Dyssynchrony and the Risk of Ventricular Arrhythmias

Kutyifa, Valentina; Pouleur, Anne‐Catherine; Knappe, Dorit; Al‐Ahmad, Amin; Gibinski, Michal; Wang, Paul J.; McNitt, Scott; Merkely, Béla; Goldenberg, Ilan; Solomon, Scott D.; Moss, Arthur J.; Zaręba, Wojciech

doi:10.1016/j.jcmg.2012.12.008

Cited by 79 publications

(47 citation statements)

References 41 publications

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“…Post-TAVR LBBB and pacing-induced dyssynchrony may be reasons for worsened outcomes in this population. 34 Indeed, further investigation including whether or not cardiac resynchronization therapy has a role in this population needs to be pursued. Of equal importance is the need to determine whether or not unnecessary PPI post-TAVR is associated with worsened outcomes.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Predictors of Pacemaker Implant Post Commercial Approval of the CoreValve System for TAVR

Lüke¹,

Huntsinger²,

Carlson³

et al. 2016

JICRM

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Section: Discussionmentioning

confidence: 99%

Incidence and Predictors of Pacemaker Implant Post Commercial Approval of the CoreValve System for TAVR

Lüke¹,

Huntsinger²,

Carlson³

et al. 2016

JICRM

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“…Penicka et al (11), Fauchier et al (27), and Bader et al (10) reported that LV dyssynchrony was prognostic of cardiac endpoints. Kutyifa et al (28) investigated VT/VF events and LV dyssynchrony in mild heart failure patients with LBBB and an implanted CRT device and compared them to patients with non LBBB and demonstrated that improved synchrony might translate into a reduction of ventricular arrhythmic events in LBBB patients. Ludwig et al (29) reported that patients with heart failure and LBBB, acute RVA pacing induces greater mechanical dyssynchrony and further impairs LV function.…”

Section: Discussionmentioning

confidence: 99%

Acute effect of primary percutaneous coronary intervention on left ventricular dyssynchrony in ST-segment elevation myocardial infarction

İnci¹,

Karakelleoğlu²,

Taş³

et al. 2014

Anadolu Kardiyol Derg

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Objective: The aim of this study was to prospectively evaluate the effect of percutaneous coronary intervention in the acute period on left ventricular dyssynchrony in ST-segment elevation myocardial infarction patients by using Tissue Synchronization Imaging. Methods: Forty-four ST-segment elevation myocardial infarction (MI) patients (29 male, 15 female), who were admitted within the first 12 hours of chest pain symptoms, were enrolled in the study. According to the localization of MI, the patients were divided into groups as anterior MI (n=26) and inferior MI (n=18). All echocardiography measurements were taken just before percutaneous coronary intervention (PCI) and following PCI at a mean of 3-6 days. They were assessed according to the time to reach the peak systolic velocity, which was calculated by the tissue synchronization imaging method from four pairs of non-apical alternate segments. The difference between the duration to reach the peak systolic velocity in alternate segments was regarded as left ventricle dyssynchrony and the results were compared. Results: In the anterior MI group, basal anterior (p<0.01), mid-anterior segment (p<0.01) and basal septal segment (p<0.01); in the inferior MI group, the basal septal segment (p=0.02), mid-septal segment (p=0.02), and basal and mid-inferior segment (p<0.01) values were significantly lower in the post-PCI measurements when compared to the measurements taken prior to PCI. In both groups, the intraventricular dyssynchrony indices of the basal anterior-basal inferior (p<0.01), mid-anterior-mid-inferior (p<0.01) segments were found to be significantly lower in the post-PCI period when compared to the pre-PCI period. Conclusion: It was found that percutaneous coronary intervention in patients with ST-elevation significantly decreases the degree of LV dyssynchrony in the acute period. (Anadolu Kardiyol Derg 2014; 14: 591-8)

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“…6,7 In the presence of abnormal substrate, several studies have showed increased risk of adverse cardiovascular outcomes in patients with dyssynchrony but data on arrhythmic events are less convincing. [8][9][10][11] A sub-study of MADIT-CRT showed no difference in the occurrence of ventricular arrhythmias in patients undergoing CRT implantation with or without baseline dyssynchrony. 10 In REVERSE trial there was no difference in occurrence of ventricular arrhythmias in patients with CRT ON vs CRT OFF implying resynchronization had little impact on occurrence of ventricular arrhythmias.…”

Section: See Related Article Pp 555-569mentioning

confidence: 99%

“…[8][9][10][11] A sub-study of MADIT-CRT showed no difference in the occurrence of ventricular arrhythmias in patients undergoing CRT implantation with or without baseline dyssynchrony. 10 In REVERSE trial there was no difference in occurrence of ventricular arrhythmias in patients with CRT ON vs CRT OFF implying resynchronization had little impact on occurrence of ventricular arrhythmias. The study population in this trial included patients with mild heart failure (NYHA classes I and II) with QRS greater than 120 ms and since there was no baseline assessment of dyssynchrony it is plausible that most of these patients did not have significant dyssynchrony to begin with.…”

Section: See Related Article Pp 555-569mentioning

confidence: 99%

Dyssynchrony: a risk marker for ventricular arrhythmias?

Kumar

2018

Journal of Nuclear Cardiology

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Mechanical left ventricular dyssynchrony can result from conduction system abnormalities like left bundle branch block (LBBB), scarring in the left ventricle from ischemic or non-ischemic cardiomyopathy, and significant left ventricular dilatation resulting in changes in gap junctions and ion channels thereby affecting conduction velocity. The end result of these processes is dyssynchronous contraction of the left ventricle, causing inefficient pump function. Resynchronization either by treatment of underlying pathology or cardiac resynchronization therapy (CRT) has been shown to improve mortality and morbidity in this patient population.1-4 In MADIT-CRT study, patients with LBBB who had improvement in their dyssynchrony with CRT were also less likely to experience ventricular arrhythmias compared to those who did not have an improvement.5 This raises the question if dyssynchronous contraction of the left ventricle is arrhythmogenic? Dyssynchrony in patients with purely conduction system abnormality and no myopathy as seen in right ventricular pacing or LBBB with normal left ventricular structure and function does not seem to be associated with increased risk of arrhythmias. 6,7 In the presence of abnormal substrate, several studies have showed increased risk of adverse cardiovascular outcomes in patients with dyssynchrony but data on arrhythmic events are less convincing.8-11 A sub-study of MADIT-CRT showed no difference in the occurrence of ventricular arrhythmias in patients undergoing CRT implantation with or without baseline dyssynchrony. 10In REVERSE trial there was no difference in occurrence of ventricular arrhythmias in patients with CRT ON vs CRT OFF implying resynchronization had little impact on occurrence of ventricular arrhythmias. The study population in this trial included patients with mild heart failure (NYHA classes I and II) with QRS greater than 120 ms and since there was no baseline assessment of dyssynchrony it is plausible that most of these patients did not have significant dyssynchrony to begin with. 12 In the InSync ICD trial, there was reduction in ventricular arrhythmias, which was related to the degree of the remodeling after CRT implantation. 13 Most of these studies used strain imaging to assess and quantify dyssynchrony, which, in itself is limited by temporal resolution of echocardiography.In the current study, Saurabh et al studied the impact of dyssynchrony as assessed by phase analysis of gated SPECT on ventricular arrhythmias in patients undergoing CRT. There results showed that most ventricular arrhythmias occurred in patients with dyssynchrony and at least some degree of myocardial scarring. Reversal of dyssynchrony was seen in only few patients post CRT-implant and these patients had decreased risk of ventricular arrhythmias. There are several limitations of the study including small sample size, retrospective design, significantly poor response to CRT, and lack of effect on mortality despite higher incidence of ventricular arrhythmias. But in spite of these limitations, ...

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Dyssynchrony and the Risk of Ventricular Arrhythmias

Abstract: Baseline LV dyssynchrony did not predict VT/VF/death or VT/VF in mild heart failure patients with or without LBBB. CRT-induced improvement of LV dyssynchrony was associated with significant reduction of ventricular arrhythmias in patients with LBBB.

Cited by 79 publications

References 41 publications

Incidence and Predictors of Pacemaker Implant Post Commercial Approval of the CoreValve System for TAVR

Incidence and Predictors of Pacemaker Implant Post Commercial Approval of the CoreValve System for TAVR

Acute effect of primary percutaneous coronary intervention on left ventricular dyssynchrony in ST-segment elevation myocardial infarction

Dyssynchrony: a risk marker for ventricular arrhythmias?

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