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Mid-term clinical and echocardiographic evaluation of super responders with and without pacing: the preliminary results of a prospective, randomized, single-centre study.

AIMS
Super response to cardiac resynchronization therapy (CRT) is related to excellent long-term prognosis. However, it is not known whether super responders (SRs) are in remission or have made a complete recovery. In other words, is CRT a destination therapy or a bridge to recovery? The objective was to assess the evolution of the clinical and echocardiographic data of SRs without pacemaker activity at the mid-term follow-up.


METHODS AND RESULTS
A total of 19 SRs were randomly assigned to a deactivated pacemaker function (Off-Pace group) or a continued pacemaker activity (On-Pace group). Clinical and echocardiographic parameters were evaluated before implantation, at randomization, and after 6 and 12 months of this randomization. Patients assigned to the Off-Pace group deteriorated in terms of the New York Heart Association class (from 1.3 ± 0.5 to 2.4 ± 0.7), 6-min walk distance (from 569 ± 68 to 343 ± 162 m), and echocardiographic data, including left ventricular ejection fraction (from 55 ± 3 to 36 ± 12%), left ventricular end-systolic volume (from 61 ± 10 to 117 ± 36 mL), left ventricular end-diastolic diameter (from 53 ± 3 to 61 ± 6 mm), and left ventricular end-systolic diameter (from 40 ± 3 to 53 ± 8 mm) at 12 months, whereas no change was observed in the On-Pace group. Turning off the pacemaker function was also related to hospitalization for heart failure and appropriate cardioverter-defibrillator device intervention.


CONCLUSION
Super responders without pacing had poor clinical and echocardiographic outcomes at the mid-term follow-up.