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Cardiac resynchronization therapy guided by cardiac magnetic resonance imaging: a prospective, single centre randomized study

Session Guided CRT and specific population

Speaker Kamil Sedlacek

Event : EHRA 2018

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Moderated Posters

Authors : K Sedlacek (Prague,CZ), R Kockova (Prague,CZ), D Wichterle (Prague,CZ), J Kautzner (Prague,CZ)

Authors:
K Sedlacek1 , R Kockova1 , D Wichterle1 , J Kautzner1 , 1IKEM - Prague - Czech Republic ,

Citation:
European Heart Journal Supplements ( 2018 ) 20 ( Supplement 1 ), i104

Background: Cardiac resynchronization therapy (CRT) improves symptoms of heart failure (HF), morbidity and mortality in selected population.
Purpose: The aim of the CMR-CRT study was to investigate the impact of cardiac magnetic resonance (CMR)-guided left ventricular (LV) lead placement on LV remodeling and clinical events in recipients of CRT.
Methods: Patients with CRT indication between 2011-2014 were randomized for CMR-guided (CMR group) or electrophysiologically (EP) guided (EP group) LV lead placement. The target site in the CMR group was defined as the most delayed and scar-free, in the EP group as site with the longest interval between the QRS onset and local electrogram. The primary endpoint was a combination of HF death and HF hospitalization. Secondary endpoints were New York Heart Association (NYHA) Class improvement =1, LV endsystolic diameter reduction >10%, B-type natriuretic peptide reduction by =30%.
Results: A total of 99 patients (47 in the CMR and 52 in the EP group) were enrolled. During a median follow-up of 47 months, primary composite endpoint occurred in 5 patients in the CMR group and 12 patients in the EP group (log rank P = 0.14). Patients with left bundle branch block and NYHA Class >2 had better clinical outcome in the CMR group (P = 0.005).
Conclusion: The use of CMR did not result in significant reduction of combined clinical endpoint of HF hospitalization or death in the total study population. Significant clinical benefit from CMR-guided procedure was observed in a subgroup of optimum CRT candidates with advanced HF.

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