Background: patients (pts) with heart failure and reduced ejection fraction (HFrEF) treated with resynchronization therapy (with or without defibrillator: CRT-D or CRT-P) require echocardiographic or device algorithms optimization for better clinical results. With remote control is further possible improve follow-up of these pts.
Methods: from 01/01/2019 42 pts treated with CRT (33 men and 9 women 30 CRT-D and 12 CRT-P) were split in 3 groups: 14 pts underwent optimization and remote control, 14 underwent optimization without remote control, 14 underwent remote control only with implant parameters.
Results: in the first group ejection fraction (EF) improved from 28 to 43% (p 0.0001)(median age 78.2 years) (y), 3 pts died (2 m and 1 w, for heart failure, neoplastic cause and pneumonia). In the second group (median age 83.3 y) EF improved from 29 to 45% (p 0.0001) 4 pts died (3 m, 1 w, all CRT-D 3 for heart failure and 1 for unknown causes). In the third group (median age 79.2 y) EF improved from 32 to 40% (p 0.012), 2 pts died (1 m and 1 w with heart failure). There weren’t relevant differences for device interventionts in the 3 groups (1 appropriate shock and 1 inappropriate shock for atrial fibrillation in the 1st group, 1 appropriate shock in the 2nd group, 1 appropriate shock in the 3rd group). In the groups with remote control a severe malfunction that needed immediate replacement of CRT and optimal elective replacement timing for 3 device were found.
Conclusions: biventricular stimolation optimization with echocardiography and with device algorythm should be always utilized after CRT implant. In our work, although the number of pts is little, a better EF is obtained in the groups with optimization compared to the group only in remote control. In the COVID19 era early recognition of arrhytmias and malfunctions of device and of suboptimal biventricular stimolation is possible with remote control and could improve pts clinical conditions, hospitalization and survival. Further data need to evaluate if remote control can improve prognosis of pts with CRT-D and CRT-P.