Cardiac Resynchronization Therapy Improves Heart Rate Variability in Patients with Symptomatic Heart Failure

Adamson, Philip B.; Kleckner, Karen J.; Vanhout, Warren L.; Srinivasan, Sriram; Abraham, William T.

doi:10.1161/01.cir.0000083368.75831.7a

Cited by 144 publications

(110 citation statements)

References 17 publications

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“…8 Biventricular pacing has been shown to improve heart rate variability, a marker of increased mortality and arrhythmia susceptibility in patients with HF. 9 Finally, CRT appears to exert a beneficial effect on electrical remodeling in the failing heart.…”

Section: Discussionmentioning

confidence: 99%

Biventricular pacing reduces ventricular arrhythmic burden and defibrillator therapies in patients with heart failure

et al. 2006

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SummaryBackground: Cardiac resynchronization therapy (CRT) has recently emerged as a new modality for the treatment of patients with advanced heart failure (HF).Hypothesis: Cardiac resynchronization therapy reduces atrial and ventricular arrhythmia burdens.Methods: We analyzed the clinical data of patients who underwent an upgrade from a dual-chamber to a biventricular implantable cardioverter-defibrillator (ICD) at a tertiary care center.Results: Nineteen patients (age 67 ± 10 years, 18 men, left ventricular [LV] ejection fraction 0.24 ± 0.07) underwent an upgrade to CRT-ICD. The LV lead was placed in a lateral position in 11, posterolateral in 4, and anterolateral in 3 patients. Baseline New York Heart Association class of HF improved in 11 (58%) patients who were considered "responders." After adjusting for the duration of follow-up before and after the upgrade, the number of patients receiving any ICD therapy decreased significantly from 13 to 4 (p = 0.004) and the total number of therapies decreased from 72 to 17 (p = 0.067). Also, the number of detections of sustained ventricular arrhythmias decreased from 40 to 11 episodes (p = 0.05), but the decrease in the number of detected supraventricular arrhythmias and mode switch episodes was not significant. The reduction in the ventricular arrhythmia load was independent of whether or not the patient responded to CRT.

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Section: Discussionmentioning

confidence: 99%

Biventricular pacing reduces ventricular arrhythmic burden and defibrillator therapies in patients with heart failure

et al. 2006

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“…Therefore, improvement in ventricular performance via resynchronization therapy shifts the cardiac autonomic balance toward a more favorable profile of less sympathetic and more parasympathetic activation. 116 …”

Section: Effect Of Resynchronization Therapy On Sympathetic Activitymentioning

confidence: 99%

The Role of the Autonomic Nervous System in Sudden Cardiac Death

Vaseghi

Shivkumar²

2008

Progress in Cardiovascular Diseases

336

233

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The cardiac autonomic nervous system consists of 2 branches-the sympathetic and the parasympathetic systems-that work in a delicately tuned, yet opposing fashion in the heart. This extrinsic control mechanism can dominate intrinsic regulatory mechanisms that modulate heart rate and cardiac output. These branches differ in their neurotransmitters (norepinephrine and acetylcholine) and exert stimulatory or inhibitory effects on target tissue via adrenergic and muscarinic receptors. Stimulation of the sympathetic branch exerts facilitatory effects on function, increasing heart rate and myocardial contractility, whereas the stimulation of the parasympathetic branch exerts inhibitory effects that decrease heart rate and contractility. The interplay between these two branches is complex and susceptible to control at several levels, from centrally mediated baroreceptors and chemoreceptors to local interneuronal interactions.Alterations in autonomic function occur in several interrelated cardiac conditions including sudden cardiac death, congestive heart failure, diabetic neuropathy, and myocardial ischemia. Although the full extent of these changes has not been elucidated, multiple autonomic remodeling mechanisms have been observed at both the neuronal fiber and myocardial cellular level that contribute to an arrhythmogenic substrate. We describe the anatomy of both systems in this review. However, the review will premdominantly focus on the sympathetic system, whose role in the modulation of cardiac arrhythmias is slightly better delineated. Cardiac Autonomic Innervation: NeuroanatomyBoth branches of the autonomic nervous system are composed of both afferent and efferent as well interneuronal fibers (Fig 1). Sympathetic innervation originates mainly in the right and left stellate ganglia. These fibers travel along the epicardial vascular structures of the heart and penetrate into the underlying myocardium similar to coronary vessels and end as sympathetic nerve terminals reaching the endocardium. Based on norepinephrine content studies, a gradient exists in sympathetic innervation from atria to the ventricles and from base to apex of the heart. Therefore, the atria are most densely innervated, but the ventricles are also supplied with a sympathetic network, most densely at the base. 1 Parasympathetic effects are carried by the right and left vagus nerves, originating in the medulla. The vagus nerve further divides into the superior and inferior cardiac nerves, finally merging with the postganglionic sympathetic neurons to form a plexus of nerves at the base of the heart, known as the cardiac plexus. In contrast to sympathetic neurons, after parasympathetic fibers cross the atrioventricular (AV) groove along the surface of the heart,

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“…15 -18 One of the first attempts to utilize the monitoring capabilities of an implanted therapeutic device was the reporting of continuously measured heart rate variability (HRV) in patients with heart failure. 16 As measured from an implanted electrical device, HRV declined significantly in association with the development of volume overload and congestion, suggesting vagal withdrawal and sympathetic activation as patients decompensated to the point of hospital admission. 17 Significant physiologic alterations in cardiac autonomic control were noted several weeks before patients actually sought medical attention, suggesting that the progression to congestive decompensation begins long before patients present with overt signs or symptoms of worsening heart failure.…”

Section: Implantable Devices and Continuous Patient Monitoringmentioning

confidence: 96%

Reducing Events in Patients with Chronic Heart Failure (REDUCEhf ) Study Design: Continuous Hemodynamic Monitoring with an Implantable Defibrillator

Adamson

Conti

Smith

et al. 2007

Clinical Cardiology

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Background The use of implantable cardioverter defibrillators (ICDs) has been proven effective in the prevention of sudden cardiac death (SCD) and constitutes standard of care in appropriate populations. Combining a pressure sensing system with ICD therapy represents the first attempt to provide continuous hemodynamic monitoring using a device previously designed exclusively for SCD protection. Methods REDUCE is a prospective, multicenter, randomized, single‐blind, parallel‐controlled trial designed to assess the safety of the Chronicle ICD system (single chamber ICD with a hemodynamic monitoring system) and the effectiveness of a management strategy guided by intracardiac pressure information among ICD‐indicated New York Heart Association (NYHA) Class II or III heart failure (HF) patients. Those successfully implanted with a Chronicle ICD will be randomized to the Chronicle group or Control group. All patients will receive optimal medical therapy, but the hemodynamic information from the device will be used to guide patient management only in the Chronicle group. Primary endpoints include freedom from system‐related complications and relative risk reduction of one or more HF‐related events (hospitalizations, and emergency department and urgent care visits requiring intravenous therapy for HF). Approximately 850 patients will be enrolled in at least 75 centers in the United States to accrue the 419 events needed to test the primary effectiveness endpoint. Enrollment began in April 2006, and is expected to end during 2009. Conclusion REDUCE will assess the safety of the Chronicle ICD system and the effectiveness of a patient management strategy based on remote access to continuous intracardiac pressures in reducing HF‐related events. Copyright © 2007 Wiley Periodicals, Inc.

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Cardiac Resynchronization Therapy Improves Heart Rate Variability in Patients with Symptomatic Heart Failure

Cited by 144 publications

References 17 publications

Biventricular pacing reduces ventricular arrhythmic burden and defibrillator therapies in patients with heart failure

Biventricular pacing reduces ventricular arrhythmic burden and defibrillator therapies in patients with heart failure

The Role of the Autonomic Nervous System in Sudden Cardiac Death

Reducing Events in Patients with Chronic Heart Failure (REDUCEhf ) Study Design: Continuous Hemodynamic Monitoring with an Implantable Defibrillator

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