Effect of cardiac resynchronization therapy on the incidence of ventricular arrhythmias in patients with an implantable cardioverter-defibrillator

Arya, Arash; Haghjoo, Majid; Dehghani, Mohammad Reza; Alasti, Mohammad; Alizadeh, Hormoz; Kazemi, Babak; Sadr‐Ameli, Mohammad Ali

doi:10.1016/j.hrthm.2005.07.007

Cited by 57 publications

(31 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the continuous analysis of post-CRT-D LVEF, the estimated event rate still remained below 3.3% for post-CRT-D LVEF >45%. Although several studies have shown a reduction in the risk of ventricular arrhythmias [10][11][12][13][14]18,19 with CRT, no previous study has provided quantitative data on the relationship between the level of post-CRT-D LVEF and subsequent sustained VT or VF. This is particularly relevant because the guidelines for implantation of CRT devices are based, in part, on a critically low LVEF.…”

Section: Discussionmentioning

confidence: 99%

“…Such patients have been referred to as super-responders, 8,9 defined arbitrarily as a post-CRT LVEF of ≥45%. 8 Several studies have suggested that CRT can reduce the occurrence of ventricular arrhythmias, [10][11][12][13][14] but no data are available on the relationship of the post-CRT-D LVEF and subsequent occurrence of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). CRT-defibrillator (CRT-D) implantation guidelines depend on the LVEF as a measure of ventricular function.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Association Between Left Ventricular Ejection Fraction Post-Cardiac Resynchronization Treatment and Subsequent Implantable Cardioverter Defibrillator Therapy for Sustained Ventricular Tachyarrhythmias

Manfredi

Al‐Khatib

Shaw

et al. 2013

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

We conducted a retrospective analysis of 423 consecutive patients who received an implantable cardioverter defibrillator (ICD) with © 2013 American Heart Association, Inc. and January 19, 2007. A retrospective analysis was performed to evaluate the relationship between post-CRT-D LVEF and ICD therapy for ventricular tachyarrhythmias. A landmark population of 270 patients, with post-CRT-D LVEF measured and no ICD therapy within 1 year of device implantation, was followed for subsequent outcomes. Of these, 22 patients (8.2%) had subsequent appropriate ICD therapy over a median follow-up of 1.5 years. The estimated 2-year risk of appropriate ICD therapy is 3.0% (95% confidence interval [95% CI], 0%-6.3%), 2.1% (95% CI, 0%-5.0%), and 1.5% (95% CI, 0%-3.9%) for post-CRT-D LVEF of 45%, 50%, and 55%, respectively. In patients with a primary prevention indication for CRT-D, the estimated 2-year risk is 3.3% (95% CI, 0%-7.3%), 2.5% (95% CI, 0%-6.1%), and 1.9% (95% CI, 0%-5.1%) for post-CRT-D LVEF of 45%, 50%, and 55%, respectively. Conclusions-When a CRT responder demonstrates near normalization in LVEF to ≥45%, the incidence of ICD therapy for ventricular arrhythmias becomes low. Future studies are needed to determine whether an ICD is still needed in some of these patients at the time of generator replacement. (Circ Arrhythm Electrophysiol. 2013;6:257-264.) Circ Arrhythm Electrophysiol

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Association Between Left Ventricular Ejection Fraction Post-Cardiac Resynchronization Treatment and Subsequent Implantable Cardioverter Defibrillator Therapy for Sustained Ventricular Tachyarrhythmias

Manfredi

Al‐Khatib

Shaw

et al. 2013

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…31 Cases have been reported of CRT inducing ventricular arrhythmias, but several trials report a reduction in these events. [32][33][34][35][36] A review of the 2 largest CRT trials did not show significant increases or decreases in ventricular arrhythmia. 37 …”

Section: Patient Selection and Therapeutic Resultsmentioning

confidence: 99%

Interventional Electrophysiology and Cardiac Resynchronization Therapy

Burkhardt

Wilkoff

2007

Circulation

View full text Add to dashboard Cite

Abstract-Implantable devices have become a readily available option for patients with heart failure. Not only do these patients develop bradycardia and ventricular tachycardia, but their ventricular dysfunction can often improve with cardiac resynchronization therapy. However, this is a complex and rapidly developing clinical science for which the physician chooses techniques and selects patients on the basis of the results of clinical trials, clinical experience, and rapidly evolving tools. The results depend on the interplay of these complex variables. Placement of the left ventricular lead has forced the device physician to develop new skills and/or interdisciplinary relationships with physicians with vascular intervention, imaging, and surgical skills. Familiarity with the cardiac venous anatomy, occlusive venography, venoplasty, guide wire tools, guiding catheters, stenting, and new intracardiac visualization and magnetic intracardiac lead positioning tools are examples of just a few of the novel skills that are useful in the delivery of cardiac resynchronization therapy. Beyond implantation, these patients and devices require specialized follow-up with continued medical therapy and echo-guided adjustments of device programming. Finally, there are ongoing controversies and many as yet unanswered questions that are the subject of ongoing and planned clinical trials. (Circulation. 2007;115:2208-2220.)Key Words: electrical stimulation Ⅲ heart failure Ⅲ pacemakers Ⅲ defibrillators, implantable P atients with advanced congestive heart failure (CHF) on maximal medical therapy have had very limited options until recently. The advent of cardiac resynchronization therapy (CRT) has revolutionized the treatment of these patients. Many patients with advanced CHF demonstrate dyssynchrony by evidence of a widened QRS complex on the EKG. Most frequently this takes the form of a left bundle-branch block morphology, but right bundle-branch block morphology and intraventricular conduction delay are also less frequently present. 1,2 Electrical dyssynchrony usually implies that different portions of the ventricle contract at different times, unlike that of a normal heart in which contraction of all segments is nearly simultaneous. The presence of a widened QRS itself in the presence of CHF symptoms is associated with increased mortality. 3,4 Dyssynchrony on EKG, particularly of the left bundle-branch type, is associated with delayed activation of the left lateral wall, mitral regurgitation, impaired left ventricular filling, and reduced measures of cardiac contractility. 5-8 CRT operates on the premise that attempts to normalize the timing of activation of the left and right ventricle or lateral wall and septum may improve the consequences of this impaired activation. 9 Multiple trials have shown that CRT improves heart failure symptoms in the majority of recipients. 10 -14 These trials include the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) trial, which studied 453 patients. All patients had a CRT device impla...

show abstract

“…Nevertheless, electrophysiologic effects of CRT are still poorly understood. Some studies demonstrated a decreased incidence of ventricular tachycardias (VTs) after CRT [9,10,[22][23][24][25][26][27]. In line with these findings, no significant proarrhythmic effects have been discovered in large-scale trials of CRT [4][5][6][7][8]19,20,28].…”

Section: Discussionmentioning

confidence: 97%

Effect of cardiac resynchronization therapy on the incidence of electrical storm

Nordbeck¹,

Seidl²,

B³

et al. 2010

International Journal of Cardiology

View full text Add to dashboard Cite

Effect of cardiac resynchronization therapy on the incidence of ventricular arrhythmias in patients with an implantable cardioverter-defibrillator

Cited by 57 publications

References 18 publications

Association Between Left Ventricular Ejection Fraction Post-Cardiac Resynchronization Treatment and Subsequent Implantable Cardioverter Defibrillator Therapy for Sustained Ventricular Tachyarrhythmias

Association Between Left Ventricular Ejection Fraction Post-Cardiac Resynchronization Treatment and Subsequent Implantable Cardioverter Defibrillator Therapy for Sustained Ventricular Tachyarrhythmias

Interventional Electrophysiology and Cardiac Resynchronization Therapy

Effect of cardiac resynchronization therapy on the incidence of electrical storm

Contact Info

Product

Resources

About