Sinergy between drugs and devices in the fight against sudden cardiac death and heart failure

Boriani, Giuseppe; Ponti, Roberto De; Guerra, Federico; Palmisano, Pietro; Zanotto, Gabriele; D’Onofrio, Antonio; Ricci, Renato Pietro

doi:10.1093/eurjpc/zwaa015

Cited by 29 publications

(22 citation statements)

References 102 publications

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“… 17 Although our data are mainly focused on a late introduction of SV in nonresponder CRT-D patients, our results also advocate for early combined therapy with S/V and CRT. 17 In patients who have left bundle branch block, medical therapy has a limited effect on LVEF, indicating that electrical (ie, CRT) therapy and medical therapy have different targets, with the potential for additive and even synergistic effects. 17 …”

Section: Discussionmentioning

confidence: 67%

“… 17 In patients who have left bundle branch block, medical therapy has a limited effect on LVEF, indicating that electrical (ie, CRT) therapy and medical therapy have different targets, with the potential for additive and even synergistic effects. 17 …”

Section: Discussionmentioning

confidence: 99%

“…HF symptom functional status improved significantly, both subjectively [New York Heart Association 2 (2-3) vs. 1 (1-2), P , 0.001] and objectively [hours of physical activity/ day: 10 (8-12) vs. 13 (10)(11)(12)(13)(14)(15)(16)(17)(18), P , 0.001]. The rate of HF rehospitalization was decreased significantly compared with the 12 months before the start of S/V therapy (35.5% vs. 19.5%, P , 0.001).…”

Section: Secondary Endpointsmentioning

confidence: 99%

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Add-on Therapy With Sacubitril/Valsartan and Clinical Outcomes in CRT-D Nonresponder Patients

Russo

Ammendola

Gasperetti

et al. 2021

Journal of Cardiovascular Pharmacology

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:No data on the add-on sacubitril/valsartan (S/V) therapy among cardiac resynchronization therapy with a defibrillator (CRT-D) nonresponder patients are currently available in literature. We conducted a prospective observational study including 190 CRT-D nonresponder patients with symptomatic heart failure with reduced ejection fraction despite the optimal medical therapy from at least 1 year. The primary endpoint was the rate of additional responders (left ventricular end-systolic volume reduction >15%) at 12 months from the introduction of S/V therapy. At the end of the 12 months follow-up, 37 patients (19.5%) were deemed as “additional responders” to the combination use of CRT + S/V therapy. The only clinical predictor of additional response was a lower left ventricular ejection fraction [OR 0.881 (0.815–0.953), P = 0.002] at baseline. At 12 months follow-up, there were significant improvements in heart failure (HF) symptoms and functional status [New York Heart Association 2 (2–3) vs. 1 (1–2), P < 0.001; physical activity duration/day: 10 (8–12) vs. 13 (10–18) hours, P < 0.001]. Compared with the 12 months preceding S/V introduction, there were significant reductions in the rate of HF rehospitalization (35.5% vs. 19.5%, P < 0.001), in atrial tachycardia/atrial fibrillation burden [6.0 (5.0–8.0) % vs. 0 (0–2.0) %, P < 0.001] and in the proportions of patients experiencing ventricular arrhythmias (21.6% vs. 6.3%; P < 0.001). Our results indicate that S/V add-on therapy in CRT-D nonresponder patients is associated with 19.5% of additional responders, a reduction in HF symptoms and rehospitalizations, AF burden, and ventricular arrhythmias.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Secondary Endpointsmentioning

confidence: 99%

See 1 more Smart Citation

Add-on Therapy With Sacubitril/Valsartan and Clinical Outcomes in CRT-D Nonresponder Patients

Russo

Ammendola

Gasperetti

et al. 2021

Journal of Cardiovascular Pharmacology

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“…Accordingly, these considerations prompted the development of ad hoc recommendations from principal national and international associations to manage urgent cardiovascular interventions in these settings both in COVID and non-COVID patients [ 15 , 16 , 17 , 18 ], while non-urgent procedures have been deferred/cancelled. However, a more interesting approach was the increase in telemedicine, especially in the field of monitoring of CIED carriers, an area that was almost up to date with such an approach [ 19 , 20 ]. This reason can explain why the enrolled patients seem not to have experienced any worsening in the thoracic fluid accumulation index during the lockdown period with respect to the control analyzed periods.…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 Pandemic and Lockdown Restrictions on Cardiac Implantable Device Recipients with Remote Monitoring

Diemberger

Vicentini

Cattafi³

et al. 2021

JCM

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From 2020, many countries have adopted several restrictions to limit the COVID-19 pandemic. The forced containment impacted on healthcare organizations and the everyday life of patients with heart disease. We prospectively analyzed data recorded from implantable defibrillators and/or cardiac resynchronization devices of Italian patients during the lockdown (LDP), post-lockdown period (PLDP) and a control period (CP) of the previous year. We analyzed device data of the period 9 March 2019–31 May 2020 of remotely monitored patients from 34 Italian centers. Patients were also categorized according to areas with high/low infection prevalence. Among 696 patients, we observed a significant drop in median activity in LDP as compared to CP that significantly increased in the PLDP, but well below CP (all p < 0.0001). The median day heart rate and heart rate variability showed a similar trend. This behavior was associated during LDP with a significant increase in the burden of atrial arrhythmias (p = 0.0150 versus CP) and of ventricular arrhythmias [6.6 vs. 1.5 per 100 patient-weeks in CP; p = 0.0026]; the latter decreased in PLDP [0.3 per 100 patient-weeks; p = 0.0035 vs. LDP]. No modifications were recorded in thoracic fluid levels. The high/low prevalence of COVID-19 infection had no significant impact. We found an increase in the arrhythmic burden in LDP coupled with a decrease in physical activity and heart rate variability, without significant modifications of transthoracic impedance, independent from COVID-19 infection prevalence. These findings suggest a negative impact of the COVID-19 pandemic, probably related to lockdown restrictions.

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“…We should consider that OMT does not improve left ventricular ejection fraction in patients with LBBB 14 . On the other hand, OMT after CRT implant is associated with prolonged survival, 14 suggesting a synergetic effect between device and drug therapy 15 …”

Section: Conventional Medical Therapymentioning

confidence: 99%

The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: insights from an individual patient data meta‐analysis of COMPANION and CARE‐HF

Leyva

Boriani

2022

European J of Heart Fail

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This article refers to 'The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta-analysis of COMPANION and CARE-HF' by J.G.F. Cleland et al., published in this issue on pages 1080-1090.In this issue of the Journal, in the individual patient data meta-analysis of COMPANION (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure) 1 and CARE-HF (Cardiac Resynchronization-Heart Failure), 2 Cleland et al. 3 explore the effects of cardiac resynchronization therapy pacemaker (CRT-P) versus medical therapy alone in 1026 CRT-P recipients and 712 controls receiving optimal medical therapy (OMT). They found that CRT-P led to a lower risk for all-cause mortality and the composite endpoint of all-cause mortality or heart failure (HF) hospitalization. Whilst a smaller body surface area and treatment with beta-blockers predicted a benefit from CRT, other baseline characteristics, namely sex, aetiology, QRS duration or morphology, PR interval and medical therapy other than beta-blockers did not. This is a welcome meta-analysis of the only randomized controlled trials (RCTs) to compare the effects of CRT-P versus OMT, undertaken nearly 20 years ago. Since then, numerous, relevant meta-analyses have been published, 4-7 but a unique aspect of this study is the comparison of CRT-P with 'no device' rather than an implantable cardioverter defibrillator (ICD). First, it confirms the prognostic benefit of CRT, both in terms of prolonging survival and reducing HF hospitalizations. Second, according to our interpretation, the confidence for a benefit of CRT is greater in QRS durations >150 ms than QRS durations <150 ms. Third, the

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Sinergy between drugs and devices in the fight against sudden cardiac death and heart failure

Cited by 29 publications

References 102 publications

Add-on Therapy With Sacubitril/Valsartan and Clinical Outcomes in CRT-D Nonresponder Patients

Add-on Therapy With Sacubitril/Valsartan and Clinical Outcomes in CRT-D Nonresponder Patients

The Impact of COVID-19 Pandemic and Lockdown Restrictions on Cardiac Implantable Device Recipients with Remote Monitoring

The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: insights from an individual patient data meta‐analysis of COMPANION and CARE‐HF

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