Optimizing CRT for Non-Responders
Interview with Dr. Domenico Maria Carretta
Well into its third decade of clinical use, cardiac resynchronization therapy still isn’t able to help all patients with a relevant indication. One 2017 study found that up to 30 percent of patients are “non-responders.” Technology, like BIOTRONIK’s CRT AutoAdapt, is designed to improve the responder rate by optimizing AV delay and adjusting the device automatically to provide either BiV or LV-only pacing.
We spoke with Dr. Domenico Maria Carretta, from the cardiology department of the Bari Polyclinic in Italy, about his clinical experience treating CRT non-responders, and how technology that automatically adapts to a patient’s clinical needs can help.
Good morning, Dr. Carretta. Daubert’s study reported that 30 percent of CRT patients are non-responders. Is this something you see in your clinical practice as well?
Of course. My experience, and that of the center where I work, reflects what we see in the literature: around 30 percent of patients are CRT non-responders. It’s an issue in terms of patient management, as well as being frustrating for the implanting physician, because a physician obviously wants all patients to respond adequately to CRT.
Around 30 percent of patients are CRT non-responders. It’s an issue in terms of patient management, as well as being frustrating for the implanting physician implantation, because a physician obviously wants all patients to respond adequately to CRT.
So how do you tackle this issue?
First, we try to optimize device programming. An electrophysiologist and an echocardiographer need to be there. They’ll then try to find the most suitable pacing formula for each individual patient. The challenge now is that the number of patients undergoing CRT implantation is consistently increasing. You would need electrophysiologists and echocardiographers entirely devoted to the optimization processes to meet this increase, and that has subsequent implications for both cost and workload.
What do you think is the ideal solution?
The ideal solution is an automatic feature, which is the main strength of BIOTRONIK’s CRT AutoAdapt. Being automatic means that it can adapt to the patient’s clinical conditions, even if they change over time. This makes the electrophysiologist’s work much easier as they can work on their own and then liaise with the echocardiographer only when they need to check if the pacing is effective. This all has a noticeable positive impact for a clinical practice.
What are the main benefits you see in clinical practice when using an automatic system?
There is a significant impact as it dramatically reduces the resources needed to manage and care for these patients. There is no need to devote extra time to optimizing device functionality when the automatic system adapts to changes in the patient’s clinical condition. This means lower costs and the electrophysiologist has more time to perform other procedures. You can also save battery power because the lower the energy consumption — for example, if the patient only needs left ventricular pacing — the longer the battery will last. There are also numerous well-known complications associated with device replacement and an increase in battery life means fewer of these replacements for the patient.
What impact can this solution have on managing follow-up?
CRT AutoAdapt. combined with BIOTRONIK’s Home Monitoring system, is excellent. You can remotely optimize device operation so a patient doesn’t have to go to the hospital for follow-up. Fewer trips to the hospital also means caregivers don’t have to take time off. That results in a lower welfare burden for everyone. With the Home Monitoring system, we can follow CRT AutoAdapt’s operation too, as it enables us to assess the LV pacing percentage. Being able to do this remotely gives us peace of mind on the optimization of resynchronization therapy.