Usefulness of suppression of ventricular arrhythmia by biventricular pacing in severe congestive cardiac failure

Walker, S; Levy, Terry; Rex, S.; Brant, S.; Allen, Julie; Ilsley, Charles; Paul, Vincent

doi:10.1016/s0002-9149(00)00865-1

Cited by 99 publications

(48 citation statements)

References 15 publications

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“…[17][18][19] In the present study, the number of patients experiencing ventricular arrhythmias was similar in both treatment groups. The 6-month duration of the study, however, may have been too short to demonstrate the full effect of CRT on the occurrence of ventricular arrhythmias, especially when one considers that significantly longer follow-up has often been required to show the benefits of antiarrhythmic agents in drug trials.…”

Section: Discussionsupporting

confidence: 59%

Effects of Cardiac Resynchronization on Disease Progression in Patients With Left Ventricular Systolic Dysfunction, an Indication for an Implantable Cardioverter-Defibrillator, and Mildly Symptomatic Chronic Heart Failure

et al. 2004

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on behalf of the Multicenter InSync ICD II Study GroupBackground-The effects of cardiac resynchronization therapy (CRT) in patients with mildly symptomatic heart failure have not been fully elucidated. Methods and Results-The Multicenter InSync ICD Randomized Clinical Evaluation II (MIRACLE ICD II) was a randomized, double-blind, parallel-controlled clinical trial of CRT in NYHA class II heart failure patients on optimal medical therapy with a left ventricular (LV) ejection fraction Յ35%, a QRS Ն130 ms, and a class I indication for an ICD. One hundred eighty-six patients were randomized: 101 to the control group (ICD activated, CRT off) and 85 to the CRT group (ICD activated, CRT on). End points included peak V O 2 , V E/V CO 2 , NYHA class, quality of life, 6-minute walk distance, LV volumes and ejection fraction, and composite clinical response. Compared with the control group at 6 months, no significant improvement was noted in peak V O 2 , yet there were significant improvements in ventricular remodeling indexes, specifically LV diastolic and systolic volumes (Pϭ0.04 and Pϭ0.01, respectively), and LV ejection fraction (Pϭ0.02). CRT patients showed statistically significant improvement in V E/V CO 2 (Pϭ0.01), NYHA class (Pϭ0.05), and clinical composite response (Pϭ0.01). No significant differences were noted in 6-minute walk distance or quality of life scores. Conclusions-In patients with mild heart failure symptoms on optimal medical therapy with a wide QRS complex and an ICD indication, CRT did not alter exercise capacity but did result in significant improvement in cardiac structure and function and composite clinical response over 6 months.

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Section: Discussionsupporting

confidence: 59%

Effects of Cardiac Resynchronization on Disease Progression in Patients With Left Ventricular Systolic Dysfunction, an Indication for an Implantable Cardioverter-Defibrillator, and Mildly Symptomatic Chronic Heart Failure

et al. 2004

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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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“…1 -3,16,17 In addition, resynchronization therapy is associated with reduced sympathetic nervous activity 18 and increased heart rate variability, 19,20 suggesting potentially favorable neurohormonal effects. Several studies have suggested that CRT may also suppress premature ventricular contractions, 4,8 reduce ventricular tachyarrhythmic events 6,17 and decrease inducibility of sustained ventricular tachycardia ( VT). 5 …”

Section: Clinical Benefit Of Crtmentioning

confidence: 99%

“…Several studies have demonstrated an antiarrhythmic effect and have suggested that cardiac resynchronization diminishes the need for ICD therapy; 4,5,7,8 however, sudden death remains a significant contributor to HF mortality and more research is required to fully understand the electrophysiologic impact of this therapy. For this reason, all patients with a CRT indication and a concomitant defibrillator indication, including those based on the multicenter automatic defibrillator implantation trial (MADIT) and SCD-HeFT studies, should receive a resynchronization device with ICD backup.…”

Section: Determining Arrhythmic Riskmentioning

confidence: 99%

Cardiac Resynchronization Therapy and its Potential Proarrhythmic Effect

Ray¹,

Fendelander²,

Singh³

2007

Clinical Cardiology

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SummaryCardiac resynchronization therapy (CRT) has become an established adjunctive treatment to optimal pharmacologic therapy in patients with advanced chronic heart failure (CHF), diminished left ventricular (LV) function and intraventricular conduction delay. Although CRT has been shown to improve ventricular hemodynamics, quality of life and exercise capacity, there is some evidence that it may rarely potentiate ventricular arrhythmias. As CRT is considered for an expanded population of CHF patients, and left-sided pacing is considered as an option for pacemaker-indicated patients (potentially without defibrillator backup), the effect of these pacing modalities on the incidence of ventricular tachyarrhythmia must be systematically studied and mechanistically understood. Strategies to prospectively predict the proarrhythmic potential of LV epicardial pacing need to be developed, and therapy accordingly individualized. This review attempts to summarize the current information on proarrhythmia in resynchronization therapy.

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Usefulness of suppression of ventricular arrhythmia by biventricular pacing in severe congestive cardiac failure

Cited by 99 publications

References 15 publications

Effects of Cardiac Resynchronization on Disease Progression in Patients With Left Ventricular Systolic Dysfunction, an Indication for an Implantable Cardioverter-Defibrillator, and Mildly Symptomatic Chronic Heart Failure

Effects of Cardiac Resynchronization on Disease Progression in Patients With Left Ventricular Systolic Dysfunction, an Indication for an Implantable Cardioverter-Defibrillator, and Mildly Symptomatic Chronic Heart Failure

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

Cardiac Resynchronization Therapy and its Potential Proarrhythmic Effect

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