Intracardiac conduction time as a predictor of cardiac resynchronization therapy response: Results of the BIO|SELECT pilot study

Kyoko Soejima; Yusuke Kondo; Shingo Sasaki; Kazumasa Adachi; Ritsushi Kato; Nobuhisa Hagiwara; Tomoo Harada; Kengo Kusano; Fumiharu Miura; Itsuro Morishima; Kazuyasu Yoshitani; Akihiko Yotsukura; Manabu Fujimoto; Nobuhiro Nishii; Kenji Shimeno; Masatsugu Ohe; Hiroshi Tasaka; Hiroto Sasaki; Juergen Schrader; Kenji Ando

doi:10.1016/j.hroo.2021.09.007

Intracardiac conduction time as a predictor of cardiac resynchronization therapy response: Results of the BIO|SELECT pilot study

Heart Rhythm O2. 2021 Sep 28;2(6Part A):588-596. doi: 10.1016/j.hroo.2021.09.007. eCollection 2021 Dec.

Authors

Kyoko Soejima¹, Yusuke Kondo², Shingo Sasaki³, Kazumasa Adachi⁴, Ritsushi Kato⁵, Nobuhisa Hagiwara⁶, Tomoo Harada⁷, Kengo Kusano⁸, Fumiharu Miura⁹, Itsuro Morishima¹⁰, Kazuyasu Yoshitani¹¹, Akihiko Yotsukura¹², Manabu Fujimoto¹³, Nobuhiro Nishii¹⁴, Kenji Shimeno¹⁵, Masatsugu Ohe¹⁶, Hiroshi Tasaka¹⁷, Hiroto Sasaki¹⁸, Juergen Schrader¹⁹, Kenji Ando²⁰

Affiliations

¹ Kyorin University Hospital, Tokyo, Japan.
² Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
³ Department of Cardiology and Nephrology, Hirosaki University, Graduate School of Medicine, Aomori, Japan.
⁴ Akashi Medical Center, Hyogo, Japan.
⁵ Saitama Medical University, Saitama, Japan.
⁶ Tokyo Women's Medical University Hospital, Tokyo, Japan.
⁷ St. Marianna University School of Medicine, Kanagawa, Japan.
⁸ National Cerebral and Cardiovascular Center, Osaka, Japan.
⁹ Hiroshima Prefectural Hospital, Hiroshima, Japan.
¹⁰ Ogaki Municipal Hospital, Gifu, Japan.
¹¹ Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan.
¹² Hokko Memorial Hospital, Hokkaido, Japan.
¹³ Kouseiren Takaoka Hospital, Toyama, Japan.
¹⁴ Okayama University Hospital, Okayama, Japan.
¹⁵ Osaka City General Hospital, Osaka, Japan.
¹⁶ Kurume University Hospital, Fukuoka, Japan.
¹⁷ Kurashiki Central Hospital, Okayamai, Japan.
¹⁸ BIOTRONIK JAPAN, Inc, Tokyo, Japan.
¹⁹ BIOTRONIK SE & CO KG, Berlin, Germany.
²⁰ Kokura Memorial Hospital, Fukuoka, Japan.

Abstract

Background: Quadripolar left ventricular (LV) leads are capable of sensing and pacing the left ventricle from 4 different electrodes, which may potentially improve patient response to cardiac resynchronization therapy (CRT).

Objective: We measured 3 different time intervals: right ventricular (RV)-sensed to LV-sensed during intrinsic rhythm (RVs-LVs), RV-paced to LV-sensed (RVp-LVs), and LV-paced to LV-sensed (LVp-LVs, between distal [LV1] and proximal pole on a quadripolar LV lead), and assessed their association with CRT response in terms of LV end-systolic volume (LVESV) and a composite benefit index (CBI) comprising LVESV, LV ejection fraction (LVEF), brain natriuretic peptide level, and NYHA class.

Methods: A CRT-defibrillator system with quadripolar LV lead was implanted in 196 patients (mean age 69 years, mean LVEF 30%, left bundle-branch block [LBBB] 58%). Conduction intervals were measured before hospital discharge. At baseline and 7-month follow-up, echocardiographic and other components of CBI were determined.

Results: The mean RVs-LV1s, RVp-LV1s, and LVp-LVs delays were 68 ± 38 ms, 132 ± 34 ms, and 99 ± 31 ms, respectively. From baseline to 7 months, LVESV decreased by 17.3% ± 28.6%. The RVs-LV1s interval correlated stronger with CBI (R² = 0.12, P < .00001) than with LVESV change (R² = 0.05, P = .006). In contrast, RVp-LV1s did not correlate and LVp-LVs correlated only weakly with CRT response. The subgroup of patients (44%) with LBBB and RVs-LV1s above the lower quartile (≥34 ms) showed the greatest response to CRT.

Conclusion: The RVs-LVs interval during intrinsic rhythm is relevant for CRT success, whereas RVp-LVs and LVp-LVs intervals did not predict CRT response.

Keywords: CRT response; Cardiac resynchronization therapy (CRT); Composite benefit index; Interventricular electrical delay; Left ventricular end-systolic volume; Quadripolar left ventricular lead.