Heart Failure Decompensation and All-Cause Mortality in Relation to Percent Biventricular Pacing in Patients With Heart Failure

Koplan, Bruce A.; Kaplan, Andrew; Weiner, Stan; Jones, Paul; Seth, Milan; Christman, Shelly A.

doi:10.1016/j.jacc.2008.09.043

Cited by 252 publications

(160 citation statements)

References 14 publications

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“…Although most studies included 100% of patients with permanent AF, 3 studies included paroxysmal or persistent AF as well. 6,21,24 AVN ablation was mostly performed after CRT implantation; however, the exact timing differed among studies. The mean follow-up was 18 months.…”

Section: Resultsmentioning

confidence: 99%

Effects of Atrioventricular Nodal Ablation on Permanent Atrial Fibrillation Patients With Cardiac Resynchronization Therapy: A Systematic Review and Meta‐analysis

Yin

Wang

et al. 2014

Clinical Cardiology

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Cardiac resynchronization therapy (CRT) is a well-established therapy for patients with heart failure (HF) and wide QRS configuration, especially for those in sinus rhythm. However, for those with permanent AF, atrioventricular nodal (AVN) ablation use remains under debate. Our objective was to evaluate clinical outcomes and mortality of AVN ablation in HF patients with permanent AF receiving CRT. Electronic publication database and reference lists through October 1, 2013 were searched. Observational cohort studies comparing CRT patients with AF who received either AVN ablation or medical therapy were selected. Outcomes included mortality, CRT nonresponse, changes in left ventricular remodeling, and functional outcomes, such as New York Heart Association (NYHA) functional class, quality of life, and 6-minute hall walk distance. Of 1641 reports identified, 13 studies with 1256 patients were included. Among patients with permanent AF and insufficient biventricular pacing (<90%), those who had undergone AVN ablation compared to those who did not had numerically lower all-cause mortality (risk ratio [RR]: 0.63, 95% confidence interval [CI]: 0.42 to 0.96, P = 0.03) and significantly lower nonresponse to CRT (RR: 0.41, 95% CI: 0.31 to 0.54, P < 0.00001). Furthermore, AVN ablation was not associated with additional improvements on left ventricular ejection fraction, NYHA functional class, 6-minute hall walking distance, and quality of life. In patients with permanent AF undergoing CRT, AVN ablation tended to reduce mortality potentially and improved clinical response when it was applied to patients with inadequate biventricular pacing (<90%). Randomized controlled trials are needed to further address the efficacy of AVN ablation among this population.

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Section: Resultsmentioning

confidence: 99%

Effects of Atrioventricular Nodal Ablation on Permanent Atrial Fibrillation Patients With Cardiac Resynchronization Therapy: A Systematic Review and Meta‐analysis

Yin

Wang

et al. 2014

Clinical Cardiology

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“…Устойчивая и эффективная бивентрикуляр-ная стимуляция имеет решающее значение для дости-жения наилучших результатов от СРТ. В недавнем исследовании, включавшем 1812 пациентов с СН и СРТ, процент бивентрикулярной стимуляции 93-100% был связан с уменьшением на 44% комби-нированной конечной точки (смертность от всех причин и госпитализации по поводу СН), в сравне-нии с процентом бивентрикулярной стимуляции на уровне 0-92% (отношение рисков 0,56, р=0,00001) [67]. Эти результаты были подтверждены у 36 935 пациентов [68], показав максимальное снижение уровня смертности при бивентрикулярной стимуля-ции, превышающей 98%.…”

Section: выбор режима стимуляции (и оптимизация сердечной ресинхронизunclassified

“…Данные крупных регистров свидетельствуют о том, что высокий процент (≥99%) бивентрикуляр-ной стимуляции являлся предпосылкой успешности СРТ, а наличие ФП было самой частой причиной потери бивентрикулярной стимуляции (см. также раздел 3.2.2) [67][68][69]. Потеря ресинхронизации была связана с впервые возникшей ФП за время наблюде-ния [w151, w152].…”

Section: пациенты с фибрилляцией предсердийunclassified

2013 Esc Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

Brignole¹,

Auricchio²,

et al. 2014

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“…This mirrors findings of long term studies of patients on CRT [28]. It is recognised that AF with a high ventricular rate may impair the delivery of biventricular pacing, and consequently undermine the clinical benefit of CRT [29]. Despite the paucity of data from randomized control trials in AF populations, recent guidelines support the use of CRT in AF patients, although restricted to a slightly wider QRS duration > 130 ms [30].…”

Section: Discussionmentioning

confidence: 66%

Right ventricular dysfunction is a predictor of non-response and clinical outcome following cardiac resynchronization therapy

Alpendurada

Guha

Sharma

et al. 2011

Journal of Cardiovascular Magnetic Resonance

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BackgroundCardiac resynchronization therapy (CRT) is an established treatment in advanced heart failure (HF). However, an important subset does not derive a significant benefit. Despite an established predictive role in HF, the significance of right ventricular (RV) dysfunction in predicting clinical benefit from CRT remains unclear. We investigated the role of RV function, assessed by cardiovascular magnetic resonance (CMR), in predicting response to and major adverse clinical events in HF patients undergoing CRT.MethodsSixty consecutive patients were evaluated with CMR prior to CRT implantation in a tertiary cardiac centre. The primary end-point was a composite of death from any cause or unplanned hospitalization for a major cardiovascular event. The secondary end-point was response to therapy, defined as improvement in left ventricular ejection fraction ≥ 5% on echocardiography at one year.ResultsEighteen patients (30%) met the primary end-point over a median follow-up period of 26 months, and 27 out of 56 patients (48%) were considered responders to CRT. On time-to-event analysis, only atrial fibrillation (HR 2.6, 95% CI 1.02-6.84, p = 0.047) and RV dysfunction, either by a reduced right ventricular ejection fraction-RVEF (HR 0.96, 95% CI 0.94-0.99, p = 0.006) or tricuspid annular plane systolic excursion-TAPSE (HR 0.88, 95% CI, 0.80-0.96, p = 0.006), were significant predictors of adverse events. On logistic regression analysis, preserved RVEF (OR 1.05, 95% CI 1.01-1.09, p = 0.01) and myocardial scar burden (OR 0.90, 95% CI 0.83-0.96, p = 0.004) were the sole independent predictors of response to CRT. Patients with marked RV dysfunction (RVEF < 30%) had a particularly low response rate (18.2%) to CRT.ConclusionsRight ventricular function is an important predictor of both response to CRT and long-term clinical outcome. Routine assessment of the right ventricle should be considered in the evaluation of patients for CRT.

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Heart Failure Decompensation and All-Cause Mortality in Relation to Percent Biventricular Pacing in Patients With Heart Failure

Abstract: For CRT patients in this retrospective analysis, the greatest magnitude of benefit was observed with >92% biventricular pacing.

Cited by 252 publications

References 14 publications

Effects of Atrioventricular Nodal Ablation on Permanent Atrial Fibrillation Patients With Cardiac Resynchronization Therapy: A Systematic Review and Meta‐analysis

Effects of Atrioventricular Nodal Ablation on Permanent Atrial Fibrillation Patients With Cardiac Resynchronization Therapy: A Systematic Review and Meta‐analysis

2013 Esc Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

Right ventricular dysfunction is a predictor of non-response and clinical outcome following cardiac resynchronization therapy

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