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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/13427

Title: Insights From a Cardiac Resynchronization Optimization Clinic as Part of a Heart Failure Disease Management Program
Authors: Mullens, Wilfried
Grimm, Richard A.
Verga, Tanya
Dresing, Thomas
Starling, Randall C.
Wilkoff, Bruce L.
Tang, W. H. Wilson
Issue Date: 2009
Abstract: Objectives Our aim was to determine the feasibility and value of a protocol-driven approach to patients with cardiac resynchronization therapy (CRT) who did not exhibit a positive response long after implant. Background Up to one-third of patients with advanced heart failure do not exhibit a positive response to CRT. Methods A total of 75 consecutive ambulatory patients with persistent advanced heart failure symptoms and/or adverse reverse remodeling and CRT implanted >6 months underwent a comprehensive protocol-driven evaluation to determine the potential reasons for a suboptimal response. Recommendations were made to maximize the potential of CRT, and adverse events were documented. Results All patients ( mean left ventricular [LV] ejection fraction 23 +/- 9%, LV end-diastolic volume 275 +/- 127 ml) underwent evaluation. Eighty-eight percent of patients had significantly better echocardiographic indexes of LV filling and LV ejection with optimal setting of their CRT compared with a temporary VVI back-up setting. Most patients had identifiable reasons for suboptimal response, including inadequate device settings (47%), suboptimal medical treatment (32%), arrhythmias ( 32%), inappropriate lead position (21%), or lack of baseline dyssynchrony ( 9%). Multidisciplinary recommendations led to changes in device settings and/or other therapy modifications in 74% of patients and were associated with fewer adverse events (13% vs. 50%, odds ratio: 0.2 [95% confidence interval: 0.07 to 0.56], p = 0.002) compared with those in which no recommendation could be made. Conclusions Routine protocol-driven approach to evaluate ambulatory CRT patients who did not exhibit a positive response is feasible, and changes in device settings and/or other therapies after multidisciplinary evaluation may be associated with fewer adverse events.
URI: http://hdl.handle.net/1942/13427
DOI: 10.1016/j.jacc.2008.11.024
ISI #: 000263667200006
ISSN: 0735-1097
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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