Current status of cardiac resynchronization therapy device optimization in Japan

BackgroundCardiac resynchronization therapy (CRT) is known to be effective for patients with heart failure. However, despite data suggesting that routine atrioventricular (AV) and interventricular (VV) delay optimization may play significant roles in CRT, there is no standard on how and when the CRT device should be optimized. The aim of this study was to characterize the current practice of CRT optimization in Japan.MethodsA survey was conducted to collect information on the procedural aspects of AV and VV delay optimization. The key survey items concerned what method is used for optimization, when optimization is performed, and what factors limit repetitive optimization.ResultsFifty-two physicians participated in the survey. Echocardiography was the chosen method for assessing AV and VV delays by 79.6% and 65.3% of physicians, respectively, and routine optimization was performed by 28.3%. The majority optimized the settings only once at pre-hospital discharge or on an “as-needed” basis. The factors limiting repeated optimization were the lack of available time (71.2%), qualified staff (53.8%), and reliable methods (55.8%).ConclusionsRepetitive CRT optimization is infrequently performed in Japan. Lack of time, human resource, and reliable methods were the major factors affecting the number of routine CRT optimization.