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Adaptive Cardiac Resynchronization Therapy Effect on Electrical Dyssynchrony (aCRT-ELSYNC): a randomized controlled trial.
  • +20
  • Kazi Haq,
  • Nichole Rogovoy,
  • Jason Thomas,
  • Christopher Hamilton,
  • Katherine Lutz,
  • Ashley Wirth,
  • Aron Bender,
  • David German,
  • Ryle Przybylowicz,
  • Peter Van Dam,
  • Thomas Dewland,
  • Khidir Dalouk,
  • Eric Stecker,
  • Babak Nazer,
  • Peter Jessel,
  • Karen MacMurdy,
  • Ignatius Gerardo Zarraga,
  • Bassel Beitinjaneh,
  • Charles Henrikson,
  • Merritt Raitt,
  • Cristina Fuss,
  • Maros Ferencik,
  • Larisa Tereshchenko
Kazi Haq
Oregon Health & Science University

Corresponding Author:haqk@ohsu.edu

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Nichole Rogovoy
Oregon Health & Science University
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Jason Thomas
Oregon Health & Science University
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Christopher Hamilton
Oregon Health & Science University
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Katherine Lutz
Oregon Health & Science University
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Ashley Wirth
Oregon Health & Science University
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Aron Bender
Oregon Health & Science University
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David German
Oregon Health & Science University
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Ryle Przybylowicz
Oregon Health & Science University Knight Cardiovascular Institute
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Peter Van Dam
UMC Utrecht
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Thomas Dewland
University of California San Francisco
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Khidir Dalouk
Portland VA Medical Center
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Eric Stecker
Oregon Health & Science University
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Babak Nazer
Oregon Health & Science University
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Peter Jessel
Portland VA Medical Center
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Karen MacMurdy
Portland VA Medical Center
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Ignatius Gerardo Zarraga
Portland VA Medical Center
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Bassel Beitinjaneh
Oregon Health & Science University Knight Cardiovascular Institute
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Charles Henrikson
Oregon Health & Science University
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Merritt Raitt
Portland VA Medical Center
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Cristina Fuss
Oregon Health & Science University
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Maros Ferencik
Oregon Health & Science University
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Larisa Tereshchenko
Oregon Health & Science University School of Medicine
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Abstract

Introduction: Adaptive cardiac resynchronization therapy (aCRT) is known to have clinical benefits over conventional CRT. We aimed to compare the effects of aCRT and conventional CRT on electrical dyssynchrony. Methods: We conducted a double-blind, randomized controlled trial in patients receiving CRT for routine clinical indications. Participants underwent cardiac computed tomography and 128-electrodes body surface mapping. We measured electrical dyssynchrony on the epicardial surface using noninvasive electrocardiographic imaging (ECGI) before and 6 months post-CRT. Ventricular electrical uncoupling (VEU) was calculated as the difference between the mean left ventricular (LV) and right ventricular (RV) activation times. An electrical dyssynchrony index (EDI) was computed as the standard deviation of local epicardial activation times. Results: We randomized 27 participants (mean age 64±12 y; 34% female; 53% ischemic cardiomyopathy; LV ejection fraction 28±8%; QRS duration 155±21 ms; strict left bundle branch block (LBBB) in 13%) to conventional CRT (n=15) versus aCRT (n=12). In atypical LBBB (n=11;41%) with S-waves in V5-V6, conduction block occurred in the anterior RV, as opposed to the interventricular groove in those who met the strict LBBB criteria. As compared to baseline, VEU reduced post-CRT in aCRT (median reduction 18.9 (interquartile range 4.3-29.2 ms; P=0.034), but not in conventional CRT (21.4 (-30.0 to 49.9 ms; P=0.525) group. There were no differences in the degree of change in VEU and EDI indices between treatment groups. Conclusion: The effect of aCRT and conventional CRT on electrical dyssynchrony is largely similar.
Aug 2021Published in Heart Rhythm O2 volume 2 issue 4 on pages 374-381. 10.1016/j.hroo.2021.06.006