Risk Stratification of Future Left Ventricular Dysfunction for Patients with Indications for Right Ventricular Pacing due to Bradycardia

Ooka, Junichi; Tanaka, Hidekazu; Hatani, Yutaka; Hatazawa, Keiko; Matsuzoe, Hiroki; Shimoura, Hiroyuki; Sano, Hiroyuki; Sawa, Takuma; Motoji, Yoshiki; Mochizuki, Yasuhide; Ryo-Koriyama, Keiko; Matsumoto, Kensuke; Fukuzawa, Koji; Hirata, Ken‐ichi

doi:10.1536/ihj.16-415

Cited by 12 publications

(12 citation statements)

References 20 publications

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“…Fourth, LVEF was measured under right ventricular pacing at CS diagnosis and after corticosteroid therapy in most cases, which might cause underestimation. 26) Further studies with a larger population including patients without CAVB are required to support the present results. Conclusion: In patients of CS with CAVB without history of extracardiac sarcoidosis, the diagnosis of CS may be delayed.…”

Section: Role Of Echocardiography For Early Diagnosis Of Csmentioning

confidence: 59%

Importance of Early Diagnosis of Cardiac Sarcoidosis in Patients with Complete Atrioventricular Block

Kaida¹,

Inomata

Minami³

et al. 2018

Int. Heart J.

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Our aim is to clarify the factors for early diagnosis of cardiac sarcoidosis (CS) in patients with complete atrioventricular block (CAVB) and its impact on cardiac function after corticosteroid therapy.A total of 15 CS patients with CAVB who underwent corticosteroid therapy were retrospectively analyzed. Patients were divided into two groups according to the time from the first CAVB onset to the diagnosis of CS. Clinical characteristics and outcomes were compared between the early diagnosis group (within 1 year; group E, n = 10) and the late diagnosis group (over 1 year; group L, n = 5).The history of extracardiac sarcoidosis (60 versus 0%, P = 0.0440) and abnormal findings on echocardiography (70 versus 0%, P = 0.0256) at the CAVB onset were significantly more frequent in group E than in group L. The change of left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) levels was significantly better in group E than in group L (0.8 ± 2.8 versus -32.4 ± 3.9%, P < 0.0001; -11.1 ± 16.0 versus 161.8 ± 35.8 pg/mL, P = 0.0013, respectively). After corticosteroid therapy, the LVEF and BNP levels were also significantly better in group E than in group L (53.3 ± 10.7 versus 37.0 ± 9.3%, P = 0.0128; 63.0 ± 46.4 versus 458.8 ± 352.0 pg/mL, P = 0.0027).The diagnosis may be delayed in CS patients with CAVB without history of extracardiac sarcoidosis. Abnormal findings on echocardiography contributed to the early diagnosis of CS. Therefore, the diagnosis of CS may be missed or delayed in patients without them. Time delay from the CAVB onset to the CS diagnosis may exacerbate the cardiac function.

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Section: Role Of Echocardiography For Early Diagnosis Of Csmentioning

confidence: 59%

Importance of Early Diagnosis of Cardiac Sarcoidosis in Patients with Complete Atrioventricular Block

Kaida¹,

Inomata

Minami³

et al. 2018

Int. Heart J.

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“…In this study, we showed that age, renal dysfunction, decreased LVEF, and appropriate ICD shocks were significant predictors of death in the univariate analysis, similar to that reported in previous studies. [24][25][26] We showed in a multivariate analysis that high BNP level, sedentary status but awake at the time of occurrence of an inappropriate therapy, and cause of inappropriate therapy were novel and potent predictors of increased mortality. A unique aspect of the current study was the measurement of BNP.…”

Section: Discussionmentioning

confidence: 99%

A Decision Tree-Based Survival Analysis of Patients with a History of Inappropriate Implantable Cardioverter-Defibrillator Therapy

Yamamoto

Okajima²,

Shimane³

et al. 2019

Int. Heart J.

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Implantable cardioverter-defibrillators (ICDs) improve survival in patients who are at risk of sudden death. However, inappropriate therapy is commonly given to ICD recipients, and this situation may be associated with an increased risk of death. This study aimed to construct a risk stratification scheme by using decision tree analysis in patients who received inappropriate ICD therapy.Mortality was calculated from a retrospective data analysis of a multicenter cohort involving 417 ICD recipients. Inappropriate therapy was defined as therapy for nonventricular arrhythmias, including sinus tachycardia, supraventricular tachycardia, atrial fibrillation/flutter, oversensing, and lead failure. Inappropriate therapy included antitachycardia pacing, cardioversion, and defibrillation. The prognostic factors were identified by a Cox proportional hazards regression analysis, and we constructed a decision tree.During an average follow-up of 5.2 years, 48 patients (12%) had all-cause death. A multivariate Cox hazard model revealed that the age (hazard ratio [HR] 1.06, P < 0.001), ln B-type natriuretic peptide (BNP) (HR 1.47, P = 0.02), nonsinus rhythm at implantation (HR 2.70, P < 0.05), and inappropriate therapy occurring during sedentary/awake conditions (HR 3.51, P = 0.001) correlated with an increased risk of mortality. An inappropriate therapy due to abnormal sensing (HR 0.16, P = 0.04) decreased the risk of mortality. Furthermore, a decision tree analysis stratified the patients well by using 4 covariates: BNP, activity at the time of inappropriate therapy, mechanism of inappropriate therapy, and baseline rhythm at ICD implantation (log-rank test, P < 0.0001).We identified the predictors of mortality in inappropriate ICD therapy recipients and constructed a risk stratification scheme by using decision tree analysis.(Int Heart J 2019; 60: 318-326)

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“…Cardiac pacing is an effective treatment for patients with bradyarrhythmia, but pacing-induced cardiomyopathy after right ventricular pacing continues to be reported in the literature, especially in pacing-dependent patients with Chen, ET AL decreased cardiac functions. [11][12][13][14] In recent years, selective site pacing from the right ventricular mid-septum has made rapid progress, and some studies suggest that it results in better cardiac function and prognosis than the right ventricular apical pacing. 15,16) However, based on the existing information from evidence-based medicine, right ventricular septal pacing did not show significant advantages.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Implications of QRS Duration in Third-Degree Atrioventricular Block Patients with Heart Failure Treated with Cardiac Resynchronization Therapy

et al. 2018

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Cardiac resynchronization therapy (CRT) improves heart function and prognosis in third-degree atrioventricular block (AVB) patients with heart failure (HF). However, it is still unclear how to screen for appropriate patients before implantation. This study aimed to evaluate the value of using QRS duration to predict CRT efficacy.This study enrolled a total of 72 third-degree AVB patients with HF who received CRT implantation. The patients were divided into Groups A (QRS duration < 120 ms, 33 cases), B (120 ms !QRS duration < 150 ms, 22 cases), and C (QRS duration "150 ms, 17 cases) according to their baseline QRS duration. The effects of different QRS durations on CRT efficacy were analyzed.The CRT response rate were 30.3%, 50.0%, and 76.5% in Groups A, B, and C, respectively (P = 0.008). The patients in the 3 groups showed significant changes in left ventricular (LV) end-diastolic volume, LV endsystolic volume, and LV ejection fraction over the baseline values at 12 months after the implantation (P < 0.05), with the greatest change observed in Group C. Survival analysis indicated statistically significant differences among Groups A, B, and C (P = 0.024). Multivariate logistic regression analysis suggested that QRS duration was an independent prognostic factor for CRT efficacy. Baseline QRS duration was associated with improved myocardial remodeling and reductions in the incidence rates of primary endpoint events.QRS "150 ms is an effective predictor of postoperative outcome in patients with third-degree AVB and HF treated with CRT. (Int Heart J 2018; 59: 1320-1326

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Risk Stratification of Future Left Ventricular Dysfunction for Patients with Indications for Right Ventricular Pacing due to Bradycardia

Cited by 12 publications

References 20 publications

Importance of Early Diagnosis of Cardiac Sarcoidosis in Patients with Complete Atrioventricular Block

Importance of Early Diagnosis of Cardiac Sarcoidosis in Patients with Complete Atrioventricular Block

A Decision Tree-Based Survival Analysis of Patients with a History of Inappropriate Implantable Cardioverter-Defibrillator Therapy

Prognostic Implications of QRS Duration in Third-Degree Atrioventricular Block Patients with Heart Failure Treated with Cardiac Resynchronization Therapy

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