Clinical outcomes of upgrade to versus de novo cardiac resynchronization therapy in mild heart failure patients with atrioventricular block

Kanai, Miwa; Daigo, Yataro; Shoda, Morio; Ejima, Koichiro; Hagiwara, Nobuhisa

doi:10.1016/j.jjcc.2021.07.012

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…With respect to prognosis in CRT upgrades, prior studies have yielded partially conflicting results. While some studies found similar overall survival in de novo and upgrade CRT patients [24,25], others found that upgrade CRT patients had worse survival [22,23]. CRT upgrade patients were noted to have an increased prevalence of atrial fibrillation and more impaired kidney function, as we found in the present cohort.…”

Section: Discussionsupporting

confidence: 68%

“…Second, although patients were on maximally tolerated medical therapy appropriate at the time of enrollment, angiotensin-neprilysin inhibitors and sodium-glucose cotransporter-2 inhibitors have since become widely used medications for heart failure. While this is an inherent limitation for any long-term study because new medications may well be introduced during the five years of follow-up, the impact on the results of this study is likely very modest, as sodium-glucose cotransporter-2 inhibitors decrease heart failure and other cardiac events with minimal impact on survival [25], and heart failure risk models such as the SHFM have been shown to perform equally well in studies of angiotensinneprilysin inhibitors [26] compared with other cohorts. Third, although conduction system pacing patients were not included in this analysis, the indication in heart failure with reduced ejection fraction is just now evolving, and the approach of incorporating CMR and neurohormonal/clinical data together with the statistical methodology presented in this paper can also be applied to future cohorts with conduction system pacing.…”

Section: Limitationsmentioning

confidence: 99%

“…Although conduction system pacing is increasing in popularity, RV pacing (RVP) is still more commonly implemented using active or passive 2 of 18 fixation leads implanted in the ventricular septum, typically near the RV apex, which leads to the need for cardiac resynchronization therapy [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] in patients who develop heart failure [21]. Unfortunately, several studies have demonstrated worse survival after CRT upgrades for heart failure associated with RVP (RVP-HF) compared with survival in patients undergoing de novo CRT implants [22,23], although this finding has not been consistent across all studies [24,25]. Chronic kidney disease and atrial fibrillation in patients with CRT upgrades have been suggested as possible explanations for this difference in prognosis [22,23].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades

Bivona,

Oomen,

Wang

et al. 2023

JCDD

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As the mechanism for worse prognosis after cardiac resynchronization therapy (CRT) upgrades in heart failure patients with RVP dependence (RVP-HF) has clinical implications for patient selection and CRT implementation approaches, this study’s objective was to evaluate prognostic implications of cardiac magnetic resonance (CMR) findings and clinical factors in 102 HF patients (23.5% female, median age 66.5 years old, median follow-up 4.8 years) with and without RVP dependence undergoing upgrade and de novo CRT implants. Compared with other CRT groups, RVP-HF patients had decreased survival (p = 0.02), more anterior late-activated LV pacing sites (p = 0.002) by CMR, more atrial fibrillation (p = 0.0006), and higher creatinine (0.002). CMR activation timing at the LV pacing site predicted post-CRT LV functional improvement (p < 0.05), and mechanical activation onset < 34 ms by CMR at the LVP site was associated with decreased post-CRT survival in a model with higher pre-CRT creatinine and B-type natriuretic peptide (AUC 0.89; p < 0.0001); however, only the higher pre-CRT creatinine partially mediated (37%) the decreased survival in RVP-HF patients. In conclusion, RVP-HF had a distinct CMR phenotype, which has important implications for the selection of LV pacing sites in CRT upgrades, and only chronic kidney disease mediated the decreased survival after CRT in RVP-HF.

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Section: Discussionsupporting

confidence: 68%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades

Bivona,

Oomen,

Wang

et al. 2023

JCDD

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Upgrading right ventricular pacemakers to biventricular pacing or conduction system pacing: a systematic review and meta-analysis

et al. 2022

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Guidelines recommend patients undergoing a first pacemaker implant who have even mild left ventricular (LV) impairment should receive biventricular or conduction system pacing (CSP). There is no corresponding recommendation for patients who already have a pacemaker. We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies assessing device upgrades. The primary outcome was the echocardiographic change in LV ejection fraction (LVEF). Six RCTs (randomizing 161 patients) and 47 observational studies (2644 patients) assessing the efficacy of upgrade to biventricular pacing were eligible for analysis. Eight observational studies recruiting 217 patients of CSP upgrade were also eligible. Fourteen additional studies contributed data on complications (25 412 patients). Randomized controlled trials of biventricular pacing upgrade showed LVEF improvement of +8.4% from 35.5% and observational studies: +8.4% from 25.7%. Observational studies of left bundle branch area pacing upgrade showed +11.1% improvement from 39.0% and observational studies of His bundle pacing upgrade showed +12.7% improvement from 36.0%. New York Heart Association class decreased by −0.4, −0.8, −1.0, and −1.2, respectively. Randomized controlled trials of biventricular upgrade found improvement in Minnesota Heart Failure Score (−6.9 points) and peak oxygen uptake (+1.1 mL/kg/min). This was also seen in observational studies of biventricular upgrades (−19.67 points and +2.63 mL/kg/min, respectively). In studies of the biventricular upgrade, complication rates averaged 2% for pneumothorax, 1.4% for tamponade, and 3.7% for infection over 24 months of mean follow-up. Lead-related complications occurred in 3.3% of biventricular upgrades and 1.8% of CSP upgrades. Randomized controlled trials show significant physiological and symptomatic benefits of upgrading pacemakers to biventricular pacing. Observational studies show similar effects between biventricular pacing upgrade and CSP upgrade.

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Conduction system pacing improves the outcomes on patients with high percentage of ventricular pacing and heart failure with mildly reduced ejection fraction

Zhang

Zhao

Yang

et al. 2023

Front. Cardiovasc. Med.

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AimsThis study aimed to investigate the efficacy and safety of CSP in patients with a high percentage of ventricular pacing and heart failure with HFmrEF.MethodsPatients who underwent CSP for HFmrEF and ventricular pacing >40% were consecutively enrolled from January 2018 to May 2021. All participants were followed up at least 12 months. Clinical data including cardiac performance and lead outcomes were compared before and after the procedure. Left ventricular ejection fraction (LVEF) was measured using the biplane Simpson's method. HFmrEF was defined as heart failure with the LVEF ranging from 41%–49%.ResultsCSP was successfully performed in 64 cases (96.97%), which included 16 cases of left bundle branch pacing (LBBP) and 48 cases of His bundle pacing (HBP). After a mean of 23.12 ± 8.17 months follow-up, NYHA classification (P < 0.001), LVEF (42.45 ± 1.84% vs. 49.97 ± 3.57%, P < 0.001) and left ventricular end diastolic diameter (LVEDD) (55.59 ± 6.17 mm vs. 51.66 ± 3.48 mm, P < 0.001) improved significantly. During follow-up, more than half (39/64,60.9%) of patients returned to normal LVEF and LVEDD with complete reverse remodeling. The pacing threshold in LBBP was lower (0.90 ± 0.27 V@0.4 ms vs. 1.61 ± 0.71 V@0.4 ms, P < 0.001) than that in HBP. No perforation, electrode dislodging, thrombosis or infection was observed during follow-up.ConclusionsCSP could improve the clinical outcomes in patients with HFmrEF and a high percentage of ventricular pacing. LBBP might be a better choice because of its feasibility and safety, especially in patients with infranodal atrioventricular block.

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Clinical outcomes of upgrade to versus de novo cardiac resynchronization therapy in mild heart failure patients with atrioventricular block

Cited by 3 publications

References 30 publications

Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades

Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades

Upgrading right ventricular pacemakers to biventricular pacing or conduction system pacing: a systematic review and meta-analysis

Conduction system pacing improves the outcomes on patients with high percentage of ventricular pacing and heart failure with mildly reduced ejection fraction

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