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Stellbrink C. [History of cardiac resynchronization therapy : 30 years of electrotherapeutic management for heart failure]. Herzschrittmacherther Elektrophysiol 2024; 35:68-76. [PMID: 38424340 PMCID: PMC10923969 DOI: 10.1007/s00399-024-01004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
The first permanent biventricular pacing system was implanted more than 30 years ago. In this article, the historical development of cardiac resynchronization therapy (CRT), starting with the pathophysiological concept, followed by the initial "proof of concept" studies and finally the large prospective-randomized studies that led to the implementation of CRT in heart failure guidelines, is outlined. Since the establishment of CRT, both an expansion of indications, e.g., for patients with mild heart failure and atrial fibrillation, but also the return to patients with broad QRS complex and left bundle branch block who benefit most of CRT has evolved. New techniques such as conduction system pacing will have major influence on pacemaker therapy in heart failure, both as an alternative or adjunct to CRT.
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Affiliation(s)
- Christoph Stellbrink
- Universitätsklinikum OWL Campus Klinikum Bielefeld., Universitätsklinik für Kardiologie und Internistische Intensivmedizin, Teutoburger Straße 50, 33604, Bielefeld, Deutschland.
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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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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: 857] [Impact Index Per Article: 285.7] [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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The Benefit of Atrioventricular Junction Ablation for Permanent Atrial Fibrillation and Heart Failure Patients Receiving Cardiac Resynchronization Therapy: An Updated Systematic Review and Meta-analysis. Indian Pacing Electrophysiol J 2021; 21:101-111. [PMID: 33548449 PMCID: PMC7952769 DOI: 10.1016/j.ipej.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/27/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is correlated with a poor biventricular pacing and inadequate response to cardiac resynchronization therapy (CRT). Biventricular pacing improvement can be achieved by conducting the atrioventricular junction ablation (AVJA). We aimed to investigate the benefit of AVJA for permanent AF and heart failure with reduced ejection fraction (HFrEF) patients receiving CRT. METHODS In August 2020, a systematic review and meta-analysis study comparing CRT plus AVJA versus CRT for permanent AF and HFrEF patients was conducted. Relevant articles were identified through the electronic scientific database such as ClinicalTrials.gov, ProQuest, ScienceDirect, PubMed, and Cochrane. The pooled risk ratio (RR) and pooled mean difference (MD) were estimated. RESULTS A total of 3199 patients from 14 cohort studies were involved in this study. Additional AVJA reduced cardiovascular mortality (RR = 0.75, 95% confidence interval [CI] = 0.61 to 0.93, P < 0.01) in permanent AF and HFrEF patients receiving CRT. Biventricular pacing rate was higher in CRT plus AVJA group (MD = 8.65%, 95% CI = 5.62 to 11.67, P < 0.01) than in CRT alone group. The reverse remodeling characterized by the reduction of left ventricular end-diastolic diameter (LVEDD) was greater in the CRT plus AVJA group (MD = -2.11 mm, 95% CI = -3.79 to -0.42, P = 0.01). CONCLUSION In permanent AF and HFrEF patients receiving CRT, AVJA effectively increased the biventricular pacing rate. Adequate biventricular pacing rate provided a better response to the CRT marked by the greater ventricular reverse remodeling and survival from cardiovascular mortality.
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Firouzbakht T, Mustafa U, Jiwani S, Dominic P. Atrial Fibrillation Management in Heart Failure: Interrupting the Vicious Cycle. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00812-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cai M, Hua W, Zhang N, Yang S, Hu Y, Gu M, Niu H, Zhang S. A prognostic nomogram for event-free survival in patients with atrial fibrillation before cardiac resynchronization therapy. BMC Cardiovasc Disord 2020; 20:221. [PMID: 32404049 PMCID: PMC7222436 DOI: 10.1186/s12872-020-01502-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background Atrial fibrillation (AF), one of the most common comorbidities of heart failure (HF), is associated with worse long-term prognosis in HF patients receiving cardiac resynchronization therapy (CRT). However, there is still no convenient tool to identify CRT candidates with AF who are at high risk of mortality and hospitalization due to HF. Methods We included 152 consecutive patients with AF for CRT in our hospital from January 2009 to July 2019. Multiple imputation was used for missing values. With imputed datasets, a multivariate Cox regression model was performed for variable selection using the backward stepwise method to predict all-cause mortality and HF readmissions. A nomogram and nomogram-based scoring system were constructed from the selected predictors. Then, internal validation and calibration were achieved by the bootstrap method, deriving the corrected concordance index and calibration curves. Sensitivity analysis was also performed to validate our selected predictors. Results Five predictors were incorporated in the nomogram, including N-terminal pro brain natriuretic protein (NT-proBNP) > 1745 pg/mL, history of syncope, previous pulmonary hypertension, moderate or severe tricuspid regurgitation, thyroid-stimulating hormone (TSH) > 4 mIU/L. The concordance index (0.70, 95% CI 0.62–0.77), corrected concordance index (0.67, 95% CI 0.59–0.74) and calibration curve showed optimal discrimination and calibration of the established nomogram. A significant difference in overall event-free survival was recognized by the nomogram-derived scores for patients with high risk (> 50 points), intermediate risk (21–50 points) and low risk (0–20 points) before CRT. Conclusion Our internally validated nomogram may be an applicable tool for the early risk stratification of CRT candidates with AF.
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Affiliation(s)
- Minsi Cai
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China.
| | - Nixiao Zhang
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Shengwen Yang
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Yiran Hu
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Min Gu
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Hongxia Niu
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Shu Zhang
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
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Mustafa U, Atkins J, Mina G, Dawson D, Vanchiere C, Duddyala N, Jones R, Reddy P, Dominic P. Outcomes of cardiac resynchronisation therapy in patients with heart failure with atrial fibrillation: a systematic review and meta-analysis of observational studies. Open Heart 2019; 6:e000937. [PMID: 31217991 PMCID: PMC6546263 DOI: 10.1136/openhrt-2018-000937] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/22/2018] [Accepted: 01/20/2019] [Indexed: 01/02/2023] Open
Abstract
Background Cardiac resynchronisation therapy (CRT) is beneficial in selected patients with heart failure (HF) in normal sinus rhythm (NSR). We sought to evaluate the impact of CRT with or without atrioventricular junction (AVJ) ablation in patients with HF with concomitant atrial fibrillation (AF). Methods and results Literature was searched (inception through 30 August 2017) for observational studies that reported outcomes in patients with HF with CRT and AF that reported all-cause and cardiovascular mortality. Thirty-one studies with 83, 571 patients were included. CRT did not decrease mortality compared with internal cardioverter defibrillator or medical therapy alone in patients with HF and AF with indications for CRT (OR: 0.851, 95% CI 0.616 to 1.176, p=0.328, I2=86.954). CRT-AF patients had significantly higher all-cause and cardiovascular mortality than CRT-NSR patients ([OR: 1.472, 95% CI 1.301 to 1.664, p=0.000] and [OR: 1.857, 95% CI 1.350 to 2.554, p=0.000] respectively). Change in left ventricular ejection fraction was not different between CRT patients with and without AF (p=0.705). AVJ ablation, however, improved all-cause mortality in CRT-AF patients when compared with CRT-AF patients without AVJ ablation (OR: 0.485, 95% CI 0.247 to 0.952, p=0.035). With AVJ ablation, there was no difference in all-cause mortality in CRT-AF patients compared with CRT-NSR patients (OR: 1.245, 95% CI 0.914 to 1.696, p=0.165). Conclusion The results of our meta-analysis suggest that AF was associated with decreased CRT benefits in patients with HF. CRT, however, benefits patients with AF with AVJ ablation.
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Affiliation(s)
- Usman Mustafa
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
| | - Jessica Atkins
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - George Mina
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Desiree Dawson
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Catherine Vanchiere
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Narendra Duddyala
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Ryan Jones
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Pratap Reddy
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Paari Dominic
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
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Abstract
Nonresponse to cardiac resynchronization therapy (CRT) is still a major issue in therapy expansion. The description of fast, simple, cost-effective methods to optimize CRT could help in adapting pacing intervals to individual patients. A better understanding of the importance of appropriate patient selection, left ventricular lead placement, and device programming, together with a multidisciplinary approach and an optimal follow-up of the patients, may reduce the percentage of nonresponders.
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Affiliation(s)
- José María Tolosana
- Hospital Clinic, Universitat de Barcelona, Villarroel 170, Barcelona, Catalonia 08036, Spain
| | - Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Villarroel 170, Barcelona, Catalonia 08036, Spain.
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Hernández-Madrid A, Facchin D, Klepfer RN, Ghosh S, Matía R, Moreno J, Locatelli A. Device pacing diagnostics overestimate effective cardiac resynchronization therapy pacing results of the hOLter for Efficacy analysis of CRT (OLÉ CRT) study. Heart Rhythm 2017; 14:541-547. [PMID: 28104482 DOI: 10.1016/j.hrthm.2017.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND A high percentage of biventricular (BiV) or left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) devices has been associated with superior clinical outcomes. However, the percent ventricular (%V) pacing reported by CRT devices simply indicates the number of paces the device has delivered and not the proportion of pacing that has captured the LV effectively. OBJECTIVE The purpose of this study was to determine whether a beat-by-beat evaluation of effective pacing would provide a more accurate evaluation of CRT delivery. METHODS An automatic electrogram (EGM)-based algorithm that classifies each LV pace as effective or ineffective based on detection of QS/QS-r morphology on the unipolar LV EGM during pacing was developed and validated. LV EGMs that were recorded by 24-hour Holter from 57 CRT patients were postprocessed. The percent effective CRT (%e-CRT) pacing was calculated by dividing the time spent in e-CRT pacing by the total time of the recording. RESULTS In this CRT cohort, the average %V pacing (94.8% ± 8%) significantly overestimated the %e-CRT pacing (87.5% ± 23%; P <.001). A significant minority of subjects (18%) had a discrepancy of at least 3 percentage points between %V pacing and %e-CRT pacing (mean 39% ± 41%). CONCLUSION Current device pacing diagnostics overestimate the amount of CRT pacing actually delivered. The new algorithm quantifies ineffective CRT pacing, which enables clinicians to identify patients with this issue and to address the reasons behind suboptimal CRT delivery.
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Affiliation(s)
- Antonio Hernández-Madrid
- Arrhythmia Unit, Cardiology Department, Ramón y Cajal Hospital, Alcalá University, Madrid, Spain.
| | - Domenico Facchin
- Division of Cardiology, Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine, Italy
| | | | - Subham Ghosh
- Medtronic PLC, Cardiac Rhythm and Heart Failure Research, Minneapolis, Minnesota
| | - Roberto Matía
- Arrhythmia Unit, Cardiology Department, Ramón y Cajal Hospital, Alcalá University, Madrid, Spain
| | - Javier Moreno
- Arrhythmia Unit, Cardiology Department, Ramón y Cajal Hospital, Alcalá University, Madrid, Spain
| | - Alessandro Locatelli
- Coronary Unit Department, Cardiology and Electrophysiology, ASST Bergamo Est, Ospedale Bolognini, Seriate, Italy
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Lopes C, Pereira T, Barra S. Cardiac resynchronization therapy in patients with atrial fibrillation: a meta-analysis. Rev Port Cardiol 2016; 33:717-25. [PMID: 25457476 DOI: 10.1016/j.repc.2014.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 02/25/2014] [Accepted: 05/17/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To combine the results of the best scientific evidence in order to compare the effects of cardiac resynchronization therapy (CRT) in heart failure patients with atrial fibrillation (AF) and in sinus rhythm (SR) and to determine the effect of atrioventricular nodal ablation in AF patients. METHODS The electronic databases PubMed, B-On and Cochrane CENTRAL were searched, and manual searches were performed, for randomized controlled trials and cohort studies up to November 2012. The endpoints analyzed were all-cause and cardiovascular mortality and response to CRT. RESULTS We included 19 studies involving 5324 patients: 1399 in AF and 3925 in SR. All-cause mortality was more likely in patients with AF compared to patients in SR (OR = 1.69; 95% CI: 1.20–2.37; p = 0.002). There were no statistically significant differences in cardiovascular mortality (OR = 1.36; 95% CI: 0.92–2.01; p = 0.12). AF was associated with an increased likelihood of lack of response to CRT (OR = 1.41; 95% CI: 1.15–1.73; p = 0.001). Among subjects with AF, ablation of the atrioventricular node was associated with a reduction in all-cause mortality (OR = 0.42; 95% CI: 0.22–0.80; p = 0.008), cardiovascular death (OR = 0.39; 95% CI: 0.20–0.75; p = 0.005) and the number of non-responders to CRT (OR = 0.30; 95% CI: 0.10–0.90; p = 0.03). CONCLUSIONS The presence of AF is associated with increased likelihood of all-cause death and non-response to CRT, compared to patients in SR. However, many patients with AF benefit from CRT. Atrioventricular nodal ablation appears to increase the benefits of CRT in patients with AF.
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Affiliation(s)
- Cláudia Lopes
- Escola Superior de Tecnologia das Saúde de Coimbra, Departamento de Cardiopneumologia, Coimbra, Portugal.
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Gianni C, Di Biase L, Mohanty S, Gökoğlan Y, Güneş MF, Al-Ahmad A, Burkhardt JD, Natale A. How to Improve Cardiac Resynchronization Therapy Benefit in Atrial Fibrillation Patients: Pulmonary Vein Isolation (and Beyond). Heart Fail Clin 2016; 13:199-208. [PMID: 27886924 DOI: 10.1016/j.hfc.2016.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although cardiac resynchronization therapy (CRT) is an important treatment of symptomatic heart failure patients in sinus rhythm with low left ventricular ejection fraction and ventricular dyssynchrony, its role is not well defined in patients with atrial fibrillation (AF). CRT is not as effective in patients with AF because of inadequate biventricular capture and loss of atrioventricular synchrony. Both can be addressed with catheter ablation of AF. It is still unclear if these therapies offer additive benefits in patients with ventricular dyssynchrony. This article discusses the role and techniques of catheter ablation of AF in patients with heart failure, and its application in CRT recipients.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Biomedical Engineering, University of Texas, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - Yalçın Gökoğlan
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - Mahmut Fatih Güneş
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, CA, USA; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA; Dell Medical School, University of Texas, Austin, TX, USA.
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Gianni C, Di Biase L, Mohanty S, Gökoğlan Y, Güneş MF, Al-Ahmad A, Burkhardt JD, Natale A. How to Improve Cardiac Resynchronization Therapy Benefit in Atrial Fibrillation Patients: Pulmonary Vein Isolation (and Beyond). Card Electrophysiol Clin 2015; 7:755-64. [PMID: 26596817 DOI: 10.1016/j.ccep.2015.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although cardiac resynchronization therapy (CRT) is an important treatment of symptomatic heart failure patients in sinus rhythm with low left ventricular ejection fraction and ventricular dyssynchrony, its role is not well defined in patients with atrial fibrillation (AF). CRT is not as effective in patients with AF because of inadequate biventricular capture and loss of atrioventricular synchrony. Both can be addressed with catheter ablation of AF. It is still unclear if these therapies offer additive benefits in patients with ventricular dyssynchrony. This article discusses the role and techniques of catheter ablation of AF in patients with heart failure, and its application in CRT recipients.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Biomedical Engineering, University of Texas, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - Yalçın Gökoğlan
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - Mahmut Fatih Güneş
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, CA, USA; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA; Dell Medical School, University of Texas, Austin, TX, USA.
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Abstract
Nonresponse to cardiac resynchronization therapy (CRT) is still a major issue in therapy expansion. The description of fast, simple, cost-effective methods to optimize CRT could help in adapting pacing intervals to individual patients. A better understanding of the importance of appropriate patient selection, left ventricular lead placement, and device programming, together with a multidisciplinary approach and an optimal follow-up of the patients, may reduce the percentage of nonresponders.
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Lopes C, Pereira T, Barra S. Cardiac resynchronization therapy in patients with atrial fibrillation: A meta-analysis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Yin J, Hu H, Wang Y, Xue M, Li X, Cheng W, Li X, Yan S. Effects of atrioventricular nodal ablation on permanent atrial fibrillation patients with cardiac resynchronization therapy: a systematic review and meta-analysis. Clin Cardiol 2014; 37:707-15. [PMID: 25156448 DOI: 10.1002/clc.22312] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/06/2014] [Accepted: 06/11/2014] [Indexed: 11/11/2022] Open
Abstract
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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Affiliation(s)
- Jie Yin
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Ji'nan, Shandong, China; Department of Cardiology School of Medicine, Shandong University, Ji'nan, Shandong, China
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18
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Khatib M, Tolosana JM, Trucco E, Borràs R, Castel A, Berruezo A, Doltra A, Sitges M, Arbelo E, Matas M, Brugada J, Mont L. EAARN score, a predictive score for mortality in patients receiving cardiac resynchronization therapy based on pre-implantation risk factors. Eur J Heart Fail 2014; 16:802-9. [PMID: 24863467 PMCID: PMC4312943 DOI: 10.1002/ejhf.102] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/07/2014] [Accepted: 03/21/2014] [Indexed: 01/21/2023] Open
Abstract
AIMS The beneficial effects of CRT in patients with advanced heart failure, wide QRS, and low LVEF have been clearly established. Nevertheless, mortality remains high in some patients. The aims of our study were to identify the predictors of mortality in patients treated with CRT and to design a risk score for mortality. METHODS AND RESULTS A cohort of 608 consecutive patients treated with CRT from 2000 to 2011 in our centre was prospectively analysed. Baseline clinical and echocardiography variables were analysed and mortality data were collected. During a mean follow-up of 36.2 ± 29.2 months, 174 patients died: 123/174 (71%) due to cardiovascular causes, 25/174 (14%) non-cardiac causes, and 26/174 (15%) unknown aetiology. In a multivariate analysis the predictors of mortality were NYHA class IV [hazard ratio (HR) 2.54, 95% confidence interval (CI) 1.7-3.7, P < 0.001], glomerular filtration rate (GFR) <60 mL/min/1.73 m2 (HR 1.61, 95% CI 1.14-2.30, P = 0.008), AF (HR 1.67, 95% CI 1.19-2.3, P = 0.01), age ≥70 years (HR 1.44, (95% CI 1.04-2.00, P = 0.02), and LVEF <22% (HR 1.83, 95% CI 1.33-2.52, P ≤ 0.001). The EAARN score (EF, Age, AF, Renal dysfunction, NYHA class IV) summarizes the predictors. Each additional predictor increased the mortality: one predictor, HR 3.28 (95% CI 1.37-7.8, P = 0.008); two, HR 5.23 (95% CI 2.24-12.10, P < 0.001); three, HR 9.63 (95% CI 4.1-22.60, P < 0.001); and four or more, HR 14.38 (95% CI 5.8-35.65, P < 0.001). CONCLUSION The predictors of mortality have a significant add-on predictive effect on mortality. The EAARN score could be useful to stratify the prognosis of CRT patients.
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Affiliation(s)
- Malek Khatib
- Thorax Institute, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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Gabrielli L, Marincheva G, Bijnens B, Doltra A, Tolosana JM, Borras R, Castel MA, Berruezo A, Brugada J, Mont L, Sitges M. Septal flash predicts cardiac resynchronization therapy response in patients with permanent atrial fibrillation. Europace 2014; 16:1342-9. [DOI: 10.1093/europace/euu023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gabrielli L, Sitges M, Mont L. Assessing reverse remodeling in heart failure patients treated with cardiac resynchronization therapy and its impact on prognosis. Expert Rev Cardiovasc Ther 2014; 10:1437-48. [DOI: 10.1586/erc.12.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Tolosana JM, Trucco E, Khatib M, Doltra A, Borras R, Castel MÁ, Berruezo A, Arbelo E, Sitges M, Matas M, Guasch E, Brugada J, Mont L. Complete atrioventricular block does not reduce long-term mortality in patients with permanent atrial fibrillation treated with cardiac resynchronization therapy. Eur J Heart Fail 2013; 15:1412-8. [PMID: 23845796 DOI: 10.1093/eurjhf/hft114] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS A maximum percentage of ventricular pacing is mandatory to obtain a good response to CRT. Atrioventricular junction (AVJ) ablation has been recommended to attain this objective in patients with AF. THE AIMS OF OUR STUDY WERE (i) to determine whether the presence of complete AVJ block (induced or spontaneous) improves survival in patients with permanent AF treated with CRT and (ii) to analyse the predictors of mortality in AF patients treated with CRT. METHODS AND RESULTS From a series of 608 patients treated with CRT in our centre from 2000 to 2011, a cohort of 155 patients with permanent AF was analysed. Patients in AF were divided into two groups, AF + AVJ block [76 (49%)] and AF non-AVJ block [79 (51%)]. Mean follow-up was 30 months (interquartile range 13-51 months). During the follow-up, 62 patients died. Overall and cardiovascular mortality were similar between both groups: hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.51-1.39, P = 0.51 and HR 0.94, 95% CI 0.52-1.68, P = 0.82. Multivariate analysis identified three independent predictors of mortality: basal NYHA functional class IV (HR 2.25, 95% CI 1.12-4.22, P = 0.03), glomerular filtration rate (HR 0.98, 95% CI 0.96-0.99, P = 0.03), and LVEF (HR 0.94, 95% CI 0.89-0.99, P = 0.02). CONCLUSIONS AVJ block did not improve survival for patients in AF treated with CRT. Basal NYHA functional class IV, poor renal function, and LVEF were the independent predictors of mortality.
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Affiliation(s)
- José M Tolosana
- Thorax Institute, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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23
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Chai AU, Nolan BP, Daccarett M. Atrial fibrillation in cardiac resynchronization therapy patients: should we ablate the atrioventricular node? Expert Rev Cardiovasc Ther 2013; 10:843-5. [PMID: 22908917 DOI: 10.1586/erc.12.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prevalence of persistent atrial fibrillation in patients undergoing cardiac resynchronization therapy remains high. Several factors, including suboptimal biventricular capture rates, compound the significant mortality and response rates in patients with atrial fibrillation and severe heart failure. Atrioventricular nodal ablation provides the best mean of rate control in this population. In this article, the authors evaluate a recently published trial addressing this issue in a prospective fashion and discuss the results and clinical applications.
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Affiliation(s)
- Andrew U Chai
- Heart Failure Section, St. Luke's Regional Medical Center, Boise, ID, USA
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Rienstra M. Atrial fibrillation and cardiac resynchronization therapy: how should rate be controlled? Eur J Heart Fail 2012; 14:569-70. [PMID: 22427435 DOI: 10.1093/eurjhf/hfs028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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