Contractility sensor-guided optimization of cardiac resynchronization therapy: results from the RESPOND-CRT trial

Josep Brugada, Peter Paul Delnoy, Johannes Brachmann, Dwight W. Reynolds, Luigi Padeletti, Georg Noelker, Charan Kantipudi, José Manuel Rubin Lopez, Wolfgang Dichtl, Alberto Borri-Brunetto, Luc Verhees, Philippe Ritter, Jagmeet P. Singh, RESPOND CRT Investigators

Research output: Contribution to journalArticle

Abstract

AIMS: Although cardiac resynchronization therapy (CRT) is effective in patients with systolic heart failure (HF) and a wide QRS interval, a substantial proportion of patients remain non-responsive. The SonR contractility sensor embedded in the right atrial lead enables individualized automatic optimization of the atrioventricular (AV) and interventricular (VV) timings. The RESPOND-CRT study investigated the safety and efficacy of the contractility sensor system in HF patients undergoing CRT.

METHODS AND RESULTS: RESPOND-CRT was a prospective, randomized, double-blinded, multicentre, non-inferiority trial. Patients were randomized (2:1, respectively) to receive weekly, automatic CRT optimization with SonR vs. an Echo-guided optimization of AV and VV timings. The primary efficacy endpoint was the rate of clinical responders (patients alive, without adjudicated HF-related events, with improvement in New York Heart Association class or quality of life), at 12 months. The study randomized 998 patients. The rate of responders was 75.0% in the SonR group vs. 70.4% within the Echo group (mean difference, 4.6%; 95% CI, 1.4% to 10.6%; P < 0.001 for non-inferiority margin 10.0%). At an overall mean follow-up of 548 ± 190 days SonR was associated with a 35% risk reduction in HF hospitalization (hazard ratio, 0.65; 95% CI, 0.46-0.92; log-rank P = 0.01).

CONCLUSION: Automatic AV and VV optimization using the contractility sensor was safe and as effective as Echo-guided AV and VV optimization in increasing response to CRT.

CLINICALTRIALSGOV NUMBER: NCT01534234.

Original languageEnglish
JournalEuropean Heart Journal
DOIs
Publication statusE-pub ahead of print - Dec 9 2016

Keywords

  • Journal Article

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    Brugada, J., Delnoy, P. P., Brachmann, J., Reynolds, D. W., Padeletti, L., Noelker, G., Kantipudi, C., Rubin Lopez, J. M., Dichtl, W., Borri-Brunetto, A., Verhees, L., Ritter, P., Singh, J. P., & RESPOND CRT Investigators (2016). Contractility sensor-guided optimization of cardiac resynchronization therapy: results from the RESPOND-CRT trial. European Heart Journal. https://doi.org/10.1093/eurheartj/ehw526