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de Vere F, Wijesuriya N, Elliott MK, Mehta V, Howell S, Bishop M, Strocchi M, Niederer SA, Rinaldi CA. Managing arrhythmia in cardiac resynchronisation therapy. Front Cardiovasc Med 2023; 10:1211560. [PMID: 37608808 PMCID: PMC10440957 DOI: 10.3389/fcvm.2023.1211560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/30/2023] [Indexed: 08/24/2023] Open
Abstract
Arrhythmia is an extremely common finding in patients receiving cardiac resynchronisation therapy (CRT). Despite this, in the majority of randomised trials testing CRT efficacy, patients with a recent history of arrhythmia were excluded. Most of our knowledge into the management of arrhythmia in CRT is therefore based on arrhythmia trials in the heart failure (HF) population, rather than from trials dedicated to the CRT population. However, unique to CRT patients is the aim to reach as close to 100% biventricular pacing (BVP) as possible, with HF outcomes greatly influenced by relatively small changes in pacing percentage. Thus, in comparison to the average HF patient, there is an even greater incentive for controlling arrhythmia, to achieve minimal interference with the effective delivery of BVP. In this review, we examine both atrial and ventricular arrhythmias, addressing their impact on CRT, and discuss the available evidence regarding optimal arrhythmia management in this patient group. We review pharmacological and procedural-based approaches, and lastly explore novel ways of harnessing device data to guide treatment of arrhythmia in CRT.
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Affiliation(s)
- Felicity de Vere
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Mark K. Elliott
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Sandra Howell
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Martin Bishop
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
| | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 705] [Impact Index Per Article: 352.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Hagopian R, O'Keefe-Baker V, Aziz Z, Beaser AD, Nayak HM. Malignant atrioventricular nodal reentry tachycardia resulting in cardiac arrest. HeartRhythm Case Rep 2019; 5:173-175. [PMID: 30891418 PMCID: PMC6404418 DOI: 10.1016/j.hrcr.2018.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Raffi Hagopian
- Center for Arrhythmia Care, The University of Chicago Pritzker School of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Virginia O'Keefe-Baker
- Center for Arrhythmia Care, The University of Chicago Pritzker School of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Zaid Aziz
- Center for Arrhythmia Care, The University of Chicago Pritzker School of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Andrew D Beaser
- Center for Arrhythmia Care, The University of Chicago Pritzker School of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Hemal M Nayak
- Center for Arrhythmia Care, The University of Chicago Pritzker School of Medicine, University of Chicago Medicine, Chicago, Illinois
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Müssigbrodt A, Knopp H, Seewöster T, Hilbert S, Lucas J, Nowotnick K, Dinov B, Hindricks G, Arya A, Richter S. Implanted defibrillators in trouble: initial device misclassification leads to correct diagnosis—a case series. Europace 2016; 19:795-801. [DOI: 10.1093/europace/euw082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/05/2016] [Indexed: 11/14/2022] Open
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Miyazaki S, Taniguchi H, Kusa S, Komatsu Y, Ichihara N, Takagi T, Iwasawa J, Kuroi A, Nakamura H, Hachiya H, Hirao K, Iesaka Y. Catheter ablation of atrial tachyarrhythmias causing inappropriate implantable cardioverter-defibrillator shocks. Europace 2014; 17:289-94. [PMID: 25061229 DOI: 10.1093/europace/euu185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Inappropriate shocks have been an important issue post-implantable cardioverter-defibrillator (ICD) implantation. Moreover, inappropriate ICD shocks are associated with increased mortality. The objective of this study was to evaluate the feasibility of catheter ablation therapy for atrial tachyarrhythmias (ATa) responsible for inappropriate ICD shocks. METHODS AND RESULTS Among 108 consecutive patients who underwent ICD implantations, 22, 5, and 3 experienced inappropriate ICD shocks due to ATa, sinus tachycardia, and T-wave oversensing, respectively. Among the 22 patients with ATa, 18 patients (55 ± 10 years, 15 men, structural heart disease in 9) underwent catheter ablation of ATa causing inappropriate shocks. The median duration between the ICD implantation and first inappropriate shock was 10.0 (3.0-24.5) months. The ATa were atrial fibrillation (AF), atrial flutter (AFL), and atrioventricular nodal reentrant tachycardia in 14, 2, and 2 patients, respectively. One patient underwent an atrioventricular nodal ablation for persistent AF associated with a venous anomaly. Among 13 patients who underwent pulmonary vein antrum isolation, 10 (76.9%) were free from AF for a median of 21.0 (13-37.3) months after an average of 1.3 ± 0.5 procedures. In four patients with AFL or a supraventricular tachycardia, none had any arrhythmia recurrence for a median of 6.0 (3.3-93.5) months after a cavotricuspid isthmus or slow pathway ablation, respectively. There were no procedural complications. During the median follow-up of 19.0 (9.5-37.3) months after the last procedure, no patients experienced any inappropriate shocks. CONCLUSION Catheter ablation is a feasible therapeutic option for treating ATa responsible for inappropriate shock(s) in patients with ICD.
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Affiliation(s)
- Shinsuke Miyazaki
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan
| | - Hiroshi Taniguchi
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan
| | - Shigeki Kusa
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan
| | - Yuki Komatsu
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan
| | - Noboru Ichihara
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan
| | - Takamitsu Takagi
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan
| | - Jin Iwasawa
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan
| | - Akio Kuroi
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan
| | - Hiroaki Nakamura
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan
| | - Hitoshi Hachiya
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Yoshito Iesaka
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan
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