P7 HEMODYNAMIC DEVICE BASED SENSOR TO CRT OPTIMIZATION

Abstract

Abstract Cardiac resynchronization therapy (CRT) is an effective and established therapy for patients with medically refractory heart failure (HF), left ventricular (LV) ejection fraction ≤ 35%, and a wide QRS complex; CRT obtained notable results but there is a not negligible rate of patients considered clinical and/or instrumental non responder. Amongst several factors that could adversely affect response, suboptimal optimization of the atrioventricular (AV) timing is the most common and most supposed correctable variable to achieve optimal outcome from CRT. All companies have a specific algorithm to obtain an automatic optimization of AV timing, among these Microport has developed a different approach to perform this automatic optimization based on a hemodynamic sensor. The SonR sensor, embedded in the tip of an atrial pacing lead, is able to perform automatic optimization recording mechanical vibration generated by cardiac contraction. The aim of the present study has been to correlate the variability of AV interval, automatically programmed by SonR sensor, with echocardiographic response. 57 patients eligible for CRT–D implantation were included in the study, for all patients programmed follow–up were performed at 6 and 12 months. We have defined three different CRT response classes: Responder A with LVESV reduction > 15%, Responder B with LVEF > 40% and Responder S (Super Responder) if the patient was at the same time Responder A and B. At 12–month follow–up we recorded the following results: Responder A = 69%, Responder B = 59% and Responder S = 55%. In all patients we decided to analyse the variability of the A–V timing controlled by SonR algorithm, we used the coefficient of variation (CV) that appears to be among the most widespread and validated in the literature. The highest values of the CV index are significantly correlated to RESP S and RESP A patients compared to the relative groups of non–responders. In conclusion, the SonR is able to improve the performance of the CRT in the majority of patients by ensuring a high variability of the programmed AV interval. Furthermore, it has been shown that as the CV index increases, the probability of response to CRT increases.