Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure. the MIRACLE ICD trial

Young, J. B.; Abraham, WT; Smith, Arthur A.

doi:10.1016/j.accreview.2003.08.087

Cited by 459 publications

(700 citation statements)

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“…On the clinical side, several trials have documented both increased functional capacity, as evaluated by means of the 6-minute walking test and the VO2 peak, and improvements in quality of life and New York Heart Association (NYHA) class [15][16][17][18][19][20][21][22][23]. Moreover, CRT has been seen to reduce HF hospitalizations and mortality by 36% [22], and the total number of days of hospitalization by 77% [17].…”

Section: Resultsmentioning

confidence: 99%

Six Sigma DMAIC for Shaking Stagnant Construction Cultures – A Conceptual Perspective

A¹

2015

J Civ Eng Environ Sci

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Heart Failure is the result of heterogeneous structural heart diseases, especially ischemic disease, and is becoming increasingly common in all Western countries.Many patients continue to be symptomatic in spite of progress in pharmacological therapy, and the risk of mortality remains high in the most advanced functional classes. Cardiac resynchronization therapy can be used as a therapeutic strategy for alleviating symptoms and reducing mortality in selected patients with heart failure.Cardiac resynchronization therapy provides both immediate and medium/long-term results. The immediate results are the reduced QRS duration, the synchrony restoration between the ventricles and between the lateral and septal walls of the left ventricle, the reduced mitral regurgitation and the increased stroke volume. In the medium/long term, left ventricular reverse remodeling occurs and left ventricular ejection fraction is increased.Several trials have documented both increased functional capacity and improvements in quality of life and New York Heart Association class. Moreover, cardiac resynchronization therapy has been seen to reduce HF hospitalizations and mortality and the total number of days of hospitalization.In order to reduce the percentage of non-responders to cardiac resynchronization therapy, it is necessary to optimize the prognostic stratification of candidates for implantation through multi-parameter evaluations and to ensure correct device programming with periodic updates which are widely recommended but not so often performed.Whether indications should be extended will need to be evaluated in view of the known complications mainly associated with lead implantation. RationaleIt is well known that QRS duration is inversely correlated with survival in HF patients in functional classes II-IV, and patients with QRS ≥200 ms have a 5-fold higher risk of death than those with a narrow QRS [7]. In particular, left bundle branch block (LBBB) usually delays activation of the posterior/lateral wall of the left ventricle, leading to asynchronous contraction between the septum and posterior-lateral wall and reducing the left ventricular ejection fraction (LVEF).CRT can correct this asynchronous contraction through the preexcitation of the posterior-lateral wall of the left ventricle, thereby improving systolic function [8,9]. Indeed, the dyssynchrony due to prolonged QRS duration involves the heterogeneous propagation of electrical activity in the ventricle, which determines various degrees of impaired coordination in filling and contraction [10]. Consequently the contractile efficiency of the heart is compromised and the myocardial oxygen consumption increases, worsening the clinical course of HF.

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Section: Resultsmentioning

confidence: 99%

Six Sigma DMAIC for Shaking Stagnant Construction Cultures – A Conceptual Perspective

A¹

2015

J Civ Eng Environ Sci

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“…Los primeros estudios aleatorizados demostraron los beneficios de la TRC en los síntomas, la capacidad de ejercicio y la estructura y la función del VI 49,[51][52][53][54] . Los estudios CARE-HF y COMPANION evaluaron los efectos de la TRC-M en las hospitalizaciones por IC y la mortalidad por cualquier causa 55,56 .…”

Section: Pacientes En Clase Funcional Iii-iv De La New York Heart Assunclassified

“…Cinco estudios aleatorizados amplios compararon los efectos de la TRC-D con los del DAI solo y constataron beneficio de la TRC-D en supervivencia, morbilidad y reducción de los síntomas 50,53,54,60,62 . Por lo tanto, cuando se indica un DAI en prevención secundaria o primaria de muerte súbita, según la guía vigente, a la que referimos w69 , se recomienda agregar la TRC para mejorar los síntomas, la tolerancia al ejercicio y la función cardiaca y reducir las hospitalizaciones de pacientes con IC crónica sintomática en tratamiento médico óptimo, FEVI ≤ 35% y BRI completo, según la recomendación apuntada en las secciones 3.2 y 3.3 de esta guía.…”

Section: Beneficio De Añadir Terapia De Resincronización Cardiaca a Punclassified

2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

Brignole

Auricchio

Barón-Esquivias

et al. 2014

Revista Española de Cardiología (English Edition)

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“…Three hundred sixty-nine patients were randomized, 182 to the control arm (ICD activate, CRT inactive) and 187 to the active CRT group (ICD activate, CRT active). 30 Primary end points were the same as those evaluated in the MIRACLE trial; measures of ICD function also were assessed.…”

Section: Abraham Crt In Heart Failurementioning

confidence: 99%

All Patients With Heart Failure and Intraventricular Conduction Defect or Dyssynchrony Should Not Receive Cardiac Resynchronization Therapy

Greenberg

Mehra

2006

Circulation

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C ase Presentation: J.S., a 72-year-old man, was diagnosed with heart failure 5 years ago. Before that, he had suffered a large anterior myocardial infarction and had undergone successful coronary artery bypass grafting surgery. An internal cardioverter-defibrillator (ICD) was implanted 3 years ago. He was hospitalized briefly for decompensated heart failure 9 months ago, and his medical regimen was intensified at that time. He subsequently resumed his usual activities, which included daily walks of up to several hundred yards around his company's construction work site and 2 to 3 rounds of golf weekly. His only symptoms were fatigue after 36 holes of golf and shortness of breath while walking uphill rapidly. Medications included 0.125 mg digoxin, 40 mg furosemide, and target doses of an angiotensin-converting enzyme inhibitor, a ␤-blocker, and warfarin. An ECG demonstrated atrial fibrillation with a controlled ventricular response. The QRS duration was 130 ms with a left bundle-branch block pattern. On echocardiogram, the left ventricular (LV) ejection fraction (EF) was 23% with anterior wall akinesis; the LV internal diastolic dimension was 83 mm; and there was trace mitral regurgitation. Cardiac resynchronization therapy (CRT) was recommended. Placement of an LV pacing lead and "upgrading" his ICD to an ICD/biventricular pacemaker was performed uneventfully. Response by Abraham p 2691Shortly after the procedure, he experienced recurrent ventricular tachyarrhythmias, and his ICD, which had not discharged since implantation, delivered 4 shocks over a 24-hour period to terminate episodes of ventricular fibrillation. There was no evidence of acute myocardial infarction, worsening heart failure, or a pericardial effusion. The ventricular arrhythmias were responsive to intravenous amiodarone. After 7 days, he was discharged on oral amiodarone in addition to his other medications. Over the next several weeks, he had only 1 episode of ventricular tachycardia terminated by pacing. During this period, however, he complained of fatigue, malaise, and gastrointestinal symptoms. Amiodarone was discontinued, and over the next several weeks, these symptoms resolved. There were no further ventricular arrhythmias, and J.S. resumed his activities at work and on the

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Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure. the MIRACLE ICD trial

Cited by 459 publications

References 0 publications

Six Sigma DMAIC for Shaking Stagnant Construction Cultures – A Conceptual Perspective

Six Sigma DMAIC for Shaking Stagnant Construction Cultures – A Conceptual Perspective

2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

All Patients With Heart Failure and Intraventricular Conduction Defect or Dyssynchrony Should Not Receive Cardiac Resynchronization Therapy

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