CRT11: VARIATION OF CRT RESPONSE DURING FOLLOW-UP: ASSESMENT AND REPROGRAMMING.

In CRT follow-up, when heart remodelling occurs, what is lacking is a means for a continuous monitoring of individual responses to automatically guide, when it is necessary, an optimal reprogramming of pacing configuration.The area of Peak Endocardial Acceleration (PEAarea) curve versus AV delay (AVD) depends on changes of both transmitral Doppler flow and contractility. Consequently the selection of CRT configuration corresponding to the maximum PEAarea allows to obtain the greatest hemodynamic benefit at implant and during the follow-up.Aim of the study to evaluate individual response to CRT during follow-up by the assessment of PEAarea at different pacing configurations. Methods In 8 patients with impaired LV function (NYHA class III or IV and QRS>150ms) a biventricular pacemaker (Living CHF, Sorin), connected to a right ventricular lead microaccelerometer sensor to record the PEA signal, was implanted. At implant and 3 months later, for each pacing configuration (BiV0, LV, LR20,LR40,RL20,RL40), AVD scanning (ranging from 60 to 300 ms) was performed and PEA was continuously recorded. PEAarea was calculated as the mean of PEA values during AVD scanning. Results At 3 months follow-up, in 4 patients PEAarea method confirmed the optimal pacing configurations selected at implant time, in 2 patients the optimal pacing configuration was changed and 2 patients resulted non responder (n.r.). Conclusions PEA signal versus AVD scanning may be a valid means to assess CRT response and to guide CRT reprogramming during follow-up. [ABSTRACT FROM PUBLISHER]