, but only aCRT harmoniously reduced interventricular dyssynchrony by reducing RV uncoupling.

Published in Heart Rhythm O2

ISSN: 2666-5018 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.journals.elsevier.com/heart-rhythm-o2

About the journal

Abstract

Keywords