Interruption of short-term cardiac resynchronization therapy (CRT) has been shown
to acutely worsen left ventricular (LV) function, mitral regurgitation, and LV dyssynchrony.
The present study aims to assess whether LV reverse remodeling influences interruption
of CRT, and, more practically, whether long-term continuous pacing is necessary in
patients with reverse LV remodeling. A total of 135 recipients of CRT were selected
after showing LV reverse remodeling defined as a decrease in LV end-systolic volume
≥15% after 6 months of CRT (“responders”). Echocardiography was performed at baseline
and after 6 months with intermittent CRT on and off. LV dyssynchrony was determined
using tissue Doppler imaging. During interruption of CRT, an acute deterioration in
LV function, mitral regurgitation, and LV desynchronization were noted in responder
patients. Of note, worsening of these echocardiographic measurements was observed,
but they did not return to baseline values. For comparison, 100 nonresponder patients
(without LV reverse remodeling) showed no significant echocardiographic changes during
interruption. In conclusion, despite the presence of LV reverse remodeling, interruption
of CRT resulted in worsening of LV function and desynchronization. Therefore, continuous
long-term pacing is warranted to maintain the beneficial effects.
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Article info
Publication history
Published online: June 20, 2008
Accepted:
May 1,
2008
Received in revised form:
May 1,
2008
Received:
March 24,
2008
Footnotes
This work was supported by the Dutch Heart Foundation, The Hague, The Netherlands, Grant 2002B109. Dr. Bax received research grants from GE Healthcare, BMS medical imaging, Boston Scientific, Medtronic, and St. Jude. Dr. Schalij received research grants from Biotronik, Medtronic, and Boston Scientific.
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Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
