Association between electrical and mechanical remodeling after cardiac resynchronization therapy: systematic review and meta-analysis of observational studies

Pilecky, Dávid; Duray, Gabor Z.; Elsner, Dietmar; Israel, Carsten W.; Erath-Honold, Julia W.; Vámos, Máté

doi:10.1007/s10741-022-10234-w

Cited by 3 publications

(1 citation statement)

References 45 publications

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“…Furthermore, it is debatable whether the increased morbidity in our study population and higher patient number might have contributed to a significantly different response rate to CRT, based on digitalis treatment. It should also be noted that patients on digitalis had less often QRS narrowing in our analysis, which can also explain the decreased echocardiographic and clinical response in this patient group [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT-Recipients

Erath,

Vigh,

Muk

et al. 2024

JCDD

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(1) Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT). (2) Methods: Consecutive patients receiving a CRT-defibrillator in three European tertiary referral centers were enrolled and followed-up for a mean 37 months ± 28 months. Digitalis use was assessed at the time of CRT implantation. A multivariate Cox-regression model and propensity score matching were used to determine all-cause mortality as the primary endpoint. CRT-response (defined as improvement of ≥1 NYHA class), echocardiographic improvement (defined as improvement of LVEF of ≥ 5%) and incidence of ICD shocks and rehospitalization were assessed as secondary endpoints in a subgroup of patients. (3) Results: The study comprised 552 CRT-recipients with standard indications, including 219 patients (40%) treated with digitalis. Compared to patients without digitalis, they had more often atrial fibrillation, poorer LVEF and a higher NYHA class (all p ≤ 0.002). Crude analysis of all-cause mortality demonstrated a similar relative risk of death for patients with and without digitalis (HR = 1.14; 95% CI 0.88–1.5; p = 0.40). After adjustment for independent predictors of mortality, digitalis therapy did not alter the risk for death (adjusted HR = 1.04; 95% CI 0.75–1.45; p = 0.82). Furthermore, in comparison to 286 propensity-score-matched patients, mortality was not affected by digitalis intake (propensity-adjusted HR = 1.11; 95% CI 0.72–1.70; p = 0.64). A CRT-response was predominant in digitalis non-users, concerning both improvement of HF symptoms and LVEF (NYHA p < 0.01; LVEF p < 0.01), while patients on digitalis had more often ventricular tachyarrhythmias requiring ICD shock (p = 0.01); although, rehospitalization for cardiac reasons was significantly lower among digitalis users compared to digitalis non-users (HR = 0.58; 95% C. I. 0.40–0.85; p = 0.01). (4) Conclusions: Digitalis therapy had no effect on mortality, but was associated with a reduced response to CRT and increased susceptibility to ventricular arrhythmias requiring ICD shock treatment. Although, digitalis administration positively altered the likelihood for cardiac rehospitalization during follow-up.

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Section: Discussionmentioning

confidence: 99%

Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT-Recipients

Erath,

Vigh,

Muk

et al. 2024

JCDD

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Reverse electrical remodelling after cardiac resynchronization therapy in a patient undergoing left bundle branch area pacing: a case report

Rijks,

Luermans,

Vernooy

2024

European Heart Journal - Case Reports

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Background Left bundle branch area pacing (LBBAP) has been introduced as an alternative to biventricular pacing in cardiac resynchronization therapy (CRT). Several studies describe echocardiographic reverse remodeling after LBBAP. Reverse electrical remodeling after LBBAP has not yet been described. Case summary A 77-year-old female with non-ischemic heart failure with reduced ejection fraction (LVEF 30-35%), left bundle branch block (QRS duration 164ms) and symptomatic atrial fibrillation irresponsive to pharmacological therapy was evaluated for CRT with LBBAP and AV node ablation. Successful LBBAP implantation resulted in confirmed left bundle branch capture. Immediately after implantation paced QRS duration was 194ms with a long stimulus-V6RWPT (time to peak R wave in V6) of 93ms, suggesting distal conduction system disease. Patient showed an echocardiographic improvement (LVEF 35% to 50%) and improvement in symptoms (NYHA III to NYHA II) at one year follow-up. Moreover, an improvement in conduction delays was found present. Paced QRS duration improved to 159ms and stimulus-V6RWPT improved to 78ms. This improvement might be due to reverse electrical remodeling. Discussion This case demonstrates that left bundle branch area pacing can induce reverse electrical remodeling, even in the presence of distal conduction system disease. With the current availability of different pacing strategies in CRT (i.e. biventricular CRT, LBBAP, left bundle branch-optimized CRT) more research on patient selection and pacing strategy selection is needed.

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Non-Pharmacological Treatment of Heart Failure—From Physical Activity to Electrical Therapies: A Literature Review

Scarà,

Palamà,

Robles

et al. 2024

JCDD

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Heart failure (HF) represents a significant global health challenge that is still responsible for increasing morbidity and mortality despite advancements in pharmacological treatments. This review investigates the effectiveness of non-pharmacological interventions in the management of HF, examining lifestyle measures, physical activity, and the role of some electrical therapies such as catheter ablation, cardiac resynchronization therapy (CRT), and cardiac contractility modulation (CCM). Structured exercise training is a cornerstone in this field, demonstrating terrific improvements in functional status, quality of life, and mortality risk reduction, particularly in patients with HF with reduced ejection fraction (HFrEF). Catheter ablation for atrial fibrillation, premature ventricular beats, and ventricular tachycardia aids in improving left ventricular function by reducing arrhythmic burden. CRT remains a key intervention for selected HF patients, helping achieve left ventricular reverse remodeling and improving symptoms. Additionally, the emerging therapy of CCM provides a novel opportunity for patients who do not meet CRT criteria or are non-responders. Integrating non-pharmacological interventions such as digital health alongside specific medications is key for optimizing outcomes in HF management. It is imperative to tailor approaches to individual patients in this diverse patient population to maximize benefits. Further research is warranted to improve treatment strategies and enhance patient outcomes in HF management.

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Association between electrical and mechanical remodeling after cardiac resynchronization therapy: systematic review and meta-analysis of observational studies

Cited by 3 publications

References 45 publications

Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT-Recipients

Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT-Recipients

Reverse electrical remodelling after cardiac resynchronization therapy in a patient undergoing left bundle branch area pacing: a case report

Non-Pharmacological Treatment of Heart Failure—From Physical Activity to Electrical Therapies: A Literature Review

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