Cardiac Resynchronization Therapy Improves Heart Rate Profile and Heart Rate Variability of Patients With Moderate to Severe Heart Failure

Fantoni, Cecilia; Raffa, Santi; Regoli, François; Giraldi, Francesco; Rovere, Maria Teresa La; Prentice, John; Pastori, Francesca; Fratini, Simona; Salerno‐Uriarte, Jorge A.; Klein, Helmut U.; Auricchio, Angelo

doi:10.1016/j.jacc.2005.06.081

Cited by 125 publications

(86 citation statements)

References 28 publications

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“…An indication of progression of heart failure can be reflected by physiological parameters including heart rate, heart rate variability, and recurrent arrhythmias. 26,27 Analysis of remote monitoring data demonstrated loss of CRT delivery and an increased mean resting heart rate. 28 Remote monitoring is of importance in heart failure patients to detect problems early, thereby preventing acute disease progression and expensive hospitalisation.…”

Section: Remote Monitoring Systemsmentioning

confidence: 99%

Remote monitoring in implantable defibrillator therapy

Theuns¹,

Jordaens²

2008

NHJL

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The major device manufacturers have introduced systems for remote patient monitoring. These remote monitoring systems promise more efficient patient management, especially in today's clinical setting with the growing number of defibrillator implantations. The aim of this article is to present the role of remote patient monitoring in implantable cardioverter-defibrillator follow-up, its potential benefits and its barriers to widespread diffusion. (Neth Heart J 2008;16:53-6.)

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Section: Remote Monitoring Systemsmentioning

confidence: 99%

Remote monitoring in implantable defibrillator therapy

Theuns¹,

Jordaens²

2008

NHJL

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“…14,15 Long-term results demonstrate evidence of reverse remodeling, increased exercise capacity and functional class, improved quality of life and decreased hospitalization rates. 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).…”

Section: Clinical Benefit Of Crtmentioning

confidence: 99%

“…While aggregate data suggest that autonomic balance generally improves after CRT implantation, individual response has been shown to vary and can even worsen in nonresponders. 20 Such effects may be particularly detrimental in the compromised physiologic milieu of heart failure where the physiology may be considerably skewed to entertain prolonged repolarization. QT-prolonging pharmaceuticals and cardiomyopathy itself are conditions that may amplify the intrinsic spatial dispersion of repolarization, thus creating the substrate for the development of reentry.…”

Section: Proarrhythmic Mechanismsmentioning

confidence: 99%

“…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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“…But it is not clear whether these short-term improvements in autonomic functions are persistent or not. Few studies investigated the long term effects of CRT on time-domain parameters of heart rate variability (Adamson et al 2004;Fantoni et al 2005). The aim of this study is to investigate the short-and long-term effects of CRT on autonomic functions quantified by measuring SDNN and mean heart rate in patients with advanced heart failure and left bundle branch block.…”

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confidence: 99%

Long-Term Effects of Cardiac Resynchronization Therapy on Heart Rate and Heart Rate Variability

Akyol

Alper

Çakmak

et al. 2006

Tohoku J. Exp. Med.

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Congestive heart failure is characterized by significant autonomic dysfunction. Development of left bundle branch block in congestive heart failure is a predictor of worse outcome. There are several lines of evidence that cardiac resynchronization therapy (CRT), by biventricular stimulation in patients with severe heart failure and left bundle branch block, improves autonomic functions which can be quantified by measuring heart rate variability. The aim of the present study was to assess the effect of CRT on autonomic functions quantified by heart rate variability and mean heart rate (HR) in patients with advanced heart failure and left bundle branch block in short and long-term follow-up. A total of 35 patients with systolic heart failure and left bundle branch block (mean-age 60 ± 11 years; 24 male and 11 female; mean left ventricular ejection fraction [EF]: 22.3 ± 3%) were enrolled. Clinical assessment and echocardiographic examination were performed at baseline and every three months. Continuous electrocardiographic monitorization by 24-hour Holter recordings was performed pre-implantation, 3 months and 2 years after implantation. Mean HR and one of the time-domain parameters of heart rate variability, standard deviation of the R-R intervals (SDNN) were measured. CRT was associated with a decrease in the mean duration of QRS, and an increase in diastolic filling time, the rate with which the left ventricular pressure rises (dP/dt), and left ventricular ejection fraction. Decrease in mean heart rate and increase in SDNN were statistically significant in the third month and second year recordings when compared to baseline recording ( p values were < 0.001 for both). In conclusion, CRT with biventricular pacing provides sustained improvement in autonomic function in patients with advanced heart failure and left bundle branch block.Congestive heart failure; biventricular pacing; heart rate variability

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Cardiac Resynchronization Therapy Improves Heart Rate Profile and Heart Rate Variability of Patients With Moderate to Severe Heart Failure

Abstract: Cardiac resynchronization therapy is able to significantly modify the sympathetic-parasympathetic interaction to the heart, as defined by HR profile and HRV. Lack of HRV improvement four weeks after CRT identifies patients at higher risk for major cardiovascular events.

Cited by 125 publications

References 28 publications

Remote monitoring in implantable defibrillator therapy

Remote monitoring in implantable defibrillator therapy

Cardiac Resynchronization Therapy and its Potential Proarrhythmic Effect

Long-Term Effects of Cardiac Resynchronization Therapy on Heart Rate and Heart Rate Variability

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