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Cardiac Resynchronization Therapy Response Is Equalized in Men and Women by Electrical Optimization: PR Matters.
Pujol-López, Margarida; Tolosana, José María; Guasch, Eduard; Trucco, Emilce; Jiménez-Arjona, Rafael; Borràs, Roger; Garre, Paz; San Antonio, Rodolfo; Doltra, Ada; Roca-Luque, Ivo; Arbelo, Elena; Alarcón, Francisco; Castel, María Ángeles; Sitges, Marta; Varma, Niraj; Mont, Lluís.
Affiliation
  • Pujol-López M; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.
  • Tolosana JM; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain.
  • Guasch E; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain. Electronic address: eguasch@clini
  • Trucco E; Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta, Girona, Catalonia, Spain.
  • Jiménez-Arjona R; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain.
  • Borràs R; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.
  • Garre P; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.
  • San Antonio R; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain.
  • Doltra A; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.
  • Roca-Luque I; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.
  • Arbelo E; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain.
  • Alarcón F; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain.
  • Castel MÁ; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain.
  • Sitges M; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain.
  • Varma N; Cardiac Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
  • Mont L; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain. Electronic address: lmont@clinic.
JACC Clin Electrophysiol ; 7(11): 1400-1409, 2021 11.
Article in En | MEDLINE | ID: mdl-34217660
ABSTRACT

OBJECTIVES:

This study hypothesized that the shorter intrinsic PR interval observed in women allows a greater degree of fusion with intrinsic conduction, achieving a shorter QRS interval duration and, thus, a better response.

BACKGROUND:

Women benefit more from cardiac resynchronization therapy (CRT) than men. However, the reason for this difference remains elusive.

METHODS:

A cohort of 180 patients included in the BEST (Fusion based optimization in resynchronization therapy [ECG Optimization of CRT Evaluation of Mid-Term Response]; NCT01439529) study were retrospectively analyzed. Patients were initially randomized to either nonoptimized CRT (NON-OPT group; n = 89) or electrocardiographically optimized CRT based on the fusion-optimized intervals (FOI) method (FOI group; n = 91). Echocardiographic response was defined as a >15% decrease in left ventricular end-systolic volume at the 12-month follow-up.

RESULTS:

The basal PR interval was shorter in women as compared to men. In the NON-OPT group, CRT resulted in a shorter paced QRS interval in women than in men (134 ± 21 ms vs. 151 ± 21 ms, respectively; p = 0.003, 95% confidence interval [CI] -27 to -5.6) and better response in women than in men 70.4% vs. 46.4%, respectively (odds ratio 0.37; p = 0.04; 95% CI 0.14 to 0.97). There were no differences in paced QRS interval duration (126 ± 13 ms vs. 129 ± 17 ms; p = 0.47) or response between women and men in the FOI group (68% vs. 70.5%; odds ratio 1.12; p = 0.82; 95% CI 0.41 to 3.07). FOI extended the atrioventricular interval to obtain the best fusion; the atrioventricular intervals tended to require greater extension in men than in women (22 ± 33 ms vs. 8 ± 28 ms, respectively; p = 0.07).

CONCLUSIONS:

Women had a shorter PR interval, which was associated with a shorter QRS interval and better response to CRT. The difference in QRS interval duration and response between men and women did not persist when CRT was optimized using fusion with intrinsic conduction (FOI programming).
Subject(s)
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cardiac Resynchronization Therapy / Heart Failure Type of study: Observational_studies Limits: Female / Humans / Male Language: En Journal: JACC Clin Electrophysiol Year: 2021 Type: Article Affiliation country: Spain

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cardiac Resynchronization Therapy / Heart Failure Type of study: Observational_studies Limits: Female / Humans / Male Language: En Journal: JACC Clin Electrophysiol Year: 2021 Type: Article Affiliation country: Spain