PO-02-008 OPTIMIZATION OF ADAPTIVE CRT NONRESPONDERS USING ELECTRICAL DYSSYNCHRONY MAPPING

We have previously demonstrated that optimization of CRT nonresponders using electrical dyssynchrony mapping (EDM) significantly improves LV size and systolic function. Adaptive (aCRT) pacing algorithm heart function clinical outcomes in select patients. However whether aCRT can be improved with is unknown. To assess the effects (using a novel measure wavefront fusion cancellation called EDM) on left ventricular (LV) programmed aCRT. studied 28 nonresponder patients 3.0 ± 3.3 years post-implantation. The area under curves (AUC) between 9 anterior/9 posterior electrograms was measured at multiple combinations atrial-ventricular ventricular-ventricular delays (AVD, VVD). Electrical quantified by cardiac resynchronization index (CRI), calculated as % change AUC all anterior electrograms, compared to native (CRI values 0-100%). EDM atrial-to-LV-paced (A-LVp) interval x-axis atrial-to-RV-paced (A-RVp) y-axis depicted CRI over wide range settings tested. Echocardiograms speckle-tracking were analyzed blinded fashion pre-optimization 4-6 months post-optimization. (Figure) LV-only 130 ms AVD 58%) optimized 90 93%). EF from 33% 40%. Table shows significant improvements (43.5%), ejection fraction (5.4%), LVESV (12.8 ml), global transverse (1.4%) longitudinal strain (2.5%) patient cohort. Nonresponders are 46% electrically resynchronized baseline improve 90% EDM. technology synchrony, This methodology provides non-invasive, practical approach quantifying AVDs/VVDs then optimizing nonresponders.Tabled 1Dyssynchrony echo variables pre- post-optimizationVariablePre-optimizationPost-optimizationp-valueCRI (%)46.4 25.689.9 11.7≤ 0.001LVEF (%)31.9 4.637.3 6.0≤ 0.001LVEDV (ml)154.9 56.6146.3 51.60.133LVESV (ml)106.1 41.893.3 38.20.024Longitudinal (%)-12.0 2.2-13.4 2.60.017Transverse (%)17.9 4.120.4 5.30.010 Open table new tab