Impact of Upgrade to Cardiac Resynchronization Therapy on Ventricular Arrhythmia Frequency in Patients With Implantable Cardioverter-Defibrillators

Ermis, Cengiz; Seutter, Ryan; Zhu, Alan X.; Benditt, Lauren C.; VanHeel, Laura; Sakaguchi, Scott; Lurie, Keith G.; Lü, Fei; Benditt, David G.

doi:10.1016/j.jacc.2005.04.067

Cited by 99 publications

(74 citation statements)

References 23 publications

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“…4,6,7,[10][11][12] The rate of CRT upgrade varies widely among studies: in a retrospective single center study, the upgrade rates from ICD to CRT-D at 1, 3, and 5 years were 0.03%, 2.4%, and 5.1%, respectively, 10 and Palmisano et al report a 3.2% rate of upgrade from pacemaker to CRT-P or ICD to CRT-D in their survey of 2671 consecutive procedures from 2 centers in Italy. 6 Conversely, in the European Cardiac Resynchronization Therapy Survey of 2367 CRT implant procedures, 29.2% were identified as having an upgrade from pacemaker to CRT-P or ICD to CRT-D. 7 Previously cited reasons for not performing upgrades in potential candidates include increased cost if performed before ICD generator change, an increased risk of complications, and lack of established trial data demonstrating efficacy of CRT in this patient population.…”

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confidence: 99%

Incidence, Predictors, and Procedural Results of Upgrade to Resynchronization Therapy

Essebag

Joza

Birnie

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-The resynchronization-defibrillation for ambulatory heart failure trial (RAFT) study demonstrated that adding cardiac resynchronization therapy (CRT) in selected patients requiring de novo implantable cardiac defibrillators (ICD) reduced mortality as compared with ICD therapy alone, despite an increase in procedure-related adverse events. Data are lacking regarding the management of patients with ICD therapy who develop an indication for CRT upgrade. Methods and Results-Participating RAFT centers provided data regarding de novo CRT-D (CRT with ICD) implant, upgrade to CRT-D during RAFT (study upgrade), and upgrade within 6 months after presentation of study results (substudy). Substudy centers enrolled 1346 (74.9%) patients in RAFT, including 644 de novo, 80 study upgrade, and 60 substudy CRT attempts. The success rate (initial plus repeat attempts) was 95.2% for de novo versus 96.3% for study upgrade and 90.0% for substudy CRT attempts (P=0.402). Acute complications occurred among 26.2% of de novo versus 18.8% of study upgrade and 3.4% of substudy CRT implantation attempts (P<0.001). The most common complication was left ventricular lead dislodgement. The principal reasons for not yet attempting upgrade in the substudy were patient preference (31.9%), New York Heart Association Class I (17.0%), and a QRS <150 ms (13.1%). Conclusions-Among a broad group of implant physicians, CRT upgrades were performed in patients with an ICD in situ with no difference in implant success rate and a reduced acute complication rate as compared with a de novo CRT implant. Decisions to upgrade were influenced by predictors of benefit in subgroup analyses of the RAFT study and other trials. (Circ Arrhythm Electrophysiol. 2015;8:152-158.

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confidence: 99%

Incidence, Predictors, and Procedural Results of Upgrade to Resynchronization Therapy

Essebag

Joza

Birnie

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…While CRT could increase the dispersion of repolarization and induce malignant ventricular tachyarrhythmias in a small subgroup of patients [1,2], over the past few years, different studies have shown that apart from hemodynamic benefits, BVP may reduce ventricular tachyarrhythmia susceptibility in HF patients with conventional indications for CRT [3][4][5][6]. This suppressive effect was also shown in electrophysiologic studies [7].…”

Section: Discussionmentioning

confidence: 89%

Biventricular with Multi-Site Left-Ventricular Pacing for the Management of Refractory Ventricular Tachycardia in a Patient with Narrow Complex QRS – Case Report

Laish-Farkash¹,

Khalameizer²,

Katz³

2017

JCCR

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A 59-year-old male was admitted to our hospital with heart failure (HF) exacerbation and sustained monomorphic ventricular tachycardia (SMVT) episodes. The patient was known to have had severe non-ischemic left ventricular (LV) dysfunction for the past four years. His history was also remarkable for diabetes mellitus, hypertension, and gastric banding. The patient had documentation of LV ejection fraction (EF) of 20%, diffuse hypokinesis and LV end systolic and diastolic volumes (LVESV/LVEDV): 134/172 ml. His coronary catheterization demonstrated non-significant coronary artery disease and he had a normal cardiac biopsy. Over those years the patient was hospitalized frequently due to worsening HF symptoms and was graded as New York Heart Association (NYHA) functional class III. His baseline ECG showed normal sinus rhythm with QRS duration of 92 ms. Recurrent 24h-Holter monitoring showed >40% (>50,000) PVCs with a morphology of intermediate right bundle (RS in V1) and right-inferior axis, with multiple episodes of SMVT. Tachycardia-induced cardiomyopathy was suspected.Sixteen months prior to current hospital admission the patient had underwent an electrophysiology study (in another medical center) in order to map and ablate the arrhythmia; endocardial, aortic cusps and coronary sinus (CS) mapping of PVCs using a 4F CARDIMA catheter for the CS and CARTO 3-D mapping system were employed. Earliest activation was located to the middle part of the great cardiac vein (anterior interventricular branching) with 12/12 pace mapping, 50 ms prior to QRS. The operator was unable to pass an ablation catheter forward to distal CS and the procedure was discontinued. A few months later the patient underwent another ablation attempt: an epicardial catheter was located opposite to the earliest point of the CARDIMA CS catheter. RF ablation at that area abolished the PVCs, but PVCs resumed after a few hours. Several months later the patient was referred for a third procedure. Conscious sedation caused temporary disappearance of PVCs and no inducibility of VT. Pace mapping was not perfect and the procedure was discontinued. The patient refused further attempts.He was treated with maximal tolerated doses of sotalol, quinidine and then was fully loaded with amiodarone (each antiarrhytmic drug at a time) along with beta blockers. Despite those antiarrhythmic drugs (several months each), the patient had recurrent hospitalizations for HF exacerbations and SMVT episodes. The patient had an indication for ICD implantation for secondary prevention and although the patient had narrow QRS, we decided to implant a CRT-D because we anticipated a need for overdrive RV pacing in a patient with an upfront severe LV dysfunction and an expected further LV function deterioration. Furthermore, the final decision was to implant two LV leads at different locations, aiming for a stronger possible antiarrhythmic effect -as proposed in the discussion section. The patient gave his written informed consent to the procedure. A transvenous biventricular ICD (PRO...

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“…So our study can represent general CRT patient population. Ermis et al reported that arrhythmia frequency and number of appropriate ICD treatments were reduced after upgrade to CRT-ICD for HF treatment [19]. The CARE-HF study [20] has demonstrated that CRT reduced sudden cardiac death in heart failure patients in 2 years follow-up.…”

Section: Discussionmentioning

confidence: 99%

Increase in QTC Dispersion Predicts Arrhythmic Events in Patients With Cardiac Resynchronization Therapy

Kocas¹,

Abacı

Kılıçkesmez

et al. 2014

Russ J Cardiol

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Aim. Benefits of CRT on mortality and morbidity in patients with severe CHF are clear but the effect of CRT on sudden cardiac death is more controversial. It has been suggested that CRT may catalyze arrhythmogenicity by reversing the normal depolarization pattern. The purpose of this study was to examine the effect of CRT on dispersion of repolarization as assessed by ECG. We also sought to determine the value of dispersion of repolarization ECG parameters in predicting the occurrence of major arrhythmic events (MAE) in follow-up. Material and methods. A total of 48 patients with end-stage heart failure and QRS duration >120 ms underwent CRT. QT dispersion (QTd), T peak t end interval (Tpe) and T peak t end dispersion (Tpe dispersion) were measured before and immediately after CRT implantation. All patients were followed at least 12 months for ventricular tachycardia or fibrillation that were treated with antitachicardia pace or cardioversion. Results. Over 16±7.1 months, 14 patients had a MAE. Compared to baseline, after CRT, QTc dispersion (84.66±37.7 vs 100.36±47.4, p=0.04) and Tpe interval (104.1±20.4 vs 122.03±33, p=0.02) increased significantly. Increase in QTD (∆QTD) (31.66±39.5 vs 5.57±5.59, p=0.03), and QTc dispersion (∆QTc dispersion) (40.19±46.6 vs 4.39±14.35, p=0.04) from baseline was signifcantly higher in MAE group. In multiple regression analyses, ∆QTc dispersion predicted MAE (p=0.045, CI: 1.000-1.033). Цель. Преимущества сердечной ресинхронизирующей терапии (CRT) в сни-жении смертности и заболеваемости больных с тяжелой ХСН ясны, но дейст-вие CRT при внезапной сердечной смерти является более спорным. Было высказано предположение, что CRT может катализировать аритмогенность, реверсируя нормальную деполяризационную структуру. Целью данного исследования было изучить влияние CRT на дисперсию реполяризации, при оценке ЭКГ. Мы также стремились определить значение дисперсии реполяри-зации параметров ЭКГ в прогнозировании возникновения крупных аритмиче-ских событий (MAE) в последующем. Материал и методы. Всего 48 пациентов с терминальной стадией сердеч-ной недостаточности и длительностью комплекса QRS >120 мс прошли CRT. Дисперсия QT (QTd), T пик t end интервал (Tpe) и T пик t end дисперсии (Tpe дисперсии) были измерены до и сразу после CRT имплантации. Все паци-енты находились под наблюдением, по крайней мере, 12 месяцев, желудоч-ковая тахикардия или аритмия лечились кардиостимуляцией или кардио-версией. Conclusion. Immediately after CRT implantationРезультаты. Более 16±7.1 месяцев у 14 пациентов были MAE. По сравнению с исходными данными, после CRT, QTc дисперсия (84.66±на 37,7 против 100.36±47.4, p=0,04) и Tpe интервал (104.1±20.4 против 122.03±33, p=0.02) значительно увеличились. Увеличение QTD (t QTd) (31.66±39.5 против 5.57±5.59, p=0,03), и QTc дисперсии (t QTc дисперсии) (40.19±против 46.6 4.39±14.35, p=0,04) от исходного уровня были значительно выше в группе с MAE. При множественном регрессионном анализе ∆QTc дисперсия предска-зывала развитие MAE (р=0,045 (CI): 1.000-1.033). Заключение. Сразу по...

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Impact of Upgrade to Cardiac Resynchronization Therapy on Ventricular Arrhythmia Frequency in Patients With Implantable Cardioverter-Defibrillators

Abstract: Arrhythmia frequency and number of appropriate ICD treatments were reduced after upgrade to CRT-ICD for HF treatment. Thus, apart from hemodynamic benefits, CRT may also ameliorate ventricular tachyarrhythmia susceptibility in HF patients.

Cited by 99 publications

References 23 publications

Incidence, Predictors, and Procedural Results of Upgrade to Resynchronization Therapy

Incidence, Predictors, and Procedural Results of Upgrade to Resynchronization Therapy

Biventricular with Multi-Site Left-Ventricular Pacing for the Management of Refractory Ventricular Tachycardia in a Patient with Narrow Complex QRS – Case Report

Increase in QTC Dispersion Predicts Arrhythmic Events in Patients With Cardiac Resynchronization Therapy

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