Pérdida de estimulación biventricular continua en pacientes con terapia de resincronización cardiaca: incidencia, causas y resultados

Colchero, Teresa; Arias, Miguel Á.; López-Sánchez, Fernando A.; Pachón, Marta; Domínguez‐Pérez, Laura; Puchol, Alberto; Jiménez‐López, Jesús; Lázaro, María; Martínez-Mateo, Virgilio; Rodríguez‐Padial, Luis

doi:10.1016/j.recesp.2012.10.010

Cited by 8 publications

(3 citation statements)

References 23 publications

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“…It is not surprising that the achieved BivP during follow-up is lower in our cohort in patients with a higher burden of AF as it is known that it can be troublesome to achieve adequate BivP in patients with AF and our results are thus in agreement with previous findings [7, 9].…”

Section: Discussionsupporting

confidence: 93%

“…However, we did not observe significant differences in baseline heart rate between AF patients with BivP > 98% compared to those with BivP ≤98% at one-year follow-up. As atrial tachyarrhythmia can be an important cause of BivP loss [7], and that our patients with AF had less BivP by the first year of follow-up, suggests that arrhythmia burden during follow-up is an important determinant of the ability to achieve adequate BivP. When comparing patients with non-permanent and permanent AF, patients with permanent AF had a higher likelihood of a BivP ≤98% (57% vs. 39%, p -value 0,04).…”

Section: Discussionmentioning

confidence: 99%

“…An effective delivery of biventricular pacing (BivP) has been shown to be a major determinant of the success of CRT [4] and AF may cause loss of BivP [7]. Previous studies have defined high BivP as > 98% of all ventricular beats and in large-scale studies, the greatest magnitude of reduction in mortality has been observed in patients with a BivP achieved in excess of 98% [8, 9].…”

Section: Introductionmentioning

confidence: 99%

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Atrial fibrillation incidence and impact of biventricular pacing on long-term outcome in patients with heart failure treated with cardiac resynchronization therapy

Jacobsson

Reitan

Carlson

et al. 2019

BMC Cardiovasc Disord

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Background In patients with cardiac resynchronization therapy (CRT), atrial fibrillation (AF) is associated with an unfavorable outcome and may cause loss of biventricular pacing (BivP). An effective delivery of BivP of more than 98% of all ventricular beats has been shown to be a major determinant of CRT-success. Methods At a Swedish tertiary referral center, data was retrospectively obtained from patient registers, medical records and preoperative electrocardiograms. Data regarding AF and BivP during the first year of follow-up was assessed from CRT-device interrogations. No intra-cardiac electrograms were studied. Kaplan-Meier curves and Cox-regression analyses adjusted for age, etiology of heart failure, left ventricular ejection fraction, left bundle branch block and NYHA class were performed to assess the impact of AF and BivP on the risk of death or heart transplantation (HTx) at 10-years of follow-up. Results Preoperative AF-history was found in 54% of the 379 included patients and was associated with, but did not independently predict death or HTx. The one-year incidence of new device-detected AF was 22% but not associated with poorer prognosis. At one-year, AF-history and BivP≤98%, was associated with a higher risk of death or HTx compared to patients without AF (HR 1.9, 95%CI 1.2–3.0, p = 0.005) whereas AF and BivP> 98% was not (HR 1.4, 95%CI 0.9–2.3, p = 0.14). Conclusions In CRT-recipients, AF-history is common and associated with poor outcome. AF-history does not independently predict mortality and is probably only a marker of a more severe underlying disease. BivP≤98% during first-year of CRT-treatment independently predicts poor outcome thus further supporting the use of 98% threshold of BivP, which should be attained to maximize the benefits of CRT.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Atrial fibrillation incidence and impact of biventricular pacing on long-term outcome in patients with heart failure treated with cardiac resynchronization therapy

Jacobsson

Reitan

Carlson

et al. 2019

BMC Cardiovasc Disord

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Impact of ventricular arrhythmia management on suboptimal biventricular pacing in cardiac resynchronization therapy

Bruck

Middeldorp

Sultan

et al. 2022

J Interv Card Electrophysiol

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Background Reduced biventricular pacing (BiVP) is a common phenomenon in cardiac resynchronization therapy (CRT) with impact on CRT-response and patients’ prognosis. Data on treatment strategies for patients with ventricular arrhythmia and BiVP reduction is sparse. We sought to assess the effects of ventricular arrhythmia treatment on BiVP. Methods In this retrospective analysis, the data of CRT patients with a reduced BiVP ≤ 97% due to ventricular arrhythmia were analyzed. Catheter ablation or intensified medical therapy was performed to optimize BiVP. Results We included 64 consecutive patients (73 ± 10 years, 89% male, LVEF 30 ± 7%). Of those, 22/64 patients (34%) underwent ablation of premature ventricular contractions (PVC) and 15/64 patients (23%) underwent ventricular tachycardia (VT) ablation while 27/64 patients (42%) received intensified medical treatment. Baseline BiVP was 88.1% ± 10.9%. An overall increase in BiVP percentage points of 8.8% (range − 5 to + 47.6%) at 6-month follow-up was achieved. No changes in left ventricular function were observed but improvement in BiVP led to an improvement in NYHA class in 24/64 patients (38%). PVC ablation led to a significantly better improvement in BiVP [9.9% (range 4 to 22%) vs. 3.2% (range − 5 to + 10.7%); p = < 0.001] and NYHA class (12/22 patients vs. 4/27 patients; p = 0.003) than intensified medical therapy. All patients with VT and reduced BiVP underwent VT ablation with an increase of BiVP of 16.3 ± 13.4%. Conclusion In this evaluation of ventricular arrhythmia treatment aiming for CRT optimization, both medical therapy and catheter ablation were shown to be effective. Compared to medical therapy, a higher increase in BiVP was observed after PVC ablation, and more patients improved in NYHA class. Clinical Trial Registration The study was registered at clinical trials.org in August 2019: NCT04065893.

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Cardiac Resynchronization Therapy Programming and Troubleshooting

Cha¹,

Mulpuru²

2017

Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy

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Pérdida de estimulación biventricular continua en pacientes con terapia de resincronización cardiaca: incidencia, causas y resultados

Cited by 8 publications

References 23 publications

Atrial fibrillation incidence and impact of biventricular pacing on long-term outcome in patients with heart failure treated with cardiac resynchronization therapy

Atrial fibrillation incidence and impact of biventricular pacing on long-term outcome in patients with heart failure treated with cardiac resynchronization therapy

Impact of ventricular arrhythmia management on suboptimal biventricular pacing in cardiac resynchronization therapy

Cardiac Resynchronization Therapy Programming and Troubleshooting

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