Association Between Frequency of Atrial and Ventricular Ectopic Beats and Biventricular Pacing Percentage and Outcomes in Patients With Cardiac Resynchronization Therapy

Abstract

Relatively low frequencies of ectopic beats (≥0.1%) dramatically increase the probability of low biventricular pacing (<97%), with reduced CRT efficacy by less reverse remodeling and higher risk of HF/death and VTA. This supports pre-implantation Holter monitoring of patients selected for CRT for optimal outcome. (MADIT-CRT: Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy; NCT00180271).

Dual intraventricular response after cardiac resynchronization

“…PVCs account for 16.6% of the loss of CRT 3 . An association between the frequency of PVCs and outcome in patients with CRT has been demonstrated 4 . Successful ablation of PVCs promotes reverse remodeling in CRT nonresponders 5 …”

Predicting Ventricular Arrhythmias in Cardiac Resynchronization Therapy: The Impact of Persistent Electrical Dyssynchrony

“…Another interesting study by Ruwald et al. demonstrated that even the presence of ectopic beats in CRT patients is significantly associated with poor outcome in terms of subsequent ventricular arrhythmias, heart failure and death …”

Prognostic Implications of ‘Paced’ and ‘Native’ QRS Durations Following Cardiac Resynchronization Therapy

“…[29][30][31] Apart from lead localisation, achievement of an almost 100% biventricular pacing rate is a major concern to derive benefit from CRT devices. 32,33 The clinical conditions that impair high pacing rates, such as atrial fibrillation and ventricular ectopic beats should be routinely searched and treated during the followup of CRT recipients. 32,33 Appropriate device programming regarding the atrioventricular (AV) and interventricular (VV) intervals is essential to achieve optimal diastolic filling and stroke volume that is associated with favourable outcomes after CRT.…”

“…32,33 The clinical conditions that impair high pacing rates, such as atrial fibrillation and ventricular ectopic beats should be routinely searched and treated during the followup of CRT recipients. 32,33 Appropriate device programming regarding the atrioventricular (AV) and interventricular (VV) intervals is essential to achieve optimal diastolic filling and stroke volume that is associated with favourable outcomes after CRT. [34][35][36] All of the above-mentioned optimisation steps are known to affect the paced QRSd following device implantation.…”