Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics

Abstract

More than 20% of the overall HF patient population treated with CRT suffer PAT episodes. Paroxysmal atrial tachycardia may interfere with response to CRT. Therefore, telemetric data may be relevant to drive the appropriate therapy in each patient.

Cardiac Resynchronization Therapy Reduces Left Atrial Volume and the Risk of Atrial Tachyarrhythmias in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy)

“…It should also be noted that the rate of new-onset AT in MADIT-CRT was somewhat lower (8%) than that in prior CRT studies that enrolled patients with more advanced HF symptoms (in which the reported frequency of new-onset AT was between 10% and 30%) (8,14,15,18). Thus, the present findings regarding reduction in the risk of newonset AT/AF among responders to CRT-D therapy pertain only to patients with asymptomatic or mildly symptomatic LV dysfunction.…”

“…Recent studies have suggested that CRT is associated with favorable reverse remodeling effects on the left atrium (LA), in addition to its well-established effects on the left ventricle (LV), thereby possibly reducing the risk for the development of AT and AF in patients with HF (9,10). Despite this, data on the effect of CRT on the resolution of chronic and prevention of new atrial arrhythmias are conflicting (11)(12)(13)(14)(15), possibly because the majority of prior studies had a nonrandomized or retrospective design and comprised relatively small sample sizes. Furthermore, previous studies were carried out among patients with advanced HF symptoms (NYHA functional class III/IV); however, currently there are no data regarding the effect of CRT on the risk of AT among patients with mild HF symptoms.…”

“…In a nonrandomized cohort of 97 patients with severe HF and no prior AF history, Fung et al (10) showed that improvement of LA function with CRT at 3 months of follow-up was associated with a reduction in the risk for new-onset AF, regardless of the occurrence of LV remodeling. Leclercq et al (15) studied a consecutive cohort of 173 patients with NYHA functional class III/IV HF symptoms and showed that patients who did not experience AT had smaller LAV at baseline and follow-up echocardiography, although the differences were not statistically significant. In a small nonrandomized cohort of 74 patients with HF and persistent or permanent AF receiving longstanding CRT, Kies et al (9) showed a nonsignificant trend toward return to Multivariate Analysis: CRT-D Versus ICD-Only Risk of AT Events From Enrollment and by Echocardiographic Response to CRT-D* 1687 JACC Vol.…”

Atrial fibrillation in cardiac resynchronization recipients with and without prior arrhythmic history. How much of arrhythmia is too much?

“…Several studies analyzed device-stored data to assess the incidence of AF in CRT patients [5,[8][9][10][11][12][13][14][15][16][17]. However, in the great majority of them + p < 0.05 vs. group with AF during follow-up; #79 patients survived the 24-month period: 10 with and 69 without AF history prior to cardiac resynchronization therapy.…”

Increasing knowledge and changing views in cardiac resynchronization therapy

“…New technologies monitor not only device function but also patient physiology including heart rate and rhythm, heart rate variability, activity and thoracic bioimpedance that may help improve the management of heart failure [58][59][60][61][62][63][64][65]. Monitoring of the device function has already been shown to have benefits in terms of early warning of device failure.…”