Arrhythmias
Luuk H.G.A Hopman
PhD Student
Department of Cardiology, Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands
Luuk H.G.A Hopman
PhD Student
Department of Cardiology, Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands
Alwin Zweerink, MD, PhD
MD
Amsterdam UMC, Noord-Holland, Netherlands
Marielle C. van de Veerdonk, MD, PhD
MD
Amsterdam UMC, Netherlands
Anne-Lotte C. van der Lingen, MD
MD
Amsterdam UMC, Netherlands
Marthe J. Huntelaar, MSc
MSc.
Amsterdam UMC, Netherlands
Mark J. Mulder, MD
MD
Amsterdam UMC, Netherlands
Lourens F. Robbers, MD, PhD
MD
Amsterdam University Medical Centers- Location VUmc
Amsterdam, Noord-Holland, Netherlands
Albert C. van Rossum, MD, PhD
MD
Amsterdam University Medical Centers- Location VUmc, Netherlands
Vokko P. van Halm, MD, PhD
MD
Amsterdam UMC, Noord-Holland, Netherlands
.jpeg "Marco J. Götte, MD, PhD photo")
Marco J. Götte, MD, PhD
MD, PhD
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands
Cornelis P. Allaart, MD, PhD
Professor
Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands
Cardiac resynchronization therapy (CRT) is an established treatment strategy for selected patients with symptomatic heart failure, left ventricular (LV) systolic dysfunction, and a left bundle branch block conduction abnormality. The effect of CRT on right ventricular (RV) function and possible reverse remodeling however, is less well understood and conflicting data are present. Moreover, the difficulty of accurately measuring RV hemodynamics non-invasively may also hamper research on RV systolic function in CRT patients.
Recent development of cardiac magnetic resonance (CMR) compatible CRT-devices allows for proper patient follow-up as BIV-pacing can be performed during the CMR exam. Therefore, this study assesses the effects of BIV-pacing on change in RV volumes and function using CMR.
Methods:
Ten patients eligible for CRT-D implantation according to the ESC guidelines were enrolled in this study. All patients underwent CMR imaging at baseline including cine imaging for volume and function assessment. Six weeks after CRT-D implantation, patients received a follow-up CMR scan which consisted of a two-staged imaging protocol. First, patients were scanned during BIV-pacing and thereafter the CRT was turned off and patients were scanned during intrinsic rhythm. RV end systolic volume (ESV), end diastolic volume (EDV), and ejection fraction (RVEF) were assessed on cine images. RV volumes and function before and after device implantation are compared using paired samples T-tests and results are displayed in the figure.
Results:
RV ESV, EDV, and RVEF were not different at CRT-on as compared to baseline (ESV; 88.88 ± 21.05ml vs. 94.02 ± 20.28ml, p=0.44, EDV; 175.06 ± 22.81ml vs. 182.35 ± 29.46ml, p=0.37, and RVEF; 49.59 ± 8.14% vs. 48.57 ± 6.55%, p=0.75). However, an acute deterioration in RVEF was observed when switching CRT-off (41.05 ± 5.72% vs. 48.57 ± 6.55%, p=0.02). Moreover, RV function was significantly worse during CRT-off compared to baseline in terms of RVEF (41.05 ± 5.72% vs. 49.59 ± 8.14%, p< 0.01) and higher volumes (ESV; 118.98 ± 26.40ml vs. 88.88 ± 21.05ml, p< 0.001, EDV; 175.06 ± 22.81ml vs. 182.35 ± 29.46ml, p< 0.01).
Conclusion:
This study showed that RV hemodynamics did not benefit from CRT. Moreover, turning off CRT at follow-up had an instantaneous negative effect on RV function as compared to BIV-pacing, leading to even worse RV hemodynamics as compared to baseline measurements.