Guía ESC 2021 sobre estimulación cardiaca y terapia de resincronización

Glikson, Michael; Nielsen, Jens Cosedis; Kronborg, Mads Brix; Michowitz, Yoav; Auricchio, Angelo; Barbash, Israel M.; Barrabés, José A.; Boriani, Giuseppe; Braunschweig, Frieder; Brignole, Michele; Burri, Haran; Coats, Andrew J.S.; Deharo, Jean‐Claude; Delgado, Victoria; Diller, Gerhard‐Paul; Israel, Carsten W.; Keren, Andre; Knops, Reinoud E.; Kotecha, Dipak; Leclercq, Christophe; Merkely, Béla; Starck, Christoph; Thylén, Ingela; Tolosana, José Marı́a

doi:10.1016/j.recesp.2021.10.025

Cited by 18 publications

(11 citation statements)

References 800 publications

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“…Although the two previously mentioned population-based studies were unable to control for all relevant SCD risk factors, such as left ventricular function, they corroborate our observations. Previous studies and pacing guidelines have defined non-specific IVCD as either a QRS duration of ≥ 110 ms (13,31,33) or a QRS duration of ≥120 ms (19,32,34) without meeting the criteria for LBBB or RBBB. Thus, we decided to include QRS duration of 110-119 ms as a covariate in our study.…”

Section: Conduction Disorders and Scdmentioning

confidence: 99%

Prognostic implications of intraventricular conduction disorders for sudden cardiac death in coronary artery disease

Lahti,

Rankinen,

Järvensivu-Koivunen

et al. 2023

Preprint

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Backround and aimsProlonged QRS duration (≥ 110 ms) and coronary artery disease are risk factors for sudden cardiac death (SCD). We explored the SCD risk associated with intraventricular conduction disorders – a prolonged QRS duration of 110–119 ms, right bundle branch block (RBBB), left bundle branch block (LBBB), and a nonspecific intraventricular conduction delay (NIVCD) – in patients with acute coronary syndrome (ACS).MethodsThis is a retrospective study of 9,700 consecutive, invasively treated ACS patients with ECGs available for analysis (2007–2018). SCD definition was based on an in-depth review of written medical records and death certificates describing the circumstances leading to the events. Endpoint data were available until December 31, 2021 (no losses to follow-up). The risk associated with conduction disorders was analyzed by calculating subdistribution hazard estimates (deaths due to other causes being considered competing events).ResultsThe median follow-up time was 6.8 years (IQR 4.0–10.2), during which 3,420 (35.3%) patients died. SCDs were overrepresented as a cause of death among patients with NIVCD (16.4%) or with a prolonged QRS duration (15.3%) when compared to patients with LBBB (5.3%), RBBB (7.1%), or with a normal QRS duration (10.5%). In an analysis adjusted for age, sex, and cardiac comorbities, NIVCD and a prolonged QRS were significant predictors of SCD (HR 3.00, 2.06– 4.35, P < 0.001; and HR 1.80, 1.37–2.35, P < 0.001, respectively). After adjusting the analysis with left ventricular ejection fraction, NIVCD and a prolonged QRS duration remained as significant risk factors for SCD. LBBB and RBBB did not predict SCD.ConclusionThe incidence of SCD is significantly higher in patients with NIVCD and a prolonged QRS duration. Approximately 23% of all SCDs occur among these patients.

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Section: Conduction Disorders and Scdmentioning

confidence: 99%

Prognostic implications of intraventricular conduction disorders for sudden cardiac death in coronary artery disease

Lahti,

Rankinen,

Järvensivu-Koivunen

et al. 2023

Preprint

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“…According to current guidelines, the patients were addressed for implantation when affected by symptomatic HFrEF (New York Heart Association class II to ambulatory class IV) despite optimal medical therapy, LV systolic dysfunction with ejection fraction ≤35%, and QRS width ≥130 ms together with LBBB morphology (8). The presence of a LBBB was defined in case of QRS ≥ 130 ms; QS or rS complex in V1 to V2; monophasic and notched or slurred R waves in I, aVL, V5, or V6; and absent Q waves in leads V5 and V6 (9). A three pacing-lead device was implanted in each patient and was programmed to obtain the highest percentage of biventricular stimulation (≥90% of total beats).…”

Section: Study Design and Participantsmentioning

confidence: 99%

The role of fibrosis, inflammation, and congestion biomarkers for outcome prediction in candidates to cardiac resynchronization therapy: is “response” the right answer?

Beltrami

Galluzzo²,

Brocci

et al. 2023

Front. Cardiovasc. Med.

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BackgroundCardiac resynchronization therapy (CRT) is an established treatment in selected patients suffering from heart failure with reduced ejection fraction (HFrEF). It has been proposed that myocardial fibrosis and inflammation could influence CRT “response” and outcome. Our study investigated the long-term prognostic significance of cardiac biomarkers in HFrEF patients with an indication for CRT.MethodsConsecutive patients referred for CRT implantation were retrospectively evaluated. The soluble suppression of tumorigenicity 2 (sST2), galectin-3 (Gal-3), N-terminal portion of the B-type natriuretic peptide (NT-proBNP), and estimated glomerular filtration rate (eGFR) were measured at baseline and after 1 year of follow-up. Multivariate analyses were performed to evaluate their correlation with the primary composite outcome of cardiovascular mortality and heart failure hospitalizations at a mean follow-up of 9 ± 2 years.ResultsAmong the 86 patients enrolled, 44% experienced the primary outcome. In this group, the mean baseline values of NT-proBNP, Gal-3, and sST2 were significantly higher compared with the patients without cardiovascular events. At the multivariate analyses, baseline Gal-3 [cut-off: 16.6 ng/ml, AUC: 0.91, p < 0.001, HR 8.33 (1.88–33.33), p = 0.005] and sST2 [cut-off: 35.6 ng/ml AUC: 0.91, p < 0.001, HR 333 (250–1,000), p = 0.003] significantly correlated with the composite outcome in the prediction models with high likelihood. Among the parameters evaluated at 1-year follow-up, sST2, eGFR, and the variation from baseline to 1-year of Gal-3 levels showed a strong association with the primary outcome [HR 1.15 (1.08–1.22), p < 0.001; HR: 0.84 (0.74–0.91), p = 0.04; HR: 1.26 (1.10–1.43), p ≤ 0.001, respectively]. Conversely, the echocardiographic definition of CRT response did not correlate with any outcome.ConclusionIn HFrEF patients with CRT, sST2, Gal-3, and renal function were associated with the combined endpoint of cardiovascular death and HF hospitalizations at long-term follow-up, while the echocardiographic CRT response did not seem to influence the outcome of the patients.

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“…In 2013, European guidelines recommend that a 7-day monitor to be used as a threshold for whether to install PPM (9), while in the 2021 European guidelines, permanent pacemaker can be used in patients with HAVB that persists for 24-48 h after TAVR (10), the new recommendation was based on an observational study of only 50 patients (11). Prospective trials to investigate surveillance and management of HAVB after TAVR are lacking and current guidelines are based mostly on expert opinions (12).…”

Section: Introductionmentioning

confidence: 99%

Feasibility study of temporary permanent pacemaker in patients with conduction block after TAVR

Chang

Liu

et al. 2023

Front. Cardiovasc. Med.

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BackgroundLimited data exist on the use of temporary permanent pacemaker (TPPM) to reduce unnecessary PPM in patients with high-degree atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR).ObjectivesThis study aims to determine the feasibility of TPPM in patients with HAVB after TAVR to provide prolonged pacing as a bridge.Materials and methodsOne hundred and eleven consecutive patients undergoing TAVR were screened from August 2021 to June 2022. Patients with HAVB eligible for PPM were included. TPPM were used in these patients instead of conventional temporary pacing or early PPM. Patients were followed up for 1 month. Holter and pacemaker interrogation were used to determine whether to implant PPM.ResultsTwenty one patients met the inclusion criteria for TPPM, of which 14 patients were third-degree AVB, 1 patient was second-degree AVB, 6 patients were first degree AVB with PR interval > 240 ms and LBBB with QRS duration > 150 ms. TPPM were placed on the 21 patients for 35 ± 7 days. Among 15 patients with HAVB, 26.7% of them (n = 4) recovered to sinus rhythm; 46.7% (n = 7) recovered to sinus rhythm with bundle branch block. The remains of 26.7% patients (n = 4) still had third-degree AVB and received PPM. For patients with first-degree AVB and LBBB, PR interval shortened to < 200 ms in all 6 patients and LBBB recovered in 2 patients. TPPM were successfully removed from all patients and no procedure-related adverse events occurred.ConclusionTPPM is reliable and safe in the small sample of patients with conduction block after TAVR to provide certain buffer time to distinguish whether a PPM is necessary. Future studies with larger sample are needed for further validation of the current results.

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Guía ESC 2021 sobre estimulación cardiaca y terapia de resincronización

Cited by 18 publications

References 800 publications

Prognostic implications of intraventricular conduction disorders for sudden cardiac death in coronary artery disease

Prognostic implications of intraventricular conduction disorders for sudden cardiac death in coronary artery disease

The role of fibrosis, inflammation, and congestion biomarkers for outcome prediction in candidates to cardiac resynchronization therapy: is “response” the right answer?

Feasibility study of temporary permanent pacemaker in patients with conduction block after TAVR

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