Combined Cardiac Resynchronization and Implantable Cardioversion Defibrillation in Advanced Chronic Heart Failure

Young, James B.; Abraham, William T.; Smith, Andrew L.; León, Angel R.; Lieberman, Randy; Wilkoff, Bruce L.; Canby, Robert C.; Schroeder, John S.; Liem, L. Bing; Hall, Shelley; Wheelan, Kevin

doi:10.1001/jama.289.20.2685

Cited by 1,437 publications

(243 citation statements)

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“…In these 2 studies, significant reverse remodeling and improvement in LVEF were seen in NYHA class III and IV patients receiving CRT. 1,2,13 In the present study, CRT produced significant improvement in LV systolic and diastolic volumes and LVEF, indicating that CRT promotes reverse remodeling even in patients with less symptomatic heart failure. These effects did not translate into improved exercise capacity, however.…”

Section: Discussionsupporting

confidence: 54%

“…The sites, investigators, and coordinators participating in the MIRACLE ICD II trial are identical to those contributing to the MIRACLE ICD study and are listed elsewhere. 2 …”

Section: Acknowledgmentsmentioning

confidence: 99%

“…T hree large, randomized, controlled trials, the Multicenter InSync Randomized Clinical Evaluation (MIRACLE), 1 the MIRACLE ICD, 2 and the Contak CD trial, 3 and smaller randomized and nonrandomized studies 4 -8 have shown that cardiac resynchronization therapy (CRT) improves quality of life, functional status, and exercise capacity in patients with systolic heart failure and a wide QRS complex with or without an indication for an implantable cardioverter-defibrillator (ICD). These studies have also demonstrated favorable effects of CRT on measures of disease progression such as left ventricular (LV) remodeling and a variety of composite outcome measures.…”

mentioning

confidence: 99%

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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: 54%

“…The sites, investigators, and coordinators participating in the MIRACLE ICD II trial are identical to those contributing to the MIRACLE ICD study and are listed elsewhere. 2 …”

Section: Acknowledgmentsmentioning

confidence: 99%

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confidence: 99%

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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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“…[1][2][3] Data regarding the effects of CRT on arrhythmia occurrence are sparse. The Multicenter InSync ICD Randomized Clinical Evaluation (MIRACLE-ICD) trial 4 showed no significant difference in ventricular arrhythmia frequency or appropriate implantable cardioverter-defibrillator (ICD) therapies between patients receiving biventricular pacing and controls. However, more recent data suggest that CRT may decrease the frequency of ventricular arrhythmias, possibly through reverse remodeling.…”

Section: Introductionmentioning

confidence: 99%

Biventricular pacing reduces ventricular arrhythmic burden and defibrillator therapies in patients with heart failure

et al. 2006

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SummaryBackground: Cardiac resynchronization therapy (CRT) has recently emerged as a new modality for the treatment of patients with advanced heart failure (HF).Hypothesis: Cardiac resynchronization therapy reduces atrial and ventricular arrhythmia burdens.Methods: We analyzed the clinical data of patients who underwent an upgrade from a dual-chamber to a biventricular implantable cardioverter-defibrillator (ICD) at a tertiary care center.Results: Nineteen patients (age 67 ± 10 years, 18 men, left ventricular [LV] ejection fraction 0.24 ± 0.07) underwent an upgrade to CRT-ICD. The LV lead was placed in a lateral position in 11, posterolateral in 4, and anterolateral in 3 patients. Baseline New York Heart Association class of HF improved in 11 (58%) patients who were considered "responders." After adjusting for the duration of follow-up before and after the upgrade, the number of patients receiving any ICD therapy decreased significantly from 13 to 4 (p = 0.004) and the total number of therapies decreased from 72 to 17 (p = 0.067). Also, the number of detections of sustained ventricular arrhythmias decreased from 40 to 11 episodes (p = 0.05), but the decrease in the number of detected supraventricular arrhythmias and mode switch episodes was not significant. The reduction in the ventricular arrhythmia load was independent of whether or not the patient responded to CRT.

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“…In den letzten Jahren haben eine Reihe von Studien die technische Durchführbarkeit der biventrikulären Stimulation und deren therapeutischen Effekt auf die Leistungsfähigkeit bei herzinsuffizienten Patienten nachgewiesen [6,7]. Mit COMPANION und CARE-HF liegen nun zwei Studien vor, welche auch eine Mortalitätsreduktion durch CRT demonstrieren konnten [1,8].…”

Section: Mortalitätsstudien Zur Kardialen Resynchronisationstherapieunclassified

Kardiale Resynchronisationstherapie (CRT): mit oder ohne ICD-back-Up?

2006

Schweiz Ärzteztg

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Cardiac Resynchronisation Therapy (CRT): with or without ICD back-up?The incidence of heart failure is increasing and patients are threatened to die of pump failure as well as of sudden cardiac death (SCD). Lately, cardiac resynchronisation therapy (CRT) has been introduced to treat patients with persistent heart failure and dyssynchronous left ventricular activation evidenced by complete left bundle branch block in the ECG. The COMPANION trial demonstrated, that in patients with an EF <0.35, NYHA class III or IV, and complete left bundle branch block, CRT with and without implantable cardioverter defibrillator (ICD) back-up reduced the combined endpoint of mortality and hospitalisation. A reduction in total mortality could only be achieved by the use of CRT-ICD. The CARE-HF trial randomised similar patients to CRT or medical treatment. The secondary endpoint of death from all causes was reached by significantly fewer patients in the CRT group. However, approximately one third of the deaths was attributable to SCD.To date, there is no trial available comparing the effects of CRT and CRT-ICD on total mortality as a primary endpoint. Apart from the results of the COMPANION trial, several conclusions can be drawn from primary prevention trials in the general ICD population. The SCD-HeFT trial showed a significant mortality reduction in patients with an LVEF 90.35 who received an ICD for primary prevention as compared to placebo and amiodarone. After successful treatment with CRT, the mean LVEF improved from 0.25 to 0.32 in the CARE-HF trial. The majority of patients would therefore continue to fulfil the criteria for ICD-implantation according to the SCDHeFT trial. SCD-HeFT also showed a mortality reduction in patients with NYHA class II but not in those with NYHA class III. It is conceivable, that CRT can change the mode of death from pump failure to SCD. To date, the available data indicate, that an ICD-back-up should at least be considered in every patient eligible for CRT therapy.

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Combined Cardiac Resynchronization and Implantable Cardioversion Defibrillation in Advanced Chronic Heart Failure

Cited by 1,437 publications

References 28 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 pacing reduces ventricular arrhythmic burden and defibrillator therapies in patients with heart failure

Kardiale Resynchronisationstherapie (CRT): mit oder ohne ICD-back-Up?

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