Resynchronisation therapy 581

Resynchronisation therapy

581

response to CRT than patients with intrinsic BBB. Baseline RV pacing and haemodynamic parameters predicted haemodynamic response but QRS duration had no predictive value.

P3164 | BEDSIDE Trying to predict the unpredictable:device-based daily monitored parameters can predict malignant arrhythmic events in patients undergoing cardiac resynchronization R. Lenarczyk 1 , E. Jedrzejczyk-Patej 2 , O. Kowalski 2 , B. Sredniawa 2 , P. Pruszkowska 2 , A. Sokal 2 , M. Szulik 2 , M. Mazurek 2 , J. Kowalczyk 2 , Z. Kalarus 2 on behalf of TRUST CRT Trial Investigators. 1 Silesian Medical University, Silesian Center for Heart Disease, Zabrze, Poland; 2 Medical University of Silesia, SCHD, Dpt. of Cardiology, Congenital Heart Disease & Electrotherapy, Zabrze, Poland

P3165 | BENCH Ventricular interaction rather than electrical resynchronisation determines haemodynamic response to cardiac resynchronisation therapy in dyssynchronous heart failure J. Lumens 1 , S. Ploux 2 , M. Strik 3 , J. Gorcsan 4 , M. Haissaguerre 2 , P. Ritter 2 , P. Jais 2 , T. Delhaas 1 , F.W. Prinzen 3 , P. Bordachar 2 . 1 Cardiovascular Research Institute Maastricht, Maastricht University, Dept of Biomedical Engineering, Maastricht, Netherlands; 2 IHU Liryc – Inserm U1045 CRCTB – Bordeaux Segalen University, Bordeaux-Pessac, France; 3 Cardiovascular Research Institute Maastricht, Maastricht University, Dept of Physiology, Maastricht, Netherlands; 4 University of Pittsburgh Medical Center, Pittsburgh, United States of America Purpose: It is still unclear why left ventricular and biventricular pacing (LVP and BiVP, respectively) have comparative positive effects on haemodynamic function of patients with dyssynchronous heart failure (HF). To enhance understanding of the working mechanism of cardiac resynchronisation therapy (CRT), we assessed haemodynamic and local electromechanical consequences of LVP in comparison to BiVP. Methods: Haemodynamic response to LVP and BiVP (%-change LVdP/dtmax) was measured in 6 dogs with HF and left-bundle branch block (LBBB) and in 40 HF patients with QRS-width ≥120ms, followed by computer simulations of local myofibre mechanics during LVP and BiVP in the failing heart with LBBB. Pacinginduced changes of electrical activation were measured in dogs using contact mapping and in patients using a noninvasive multielectrode epicardial electrocardiographic mapping technique. Results: LVP and BiVP similarly increased LVdP/dtmax in dogs (p=0.33) and in patients (p=0.93), but only BiVP significantly decreased electrical dyssynchrony (Figure). In the simulations, LVP and BiVP increased total ventricular myofibre work to the same extent (Figure). While the LVP-induced increase was entirely due to enhanced right ventricular (RV) myofibre work, the BiVP-induced increase was due to enhanced myofibre work of both the LV and RV. Overall, LVdP/dtmax correlated better with total ventricular myofibre work than with LV or RV myofibre work alone.

P3166 | BEDSIDE Lack of improvement in quality of life after cardiac resynchronization therapy is a potent determinant of unfavorable outcomes independently from functional and echocardiographic response R. Lenarczyk 1 , E. Jedrzejczyk-Patej 2 , O. Kowalski 2 , B. Sredniawa 2 , P. Pruszkowska 2 , A. Sokal 2 , M. Szulik 2 , M. Mazurek 2 , J. Kowalczyk 2 , Z. Kalarus 2 on behalf of TRUST CRT Trial Investigators. 1 Silesian Medical University, Silesian Center for Heart Disease, Zabrze, Poland; 2 Medical University of Silesia, SCHD, Dpt. of Cardiology, Congenital Heart Disease & Electrotherapy, Zabrze, Poland Background: Cardiac resynchronization therapy is highly effective in improving many objective and subjective indices in a subgroup of Heart Failure (HF) patients. The prognostic impact of improvement in Quality of Life (QoL) due to CRT has never been evaluated. Aim of the study: We aimed at assessing if range of QoL improvement after pacing influences future outcomes in CRT patients. Material and methods: Patients participating in TRUST CRT randomized trial, with HF in NYHA class III-IV, QRS width ≥120ms, left ventricular ejection fraction ≤35% and significant mechanical dyssynchrony were included. Ninety-seven participants (21 female, median age 61, 61% ischemic) of who survived 6 months after randomization were analyzed in this substudy. All subjects fulfilled Minnesota quality of life questionnaire prior to and 6 months after CRT-D implantation. Data on Major Adverse Cardiac Events (MACE - death, HF hospitalization or heart transplant) collected within the next 1.5 year and adjudicated blindly were censoring variables. Results: Within the first 6 months of resynchronization QoL scores improved in 81%, while worsened in 19% of patients (median change 14 points, interquartile range 23). During subsequent 1.5 year MACEs occurred in 33% of patients, including 17% who died. Patients who experienced MACE had higher baseline creatinine, NT-proBNP levels, greater left atrium, severity of mitral regurgitation and were taking more often Digoxin. Subjects without QoL improvement were significantly (both P