Cardiac Resynchronization Defibrillator Therapy for Nonspecific Intraventricular Conduction Delay Versus Right Bundle Branch Block

Kawata, Hiro; Bao, Haikun; Curtis, Jeptha P.; Minges, Karl E.; Mitiku, Teferi; Birgersdotter‐Green, Ulrika; Feld, Gregory K.; Hsu, Jonathan C.

doi:10.1016/j.jacc.2019.04.025

Cited by 22 publications

(30 citation statements)

References 31 publications

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“…Imputation of missing values was performed using the study group median for continuous variables and the most common value for categorical variables. 30,31 Tests for statistical significance were 2-tailed and evaluated at a significance level of .05. Because of the potential for type I error due to multiple comparisons, findings for analyses of secondary end points should be interpreted as exploratory.…”

Section: Discussionmentioning

confidence: 99%

“…For the ICD Registry data, rate of missingness of variables in this study were rare (<1%) except for the following: LVEF (2.6%), QRS morphology (6.5%), and blood urea nitrogen (2.0%). Imputation of missing values was performed using the study group median for continuous variables and the most common value for categorical variables . Tests for statistical significance were 2-tailed and evaluated at a significance level of .05.…”

Section: Methodsmentioning

confidence: 99%

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Association Between Industry Payments to Physicians and Device Selection in ICD Implantation

Annapureddy

Henien

Wang

et al. 2020

JAMA

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IMPORTANCELittle is known about the association between industry payments and medical device selection.OBJECTIVE To examine the association between payments from device manufacturers to physicians and device selection for patients undergoing first-time implantation of a cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D). DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional study, patients who received a first-time ICD or CRT-D device from any of the 4 major manufacturers (January 1, 2016-December 31, 2018) were identified. The data from the National Cardiovascular Data Registry ICD Registry was linked with the Open Payments Program's payment data. Patients were categorized into 4 groups (A, B, C, and D) corresponding to the manufacturer from which the physician who performed the implantation received the largest payment. For each patient group, the proportion of patients who received a device from the manufacturer that provided the largest payment to the physician who performed implantation was determined. Within each group, the absolute difference in proportional use of devices between the manufacturer that made the highest payment and the proportion of devices from the same manufacturer in the entire study cohort (expected prevalence) was calculated.EXPOSURES Manufacturers' payments to physicians who performed an ICD or CRT-D implantation. MAIN OUTCOMES AND MEASURESThe primary outcome of the study was the manufacturer of the device used for the implantation.RESULTS Over a 3-year period, 145 900 patients (median age, 65 years; 29.6% women) received ICD or CRT-D devices from the 4 manufacturers implanted by 4435 physicians at 1763 facilities.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Association Between Industry Payments to Physicians and Device Selection in ICD Implantation

Annapureddy

Henien

Wang

et al. 2020

JAMA

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“… 5 , 6 Only targeting subgroups with a higher likelihood of response may come at the cost of not treating patients with potential benefit, and targeting all patients with widened QRS complex will likely burden patients with detrimental effects. 7 , 8 Therefore, it is of utmost importance to find selection criteria with incremental value beyond current guidelines to select suitable patients for CRT. 9 We aimed to analyse time‐to‐peak left ventricle (LV) dP/dt, and Td in animals and patients.…”

Section: Introductionmentioning

confidence: 99%

“…Left bundle branch block in non‐ischaemic cardiomyopathy is typically associated with better response, while unspecific conduction delay and ischaemic cardiomyopathy are associated with less beneficial effects, 4 and CRT may increase and decrease mortality in different subpopulations 5,6 . Only targeting subgroups with a higher likelihood of response may come at the cost of not treating patients with potential benefit, and targeting all patients with widened QRS complex will likely burden patients with detrimental effects 7,8 . Therefore, it is of utmost importance to find selection criteria with incremental value beyond current guidelines to select suitable patients for CRT 9 .…”

Section: Introductionmentioning

confidence: 99%

Shortening of time‐to‐peak left ventricular pressure rise (Td) in cardiac resynchronization therapy

et al. 2021

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AimsWe tested the hypothesis that shortening of time-to-peak left ventricular pressure rise (Td) reflect resynchronization in an animal model and that Td measured in patients will be helpful to identify long-term volumetric responders [end-systolic volume (ESV) decrease >15%] in cardiac resynchronization therapy (CRT). Methods Td was analysed in an animal study (n = 12) of left bundle-branch block (LBBB) with extensive instrumentation to detect left ventricular myocardial deformation, electrical activation, and pressures during pacing. The sum of electrical delays from the onset of pacing to four intracardiac electrodes formed a synchronicity index (SI). Pacing was performed at baseline, with LBBB, right and left ventricular pacing and finally with biventricular pacing (BIVP). We then studied Td at baseline and with BIVP in a clinical observational study in 45 patients during the implantation of CRT and followed up for up to 88 months. ResultsWe found a strong relationship between Td and SI in the animals (R = 0.84, P < 0.01). Td and SI increased from narrow QRS at baseline (Td = 95 ± 2 ms, SI = 141 ± 8 ms) to LBBB (Td = 125 ± 2 ms, SI = 247 ± 9 ms, P < 0.01), and shortened with biventricular pacing (BIVP) (Td = 113 ± 2 ms and SI = 192 ± 7 ms, P < 0.01). Prolongation of Td was associated with more wasted deformation during the preejection period (R = 0.77, P < 0.01). Six patients increased ESV by 2.5 ± 18%, while 37 responders (85%) had a mean ESV decrease of 40 ± 15% after more than 6 months of follow-up. Responders presented with a higher Td at baseline than non-responders (163 ± 26 ms vs. 121 ± 19 ms, P < 0.01). Td decreased to 156 ± 16 ms (P = 0.02) with CRT in responders, while in non-responders, Td increased to 148 ± 21 ms (P < 0.01). A decrease in Td with BIVP to values similar or below what was found at baseline accurately identified responders to therapy (AUC 0.98, P < 0.01). Td at baseline and change in Td from baseline was linear related to the decrease in ESV at follow-up. All-cause mortality was high among six non-responders (n = 4), while no patients died in the responder group during follow-up. Conclusions Prolongation of Td is associated with cardiac dyssynchrony and more wasted deformation during the preejection period. Shortening of a prolonged Td with CRT in patients accurately identifies volumetric responders to CRT with incremental value on top of current guidelines and practices. Thus, Td carries the potential to become a biomarker to predict long-term volumetric response in CRT candidates.

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“…We found that lower LVEF and longer QRS duration were associated with a higher probability of CRT response for patients without intrinsic LBBB, which suggests that QRS duration of 150 ms or longer was an important predictor of CRT response for patients without intrinsic LBBB. A recent prospective study showed that CRT-ICD was associated with better outcomes in patients with IVCD and QRS longer than 150 ms but not in patients with RBBB ( 28 ). Other studies have also shown that RBBB was associated with worse outcomes ( 29 , 30 ), although left ventricular dyssynchrony may be present concomitantly in patients with RBBB ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Better CRT Response in Patients Who Underwent Atrioventricular Node Ablation or Upgrade From Pacemaker: A Nomogram to Predict CRT Response

Xiao

Cai

Zhang

et al. 2021

Front. Cardiovasc. Med.

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Background: Response rates for cardiac resynchronization therapy (CRT) in patients without intrinsic left bundle-branch block (LBBB) morphology are poor.Objective: We sought to develop a nomogram model to predict response to CRT in patients without intrinsic LBBB.Methods: We searched electronic health records for patients without intrinsic LBBB who underwent CRT at Mayo Clinic. Logistic regression and Cox proportional hazards regression analysis were performed for the odds of response to CRT and risk of death, respectively. Results were used to develop the nomogram model.Results: 761 patients without intrinsic LBBB were identified. Six months after CRT, 47.8% of patients demonstrated improvement of left ventricular ejection fraction by more than 5%. The 1-, 3-, and 5-year survival rates were 95.9, 82.4, and 66.70%, respectively. Patients with CRT upgrade from pacemaker [odds ratio (OR), 1.67 (95% CI, 1.05–2.66)] or atrioventricular node (AVN) ablation [OR, 1.69 (95% CI, 1.09–2.64)] had a greater odds of CRT response than those patients who had new implant, or who did not undergo AVN ablation. Patients with right bundle-branch block had a low response rate (39.2%). Patients undergoing AVN ablation had a lower mortality rate than those without ablation [hazard ratio, 0.65 (95% CI, 0.46–0.91)]. Eight clinical variables were automatically selected to build a nomogram model and predict CRT response. The model had an area under the receiver operating characteristic curve of 0.71 (95% CI, 0.63–0.78).Conclusions: Among patients without intrinsic LBBB undergoing CRT, upgrade from pacemaker and AVN ablation were favorable factors in achieving CRT response and better long-term outcomes.

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Cardiac Resynchronization Defibrillator Therapy for Nonspecific Intraventricular Conduction Delay Versus Right Bundle Branch Block

Cited by 22 publications

References 31 publications

Association Between Industry Payments to Physicians and Device Selection in ICD Implantation

Association Between Industry Payments to Physicians and Device Selection in ICD Implantation

Shortening of time‐to‐peak left ventricular pressure rise (Td) in cardiac resynchronization therapy

Better CRT Response in Patients Who Underwent Atrioventricular Node Ablation or Upgrade From Pacemaker: A Nomogram to Predict CRT Response

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