Cardiac Resynchronization Therapy and Left Atrial Remodeling: A Novel Insight?

Cardiac resynchronization therapy (CRT) restores ventricular dyssynchrony, improving left ventricle (LV) systolic function, symptoms, and outcome in patients with heart failure, systolic dysfunction, and prolonged QRS interval. The left atrium (LA) plays tremendous roles in maintaining cardiac function, being often inflicted in various cardiovascular diseases. LA remodeling implies structural-dilation, functional-altered phasic functions, and strain and electrical-atrial fibrillation remodeling. Until now, several important studies have approached the relationship between LA and CRT. LA volumes can predict responsiveness to CRT, being also associated with improved outcome in these patients. LA function and strain parameters have been shown to improve after CRT, especially in those who were positive responders to it. Further studies still need to be conducted to comprehensively characterize the impact of CRT on LA phasic function and strain, and, also, in conjunction with its impact on functional mitral regurgitation and LV diastolic dysfunction. The aim of this review was to provide an overview of current available data regarding the relation between CRT and LA remodeling.

Automated summary

Cardiac resynchronization therapy (CRT) improves ventricular dyssynchrony and left ventricle (LV) systolic function in heart failure patients with prolonged QRS interval. The left atrium (LA) is often affected in cardiovascular diseases and its remodeling can be characterized by structural-dilation, altered phasic functions, and atrial fibrillation remodeling. Studies have shown that LA volumes can predict CRT responsiveness and improved outcome. LA function and strain parameters also improve in positive responders to CRT. Further research is needed to fully understand the impact of CRT on LA function and strain, as well as its effects on functional mitral regurgitation and LV diastolic dysfunction.