Prevalence of ventricular arrhythmias in patients with cardiac resynchronization therapy without back-up ICD

Bortnik, Miriam; Degiovanni, Anna; Dell’Era, Gabriele; Cavallino, Chiara; Occhetta, Eraldo; Marino, Paolo

doi:10.2459/jcm.0b013e3283638148

Cited by 9 publications

(7 citation statements)

References 32 publications

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“…The narrowing of QRS complexes, as well as the resolution of electromechanical dyssynchrony, for example, apical rocking and septal flash in echocardiography after CRT, is a well‐described predictor of reverse LV remodeling, LVEF improvement, and a reduction in the number of ventricular arrhythmia episodes and mortality 11,16,21,24 . Correction of severe dyssynchrony seems to be crucial in the PICM population in the absence of a history of ventricular arrhythmias influencing survival despite the use of HV therapy 2,7,8,9 . Our findings, by directly comparing the PM/CRT‐P versus the PM/CRT‐D group, seems to confirm these observations in the patients at high risk of PICM, without severe, irreversible LV dysfunction.…”

Section: Discussionmentioning

confidence: 76%

“…The current European Society of Cardiology guidelines give II B recommendations for an upgrade from right ventricular to biventricular (BiV) pacing in patients who develop worsening Heart Failure (HF) due to a high percentage of RVP, despite Optimal Medical Therapy (OMT) 6 . However, there are only a few data on whether the addition of implantable cardioverter defibrillator (ICD) to CRT in the PICM population affects survival 7,8,9 …”

Section: Introductionmentioning

confidence: 99%

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Survival of patients with pacing‐induced cardiomyopathy upgraded to CRT does not depend on defibrillation therapy

Loboda

Gibinski

Zietek

et al. 2020

Pacing Clinical Electrophis

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Background: Permanent right ventricular pacing (RVP) results in cardiac dyssynchrony that may lead to heart failure and may be an indication for the use of cardiac resynchronization therapy (CRT). The study aimed to evaluate predictors of outcomes in patients with pacing-induced cardiomyopathy (PICM) if upgraded to CRT. Methods: One hundred fifteen patients, 75.0 years old (IQR 67.0-80.0), were upgraded to CRT due to the decline in left ventricle ejection fraction (LVEF) caused by the long-term RVP. A retrospective analysis was performed using data from hospital and outpatient clinic records and survival data from the National Health System. Results: The prior percentage of RVP was 100.0% (IQR 97.0-100.0), with a QRS duration of 180.0 ms (IQR 160.0-200.0). LVEF at the time of the upgrade procedure was 27.0% (IQR 21.0-32.75). The mean follow-up was 980 ± 522 days. The primary endpoint, death from any cause, was met by 26 (22%) patients. Age > 82 years (HR 5.96; 95% CI 2.24-15.89; P = .0004) and pre-CRT implantation LVEF < 20% (HR 5.63; 95%CI 2.19-14.47; P = .0003), but neither the cardioverterdefibrillator (ICD) implantation (HR 1.00; 95%CI 0.45-2.22; P = 1.00), nor the presence of atrial fibrillation (HR 1.22; 95%CI 0.56-2.64; P = .62), were independently associated with all-cause mortality. Conclusion: Advanced age and an extremely low LVEF, but neither the presence of atrial fibrillation nor implanting an additional high voltage lead, influence the all-cause mortality in patients after long-term RVP, when upgraded to CRT. K E Y W O R D S cardiac resynchronization therapy upgrade, chronic right ventricular pacing, defibrillator, pacinginduced cardiomyopathy

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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Survival of patients with pacing‐induced cardiomyopathy upgraded to CRT does not depend on defibrillation therapy

Loboda

Gibinski

Zietek

et al. 2020

Pacing Clinical Electrophis

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“…Patients receiving CRT-D had a mean age in their 60s in all studies, while the mean age of CRT-P patients was in their 70s in eight studies 3,14,27,30,33,37,38,50 . Overall, those receiving CRT-D were younger (65 years vs. 68.2) , more often males (80.3% vs. 72%), had lower NYHA class (60% in NYHA class 2 vs. 88.6%), lower prevalence of atrial fibrillation (21% vs.…”

Section: Search Results and Patients' Characteristicsmentioning

confidence: 99%

Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: a systematic review and proportional meta-analysis

et al. 2017

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“…On one hand, the majority of CRT upgrades are performed in patients with an LV ejection fraction <35%, thus fulfilling ICD implantation criteria according to the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) (7). On the other hand, some studies suggested that de novo CRT-P patients and those upgraded from pacemaker to CRT-defibrillator (CRT-D) have a low annual risk of sustained ventricular arrhythmias and sudden cardiac death (8)(9)(10). In addition, chronically RV paced heart failure patients may respond even better to CRT with greater improvements in ejection fraction and intraventricular dyssynchrony than heart failure patients without RV pacing (11).…”

Section: Bradycardia Indications Who During Follow-up Develop Severmentioning

confidence: 99%

Patients upgraded to cardiac resynchronization therapy due to pacing-induced cardiomyopathy are at low risk of life-threatening ventricular arrhythmias: a long-term cause-of-death analysis

et al. 2016

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Aims: Upgrade to cardiac resynchronization therapy (CRT) should be offered to patients who have developed pacing-induced cardiomyopathy with conventional right ventricular pacing. The extent to which those patients would also benefit from defibrillator back-up at the time of CRT upgrade is, however, unknown. Methods:Retrospective observational cohort study of 199 patients with pacing-induced cardiomyopathy (without history of sustained ventricular arrhythmia), including 104 upgraded to CRT-Pacemaker (CRT-P) and 95 upgraded to CRT-Defibrillator (CRT-D). The incidence of ventricular arrhythmias and, through a cause-of-death analysis based on clinical data and necropsy results, the risk of sudden arrhythmic death were assessed and compared between the two groups.Results: During a mean follow-up of 66±24 months, 40 (38.5%) CRT-P patients died: three from primary arrhythmic death, while the remaining died of different causes (especially progressive heart failure), giving an incidence of 6.2 sudden arrhythmic deaths per 1000 patient-years. No episode of sustained VT was observed in the study group. There were no sudden arrhythmic deaths in the CRT-D group during a shorter follow-up, but the small and non-significant difference in all-cause mortality between CRT-P and CRT-D groups was mostly accounted for by an increase in non-sudden death. Women upgraded to CRT were at particularly low risk of all-cause mortality compared with men (HR 0.232, p=0.048). Conclusion:Our findings suggest that patients who develop pacing-induced cardiomyopathy and are upgraded to CRT may not derive any significant benefit from the addition of the defibrillator in the absence of a history of ventricular arrhythmias. 3 KEYWORDSCardiac resynchronization therapy; pacemaker; implantable cardioverter-defibrillator; ventricular arrhythmias; cause-of-death; sudden arrhythmic death. 4 CONDENSED ABSTRACTIn our retrospective cohort study of 199 patients with pacing induced cardiomyopathy submitted to CRT upgrade, we have found that the risk of sustained ventricular tachycardia or sudden arrhythmic death is very low, and any increased mortality risk in those receiving CRT-P compared with CRT-D is mostly accounted for by an increase in non-sudden death. 5 WHAT'S NEW? Our study provides the largest and longest-term cause-of-death analysis in patients with pacing-induced cardiomyopathy based on post-mortem examinations and death certificates. We have found that the annual risk of sudden arrhythmic death or sustained ventricular arrhythmias in these patients is very low, and similar to a control group implanted with CRT with a defibrillator.  The small difference in all-cause mortality between CRT-Pacemaker and CRTDefibrillator in patients with pacing-induced cardiomyopathy is mostly accounted for by an increase in non-sudden death. Our results suggest that an upgrade to CRT-Defibrillator in patients with pacinginduced cardiomyopathy may convey no additional benefit when compared with upgrade to CRT-Pacemaker, and the cost-effectiveness ratio of...

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Prevalence of ventricular arrhythmias in patients with cardiac resynchronization therapy without back-up ICD

Abstract: Our data show that CRT-P may be well tolerated in selected patients even during a long-term follow-up; and that an upgrade to CRT-D may not be enough to prevent sudden death.

Cited by 9 publications

References 32 publications

Survival of patients with pacing‐induced cardiomyopathy upgraded to CRT does not depend on defibrillation therapy

Survival of patients with pacing‐induced cardiomyopathy upgraded to CRT does not depend on defibrillation therapy

Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: a systematic review and proportional meta-analysis

Patients upgraded to cardiac resynchronization therapy due to pacing-induced cardiomyopathy are at low risk of life-threatening ventricular arrhythmias: a long-term cause-of-death analysis

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