Biventricular pacing decreases the inducibility of ventricular tachycardia in patients with ischemic cardiomyopathy

Zagrodzky, Jason; Ramaswamy, Karthik; Page, Richard L.; Joglar, José A.; Sheehan, Clifford J; Smith, Michael L.; Hamdan, Mohamed H.

doi:10.1016/s0002-9149(01)01498-9

Cited by 79 publications

(57 citation statements)

References 7 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: 60%

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: 60%

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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“…13 Other studies suggested that this antiarrhythmic effect is due to reductions in the number of ventricular extrasystoles, 14 the incidence of tachyarrhythmic events 15 and the inducibility of sustained VT. 16 More recent research has indicated that this effect is mainly seen in patients who respond to CRT, as a consequence of the hemodynamic improvement induced by BiV pacing, 17,18 but not in nonresponders.…”

Section: Discussionmentioning

confidence: 99%

The proarrhythmic effect of cardiac resynchronization therapy: An issue that should be borne in mind

Cabanelas

Oliveira

Silva

et al. 2014

Revista Portuguesa de Cardiologia (English Edition)

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The demonstrated benefits of cardiac resynchronization therapy (CRT) in reducing mortality and hospitalizations for heart failure, improving NYHA functional class and inducing reverse remodeling have led to its increasing use in clinical practice. However, its potential contribution to complex ventricular arrhythmias is controversial.We present the case of a female patient with valvular heart failure and severe systolic dysfunction, in NYHA class III and under optimal medical therapy, without previous documented ventricular arrhythmias. After implantation of a CRT defibrillator, she suffered an arrhythmic storm with multiple episodes of monomorphic ventricular tachycardia (VT), requiring 12 shocks. Subsequently, a pattern of ventricular bigeminy was observed, as well as reproducible VT runs induced by biventricular pacing.Since no other vein of the coronary sinus system was accessible, it was decided to implant an epicardial lead to stimulate the left ventricle, positioned in the left ventricular mid-lateral wall. No arrhythmias were detected in the following six months.This case highlights the possible proarrhythmic effect of biventricular pacing with a left ventricular lead positioned in the coronary sinus venous system. © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved. 309.e2 N. Cabanelas et al. PALAVRAS-CHAVE Heterogeneidade da repolarizaçãode remodelagem inversa em doentes selecionados com insuficiência cardíaca (ICC), têm contribuído para a crescente utilização destes dispositivos na prática clínica. No entanto, permanece controverso o impacto da TRC como fator causador de arritmias ventriculares complexas. Apresentamos o caso duma doente com cardiopatia valvular operada, disfunção sistólica grave e ICC classe III da NYHA, com terapêutica médica otimizada, sem documentação prévia de arritmias ventriculares significativas. Após implantação do sistema de TRC com cardioversor-desfibrilhador, desenvolveu quadro de tempestade arrítmica com múltiplos episódios de taquicardia ventricular monomórfica (TV) e necessidade de 12 choques, mantendo padrão de bigeminismo ventricular reprodutível e indução de salvas de TV pelo pacing biventricular. Dada a inacessibilidade a outra veia tributária do seio coronário foi decidido implantar elétrodo epicárdico em localização diferente (de veia póstero-lateral para posição lateral-mediana), sem registo de recorrência de arritmias num follow-up de seis meses. Este caso sugere que a TRC pode contribuir para um efeito pró-arrítmico com consequências clínicas potencialmente graves.

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“…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%

“…Patients with nonischemic cardiomyopathy may be more susceptible due to existing electrical heterogeneity and the tendency to develop polymorphic VT. 26,28 In patients with ischemic cardiomyopathy, CRT has been shown to decrease the inducibility of ventricular tachycardia. 5,32 In such cases, however, it may be important to note the final position of the left ventricular pacing lead in relation to the scar. It could be speculated that inappropriately positioned LV leads, through the effect on the cardiac substrate, ventricular activation pattern or cardiac autonomic tone, 20 could be proarrhythmic.…”

Section: Determining Arrhythmic Riskmentioning

confidence: 99%

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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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Biventricular pacing decreases the inducibility of ventricular tachycardia in patients with ischemic cardiomyopathy

Cited by 79 publications

References 7 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

The proarrhythmic effect of cardiac resynchronization therapy: An issue that should be borne in mind

Cardiac Resynchronization Therapy and its Potential Proarrhythmic Effect

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