Coronary artery diseasePredictors of Lack of Response to Resynchronization Therapy
Section snippets
Study design
This observational, longitudinal study involved 6 centers in Spain. Enrollment began in January 2001, and patients were included consecutively. Follow-up examinations were scheduled for 6 months.
LV pacing leads were implanted transvenously through the coronary sinus, and whenever possible, in a lateral branch. In patients with sinus rhythm, the optimal atrioventricular (AV) delay was determined with pulse-wave Doppler of the LV inflow, selecting the AV delay that produced the longest LV filling
Study population
Between January 2001 and January 2003, 197 consecutive patients were scheduled to receive CRT. Twenty patients were excluded from the study because they did not undergo a baseline 6-minute walk test despite not being in NYHA functional class IV. In the remaining 177 patients, endocardial stimulation from the coronary sinus was acutely unsuccessful in 20 patients (11.3%). In 10 additional patients, pacing was only achieved at the anterior vein, in a septal position, and they were also excluded
Discussion
The major finding of the present study is the identification of simple, clinical, and echocardiographic preimplantation parameters that are able to predict a lower probability of clinical improvement with CRT in patients with heart failure and intraventricular conduction delay.
Previous multicenter studies such as the Pacing Therapies in Congestive Heart Failure (PATH-CHF),5 Multicenter InSync Randomized Clinical Evaluation,4 MUltisite STimulation In Cardiomyopathies,10 and Comparison of Medical
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Dr. Díaz-Infante was supported by a grant from Sociedad Española de Cardiología, Madrid, Spain. Investigator meetings were supported by a grant from Guidant Corporation, Madrid, Spain.