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Park YM. Does Age Play a Role in Patients with Heart Failure Receiving Cardiac Implantable Electronic Devices? Cardiology 2024; 149:484-486. [PMID: 38763128 PMCID: PMC11449178 DOI: 10.1159/000538631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 05/21/2024]
Affiliation(s)
- Yae Min Park
- Cardiology Division, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Dutta A, Alqabbani RRM, Hagendorff A, Tayal B. Understanding the Application of Mechanical Dyssynchrony in Patients with Heart Failure Considered for CRT. J Cardiovasc Dev Dis 2024; 11:64. [PMID: 38392278 PMCID: PMC10888548 DOI: 10.3390/jcdd11020064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Over the past two decades of CRT use, the failure rate has remained around 30-35%, despite several updates in the guidelines based on the understanding from multiple trials. This review article summarizes the role of mechanical dyssynchrony in the selection of heart failure patients for cardiac resynchronization therapy. Understanding the application of mechanical dyssynchrony has also evolved during these past two decades. There is no role of lone mechanical dyssynchrony in the patient selection for CRT. However, mechanical dyssynchrony can complement the electrocardiogram and clinical criteria and improve patient selection by reducing the failure rate. An oversimplified approach to mechanical dyssynchrony assessment, such as just estimating time-to-peak delays between segments, should not be used. Instead, methods that can identify the underlying pathophysiology of HF and are representative of a substrate to CRT should be applied.
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Affiliation(s)
- Abhishek Dutta
- Department of Cardiology, Nazareth Hospital, Philadelphia, PA 19020, USA
| | - Rakan Radwan M Alqabbani
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Andreas Hagendorff
- Department of Cardiology, Leipzig University Hospital, 04103 Leipzig, Germany
| | - Bhupendar Tayal
- Harrington and Heart and Vascular Center, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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Hara H, Igarashi T, Kaida T, Murakami M, Ito H, Niwano S, Ako J. Estimation of left ventricular activation sequence in patients with heart failure using two-dimensional speckle tracking echocardiography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1251-1262. [PMID: 36971867 DOI: 10.1007/s10554-023-02834-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/10/2023] [Indexed: 06/09/2023]
Abstract
Evaluation of longitudinal strain (LS) from two-dimensional echocardiography is useful for global and regional left ventricular (LV) dysfunction assessment. We determined whether the LS reflects contraction process in patients with asynchronous LV activation. We studied 144 patients with an ejection fraction ≤ 35%, who had left bundle branch block (LBBB, n = 42), right ventricular apical (RVA) pacing (n = 34), LV basal- or mid-lateral pacing (n = 23), and no conduction block (Narrow-QRS, n = 45). LS distribution maps were constructed using 3 standard apical views. The times from the QRS onset-to-early systolic positive peak (Q-EPpeak) and late systolic negative peak (Q-LNpeak) were measured to determine the beginning and end of contractions in each segment. Negative strain in LBBB initially appeared in the septum and basal-lateral contracted late. In RVA and LV pacing, the contracted area enlarged centrifugally from the pacing site. Narrow-QRS showed few regional differences in strain during the systolic period. The Q-EPpeak and Q-LNpeak exhibited similar sequences characterized by septum to basal-lateral via the apical regions in LBBB, apical to basal regions in RVA pacing, and lateral to a relatively large delayed contracted area between the apical- and basal-septum in LV pacing. Differences in Q-LNpeaks between the apical and basal segments in delayed contracted wall were 107 ± 30 ms in LBBB, 133 ± 46 ms in RVA pacing, and 37 ± 20 ms in LV pacing (p < 0.05, between QRS groups). Specific LV contraction processes were demonstrated by evaluating the LS distribution and time-to-peak strain. These evaluations may have potential to estimate the activation sequence in patients with asynchronous LV activation.
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Affiliation(s)
- Hideyuki Hara
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan.
| | - Tazuru Igarashi
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Toyoji Kaida
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Masami Murakami
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Hiroshi Ito
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Kaza N, Htun V, Miyazawa A, Simader F, Porter B, Howard JP, Arnold AD, Naraen A, Luria D, Glikson M, Israel C, Francis DP, Whinnett ZI, Shun-Shin MJ, Keene D. Upgrading right ventricular pacemakers to biventricular pacing or conduction system pacing: a systematic review and meta-analysis. Europace 2023; 25:1077-1086. [PMID: 36352513 PMCID: PMC10062368 DOI: 10.1093/europace/euac188] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/08/2022] [Indexed: 11/11/2022] Open
Abstract
Guidelines recommend patients undergoing a first pacemaker implant who have even mild left ventricular (LV) impairment should receive biventricular or conduction system pacing (CSP). There is no corresponding recommendation for patients who already have a pacemaker. We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies assessing device upgrades. The primary outcome was the echocardiographic change in LV ejection fraction (LVEF). Six RCTs (randomizing 161 patients) and 47 observational studies (2644 patients) assessing the efficacy of upgrade to biventricular pacing were eligible for analysis. Eight observational studies recruiting 217 patients of CSP upgrade were also eligible. Fourteen additional studies contributed data on complications (25 412 patients). Randomized controlled trials of biventricular pacing upgrade showed LVEF improvement of +8.4% from 35.5% and observational studies: +8.4% from 25.7%. Observational studies of left bundle branch area pacing upgrade showed +11.1% improvement from 39.0% and observational studies of His bundle pacing upgrade showed +12.7% improvement from 36.0%. New York Heart Association class decreased by -0.4, -0.8, -1.0, and -1.2, respectively. Randomized controlled trials of biventricular upgrade found improvement in Minnesota Heart Failure Score (-6.9 points) and peak oxygen uptake (+1.1 mL/kg/min). This was also seen in observational studies of biventricular upgrades (-19.67 points and +2.63 mL/kg/min, respectively). In studies of the biventricular upgrade, complication rates averaged 2% for pneumothorax, 1.4% for tamponade, and 3.7% for infection over 24 months of mean follow-up. Lead-related complications occurred in 3.3% of biventricular upgrades and 1.8% of CSP upgrades. Randomized controlled trials show significant physiological and symptomatic benefits of upgrading pacemakers to biventricular pacing. Observational studies show similar effects between biventricular pacing upgrade and CSP upgrade.
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Affiliation(s)
- Nandita Kaza
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Varanand Htun
- School of Public Health, Imperial College London, London, UK
| | - Alejandra Miyazawa
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Florentina Simader
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Bradley Porter
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - James P Howard
- Warrington and Halton Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ahran D Arnold
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Akriti Naraen
- Warrington and Halton Hospitals NHS Foundation Trust, Liverpool, UK
| | - David Luria
- Hebrew University Jerusalem, Jerusalem, Israel
| | | | | | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 140] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Stassen J, Scherrenberg M, Dilling-Boer D, Vijgen J, Koopman P, Schurmans J, Herbots L, Verwerft J, Schroyens M, Timmermans P. Comparison of de novo versus upgrade cardiac resynchronisation therapy on clinical effect and long-term outcome. Acta Cardiol 2021; 76:993-1000. [PMID: 33432875 DOI: 10.1080/00015385.2020.1867387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The benefit of de novo cardiac resynchronisation therapy (CRT) implantation in selected patients with heart failure is well known. The number of upgrade procedures is increasing but data on clinical response and outcome are less well documented as compared to de novo implantation. OBJECTIVES To investigate the efficacy and outcome of CRT upgrade procedures in patients with existing cardiac implantable electronic devices (CIEDs). METHODS Baseline characteristics, change in New York Heart Association (NYHA) functional class, echocardiographic parameters, life-threatening ventricular tachyarrhythmias, all-cause mortality and mode of death were evaluated in CRT patients with the comparison between de novo and upgrade CRT procedures. RESULTS About 410 patients (CRT upgrade/de novo CRT, n = 97/313) were followed for 63.5 ± 38.1 months. Upgrade patients were older (75.5 ± 8.1 vs 69.9 ± 10.7 years; p < 0.001), had more often an ischaemic cause of heart failure (58.8% vs 45.4%; p = 0.021), a higher NYHA functional class (p = 0.004) and a higher comorbidity burden. Improvement in left ventricular ejection fraction (LVEF) was higher in the de novo CRT group (8.4 ± 9.9 vs 11.0 ± 10.3%; p = 0.035). Clinical response was similar between both groups (60.5 vs 62.5%; p = 0.793), as was mortality at 1 year (8.2 vs 5.8%; p = 0.351) and at last follow-up (33.0 vs 28.8%; p = 0.447). The proportion of cardiovascular related deaths was similar between both groups (46.9% vs 38.9%; p = 0.531). CONCLUSIONS Patients with CRT upgrade procedures have similar symptomatic improvements, as well as 1 year and long-term outcome as compared to patients with de novo CRT implantation.
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Affiliation(s)
- Jan Stassen
- Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium
| | - Martijn Scherrenberg
- Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt – Hasselt University, Agoralaan, Belgium
| | | | - Johan Vijgen
- Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium
| | | | | | | | - Jan Verwerft
- Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 893] [Impact Index Per Article: 297.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Gavaghan C. Pacemaker Induced Cardiomyopathy: An Overview of Current Literature. Curr Cardiol Rev 2021; 18:e010921196020. [PMID: 34468302 DOI: 10.2174/2772432816666210901111616] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022] Open
Abstract
Pacemaker induced cardiomyopathy (PICM) is commonly defined as a reduction in left ventricular (LV) function in the setting of right ventricular (RV) pacing. This condition may be associated with the onset of clinical heart failure in those affected. Recent studies have focused on potential methods of identifying patients at risk of this condition, in addition to hypothesizing the most efficacious ways to manage these patients. Newer pacing options, such as His bundle pacing, may avoid the onset of PICM entirely.
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Affiliation(s)
- Callan Gavaghan
- Cardiology Department, Princess Alexandra Hospital, Brisbane, Australia
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Jędrzejczyk-Patej E, Mazurek M, Kotalczyk A, Kowalska W, Konieczny-Kozielska A, Kozielski J, Podolecki T, Szulik M, Sokal A, Kowalski O, Kalarus Z, Średniawa B, Lenarczyk R. Upgrade from implantable cardioverter-defibrillator vs. de novo implantation of cardiac resynchronization therapy: long-term outcomes. Europace 2021; 23:113-122. [PMID: 33257952 DOI: 10.1093/europace/euaa339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/17/2020] [Indexed: 12/24/2022] Open
Abstract
AIMS To assess and compare long-term mortality and predictors thereof in de novo cardiac resynchronization therapy defibrillators (CRT-D) vs. upgrade from an implantable cardioverter-defibrillator (ICD) to CRT-D. METHODS AND RESULTS Study population consisted of 595 consecutive patients with CRT-D implanted between 2002 and 2015 in a tertiary care, university hospital, in a densely inhabited, urban region of Poland [480 subjects (84.3%) with CRT-D de novo implantation; 115 patients (15.7%) upgraded from ICD to CRT-D]. In a median observation of 1692 days (range 457-3067), all-cause mortality for de novo CRT-D vs. CRT-D upgrade was 35.5% vs. 43.5%, respectively (P = 0.045). On multivariable regression analysis including all CRT recipients, the previously implanted ICD was an independent predictor for death [hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.10-2.29, P = 0.02]. For those, who were upgraded from ICD to CRT-D, the independent predictors for all-cause death were as follows: creatinine level (HR 1.01, 95% CI 1.00-1.02, P = 0.01), left ventricular end-systolic diameter (HR 1.07, 95% CI 1.02-1.11, P = 0.002), New York Heart Association (NYHA) IV class at baseline (HR 2.36, 95% CI 1.00-5.53, P = 0.049) and cardiac device-related infective endocarditis during follow-up (HR 2.42, 95% CI 1.02-5.75, P = 0.046). A new CRT scale (Creatinine ≥150 μmol/L; Remodelling, left ventricular end-systolic ≥59 mm; Threshold for NYHA, NYHA = IV) showed high prediction for mortality in CRT-D upgrades (AUC 0.70, 95% CI 0.59-0.80, P = 0.0007). CONCLUSION All-cause mortality in patients upgraded from ICD is significantly higher compared with de novo CRT-D implantations and reaches almost 45% within 4.5 years. A new CRT scale (Creatinine; Remodelling; Threshold for NYHA) has been proposed to help survival prediction following CRT upgrade.
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Affiliation(s)
- Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Michał Mazurek
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Agnieszka Kotalczyk
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Wiktoria Kowalska
- Students Scientific Society, Department of Cardiology, Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Konieczny-Kozielska
- Students Scientific Society, Department of Cardiology, Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jonasz Kozielski
- Students Scientific Society, Department of Cardiology, Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Podolecki
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Mariola Szulik
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Adam Sokal
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Oskar Kowalski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Zbigniew Kalarus
- Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Beata Średniawa
- Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Radosław Lenarczyk
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
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Rath B, Willy K, Wolfes J, Ellermann C, Reinke F, Köbe J, Eckardt L, Frommeyer G. Predictors of response to cardiac resynchronization therapy in patients with chronic right ventricular pacing. Clin Res Cardiol 2020; 110:877-883. [PMID: 33320290 PMCID: PMC8166655 DOI: 10.1007/s00392-020-01785-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/23/2020] [Indexed: 01/20/2023]
Abstract
Background The benefits of de novo cardiac resynchronization therapy (CRT) in patients with QRS-prolongation and impaired left-ventricular function (LVEF) are well established. Current guidelines also recommend CRT-upgrade in patients requiring permanent or frequent right ventricular pacing (RVP) with symptomatic heart failure and reduced LVEF. Whereas several predictors of response to de novo CRT-implantation such as female gender, QRS-duration, non-ischemic cardiomyopathy (NICM) are known due to large prospective trials, similar factors regarding CRT-upgrade are currently lacking. Methods and results We examine 114 patients 3–6 months after CRT-upgrade due to frequent RVP (> 50%) and symptomatic heart failure. Response to CRT was evaluated by improvement in NYHA class referring to the Minnesota Living With Heart Failure Questionnaire. Only cardiomyopathy type and use of Angiotensin-converting-enzyme (ACE) inhibitor had an impact on response to CRT-upgrade in a linear regression model. Patients with NICM presented a greater responder rate than patients with ischemic cardiomyopathy (ICM) (80.4 vs. 60.3%, p < 0.05). Other traditional response predictors in de novo CRT recipients (e.g. QRS-width, female gender) showed no effect on CRT-response in this cohort. Conclusion Only underlying heart disease (NICM vs. ICM) and the use of ACE inhibitor were significant predictors of response to CRT-upgrade. In contrast to de novo CRT-recipients, where pre-implant QRS-duration is a key predictor, QRS-duration during RV-pacing has no significant impact on CRT-response in this cohort. Graphic abstract ![]()
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Affiliation(s)
- Benjamin Rath
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Kevin Willy
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Julian Wolfes
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Christian Ellermann
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Florian Reinke
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Julia Köbe
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Comparison of left ventricular lead upgrade vs continued medical care among patients eligible for cardiac resynchronization therapy at the time of defibrillator generator replacement: Predictors of left ventricular lead upgrade and associations with long-term outcomes. Heart Rhythm 2020; 17:1878-1886. [PMID: 32497762 DOI: 10.1016/j.hrthm.2020.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/08/2020] [Accepted: 05/25/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Randomized trials evaluating cardiac resynchronization therapy (CRT) have excluded patients with a pre-existing implantable cardioverter-defibrillator (ICD). The association of CRT upgrade with clinical outcomes in patients with a pre-existing ICD is unclear. OBJECTIVE The purpose of this study was to examine a CRT-eligible population to evaluate clinical outcomes associated with CRT upgrade compared to patients who did not undergo CRT. METHODS Using the National Cardiovascular Data Registry (NCDR) ICD Registry between April 2010 and December 2014, we created a hierarchical logistic regression model to identify predictors of CRT upgrade in a CRT-eligible ICD population. In the subpopulation of patients with Medicare-linked claims data, differential outcomes were determined with censoring at 3 years. The primary endpoint of this study was all-cause mortality, with secondary endpoints of rates of hospitalization and procedural complications. RESULTS CRT upgrade was performed in 75.5% of CRT-eligible patients with pre-existing ICD (n = 15,803). Presence of left bundle branch block conduction was the strongest predictor of CRT upgrade (odds ratio [OR] 4.56; 95% confidence interval [CI] 4.08-5.11; P <.0001). In both unadjusted and adjusted analyses, CRT upgrade was associated with a reduction in mortality at 3 years (unadjusted hazard ratio [HR] 0.80; 95% CI 0.70-0.92; P = .001; adjusted HR 0.84; 95% CI 0.72-0.98; P = .02, respectively). Compared to patients with ICD generator replacement only, patients who underwent CRT upgrade experienced no different 3-year rates of hospitalization (adjusted HR 1.01; 95% CI 0.91-1.12; P = .81) or 1-year periprocedural complication rates (adjusted HR 1.07; 95% CI 0.79-1.45; P = .66). CONCLUSION In a national registry of CRT-eligible patients with pre-existing ICD, upgrade to CRT was associated with lower rates of mortality than continued medical management.
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Loboda D, Gibinski M, Zietek K, Wilczek J, Gardas R, Gladysz-Wanha S, Golba KS. Survival of patients with pacing-induced cardiomyopathy upgraded to CRT does not depend on defibrillation therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:471-478. [PMID: 32198771 DOI: 10.1111/pace.13906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/15/2020] [Accepted: 03/15/2020] [Indexed: 12/28/2022]
Abstract
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 cardioverter-defibrillator (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.
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Affiliation(s)
- Danuta Loboda
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Michal Gibinski
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Karolina Zietek
- Faculty of Medicine, Medical University of Silesia, Katowice, Poland
| | - Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Rafal Gardas
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Sylwia Gladysz-Wanha
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Krzysztof S Golba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
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Beca B, Sapp JL, Gardner MJ, Gray C, AbdelWahab A, MacIntyre C, Doucette S, Parkash R. Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy. CJC Open 2020; 1:93-99. [PMID: 32159089 PMCID: PMC7063653 DOI: 10.1016/j.cjco.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/13/2019] [Indexed: 11/03/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is effective in treating advanced heart failure (HF), but data describing benefits and long-term outcomes for upgrades from a preexisting device are limited. This study sought to compare long-term outcomes in de novo CRT implants with those eligible for CRT with a prior device. Methods This is a retrospective cohort study using data from a provincial registry (2002-2015). Patients were included if they had mild-moderate HF, left ventricular ejection fraction ≤ 35%, and QRS duration ≥ 130 ms. Patients were classified as de novo CRT or upgraded to CRT from a prior device. Outcomes were mortality and composite mortality and HF hospitalization. Results There were 342 patients included in the study. In a multivariate model, patients in the upgraded cohort (n = 233) had a higher 5-year mortality rate (adjusted hazard ratio, 2.86; 95% confidence interval, 1.59-5.15; P = 0.0005) compared with the de novo cohort (n = 109) and higher composite mortality and HF hospitalization (adjusted hazard ratio, 2.60; 95% confidence interval, 1.54-4.37; P = 0.0003). Conclusions Implantation of de novo CRTs was associated with lower mortality and HF hospitalization compared with upgraded CRTs from preexisting devices. It is unknown whether these differences are due to the timing of CRT implementation or other clinical factors. Further work in this area may be helpful to determine how to improve outcomes for these patients.
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Affiliation(s)
- Bogdan Beca
- Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Martin J Gardner
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Christopher Gray
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Amir AbdelWahab
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Ciorsti MacIntyre
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Steve Doucette
- Research Methods Unit, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
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Tayal B, Fruelund P, Sogaard P, Riahi S, Polcwiartek C, Atwater BD, Gislason G, Risum N, Torp-Pedersen C, Kober L, Kragholm KH. Incidence of heart failure after pacemaker implantation: a nationwide Danish Registry-based follow-up study. Eur Heart J 2019; 40:3641-3648. [DOI: 10.1093/eurheartj/ehz584] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/25/2019] [Accepted: 07/30/2019] [Indexed: 01/14/2023] Open
Abstract
Abstract
Aims
The objective of the current study is to investigate the risk of heart failure (HF) after implantation of a pacemaker (PM) with a right ventricular pacing (RVP) lead in comparison to a matched cohort without a PM and factors associated with this risk.
Methods and results
All patients without a known history of HF who had a PM implanted with an RVP lead between 2000 and 2014 (n = 27 704) were identified using Danish nationwide registries. An age- and gender-matched control cohort (matched 1:5, n = 138 520) without PM and HF was identified to compare the risk. Outcome was the cumulative incidence of HF including fatal HF within the first 2 years of PM implantation, with all-cause mortality and myocardial infarction (MI) as competing risks. Due to violation of proportional hazards, the follow-up period was divided into three time-intervals: <30 days, 30–180 days, and >180 days–2 years. The cumulative incidence of HF including fatal HF was observed in 2937 (10.6%) PM patients. Risks for the three time-intervals were <30 days [hazard ratio (HR) 5.98, 95% CI 5.19–6.90], 30–180 days (HR 1.84, 95% CI 1.71–1.98), and >180 days (HR 1.11, 95% CI 1.04–1.17). Among patients with a PM device, factors associated with increased risk of HF were male sex (HR 1.33, 95% CI 1.24–1.43), presence of chronic kidney disease (CKD) (HR 1.64, 95% CI 1.29–2.09), and prior MI (1.77, 95% 1.50–2.09).
Conclusions
Pacemaker with an RVP lead is strongly associated with risk of HF specifically within the first 6 months. Patients with antecedent history of MI and CKD had substantially increased risk.
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Affiliation(s)
- Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - Patricia Fruelund
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - Peter Sogaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Brett D Atwater
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Gunnar Gislason
- Department of Medicine, Zealand University Hospital, Køge, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Niels Risum
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Lars Kober
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
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17
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Rickard J, Gorodeski EZ, Patel D, Hussein A, Moennich LA, Cantillon D, Trulock K, Toro S, Niebauer M, Varma N, Wilkoff BL. Long term outcomes in patients with chronic right ventricular pacing upgraded to cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2019; 30:1979-1983. [PMID: 31211474 DOI: 10.1111/jce.14038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/09/2019] [Accepted: 06/14/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION In patients with chronic systolic heart failure and frequent right ventricular pacing (RVP), upgrade to cardiac resynchronization therapy (CRT) has become common practice despite a lack of randomized clinical trials. We aimed to evaluate long term outcomes in patients upgraded to CRT from chronic RVP compared with de novo CRT implants. METHODS AND RESULTS We reviewed medical charts on consecutive patients with a left ventricular ejection fraction (LVEF) ≤ 35% and a QRSd ≥ 120 ms undergoing CRT. Survival free of left ventricular assist device (LVAD) and a heart transplant was compared amongst patients on the basis of pre-CRT QRS morphology. Improvement in LVEF was also compared across groups. A total of 1260 patients met inclusion criteria of whom 233 were upgraded from chronic RVP. Over a mean follow up 6.5 ± 4.0 years there were 821 endpoints (27 LVAD, 30 heart transplants, and 764 deaths). In a multivariate Cox regression model, upgraded patients had worse outcomes (HR 1.3(1.1-1.7) P = .007) compared with those with native LBBB and similar outcomes to patients with non-LBBB(HR 0.96(0.76-1.21) P = .7). The survival curve for chronic RVP parallels native LBBB for approximately 2.5 years before dropping sharply. Patients with chronic RVP derive similar improvements in LVEF compared with those with LBBB and superior improvements compared with those with non-LBBB. CONCLUSIONS Despite achieving similar levels of LVEF improvement, patients with systolic heart failure with chronic RVP undergoing upgrade to CRT have inferior long term outcomes compared with patients with native LBBB. Long term outcomes with CRT in patients with chronic RVP, RBBB, and IVCD are similar.
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Affiliation(s)
- John Rickard
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Eiran Z Gorodeski
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Divyang Patel
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Ayman Hussein
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Laurie Anne Moennich
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Daniel Cantillon
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Kevin Trulock
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Saleem Toro
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Mark Niebauer
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Niraj Varma
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Bruce L Wilkoff
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
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Abstract
Cardiac resynchronization therapy (CRT) is an electrical therapy to resolve an electrical problem. Any method to predict CRT response must specifically reflect the electrical substrate. Time-to-peak dyssynchrony is too unspecific for prediction of response because dyssynchrony by this approach may reflect the presence of scar or fibrosis even in the absence of conduction delay. New methods are based on the actual physiology of activation delay-induced heart failure (HF) and are superior to time-to-peak methods in predicting CRT response. Time-to-peak dyssynchrony may be used for prognosis in HF patients without signs of delayed ventricular activation and for monitoring CRT response.
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Affiliation(s)
- Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark
| | - Peter Sogaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark.
| | - Niels Risum
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
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19
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Sidhu BS, Gould J, Sieniewicz BJ, Porter B, Rinaldi CA. Complications associated with cardiac resynchronization therapy upgrades versus de novo implantations. Expert Rev Cardiovasc Ther 2018; 16:607-615. [PMID: 29985076 DOI: 10.1080/14779072.2018.1498783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION A significant number of patients undergo upgrade to cardiac resynchronization therapy (CRT). These patients tend to differ from individuals undergoing de novo CRT implantations both in terms of their baseline demographics and the etiology underlying their heart failure. Areas covered: There are several factors that need to be considered when upgrading patients to CRT, such as, venous patency. Potentially, these conditions can cause issues which may result in procedures being more difficult than de novo implantations. This article discusses these issues and compares the rates of procedural-related complications for CRT upgrades and de novo implantations. It discusses the proportion of patients that are likely to respond to CRT with each intervention. Expert commentary: Understanding the relative risks of CRT upgrades versus de novo implantations is important to help operators select the correct initial device and counsel patients accordingly. Growing experience with image-guided implantations and endocardial pacing may prove to be particularly relevant to patients undergoing CRT upgrades.
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Affiliation(s)
- Baldeep S Sidhu
- a Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK.,b Cardiology Department , Guys and St Thomas' NHS Foundation Trust , London , UK
| | - Justin Gould
- a Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK.,b Cardiology Department , Guys and St Thomas' NHS Foundation Trust , London , UK
| | - Benjamin J Sieniewicz
- a Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK.,b Cardiology Department , Guys and St Thomas' NHS Foundation Trust , London , UK
| | - Bradley Porter
- a Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK.,b Cardiology Department , Guys and St Thomas' NHS Foundation Trust , London , UK
| | - Christopher A Rinaldi
- a Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK.,b Cardiology Department , Guys and St Thomas' NHS Foundation Trust , London , UK
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20
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Kosztin A, Vamos M, Aradi D, Schwertner WR, Kovacs A, Nagy KV, Zima E, Geller L, Duray GZ, Kutyifa V, Merkely B. De novo implantation vs. upgrade cardiac resynchronization therapy: a systematic review and meta-analysis. Heart Fail Rev 2018; 23:15-26. [PMID: 29047028 PMCID: PMC5756552 DOI: 10.1007/s10741-017-9652-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patients with conventional pacemakers or implanted defibrillators are often considered for cardiac resynchronization therapy (CRT). Our aim was to summarize the available evidences regarding the clinical benefits of upgrade procedures. A systematic literature search was performed from studies published between 2006 and 2017 in order to compare the outcome of CRT upgrade vs. de novo implantations. Outcome data on all-cause mortality, heart failure events, New York Heart Association (NYHA) Class, QRS narrowing and echocardiographic parameters were analysed. A total of 16 reports were analysed comprising 489,568 CRT recipients, of whom 468,205 patients underwent de novo and 21,363 upgrade procedures. All-cause mortality was similar after CRT upgrade compared to de novo implantations (RR 1.19, 95% CI 0.88-1.60, p = 0.27). The risk of heart failure was also similar in both groups (RR 0.96, 95% CI 0.70-1.32, p = 0.81). There was no significant difference in clinical response after CRT upgrade compared to de novo implantations in terms of improvement in left ventricular ejection fraction (ΔEF de novo - 6.85% vs. upgrade - 9.35%; p = 0.235), NYHA class (ΔNYHA de novo - 0.74 vs. upgrade - 0.70; p = 0.737) and QRS narrowing (ΔQRS de novo - 9.6 ms vs. upgrade - 29.5 ms; p = 0.485). Our systematic review and meta-analysis of currently available studies reports that CRT upgrade is associated with similar risk for all-cause mortality compared to de novo resynchronization therapy. Benefits on reverse remodelling and functional capacity improved similarly in both groups suggesting that CRT upgrade may be safely and effectively offered in routine practice. CLINICAL TRIAL REGISTRATION Prospero Database-CRD42016043747.
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Affiliation(s)
- Annamaria Kosztin
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, 1122, Hungary
| | - Mate Vamos
- University Hospital Frankfurt-Goethe University, Frankfurt am Main, Germany
- Medical Centre-Hungarian Defence Forces, Budapest, Hungary
| | - Daniel Aradi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, 1122, Hungary
- Heart Center, Balatonfüred, Hungary
| | | | - Attila Kovacs
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, 1122, Hungary
| | - Klaudia Vivien Nagy
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, 1122, Hungary
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, 1122, Hungary
| | - Laszlo Geller
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, 1122, Hungary
| | | | - Valentina Kutyifa
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, 1122, Hungary
- University of Rochester, Medical Center, Rochester, NY, USA
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, 1122, Hungary.
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Stankovic I, Prinz C, Ciarka A, Daraban AM, Mo Y, Aarones M, Szulik M, Winter S, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Penicka M, Faber L, Voigt JU. Long-Term Outcome After CRT in the Presence of Mechanical Dyssynchrony Seen With Chronic RV Pacing or Intrinsic LBBB. JACC Cardiovasc Imaging 2017; 10:1091-1099. [DOI: 10.1016/j.jcmg.2016.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/15/2016] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
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22
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Gorcsan J, Lumens J. Rocking and Flashing With RV Pacing. JACC Cardiovasc Imaging 2017; 10:1100-1102. [DOI: 10.1016/j.jcmg.2016.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
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23
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Gwag HB, Chun KJ, Hwang JK, Park KM, On YK, Kim JS, Park SJ. Comparison of De Novo versus Upgrade Cardiac Resynchronization Therapy; Focused on the Upgrade for Pacing-Induced Cardiomyopathy. Yonsei Med J 2017; 58:703-709. [PMID: 28540981 PMCID: PMC5447099 DOI: 10.3349/ymj.2017.58.4.703] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/13/2017] [Accepted: 03/13/2017] [Indexed: 12/04/2022] Open
Abstract
PURPOSE This study aimed to determine whether upgrade cardiac resynchronization therapy (CRT) shows better outcomes than de novo CRT. To do so, we compared the efficacy of CRT between de novo and upgrade groups, focusing particularly on the effect of upgrade CRT on patients with pacing-induced cardiomyopathy (PiCM). MATERIALS AND METHODS PiCM was defined as new-onset dilated cardiomyopathy following pacemaker implantation in patients with baseline normal ejection fraction ≥50%. Electro-mechanical reverse remodeling and clinical outcomes were compared among the de novo (n=62), PiCM upgrade (n=7), and non-PiCM upgrade (n=8) CRT groups. RESULTS The PiCM upgrade group showed significantly greater electro-mechanical reverse remodeling than the de novo CRT or non-PiCM upgrade groups at 6-month follow-up. The rate of super-responders was significantly higher in the PiCM upgrade group than the other CRT groups. The group factor of the PiCM upgrade was identified as an independent predictor of super-responder in multivariate analysis (odds ratio 10.4, 95% confidential interval 1.08-99.4, p=0.043). During the median follow-up of 15.8 months, the PiCM upgrade group showed the lowest rate of composite clinical outcomes, including cardiac death, heart transplantation, and heart failure-related rehospitalization (p=0.059). CONCLUSION The upgrade CRT for PiCM patients showed better performance in terms of electro-mechanical reverse remodeling than de novo implantation or upgrade CRT in non-PiCM patients.
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Affiliation(s)
- Hye Bin Gwag
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Jin Chun
- Department of Cardiology, Hallym University Medical Center, Seoul, Korea
| | - Jin Kyung Hwang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Min Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Jung Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Merchant FM, Hoskins MH, Musat DL, Prillinger JB, Roberts GJ, Nabutovsky Y, Mittal S. Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/circoutcomes.117.003564] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Faisal M. Merchant
- From the Cardiology Division, Emory University School of Medicine, Atlanta, GA (F.M.M., M.H.H.); Cardiology Division, Valley Health System, Ridgewood, NJ (D.L.M., S.M.); and Abbott, Sunnyvale, CA (J.B.P., G.J.R., Y.N.)
| | - Michael H. Hoskins
- From the Cardiology Division, Emory University School of Medicine, Atlanta, GA (F.M.M., M.H.H.); Cardiology Division, Valley Health System, Ridgewood, NJ (D.L.M., S.M.); and Abbott, Sunnyvale, CA (J.B.P., G.J.R., Y.N.)
| | - Dan L. Musat
- From the Cardiology Division, Emory University School of Medicine, Atlanta, GA (F.M.M., M.H.H.); Cardiology Division, Valley Health System, Ridgewood, NJ (D.L.M., S.M.); and Abbott, Sunnyvale, CA (J.B.P., G.J.R., Y.N.)
| | - Julie B. Prillinger
- From the Cardiology Division, Emory University School of Medicine, Atlanta, GA (F.M.M., M.H.H.); Cardiology Division, Valley Health System, Ridgewood, NJ (D.L.M., S.M.); and Abbott, Sunnyvale, CA (J.B.P., G.J.R., Y.N.)
| | - Gregory J. Roberts
- From the Cardiology Division, Emory University School of Medicine, Atlanta, GA (F.M.M., M.H.H.); Cardiology Division, Valley Health System, Ridgewood, NJ (D.L.M., S.M.); and Abbott, Sunnyvale, CA (J.B.P., G.J.R., Y.N.)
| | - Yelena Nabutovsky
- From the Cardiology Division, Emory University School of Medicine, Atlanta, GA (F.M.M., M.H.H.); Cardiology Division, Valley Health System, Ridgewood, NJ (D.L.M., S.M.); and Abbott, Sunnyvale, CA (J.B.P., G.J.R., Y.N.)
| | - Suneet Mittal
- From the Cardiology Division, Emory University School of Medicine, Atlanta, GA (F.M.M., M.H.H.); Cardiology Division, Valley Health System, Ridgewood, NJ (D.L.M., S.M.); and Abbott, Sunnyvale, CA (J.B.P., G.J.R., Y.N.)
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25
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Effects of Upgrade Versus De Novo Cardiac Resynchronization Therapy on Clinical Response and Long-Term Survival. Circ Arrhythm Electrophysiol 2017; 10:e004471. [DOI: 10.1161/circep.116.004471] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 12/13/2016] [Indexed: 12/19/2022]
Abstract
Background—
Benefits of cardiac resynchronization therapy (CRT) on morbidity and mortality in selected patients are well known. Although the number of upgrade procedures from single- or dual-chamber devices to CRT is increasing, there are only sparse data on the outcomes of upgrade procedures compared with de novo CRT. This study aimed to evaluate clinical response and survival in patients receiving de novo versus upgrade CRT defibrillator therapy.
Methods and Results—
Prospectively collected outcome data were compared in patients undergoing de novo or upgrade CRT defibrillator implantation at 3 implant centers in Germany and Hungary. Clinical response was defined as an improvement by at least one New York Heart Association (NYHA) functional class. CRT implantation was performed in 552 consecutive patients of whom 375 underwent a de novo and 177 an upgrade procedure. Upgrade patients were more often implanted for secondary prevention, suffered more often from atrial fibrillation, chronic kidney disease, diabetes mellitus, and dyslipidemia, and had more often a non-LBBB (left bundle branch block) wide QRS complex, and lower left ventricular ejection fraction. Upgrade procedures were associated with a lower response rate compared to the de novo group (57% versus 69%,
P
univariate=0.008,
P
multivariate=0.021). During the follow-up of 37±28 months, survival was worse after upgrade compared with de novo CRT defibrillator implantations (hazard ratio, 1.65; 95% confidence interval, 1.22–2.24;
P
=0.001) even after careful adjustment for important baseline variables (adjusted hazard ratio, 1.68; 95% confidence interval, 1.20–2.34;
P
=0.002) and after propensity-score matching (propensity-adjusted hazard ratio, 1.79; 95% confidence interval, 1.08–2.95;
P
=0.023).
Conclusions—
Both clinical response and long-term survival were less favorable in patients undergoing CRT upgrade compared to de novo implantations.
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Marechaux S, Menet A, Guyomar Y, Ennezat PV, Guerbaai RA, Graux P, Tribouilloy C. Role of echocardiography before cardiac resynchronization therapy: new advances and current developments. Echocardiography 2016; 33:1745-1752. [DOI: 10.1111/echo.13334] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Sylvestre Marechaux
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
- INSERM U 1088; University of Picardie; Amiens France
| | - Aymeric Menet
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
- INSERM U 1088; University of Picardie; Amiens France
| | - Yves Guyomar
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
| | | | - Raphaëlle Ashley Guerbaai
- Cardiology Department; Grenoble University Hospital; Grenoble France
- Cardiovascular and Thoracic Department; Amiens University Hospital; Amiens France
| | - Pierre Graux
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
| | - Christophe Tribouilloy
- INSERM U 1088; University of Picardie; Amiens France
- Cardiovascular and Thoracic Department; Amiens University Hospital; Amiens France
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