Systematic Withdrawal of Neurohumoral Blocker Therapy in Optimally Responding CRT Patients

Launched by HASSELT UNIVERSITY · Jul 24, 2014

Keywords

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Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • ≥18 years
• • CRT implantation
• * based on class I recommendations of ESC (European society of CArdiology) guidelines:
• • Left bundle branch block (LBBB) with QRS duration \>150 ms and left ventricular ejection fraction (LVEF) ≤35% who remained NYHA functional class II, III and ambulatory IV despite adequate medical treatment
• • LBBB with QRS duration 120-150 ms and LVEF ≤ 35% who remain in NYHA functional class II, III and ambulatory IV despite adequate medical treatment
• • At the moment of inclusion: ≥ 6 months after implantation
• • At the moment of inclusion: normalised LVEF (≥ 50%), LVIDD/BSA (left ventricular internal diastolic diameter indexed to body surface area) ≤3.2 cm/m²(woman) en ≤3.1 cm/m² (men) or LVDV/BSA (left ventricular diastolic volume indexed to body surface area) ≤75 ml/m² (women) or ≤75 ml/m² (men)
• • euvolemic clinical state and functioning in NYHA class I
• Exclusion Criteria:
• • contraindication for withdrawal of ACE-I/ARB such as diabetic nephropathy and proteinuria \> 1g / 24 h
• • severe ventricular arrythmia (sustained VT or ventricular fibrillation) occuring at the time LV function was normalized
• • ischemic cardiomyopathy with evidence of scarring (scarring on MRI or severe hypokinesia/akinesia in \>1 LV wall segment on echocardiography)
• • known severe coronary atherosclerosis (stenosis ≥ 80%)