Electrical optimization can overcome gender bias in CRT outcomes, JACC study.
Why women benefit more from cardiac resynchronization therapy (CRT) than men, is still an unexplained observation. Exploring this enigma, Lopez et al have 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 accounting for a better response. Their recent study shows that the difference in QRS interval duration and response between men and women does not persist when CRT was optimized using fusion with intrinsic conduction. These findings were published in an online edition of JACC Clinical Electrophysiology this week.
Subanalyses of randomized clinical trials and meta-analyses have shown that women achieve better CRT outcomes than men. Previous findings in the BEST (Fusion Based optimization in resynchronization Therapy demonstrated that CRT optimization based on the fusion-optimized intervals (FOI) method resulted in a narrower QRS interval and greater LV remodeling compared to nominal settings.
Lopez et al hypothesized that women respond better to CRT because their shorter PR interval promotes better spontaneous fusion with intrinsic conduction, resulting in a narrower QRS interval and better resynchronization. Controlling this factor by optimizing CRT with the FOI method would eliminate sex differences in CRT outcomes.
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