1
|
Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP, Lopez-Cabanillas N, Ellenbogen KA, Hua W, Ikeda T, Mackall JA, Mason PK, McLeod CJ, Mela T, Moore JP, Racenet LK. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. J Arrhythm 2023; 39:681-756. [PMID: 37799799 PMCID: PMC10549836 DOI: 10.1002/joa3.12872] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Eugene H Chung
- University of Michigan Medical School Ann Arbor Michigan USA
| | | | | | | | | | - Anne M Dubin
- Stanford University, Pediatric Cardiology Palo Alto California USA
| | - Douglas P Ensch
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Taya V Glotzer
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
| | - Michael R Gold
- Medical University of South Carolina Charleston South Carolina USA
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
| | | | | | - Weijian Huang
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Peter B Imrey
- Cleveland Clinic Cleveland Ohio USA
- Case Western Reserve University Cleveland Ohio USA
| | - Julia H Indik
- University of Arizona, Sarver Heart Center Tucson Arizona USA
| | - Saima Karim
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
| | - Peter P Karpawich
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
| | - Yaariv Khaykin
- Southlake Regional Health Center Newmarket Ontario Canada
| | | | - Jordana Kron
- Virginia Commonwealth University Richmond Virginia USA
| | | | - Mark S Link
- University of Texas Southwestern Medical Center Dallas Texas USA
| | - Joseph E Marine
- Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
| | - Seung-Jung Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
| | | | | | - Rajeev Kumar Pathak
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
| | | | | | | | | | | | - Morio Shoda
- Tokyo Women's Medical University Tokyo Japan
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - David J Slotwiner
- Weill Cornell Medicine Population Health Sciences New York New York USA
| | | | - Uma N Srivatsa
- University of California Davis Sacramento California USA
| | | | | | | | | | - Cynthia M Tracy
- George Washington University Washington District of Columbia USA
| | | | | | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
| | | | | | - Wojciech Zareba
- University of Rochester Medical Center Rochester New York USA
| | | | - Nestor Lopez-Cabanillas
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Kenneth A Ellenbogen
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Wei Hua
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Takanori Ikeda
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Judith A Mackall
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Pamela K Mason
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Christopher J McLeod
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Theofanie Mela
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Jeremy P Moore
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Laurel Kay Racenet
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| |
Collapse
|
2
|
Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. Heart Rhythm 2023; 20:e17-e91. [PMID: 37283271 PMCID: PMC11062890 DOI: 10.1016/j.hrthm.2023.03.1538] [Citation(s) in RCA: 105] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 06/08/2023]
Abstract
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Eugene H Chung
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | | | | | - Anne M Dubin
- Stanford University, Pediatric Cardiology, Palo Alto, California
| | | | - Taya V Glotzer
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Michael R Gold
- Medical University of South Carolina, Charleston, South Carolina
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | | | - Weijian Huang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peter B Imrey
- Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University, Cleveland, Ohio
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Saima Karim
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Peter P Karpawich
- The Children's Hospital of Michigan, Central Michigan University, Detroit, Michigan
| | - Yaariv Khaykin
- Southlake Regional Health Center, Newmarket, Ontario, Canada
| | | | - Jordana Kron
- Virginia Commonwealth University, Richmond, Virginia
| | | | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joseph E Marine
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg Genk, Belgium and Hasselt University, Hasselt, Belgium
| | - Seung-Jung Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Ratika Parkash
- QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | | | - Rajeev Kumar Pathak
- Australian National University, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | | | | | | | | | | | - Morio Shoda
- Tokyo Women's Medical University, Tokyo, Japan
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Slotwiner
- Weill Cornell Medicine Population Health Sciences, New York, New York
| | | | | | | | | | | | | | - Cynthia M Tracy
- George Washington University, Washington, District of Columbia
| | | | | | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | | | | |
Collapse
|
3
|
Gras D, Clémenty N, Ploux S, Guyomar Y, Legallois D, Segreti L, Blangy H, Laurent G, Bizeau O, Fauquembergue S, Lazarus A. CRT-D replacement strategy: results of the BioCONTINUE study. J Interv Card Electrophysiol 2023; 66:1201-1209. [PMID: 36459310 DOI: 10.1007/s10840-022-01440-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND In patients with cardiac resynchronization therapy defibrillators (CRT-Ds), the need for implantable cardioverter-defibrillator (ICD) back-up may be questionable at time of CRT-D replacement (REP) if ICD implant criteria are no longer met due to an improved left ventricular ejection fraction (LVEF) and if no major ventricular arrhythmic event (VAE) occurred during the CRT-D lifetime. The aim of our study was to assess the relevance of ICD back-up and predictors of VAE after REP in primary prevention CRT-D patients. METHODS The prospective, observational, international BioCONTINUE study investigated the rate of patients with at least 1 sustained VAE (sVAE) post-REP and searched for predictive factors of sVAE. RESULTS Two hundred seventy-six patients (70 ± 10 years, 77% men, mean LVEF 40.6 ± 12.6%) were followed for 28.4 ± 10.2 months. The rate of patients with sVAE was 8.3%, 10.3%, and 21.2% at 1, 2, and 4 years post-REP. Patients without persistent ICD indication at REP still had a sVAE rate of 5.7% (95% CI 2.3-11.5%) at 2 years. In multivariate analysis, predictive factors of subsequent sVAE were (i) persistent ICD indication (hazard ratio (HR) 3.6; 95% CI 1.6-8.3; p = 0.003); (ii) 64-72 years of age as compared to ≥ 79 years (HR 3.7; 95% CI 1.4-9.7; p = 0.008); and (iii) ischemic heart disease (HR 4.4; 95% CI 2.1-9.3; p < 0.0001). CONCLUSIONS The risk of sVAE (21.2% at 4 years post-REP) depends on age, ischemic heart disease, and ICD indication at the time of REP. A non-trivial risk of sVAE remains in patients without persistent ICD indication. CLINICAL TRIAL REGISTRATION NCT02323503.
Collapse
Affiliation(s)
- Daniel Gras
- Hôpital Privé du Confluent, 2-4 Rue Eric Tabarly, 44200, Nantes, France.
| | | | - Sylvain Ploux
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, 33600, Pessac, France
| | - Yves Guyomar
- Centre Hospitalier Saint Philibert, Lomme, France
| | | | | | | | | | - Olivier Bizeau
- Centre Hospitalier Régional Orléans La Source, Orléans, France
| | | | | |
Collapse
|
4
|
Chang DD, Pantlin PG, Benn FA, Ryan Gullatt T, Bernard ML, Elise Hiltbold A, Khatib S, Polin GM, Rogers PA, Velasco-Gonzalez C, Morin DP. Risk of ventricular arrhythmias following implantable cardioverter-defibrillator generator change in patients with recovered ejection fraction: Implications for shared decision-making. J Cardiovasc Electrophysiol 2023; 34:1405-1414. [PMID: 37146210 DOI: 10.1111/jce.15913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/29/2023] [Accepted: 04/13/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Guidelines indicate primary-prevention implantable cardioverter-defibrillators (ICDs) for most patients with left ventricular ejection fraction (LVEF) ≤ 35%. Some patients' LVEFs improve during the life of their first ICD. In patients with recovered LVEF who never received appropriate ICD therapy, the utility of generator replacement upon battery depletion remains unclear. Here, we evaluate ICD therapy based on LVEF at the time of generator change, to educate shared decision-making regarding whether to replace the depleted ICD. METHODS We followed patients with a primary-prevention ICD who underwent generator change. Patients who received appropriate ICD therapy for ventricular tachycardia or ventricular fibrillation (VT/VF) before generator change were excluded. The primary endpoint was appropriate ICD therapy, adjusted for the competing risk of death. RESULTS Among 951 generator changes, 423 met inclusion criteria. During 3.4 ± 2.2 years follow-up, 78 (18%) received appropriate therapy for VT/VF. Compared to patients with recovered LVEF > 35% (n = 161 [38%]), those with LVEF ≤ 35% (n = 262 [62%]) were more likely to require ICD therapy (p = .002; Fine-Gray adjusted 5-year event rates: 12.7% vs. 25.0%). Receiver operating characteristic analysis revealed the optimal LVEF cutoff for VT/VF prediction to be 45%, the use of which further improved risk stratification (p < .001), with Fine-Gray adjusted 5-year rates 6.2% versus 25.1%. CONCLUSION Following ICD generator change, patients with primary-prevention ICDs and recovered LVEF have significantly lower risk of subsequent ventricular arrhythmias compared to those with persistent LVEF depression. Risk stratification at LVEF 45% offers significant additional negative predictive value over a 35% cutoff, without a significant loss in sensitivity. These data may be useful during shared decision-making at the time of ICD generator battery depletion.
Collapse
MESH Headings
- Humans
- Defibrillators, Implantable
- Ventricular Function, Left
- Stroke Volume
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/therapy
- Ventricular Fibrillation/diagnosis
- Ventricular Fibrillation/therapy
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Risk Factors
Collapse
Affiliation(s)
- Donald D Chang
- University of Queensland-Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Peter G Pantlin
- Department of Cardiology, Division of Electrophysiology, Ochsner Medical Center, Louisiana, New Orleans, USA
| | - Francis A Benn
- Department of Cardiology, Division of Electrophysiology, Ochsner Medical Center, Louisiana, New Orleans, USA
| | - T Ryan Gullatt
- Department of Cardiology, Division of Electrophysiology, Ochsner Medical Center, Louisiana, New Orleans, USA
| | - Michael L Bernard
- Department of Cardiology, Division of Electrophysiology, Ochsner Medical Center, Louisiana, New Orleans, USA
| | - A Elise Hiltbold
- Department of Cardiology, Division of Electrophysiology, Ochsner Medical Center, Louisiana, New Orleans, USA
| | - Sammy Khatib
- Department of Cardiology, Division of Electrophysiology, Ochsner Medical Center, Louisiana, New Orleans, USA
| | - Glenn M Polin
- Department of Cardiology, Division of Electrophysiology, Ochsner Medical Center, Louisiana, New Orleans, USA
| | - Paul A Rogers
- Department of Cardiology, Division of Electrophysiology, Ochsner Medical Center, Louisiana, New Orleans, USA
| | - Cruz Velasco-Gonzalez
- Ochsner Health Center for Outcomes and Health Services Research, New Orleans, Louisiana, USA
| | - Daniel P Morin
- University of Queensland-Ochsner Clinical School, New Orleans, Louisiana, USA
- Department of Cardiology, Division of Electrophysiology, Ochsner Medical Center, Louisiana, New Orleans, USA
| |
Collapse
|
5
|
NESTI M, RICCIARDI G, PIERAGNOLI P, FUMAGALLI S, PADELETTI M, PERINI AP, CAVARRETTA E, SCIARRA L. Incidence of ventricular arrhythmias after biventricular defibrillator replacement: impact on safety of downgrading from CRT-D to CRT-P. Minerva Cardiol Angiol 2022; 70:447-454. [DOI: 10.23736/s2724-5683.20.05352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
6
|
Theuns DAMJ, Niazi K, Schaer BA, Sticherling C, Yap SC, Caliskan K. Reassessment of clinical variables in cardiac resynchronization defibrillator patients at the time of first replacement: Death after replacement of CRT (DARC) score. J Cardiovasc Electrophysiol 2021; 32:1687-1694. [PMID: 33825257 PMCID: PMC8251620 DOI: 10.1111/jce.15031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/10/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
Introduction Cardiac resynchronization defibrillator (CRT‐D) as primary prevention is known to reduce mortality. At the time of replacement, higher age and comorbidities may attenuate the benefit of implantable cardioverter‐defibrillator (ICD) therapy. The purpose of this study was to evaluate the progression of comorbidities after implantation and their association with mortality following CRT‐D generator replacement. In addition, a risk score was developed to identify patients at high risk for mortality after replacement. Methods and Results We identified patients implanted with a primary prevention CRT‐D (n = 648) who subsequently underwent elective generator replacement (n = 218) from two prospective ICD registries. The cohort consisted of 218 patients (median age: 70 years, male gender: 73%, mean left ventricular ejection fraction [LVEF]: 36 ± 11% at replacement). Median follow‐up after the replacement was 4.2 years during which 64 patients (29%) died and 11 patients (5%) received appropriate ICD shocks. An increase in comorbidities was observed in 77 patients (35%). The 5‐year mortality rate was 41% in patients with ≥2 comorbidities at the time of replacement. A risk score incorporating age, gender, LVEF, atrial fibrillation, anemia, chronic kidney disease, and history of appropriate ICD shocks at time of replacement accurately predicted 5‐year mortality (C‐statistic 0.829). Patients with a risk score of greater than 2.5 had excess mortality at 5‐year postreplacement compared with patients with a risk score less than 1.5 (57% vs. 6%; p < .001). Conclusion A simple risk score accurately predicts 5‐year mortality after replacement in CRT‐D patients, as patients with a risk score of greater than 2.5 are at high risk of dying despite ICD protection.
Collapse
Affiliation(s)
| | - Kaijbar Niazi
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Beat A Schaer
- Department of Cardiology, University of Basel Hospital, Basel, Switzerland
| | | | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Arcinas LA, Chew DS, Seifer CM, Baranchuk A, Supel I, Exner DV, Boles U, McIntyre WF. Predictors of appropriate shock after generator replacement in patients with an implantable cardioverter defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:911-918. [PMID: 33826179 DOI: 10.1111/pace.14236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/02/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) are indicated for the primary prevention of sudden cardiac death in patients with reduced left ventricular ejection fraction (LVEF). The ongoing risk/benefit profile of an ICD at generator replacement is unknown. This study aimed to identify predictors of appropriate ICD shocks and therapies after first ICD generator replacement, and its procedure-related complications. METHODS We conducted a multicenter, retrospective cohort study including patients with primary prevention ICDs who underwent generator replacement between April 2005 and July 2015 at three Canadian centers. The primary and secondary outcomes were appropriate ICD shock and any appropriate ICD therapy, respectively. Procedure-related complication rates were also reported. RESULTS Of the 219 patients in the cohort, 61 (28%) experienced an appropriate shock while 40 (18%) experienced appropriate antitachycardia pacing over a median follow up of 2.2 years. Independent predictors of appropriate ICD shocks included: LVEF at time of replacement (adjusted odds ratio [OR] 0.4 per 10% increase in LVEF, P < .001), a history of appropriate ICD shocks prior to replacement (OR 4.9, P < .001), and a history of inappropriate ICD shocks (OR 4.2, 95%, P < .002). Similar predictors were identified for the secondary outcome of any appropriate ICD therapy. Device-related complications were reported in 25 (11%) patients, with 1 (0.5%) resulting in death, 14 (6.3%) requiring site re-operation, and 6 (2.7%) requiring cardiac surgical management. CONCLUSION Not all primary prevention ICD patients undergoing generator replacement will require appropriate device therapies afterwards. Generator replacement is associated with several risks that should be weighed against its anticipated benefit. A comprehensive assessment of the risk-benefit profile of patients undergoing generator replacement is warranted.
Collapse
Affiliation(s)
- Liane A Arcinas
- Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Derek S Chew
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.,Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Colette M Seifer
- Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adrian Baranchuk
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Izabella Supel
- Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Derek V Exner
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Usama Boles
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - William F McIntyre
- Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
8
|
Downgrade of cardiac defibrillator devices to pacemakers in elderly heart failure patients: clinical considerations and the importance of shared decision-making. Neth Heart J 2021; 29:243-252. [PMID: 33710494 PMCID: PMC8062634 DOI: 10.1007/s12471-021-01555-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/11/2022] Open
Abstract
Implantable cardioverter defibrillators are implanted on a large scale in patients with heart failure (HF) for the prevention of sudden cardiac death. There are different scenarios in which defibrillator therapy is no longer desired or indicated, and this is occurring increasingly in elderly patients. Usually device therapy is continued until the device has reached battery depletion. At that time, the decision needs to be made to either replace it or to downgrade to a pacing-only device. This decision is dependent on many factors, including the vitality of the patient and his/her preferences, but may also be influenced by changes in recommendations in guidelines. In the last few years, there has been an increased awareness that discussions around these decisions are important and useful. Advanced care planning and shared decision-making have become important and are increasingly recognised as such. In this short review we describe six elderly patients with HF, in whose cases we discussed these issues, and we aim to provide some scientific and ethical rationale for clinical decision-making in this context. Current guidelines advocate the discussion of end-of-life options at the time of device implantation, and physicians should realise that their choices influence patients’ options in this critical phase of their illness.
Collapse
|
9
|
Primary Prevention Implantable Cardioverter-Defibrillator Therapy in Heart Failure with Recovered Ejection Fraction. J Card Fail 2021; 27:585-596. [PMID: 33636331 DOI: 10.1016/j.cardfail.2021.02.006] [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: 12/01/2020] [Revised: 01/26/2021] [Accepted: 02/07/2021] [Indexed: 11/21/2022]
Abstract
Given recent advances in both pharmacologic and nonpharmacologic strategies for improving outcomes related to chronic systolic heart failure, heart failure with recovered ejection fraction (HFrecEF) is now recognized as a distinct clinical entity with increasing prevalence. In many patients who once had an indication for active implantable cardioverter-defibrillator (ICD) therapy, questions remain regarding the usefulness of this primary prevention strategy to protect against syncope and cardiac arrest after they have achieved myocardial recovery. Early, small studies provide convincing evidence for continued guideline-directed medical therapy (GDMT) in segments of the HFrecEF population to promote persistent left ventricular myocardial recovery. Retrospective data suggest that the risk of sudden cardiac death is lower, but still present, in HFrecEF as compared with HF with reduced ejection fraction, with reports of up to 5 appropriate ICD therapies delivered per 100 patient-years. The usefulness of continued ICD therapy is weighed against the unfavorable effects of this strategy, which include a cumulative risk of infection, inappropriate discharge, and patient-level anxiety. Historically, many surrogate measures for risk stratification have been explored, but few have demonstrated efficacy and widespread availability. We found that the available data to inform decisions surrounding the continued use of active ICD therapies in this population are incomplete, and more advanced tools such as genetic testing, evaluation of high-risk structural cardiomyopathies (such as noncompaction), and cardiac magnetic resonance imaging have emerged as vital in risk stratification. Clinicians and patients should engage in shared decision-making to evaluate the appropriateness of active ICD therapy for any given individual. In this article, we explore the definition of HFrecEF, data underlying continuation of guideline-directed medical therapy in patients who have achieved left ventricular ejection fraction recovery, the benefits and risks of active ICD therapy, and surrogate measures that may have a role in risk stratification.
Collapse
|
10
|
Demarchi A, Cornara S, Sanzo A, Savastano S, Petracci B, Vicentini A, Pontillo L, Baldi E, Frigerio L, Astuti M, Leonardi S, Ghio S, Oltrona Visconti L, Rordorf R. Incidence of Ventricular Arrhythmias and 1-Year Predictors of Mortality in Patients Treated With Implantable Cardioverter-Defibrillator Undergoing Generator Replacement. J Am Heart Assoc 2021; 10:e018090. [PMID: 33522246 PMCID: PMC7955330 DOI: 10.1161/jaha.120.018090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background When implantable cardioverter defibrillator (ICD) battery is depleted most patients undergo generator replacement (GR) even in the absence of persistent ICD indication. The aim of this study was to assess the incidence of ventricular arrhythmias and the overall prognosis of patients with and without persistent ICD indication undergoing GR. Predictors of 1‐year mortality were also analyzed. Methods and Results Patients with structural heart disease implanted with primary prevention ICD undergoing GR were included. Patients were stratified based on the presence/absence of persistent ICD indication (left ventricular ejection fraction ≤35% at the time of GR and/or history of appropriate ICD therapies during the first generator's life). The study included 371 patients (82% male, 40% with ischemic heart disease). One third of patients (n=121) no longer met ICD indication at the time of GR. During a median follow‐up of 34 months after GR patients without persistent ICD indication showed a significantly lower incidence of appropriate ICD shocks (1.9% versus 16.2%, P<0.001) and ICD therapies. 1‐year mortality was also significantly lower in patients without persistent ICD indication (1% versus 8.3%, P=0.009). At multivariable analysis permanent atrial fibrillation, chronic advanced renal impairment, age >80, and persistent ICD indication were found to be significant predictors of 1‐year mortality. Conclusions Patients without persistent ICD indication at the time of GR show a low incidence of appropriate ICD therapies after GR. Persistent ICD indication, atrial fibrillation, advanced chronic renal disease, and age >80 are significant predictors of 1‐year mortality. Our findings enlighten the need of performing a comprehensive clinical reevaluation of ICD patients at the time of GR.
Collapse
Affiliation(s)
- Andrea Demarchi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Department of Molecular Medicine Unit of Cardiology Fondazione IRCCS Policlinico San MatteoUniversity of Pavia Italy.,Cardiocentro Ticino Lugano Switzerland
| | - Stefano Cornara
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Department of Molecular Medicine Unit of Cardiology Fondazione IRCCS Policlinico San MatteoUniversity of Pavia Italy.,Department of Cardiology San Paolo Hospital Savona Italy
| | - Antonio Sanzo
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Simone Savastano
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Barbara Petracci
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Alessandro Vicentini
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Lorenzo Pontillo
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Department of Molecular Medicine Unit of Cardiology Fondazione IRCCS Policlinico San MatteoUniversity of Pavia Italy
| | - Enrico Baldi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Department of Molecular Medicine Unit of Cardiology Fondazione IRCCS Policlinico San MatteoUniversity of Pavia Italy
| | - Laura Frigerio
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Department of Molecular Medicine Unit of Cardiology Fondazione IRCCS Policlinico San MatteoUniversity of Pavia Italy
| | - Matteo Astuti
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Department of Molecular Medicine Unit of Cardiology Fondazione IRCCS Policlinico San MatteoUniversity of Pavia Italy.,Department of Cardiology San Paolo Hospital Savona Italy
| | - Sergio Leonardi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Department of Molecular Medicine Unit of Cardiology Fondazione IRCCS Policlinico San MatteoUniversity of Pavia Italy.,Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Stefano Ghio
- Division of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | - Roberto Rordorf
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| |
Collapse
|
11
|
Yuyun MF, Erqou SA, Peralta AO, Hoffmeister PS, Yarmohammadi H, Echouffo Tcheugui JB, Martin DT, Joseph J, Singh JP. Risk of ventricular arrhythmia in cardiac resynchronization therapy responders and super-responders: a systematic review and meta-analysis. Europace 2021; 23:1262-1274. [PMID: 33496319 DOI: 10.1093/europace/euaa414] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/18/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS Response to cardiac resynchronization therapy (CRT) is associated with improved survival, and reduction in heart failure hospitalization, and ventricular arrhythmia (VA) risk. However, the impact of CRT super-response [CRT-SR, increase in left ventricular ejection fraction (LVEF) to ≥ 50%] on VA remains unclear. METHODS AND RESULTS We undertook a meta-analysis aimed at determining the impact of CRT response and CRT-SR on risk of VA and all-cause mortality. Systematic search of PubMed, EMBASE, and Cochrane databases, identifying all relevant English articles published until 31 December 2019. A total of 34 studies (7605 patients for VA and 5874 patients for all-cause mortality) were retained for the meta-analysis. The pooled cumulative incidence of appropriate implantable cardioverter-defibrillator therapy for VA was significantly lower at 13.0% (4.5% per annum) in CRT-responders, vs. 29.0% (annualized rate of 10.0%) in CRT non-responders, relative risk (RR) 0.47 [95% confidence interval (CI) 0.39-0.56, P < 0.0001]; all-cause mortality 3.5% vs. 9.1% per annum, RR of 0.38 (95% CI 0.30-0.49, P < 0.0001). The pooled incidence of VA was significantly lower in CRT-SR compared with CRT non-super-responders (non-responders + responders) at 0.9% vs. 3.8% per annum, respectively, RR 0.22 (95% CI 0.12-0.40, P < 0.0001); as well as all-cause mortality at 2.0% vs. 4.3%, respectively, RR 0.47 (95% CI 0.33-0.66, P < 0.0001). CONCLUSIONS Cardiac resynchronization therapy super-responders have low absolute risk of VA and all-cause mortality. However, there remains a non-trivial residual absolute risk of these adverse outcomes in CRT responders. These findings suggest that among CRT responders, there may be a continued clinical benefit of defibrillators.
Collapse
Affiliation(s)
- Matthew F Yuyun
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Sebhat A Erqou
- Department of Medicine, Brown University, Providence, RI, USA.,Division of Cardiology, Providence VA Medical Center, Providence, RI, USA
| | - Adelqui O Peralta
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Peter S Hoffmeister
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | | | - David T Martin
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacob Joseph
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jagmeet P Singh
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
12
|
Hammersley DJ, Halliday BP. Sudden Cardiac Death Prediction in Non-ischemic Dilated Cardiomyopathy: a Multiparametric and Dynamic Approach. Curr Cardiol Rep 2020; 22:85. [PMID: 32648053 PMCID: PMC7347683 DOI: 10.1007/s11886-020-01343-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Sudden cardiac death is recognised as a devastating consequence of non-ischaemic dilated cardiomyopathy. Although implantable cardiac defibrillators offer protection against some forms of sudden death, the identification of patients in this population most likely to benefit from this therapy remains challenging and controversial. In this review, we evaluate current guidelines and explore established and novel predictors of sudden cardiac death in patients with non-ischaemic dilated cardiomyopathy. RECENT FINDINGS Current international guidelines for primary prevention implantable defibrillator therapy do not result in improved longevity for many patients with non-ischemic cardiomyopathy and severe left ventricular dysfunction. More precise methods for identifying higher-risk patients that derive true prognostic benefit from this therapy are required. Dynamic and multi-parametric characterization of myocardial, electrical, serological and genetic substrate offers novel strategies for predicting major arrhythmic risk. Balancing the risk of non-sudden death offers an opportunity to personalize therapy and avoid unnecessary device implantation for those less likely to derive benefit.
Collapse
Affiliation(s)
- Daniel J. Hammersley
- Cardiovascular Research Centre, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Brian P. Halliday
- Cardiovascular Research Centre, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- National Heart & Lung Institute, Imperial College London, London, UK
| |
Collapse
|
13
|
Xie E, Mayer K, Capps MF, Barth AS, Love CJ, Coronel R, Ashikaga H. Mechanism of spontaneous initiation of ventricular fibrillation in patients with implantable defibrillators. J Cardiovasc Electrophysiol 2020; 31:2415-2424. [PMID: 32618399 DOI: 10.1111/jce.14648] [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: 03/26/2020] [Revised: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To improve the mechanistic understanding of spontaneous initiation of ventricular fibrillation (VF), we characterized the patterns of premature ventricular complex (PVC) preceding spontaneous VF in primary and secondary implantable cardioverter-defibrillator (ICD) recipients. METHODS AND RESULTS A single-center, cross-sectional analysis of 1209 patients with primary and secondary prevention ICD identified 190 patients who received ICD therapy (firing or antitachycardia pacing) for VF or monomorphic ventricular tachycardia (MMVT). Initiation was quantified by the coupling interval (CI), the cycle length immediately preceding the CI (CL(-1)), the CI corrected by CL(-1) using Fridericia's formula (CIc), and the prematurity index (PI). In both VF (n = 44; 23%) and MMVT (n = 134; 71%), the most common pattern of initiation was late-coupled PVC, followed by the short-long-short pattern. The parameters such as pre-initiation median CL, CL(-1), CI, and PI were not significantly different between VF and MMVT for any patterns. At least some events (45% of VF and 63% of MMVT) had extremely long CIs beyond the QTc cut-off estimated from the CL(-1), suggestive of initiation by a train of multiple PVCs or nonsustained VT instead of a single PVC. CONCLUSION Some spontaneous VF events in ICD recipients appear to be initiated by a train of multiple PVC or nonsustained VT rather than a single PVC. This finding indicates that patterns of a single PVC are not an important determinant of VF initiation and thus account for conflicting results in previous studies.
Collapse
Affiliation(s)
- Eric Xie
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Katarina Mayer
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Melissa F Capps
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andreas S Barth
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles J Love
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ruben Coronel
- Department of Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands.,IHU Liryc (L'institut de rythmologie et modélisation cardiaque), Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Hiroshi Ashikaga
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, Maryland.,IHU Liryc (L'institut de rythmologie et modélisation cardiaque), Fondation Bordeaux Université, Pessac-Bordeaux, France
| |
Collapse
|
14
|
Sherazi S, Shah F, Kutyifa V, McNitt S, Aktas MK, Polonsky B, Zareba W, Goldenberg I. Risk of Ventricular Tachyarrhythmic Events in Patients Who Improved Beyond Guidelines for a Defibrillator in MADIT-CRT. JACC Clin Electrophysiol 2019; 5:1172-1181. [DOI: 10.1016/j.jacep.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/29/2019] [Accepted: 08/09/2019] [Indexed: 10/25/2022]
|
15
|
Adabag S, Patton KK, Buxton AE, Rector TS, Ensrud KE, Vakil K, Levy WC, Poole JE. Association of Implantable Cardioverter Defibrillators With Survival in Patients With and Without Improved Ejection Fraction: Secondary Analysis of the Sudden Cardiac Death in Heart Failure Trial. JAMA Cardiol 2019; 2:767-774. [PMID: 28724134 DOI: 10.1001/jamacardio.2017.1413] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance Improvement in left ventricular ejection fraction (EF) to >35% occurs in many patients with reduced EF at baseline. To our knowledge, whether implantable cardioverter defibrillator (ICD) therapy improves survival for these patients is unknown. Objective To examine the efficacy of ICD therapy in reducing risk of all-cause mortality and sudden cardiac death among patients with an EF ≤35% at baseline, with or without an improvement in EF to >35% during follow-up. Design, Setting, and Participants This retrospective analysis examined data collected in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), which randomly assigned 2521 patients to placebo, amiodarone, or ICD between 1997 and 2001. A subset of 1902 participants (75.4%) of the SCD-HeFT had a repeated assessment of EF a mean (SD) of 13.5 (6) months after randomization. We stratified these patients by EF ≤35% and >35% based on the first repeated EF measurement after randomization and compared all-cause mortality in 649 patients randomized to placebo vs 624 patients randomized to ICD. Follow-up started with the repeated EF assessment. Analysis was performed between January 2016 and July 2016. Exposures Implantable cardioverter-defibrillator therapy. Main Outcomes and Measures All-cause mortality and sudden cardiac death. Results Of the included 1273 patients, the mean (SD) age was 59 (12) years, and 977 (76.7%) were male and 1009 (79.3%) were white. Repeated EF was >35% in 186 participants (29.8%) randomized to ICD and 185 participants (28.5%) randomized to placebo. During a median follow-up of 30 months, the all-cause mortality rate was lower in the ICD vs placebo group, both in patients whose EF remained ≤35% (7.7 vs 10.7 per 100 person-year follow-up) and in those whose EF improved to >35% (2.6 vs 4.5 per 100 person-year follow-up). Compared with placebo, the adjusted hazard ratio for the effect of ICD on mortality was 0.64 (95% CI, 0.48-0.85) in patients with a repeated EF of ≤35% and 0.62 (95% CI, 0.29-1.30) in those with a repeated EF >35%. There was no interaction between treatment assignment and repeated EF for predicting mortality. Conclusions and Relevance Among participants in the SCD-HeFT who had a repeated EF assessment during the course of follow-up, those who had an improvement in EF to >35% accrued a similar relative reduction in mortality with ICD therapy as those whose EF remained ≤35%. Prospective randomized clinical trials are needed to test ICD efficacy in patients with an EF >35%. Trial Registration clinicaltrials.gov Identifier: NCT01114269.
Collapse
Affiliation(s)
- Selcuk Adabag
- Division of Cardiology, Veterans Affairs Health Care System, Minneapolis, Minnesota2Division of Cardiovascular Diseases, University of Minnesota, Minneapolis
| | - Kristen K Patton
- Division of Cardiology, Department of Medicine, University of Washington, Seattle
| | - Alfred E Buxton
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Thomas S Rector
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Kristine E Ensrud
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota6Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Kairav Vakil
- Division of Cardiology, Veterans Affairs Health Care System, Minneapolis, Minnesota2Division of Cardiovascular Diseases, University of Minnesota, Minneapolis
| | - Wayne C Levy
- Division of Cardiology, Department of Medicine, University of Washington, Seattle
| | - Jeanne E Poole
- Division of Cardiology, Department of Medicine, University of Washington, Seattle
| |
Collapse
|
16
|
Krieger K, Lenz C. [Continuation of ICD treatment at the time of device exchange without adequate treatment?]. Herzschrittmacherther Elektrophysiol 2019; 30:191-196. [PMID: 31001686 DOI: 10.1007/s00399-019-0621-3] [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] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Due to improved treatment of heart failure, patients are older and have more comorbidities at the time of an elective device exchange. This leads to higher rates of complications and represents an opportunity for re-evaluation of the implantable cardioverter defibrillator (ICD) treatment. OBJECTIVE This article reviews the current literature regarding the indications for continued ICD therapy and device exchange in patients who have never received adequate treatment through the ICD. MATERIAL AND METHODS Patients with primarily prophylactic indications, who have not received adequate treatment and have shown significant improvement in the left ventricular ejection fraction (LVEF) >35%, have a significantly lower risk of ventricular arrythmia (VA) after device exchange. Although further ventricular events can occur in these patients, the continuation of ICD treatment should be individually discussed in cases of high age and increased comorbidities. In female patients with a non-ischemic cardiac myopathy and an almost normalized LVEF, mostly during cardiac resynchronization therapy (CRT), a discontinuation of ICD treatment or downgrading to CRT with pacemaker (CRT-P) treatment should be discussed. CONCLUSION At the time of an elective device exchange for primarily prophylactic indications, the possibility to discontinue ICD treatment can be discussed with patients who have not experienced adequate treatment. Additional factors, such as LVEF, age, sex and comorbidities of the patient should be taken into consideration in order to make an individualized decision. As prospective randomized studies are lacking, it is not possible to give generally valid recommendations.
Collapse
Affiliation(s)
- Konstantin Krieger
- Klinik für Innere Medizin und Kardiologie, Unfallkrankenhaus Berlin, Warenerstraße 7, 12683, Berlin, Deutschland.
| | - Corinna Lenz
- Klinik für Innere Medizin und Kardiologie, Unfallkrankenhaus Berlin, Warenerstraße 7, 12683, Berlin, Deutschland.
| |
Collapse
|
17
|
Incidence of appropriate anti-tachycardia therapies after elective generator replacement in patient with heart failure initially implanted with a defibrillator for primary prevention: Results of a meta-analysis. Int J Cardiol 2019; 283:122-127. [DOI: 10.1016/j.ijcard.2018.12.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/16/2018] [Accepted: 12/24/2018] [Indexed: 11/20/2022]
|
18
|
Ogano M, Iwasaki YK, Tsuboi I, Kawanaka H, Tajiri M, Takagi H, Tanabe J, Shimizu W. Mid-term feasibility and safety of downgrade procedure from defibrillator to pacemaker with cardiac resynchronization therapy. IJC HEART & VASCULATURE 2019; 22:78-81. [PMID: 30619931 PMCID: PMC6312857 DOI: 10.1016/j.ijcha.2018.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/20/2018] [Indexed: 11/27/2022]
Abstract
Backgrounds Some patients who undergo implantation of cardiac resynchronization therapy with defibrillator (CRT-D) survive long enough, thus requiring CRT-D battery replacement. Defibrillator therapy might become unnecessary in patients who have had significant clinical improvement and recovery of left ventricular ejection fraction (LVEF) after CRT-D implantation. Methods Forty-nine patients who needed replacement of a CRT-D battery were considered for exchange of CRT-D for cardiac resynchronization therapy with pacemaker (CRT-P) if they met the following criteria: LVEF >45%; the indication for an implantable cardioverter defibrillator was primary prevention at initial implantation and no appropriate implantable cardioverter defibrillator therapy was documented after initial implantation of the CRT-D. Results Seven patients (14.2%) were undergone a downgrade from CRT-D to CRT-P without any complications. No ventricular tachyarrhythmic events were observed during a mean follow-up of 39.7 ± 21.1 months and there was no significant change in LVEF between before and 1 year after device replacement (53.5% ± 6.2% vs. 56.4% ± 7.3%, P = 0.197). Conclusions This study confirmed mid-term feasibility and safety of downgrade from CRT-D to CRT-P alternative to conventional replacement with CRT-D. Downgrade from CRT-D to CRT-P is feasible for patients with improved LVEF of >45%. Patients without VT/VF after initial CRT-D implantation are suitable for downgrade. Patients had no ventricular arrhythmias or HF hospitalization after the downgrade.
Collapse
Affiliation(s)
- Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto Shizuoka 4110906, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 1138603, Japan
| | - Ippei Tsuboi
- Department of Cardiovascular Medicine, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto Shizuoka 4110906, Japan
| | - Hidekazu Kawanaka
- Department of Cardiovascular Medicine, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto Shizuoka 4110906, Japan
| | - Masaharu Tajiri
- Department of Cardiovascular Medicine, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto Shizuoka 4110906, Japan
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto Shizuoka 4110906, Japan
| | - Jun Tanabe
- Department of Cardiovascular Medicine, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto Shizuoka 4110906, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 1138603, Japan
| |
Collapse
|
19
|
Al-Khatib SM, Friedman DJ, Sanders GD. When Is It Safe Not to Reimplant an Implantable Cardioverter Defibrillator at the Time of Battery Depletion? Card Electrophysiol Clin 2019; 10:137-144. [PMID: 29428135 DOI: 10.1016/j.ccep.2017.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The implantable cardioverter defibrillator (ICD) is a life-saving therapy in various patient populations. Although data on the outcomes of initial ICD implants are abundant, data on ICD replacements, especially in patients with improved left ventricular (LV) function, are scarce. Therefore, it is not known when it is safe to not replace an ICD that has reached the end of battery life. This article reviews data on patients with primary prevention ICDs who have improvement in left ventricular ejection fraction during follow-up and provides some guidance, based on the available evidence, related to circumstances when replacement of an ICD may be forgone.
Collapse
Affiliation(s)
- Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA.
| | - Daniel J Friedman
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA
| | - Gillian D Sanders
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA
| |
Collapse
|
20
|
Giedrimas A, Sisson B, Casavant D. A novel method to enable biventricular defibrillator to biventricular pacemaker downgrade involving DF4 defibrillator lead. HeartRhythm Case Rep 2018; 4:598-600. [PMID: 30581741 PMCID: PMC6301893 DOI: 10.1016/j.hrcr.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
21
|
Liang Y, Wang Q, Zhang M, Wang J, Chen H, Yu Z, Gong X, Su Y, Ge J. Cessation of pacing in super‐responders of cardiac resynchronization therapy: A randomized controlled trial. J Cardiovasc Electrophysiol 2018; 29:1548-1555. [PMID: 30106214 DOI: 10.1111/jce.13711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Yixiu Liang
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Qingqing Wang
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Mingliang Zhang
- Department of CardiologyCentral Hospital of Tai’an Shandong China
| | - Jingfeng Wang
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Haiyan Chen
- Department of EchocardiographyShanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Ziqing Yu
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Xue Gong
- Department of CardiologyDeltahealth HospitalShanghai China
| | - Yangang Su
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Junbo Ge
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| |
Collapse
|
22
|
Narducci ML, Biffi M, Ammendola E, Vado A, Campana A, Potenza DR, Iori M, Zanon F, Zacà V, Zoni Berisso M, Bertini M, Lissoni F, Bandini A, Malacrida M, Crea F. Appropriate implantable cardioverter-defibrillator interventions in cardiac resynchronization therapy–defibrillator (CRT-D) patients undergoing device replacement: time to downgrade from CRT-D to CRT-pacemaker? Insights from real-world clinical practice in the DECODE CRT-D analysis. Europace 2018; 20:1475-1483. [DOI: 10.1093/europace/eux323] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Maria Lucia Narducci
- Department of Cardiovascular Sciences, Catholic University of Sacred Heart Rome, Via Largo Francesco Vito, 1, Rome, Italy
| | - Mauro Biffi
- Azienda Ospedaliero-Universitaria Policlinico Sant’Orsola Malpighi, Bologna, Italy
| | | | | | - Andrea Campana
- A.O. Universitaria S. Giovanni Di Dio E Ruggi D’Aragona, Salerno, Italy
| | | | - Matteo Iori
- A.O. IRCCS Arcispedale S. Maria Nuova Di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valerio Zacà
- Azienda Ospedaliero Universitaria Policlinico S. Maria Delle Scotte, Siena, Italy
| | | | - Matteo Bertini
- Azienda Ospedaliero Universitaria Di Ferrara Arcispedale S. Anna, Ferrara, Italy
| | | | | | | | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of Sacred Heart Rome, Via Largo Francesco Vito, 1, Rome, Italy
| |
Collapse
|
23
|
Kronborg MB, Johansen JB, Haarbo J, Riahi S, Philbert BT, Jørgensen OD, Nielsen JC. Association between implantable cardioverter-defibrillator therapy and different lead positions in patients with cardiac resynchronization therapy. Europace 2018; 20:e133-e139. [PMID: 29036292 DOI: 10.1093/europace/eux296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/28/2017] [Indexed: 11/14/2022] Open
Abstract
Aims To evaluate the impact of different right and left ventricular lead positions (RV-LP and LV-LP) on the risk of therapy for ventricular tachycardia/ventricular fibrillation in patients with a cardiac resynchronization therapy device (CRT-D). Methods and results We performed a large nationwide cohort study on patients in Denmark receiving a CRT-D device from 2008 to 2012 from the Danish Pacemaker and implantable cardioverter defibrillator (ICD) registry. Lead positions were registered during the implantation and categorized as anterior/lateral/posterior and basal/mid-ventricular/apical for the LV-LP, and as apical/non-apical for the RV-LP. Appropriate and inappropriate therapies were registered during follow-up via remote monitoring or at device interrogations. Time to event was summarized with Kaplan-Meier plots, and competed risk regression analysis was used to calculate adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Following variables were included in the analysis: gender, age, heart failure aetiology, New York heart association class, left ventricular ejection fraction, QRS duration, indication (secondary or primary prophylactic), RV-LP, LV-LP, and antiarrhythmic therapy. We included 1643 patients [mean age 68 (±10) years, 1343 (83%) men]. After a mean of 2.0 years, 322 (20%) patients received appropriate and 66 (4%) patients received inappropriate therapy. The aHR for appropriate therapy with a non-apical RV-LP was 0.70 95% CI (0.55-0.87, P = 0.002) as compared with an apical. We observed no significant association between appropriate therapy and LV-LP in left anterior oblique or right anterior oblique views or inappropriate therapy between any lead positions. Conclusion An apical RV-LP is associated with an increased risk of appropriate therapy for ventricular tachyarrhythmia in patients with a CRT-D device.
Collapse
Affiliation(s)
- Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, Aarhus N, Denmark
| | | | - Jens Haarbo
- Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Berit Thornvig Philbert
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Dan Jørgensen
- Department of Heart, Lung and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, Aarhus N, Denmark
| |
Collapse
|
24
|
Deif B, Ballantyne B, Almehmadi F, Mikhail M, McIntyre WF, Manlucu J, Yee R, Sapp JL, Roberts JD, Healey JS, Leong-Sit P, Tang AS. Cardiac resynchronization is pro-arrhythmic in the absence of reverse ventricular remodelling: a systematic review and meta-analysis. Cardiovasc Res 2018; 114:1435-1444. [PMID: 30010807 DOI: 10.1093/cvr/cvy182] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/27/2018] [Indexed: 11/14/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) has been shown to reduce mortality and heart failure (HF) hospitalization but its effects on the rate of ventricular arrhythmias (VAs) appears to be neutral. We hypothesize that CRT with LV epicardial stimulation is inherently pro-arrhythmic and increases VA rates in the absence of reverse ventricular remodelling while conferring an anti-arrhythmic effect in mechanical responders. Methods and results In this systematic review and meta-analysis, we considered retrospective cohort, prospective cohort, and randomized controlled trials comparing VA rates between cardiac resynchronization therapy-defibrillator (CRT-D) non-responders, CRT-D responders and those with implantable cardioverter-defibrillator (ICD) only. Studies were eligible if they defined CRT-D responders using a discrete left ventricular volumetric value as assessed by any imaging modality. Studies were identified through searching electronic databases from their inception to July 2017. We identified 2579 citations, of which 23 full-text articles were eligible for final analysis. Our results demonstrated that CRT-D responders were less likely to experience VA than CRT-D non-responders, relative risk (RR) 0.49 [95% confidence interval (CI) 0.41-0.58, P < 0.01] and also less than patients with ICD only: RR 0.59 (95% CI 0.50-0.69, P < 0.01). However, CRT-D mechanical non-responders had a greater likelihood of VA compared with ICD only, RR 0.76 (95% CI 0.63-0.92, P = 0.004). Conclusion CRT-D non-responders experienced more VA than CRT-D responders and also more than those with ICD only, suggesting that CRT with LV epicardial stimulation may be inherently pro-arrhythmic in the absence of reverse remodelling.
Collapse
Affiliation(s)
- Bishoy Deif
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Brennan Ballantyne
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Fahad Almehmadi
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Michael Mikhail
- School of Biomedical Sciences, Department of Graduate Studies, Rowan University, Stratford, New Jersey, USA
| | - William F McIntyre
- Population Health Research Institute & Division of Cardiology, Department of Medicine McMaster University, Hamilton, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Raymond Yee
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - John L Sapp
- Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, Canada
| | - Jason D Roberts
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute & Division of Cardiology, Department of Medicine McMaster University, Hamilton, Canada
| | - Peter Leong-Sit
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Anthony S Tang
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| |
Collapse
|
25
|
Galve E, Oristrell G, Acosta G, Ribera‐Solé A, Moya‐Mitjans À, Ferreira‐González I, Pérez‐Rodon J, García‐Dorado D. Cardiac resynchronization therapy is associated with a reduction in ICD therapies as it improves ventricular function. Clin Cardiol 2018; 41:803-808. [PMID: 29604094 PMCID: PMC6490060 DOI: 10.1002/clc.22958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Repeated implantable cardioverter-defibrillator (ICD) therapies cause myocardial damage and, thus, an increased risk of arrhythmias and mortality. HYPOTHESIS Cardiac resynchronization therapy-defibrillator (CRT-D) reduces the number of appropriate therapies in patients with left ventricular dysfunction (left ventricular ejection fraction [LVEF] <50%). METHODS The retrospective study involved 175 consecutive patients (mean age, 64.6 ±10.4 years; 86.9% males) with reduced LVEF of 27.9% ±7.6% treated with an ICD (56.6%) or CRT-D (43.4%), according to standard indications, between January 2009 and July 2014. Devices were placed for either primary (54.3%) or secondary prevention (45.7%). Mean follow-up was 2.5 ±1.5 years. Predictors of first appropriate therapy were assessed using Cox regression analysis. RESULTS Forty-four (25.1%) patients received ≥1 appropriate therapy. Although patients treated with CRT-D had lower LVEF and poorer New York Heart Association class, CRT-D patients with LVEF improvement >35% at the end of follow-up had a significantly lower risk of receiving a first appropriate therapy relative to those with an ICD (adjusted hazard ratio: 0.24, 95% confidence interval: 0.07-0.83, P = 0.025), independently of ischemic cardiomyopathy, baseline LVEF, and secondary prevention. There were no differences in mortality between the ICD and the CRT-D groups. CONCLUSIONS Although patients receiving CRT-D had a worse clinical profile, they received fewer device therapies in comparison with those receiving an ICD. This reduction is associated with a significant improvement in LVEF.
Collapse
Affiliation(s)
- Enrique Galve
- Department of CardiologyVall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - Gerard Oristrell
- Department of CardiologyVall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - Gabriel Acosta
- Department of CardiologyVall d'Hebron University HospitalBarcelonaSpain
| | - Aida Ribera‐Solé
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
| | | | - Ignacio Ferreira‐González
- Department of CardiologyVall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
| | - Jordi Pérez‐Rodon
- Department of CardiologyVall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - David García‐Dorado
- Department of CardiologyVall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)BarcelonaSpain
| |
Collapse
|
26
|
Biton Y, Ng CY, Xia X, Baman JR, Couderc JP, Moss AJ, Kutyifa V, McNitt S, Polonsky B, Zareba W. Baseline adverse electrical remodeling and the risk for ventricular arrhythmia in Cardiac Resynchronization Therapy Recipients (MADIT CRT). J Cardiovasc Electrophysiol 2018; 29:1017-1023. [PMID: 29846992 DOI: 10.1111/jce.13640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Adverse electrical remodeling (AER), represented here as the sum absolute QRST integral (SAI QRST), has previously been shown to be directly associated with the risk for ventricular arrhythmia (VA). Cardiac resynchronization therapy (CRT) is known to reduce the risk for VA through various mechanisms, including reverse remodeling, and we aimed to evaluate the association between baseline AER and the risk for VA in CRT recipients. METHODS AND RESULTS The study population comprised 961 CRT-D implanted patients from the MADIT CRT study. The relationship between SAI QRST, VA risk, and VA risk/death was evaluated as a continuous and as a categorical variable-tertiles (T1 ≤ 0.527, T2 0.528-0.766, T3 > 0.766). In a multivariable model, AER was inversely associated with the risk of VA. Each unit increase in SAI QRST was associated with 64% (P = 0.007) and 54% (P = 0.003) decrease in the risk of VA and VA/death, respectively. Patients with high SAI QRST (T3) and medium SAI QRST (T2) had 52% (P < 0.001) and 32% (P = 0.027) reduced risk for VA and 44% (P = 0.002) and 26% (P = 0.055) reduced risk for VA/death as compared with patients with low SAI QRST (T1), respectively. CONCLUSION In CRT implanted patients with mild heart failure, baseline AER was inversely associated with the risk for VA and VA/death; this is a finding that contradicts the relationship previously reported in non-CRT implanted patients. We theorize that CRT may abate the process of AER; however, characterization of this mechanism requires further study.
Collapse
Affiliation(s)
- Yitschak Biton
- Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Chee Yuan Ng
- Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Xiaojuan Xia
- Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Jayson R Baman
- Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jean-Philippe Couderc
- Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Arthur J Moss
- Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Valentina Kutyifa
- Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Scott McNitt
- Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Bronislava Polonsky
- Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Wojciech Zareba
- Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
27
|
Nakou ES, Simantirakis EN, Kallergis EM, Nakos KS, Vardas PE. Cardiac resynchronization therapy (CRT) device replacement considerations: upgrade or downgrade? A complex decision in the current clinical setting. Europace 2018; 19:705-711. [PMID: 28011795 DOI: 10.1093/europace/euw317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/19/2016] [Indexed: 11/13/2022] Open
Abstract
There are limited data about the management of patients presenting for elective generator replacements in the setting of previously implanted cardiac resynchronization therapy (CRT) devices that are nearing end-of-life. The individual patient's clinical status and concomitant morbidities may evolve so that considerations may include not only replacement of the pulse generator, but also potentially changing the type of device [e.g. downgrading CRT-defibrillator (CRT-D) to CRT-pacemaker (CRT-P) or ICD or upgrading of CRT-P to CRT-D]. Moreover, the clinical evidence for CRT-D/CRT-P implantation may change over time, with ongoing research and availability of new trial data. In this review we discuss the ethical, clinical and financial implications related to CRT generator replacements and the need for additional clinical trials to better understand which patients should undergo CRT device downgrading or upgrading at the time of battery depletion.
Collapse
Affiliation(s)
- Eleni S Nakou
- University Hospital of Heraklion, PO box 1352, Stavrakia, Heraklion Crete, Greece
| | | | | | - Konstantinos S Nakos
- University Hospital of Heraklion, PO box 1352, Stavrakia, Heraklion Crete, Greece
| | - Panos E Vardas
- University Hospital of Heraklion, PO box 1352, Stavrakia, Heraklion Crete, Greece
| |
Collapse
|
28
|
Li X, Yang D, Kusumoto F, Shen WK, Mulpuru S, Zhou S, Liang J, Wu G, Yang M, Liu JQ, Friedman PA, Cha YM. Predictors and outcomes of cardiac resynchronization therapy extended to the second generator. Heart Rhythm 2017; 14:1793-1800. [DOI: 10.1016/j.hrthm.2017.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Indexed: 10/18/2022]
|
29
|
Madeira M, António N, Milner J, Ventura M, Cristóvão J, Costa M, Nascimento J, Elvas L, Gonçalves L, Mariano Pego G. Who still remains at risk of arrhythmic death at time of implantable cardioverter-defibrillator generator replacement? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1129-1138. [DOI: 10.1111/pace.13163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/25/2017] [Accepted: 07/09/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Marta Madeira
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
- Faculdade de Medicina da Universidade de Coimbra; Coimbra Portugal
| | - Natália António
- Faculdade de Medicina da Universidade de Coimbra; Coimbra Portugal
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Universitário de Coimbra; Coimbra Portugal
| | - James Milner
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Universitário de Coimbra; Coimbra Portugal
| | - Miguel Ventura
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Universitário de Coimbra; Coimbra Portugal
| | - João Cristóvão
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Universitário de Coimbra; Coimbra Portugal
| | - Marco Costa
- Faculdade de Medicina da Universidade de Coimbra; Coimbra Portugal
| | - José Nascimento
- Faculdade de Medicina da Universidade de Coimbra; Coimbra Portugal
| | - Luís Elvas
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Universitário de Coimbra; Coimbra Portugal
| | - Lino Gonçalves
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
- Faculdade de Medicina da Universidade de Coimbra; Coimbra Portugal
| | - Guilherme Mariano Pego
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Universitário de Coimbra; Coimbra Portugal
| |
Collapse
|
30
|
Duration of reverse remodeling response to cardiac resynchronization therapy: Rates, predictors, and clinical outcomes. Int J Cardiol 2017; 243:340-346. [DOI: 10.1016/j.ijcard.2017.05.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/15/2017] [Accepted: 05/11/2017] [Indexed: 11/19/2022]
|
31
|
Killu AM, Mazo A, Grupper A, Madhavan M, Webster T, Brooke KL, Hodge DO, Asirvatham SJ, Friedman PA, Glikson M, Cha YM. Super-response to cardiac resynchronization therapy reduces appropriate implantable cardioverter defibrillator therapy. Europace 2017; 20:1303-1311. [DOI: 10.1093/europace/eux235] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 07/05/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ammar M Killu
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - Anna Mazo
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer and Tel Aviv University, Emek HaEla St 1, Ramat Gan, Israel
| | - Avishay Grupper
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer and Tel Aviv University, Emek HaEla St 1, Ramat Gan, Israel
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - Tracy Webster
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - Kelly L Brooke
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - Paul A Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - Michael Glikson
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer and Tel Aviv University, Emek HaEla St 1, Ramat Gan, Israel
| | - Yong-Mei Cha
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| |
Collapse
|
32
|
Smer A, Saurav A, Azzouz MS, Salih M, Ayan M, Abuzaid A, Akinapelli A, Kanmanthareddy A, Rosenfeld LE, Merchant FM, Abuissa H. Meta-analysis of Risk of Ventricular Arrhythmias After Improvement in Left Ventricular Ejection Fraction During Follow-Up in Patients With Primary Prevention Implantable Cardioverter Defibrillators. Am J Cardiol 2017; 120:279-286. [PMID: 28532779 DOI: 10.1016/j.amjcard.2017.04.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 11/17/2022]
Abstract
Implantable cardioverter defibrillators (ICDs) reduce the risk of sudden cardiac death in patients with impaired left ventricular ejection fraction (LVEF). However, there are limited data on the long-term benefit of ICD therapy in patients whose LVEF subsequently improves. We conducted a meta-analysis to evaluate the effect of LVEF improvement on ICD therapy during follow-up. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated using random-effects modeling. Sixteen studies with 3,959 patients were included in our analysis. Study arms were defined by LVEF improvement at follow-up (improved LVEF [>35%]: 1,622; low LVEF [≤35%] 2,337). Mean age (64.8 vs 64.9 years, p = 0.97) was similar, whereas men were overrepresented in the persistent low LVEF group (79% vs 72%, p <0.001). Appropriate ICD therapy rate was 9.7% (improved LVEF) versus 21.8% (low LVEF) over a median follow-up period of 2.9 years. In the meta-analysis, improved LVEF group had significantly lower (3.3% vs 7.2% per year IRR 0.52; CI 0.38 to 0.70; p <0.001) appropriate ICD therapies which was uniformly seen across all subgroups (ICD-only studies: IRR 0.59; p = 0.004) (cardiac resynchronization therapy-defibrillator-only studies: IRR 0.31; p = 0.002) (super-responder studies [mean LVEF > 45%]: IRR 0.53; p = 0.002). Inappropriate ICD therapy rates were, however, similar in both groups (3.01% vs 2.56% per year IRR 0.76; CI 0.43 to 1.36; p = 0.35). All-cause mortality rates in our meta-analysis favored (3.63% vs 8.23% per year IRR 0.49; CI 0.35 to 0.69; p <0.001) the improved LVEF group. In conclusion, our meta-analysis demonstrates that an improvement in LVEF is associated with a significantly reduced risk of ventricular arrhythmia and mortality. However, inappropriate ICD therapy rates remain similar.
Collapse
Affiliation(s)
- Aiman Smer
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska.
| | - Alok Saurav
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska
| | - Muhammad Soubhi Azzouz
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska
| | - Mohsin Salih
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
| | - Mohamed Ayan
- Department of Cardiovascular Medicine, University of Arkansas Medical Science, Little Rock, Arkansas
| | - Ahmed Abuzaid
- Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, Delaware
| | - Abhilash Akinapelli
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska
| | - Arun Kanmanthareddy
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska
| | - Lynda E Rosenfeld
- Section of Cardiovascular Medicine, Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Faisal M Merchant
- Cardiology Division, Section of Cardiac Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Hussam Abuissa
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska
| |
Collapse
|
33
|
Dell'Era G, Degiovanni A, Occhetta E, Magnani A, Bortnik M, Francalacci G, Plebani L, Prenna E, Valsecchi S, Marino P. Persistence of ICD indication at the time of replacement in patients with initial implant for primary prevention indication: Effect on subsequent ICD therapies. Indian Pacing Electrophysiol J 2017; 17:29-33. [PMID: 29072989 PMCID: PMC5405747 DOI: 10.1016/j.ipej.2016.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 10/31/2016] [Accepted: 11/12/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Indication to implantable cardioverter defibrillator (ICD) for primary prevention of sudden death relies on left ventricular ejection fraction (LVEF). We measured the proportion of patients in whom indication to ICD persisted at the time of generator replacement (GR) and searched for predictors of appropriate therapies after GR. METHODS We identified all consecutive patients who had received an ICD at our hospital, for LVEF ≤35% and no previous arrhythmias or unexplained syncope. Then, we included the 166 patients who outlived their first device and underwent GR. RESULTS At the time of GR (mean follow-up 59 ± 20 months), ICD indication (i.e. LVEF ≤35% or previously treated ventricular arrhythmias) persisted in 114 (69%) patients. After GR, appropriate ICD therapies were delivered in 30 (26%) patients with persistent ICD indication and in 12 (23%) of the remaining patients (p = 0.656). Nonetheless, the annual rate of therapies was higher in the first group (1.08 versus 0.53 events/year; p < 0.001), as well as the rate of inappropriate therapies (0.03 versus 0 events/year; p = 0.031). The only independent predictor of appropriate ICD therapies after GR was the rate of shocks received before replacement (Hazard Ratio: 1.41; 95% confidence interval: 1.01-1.96; p = 0.041). CONCLUSION In heart failure with reduced LVEF, ICD indication persisted at the time of GR in 69% of patients. However, even in the absence of persistent ICD indication at GR, the risk of recurrence of arrhythmic events was not null.
Collapse
Affiliation(s)
| | - Anna Degiovanni
- Clinica Cardiologica A.O.U. Maggiore della Carità, Novara, Italy
| | - Eraldo Occhetta
- Clinica Cardiologica A.O.U. Maggiore della Carità, Novara, Italy.
| | - Andrea Magnani
- Clinica Cardiologica A.O.U. Maggiore della Carità, Novara, Italy
| | - Miriam Bortnik
- Clinica Cardiologica A.O.U. Maggiore della Carità, Novara, Italy
| | | | - Laura Plebani
- Clinica Cardiologica A.O.U. Maggiore della Carità, Novara, Italy
| | - Eleonora Prenna
- Clinica Cardiologica A.O.U. Maggiore della Carità, Novara, Italy
| | | | - Paolo Marino
- Clinica Cardiologica A.O.U. Maggiore della Carità, Novara, Italy
| |
Collapse
|
34
|
Caputo ML, Regoli F, Conte G, Adjibodou B, Svab S, Del Bufalo A, Moccetti T, Curti M, Klersy C, Auricchio A. Temporal trends and long term follow-up of implantable cardioverter defibrillator therapy for secondary prevention: A 15-year single-centre experience. Int J Cardiol 2016; 228:31-36. [PMID: 27863358 DOI: 10.1016/j.ijcard.2016.11.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/05/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to determine overall and aetiology-related incidence of secondary prevention ICD implantation over the last 15years in Canton Ticino and to assess clinical outcome according to time period of implantation. METHODS AND RESULTS Consecutive patients treated by implantation of an ICD for secondary prevention from 2000 to 2015 were included in the current study and compared between 5-year cohorts (2000/2004; 2005/2009; 2010/2015). Yearly implantation rate, changing in clinical presentation over years and events during follow-up were evaluated. One-hundred fifty six patients were included. ICD implantation rate increased from 2.1 in 2000-2005 to 5.1 in 2010-2015, respectively (p 0.001). There was an increase in the proportion of non-ischaemic patients and of ventricular tachycardia (VT) as presenting rhythm. No differences in appropriate ICD interventions were observed according to aetiology, presenting arrhythmia or type of device. Reverse remodelling was observed more often in non-ischaemic patients, without any influence on the occurrence of appropriate interventions. Previous myocardial infarction (MI), atrial fibrillation (AF), NYHA class 2-3 and left ventricular ejection fraction (LVEF)<35% were predictors of appropriate therapies during follow-up. CONCLUSIONS Rate of implants for secondary prevention indication has almost doubled during the last 15years. Importantly, there has been a progressive increase of non-ischaemic patients receiving an ICD, and of VT as presenting rhythm. Patients had an overall good survival and a relatively low incidence of appropriate therapies. Improvement of ejection fraction did not correlate with risk reduction of ventricular arrhythmias.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Moreno Curti
- Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | |
Collapse
|
35
|
van der Heijden AC, Höke U, Thijssen J, Willem Borleffs CJ, Wolterbeek R, Schalij MJ, van Erven L. Long-Term Echocardiographic Outcome in Super-Responders to Cardiac Resynchronization Therapy and the Association With Mortality and Defibrillator Therapy. Am J Cardiol 2016; 118:1217-1224. [PMID: 27586169 DOI: 10.1016/j.amjcard.2016.07.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/10/2016] [Accepted: 07/10/2016] [Indexed: 01/14/2023]
Abstract
Super-response to cardiac resynchronization therapy (CRT) is associated with significant left ventricular (LV) reverse remodeling and improved clinical outcome. The study aimed to: (1) evaluate whether LV reverse remodeling remains sustained during long-term follow-up in super-responders and (2) analyze the association between the course of LV reverse remodeling and ventricular arrhythmias. Of all, primary prevention super-responders to CRT were selected. Super-response was defined as LV end-systolic volume reduction of ≥30% 6 months after device implantation. Cox regression analysis was performed to investigate the association of LV ejection fraction (LVEF) as time-dependent variable with implantable-cardioverter defibrillator (ICD) therapy and mortality. A total of 171 super-responders to CRT-defibrillator were included (mean age 67 ± 9 years; 66% men; 37% ischemic heart disease). Here of 129 patients received at least 1 echocardiographic evaluation after a median follow-up of 62 months (25th to 75th percentile, 38 to 87). LV end-diastolic volume, LV end-systolic volume, and LVEF after 6-month follow-up were comparable with those after 62-month follow-up (p = 0.90, p = 0.37, and p = 0.55, respectively). Changes in LVEF during follow-up in super-responders were independently associated with appropriate ICD therapy (hazard ratio 0.94, 95% CI 0.90 to 0.98; p = 0.005) and all-cause mortality (hazard ratio 0.95, 95% CI 0.91 to 1.00; p = 0.04). A 5% increase in LVEF was associated with a 1.37 times lower risk of appropriate ICD therapy and a 1.30 times lower risk of mortality. In conclusion, LV reverse remodeling in super-responders to CRT remains sustained during long-term follow-up. Changes in LVEF during follow-up were associated with mortality and ICD therapy.
Collapse
|
36
|
KIM MINSU, KIM JUN, LEE JIHYUN, HWANG YOUMI, KIM MINSEOK, NAM GIBYOUNG, CHOI KEEJOON, KIM JAEJOONG, KIM YOUHO. Impact of Improved Left Ventricular Systolic Function on the Recurrence of Ventricular Arrhythmia in Heart Failure Patients With an Implantable Cardioverter-Defibrillator. J Cardiovasc Electrophysiol 2016; 27:1191-1198. [DOI: 10.1111/jce.13037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/07/2016] [Accepted: 06/13/2016] [Indexed: 11/27/2022]
Affiliation(s)
- MINSU KIM
- Heart Institute, Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - JUN KIM
- Heart Institute, Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - JI HYUN LEE
- Heart Institute, Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - YOU MI HWANG
- Heart Institute, Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - MIN-SEOK KIM
- Heart Institute, Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - GI-BYOUNG NAM
- Heart Institute, Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - KEE-JOON CHOI
- Heart Institute, Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - JAE-JOONG KIM
- Heart Institute, Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - YOU-HO KIM
- Heart Institute, Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| |
Collapse
|
37
|
Saini A, Kannabhiran M, Reddy P, Gopinathannair R, Olshansky B, Dominic P. Cardiac Resynchronization Therapy May Be Antiarrhythmic Particularly in Responders. JACC Clin Electrophysiol 2016; 2:307-316. [DOI: 10.1016/j.jacep.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/22/2015] [Indexed: 02/09/2023]
|
38
|
BERTHELOT-RICHER MAXIME, BONENFANT FRANCIS, CLAVEL MARIEANNICK, FARAND PAUL, PHILIPPON FRANÇOIS, AYALA-PAREDES FELIX, ESSADIQI BTISSAMA, BADRA-VERDU MG, ROUX JEANFRANÇOIS. Arrhythmic Risk Following Recovery of Left Ventricular Ejection Fraction in Patients with Primary Prevention ICD. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:680-9. [DOI: 10.1111/pace.12868] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 03/16/2016] [Accepted: 03/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - FRANCIS BONENFANT
- Department of Medicine, Cardiovascular Division; Centre Hospitalier Universitaire de Sherbrooke; Quebec Canada
| | - MARIE-ANNICK CLAVEL
- Faculty of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec; Université Laval; Quebec City Quebec Canada
| | - PAUL FARAND
- Department of Medicine, Cardiovascular Division; Centre Hospitalier Universitaire de Sherbrooke; Quebec Canada
| | - FRANÇOIS PHILIPPON
- Faculty of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec; Université Laval; Quebec City Quebec Canada
| | - FELIX AYALA-PAREDES
- Department of Medicine, Cardiovascular Division; Centre Hospitalier Universitaire de Sherbrooke; Quebec Canada
| | - BTISSAMA ESSADIQI
- Department of Medicine, Cardiovascular Division; Centre Hospitalier Universitaire de Sherbrooke; Quebec Canada
| | - Mariano Gonzalo BADRA-VERDU
- Department of Medicine, Cardiovascular Division; Centre Hospitalier Universitaire de Sherbrooke; Quebec Canada
| | - JEAN-FRANÇOIS ROUX
- Department of Medicine, Cardiovascular Division; Centre Hospitalier Universitaire de Sherbrooke; Quebec Canada
| |
Collapse
|
39
|
KAWATA HIRO, HIRAI TAISHI, DOUKAS DEMETRIOS, HIRAI RIE, STEINBRUNNER JENNI, WILSON JOHN, NODA TAKASHI, HSU JONATHAN, KRUMMEN DAVID, FELD GREGORY, WILBER DAVID, SANTUCCI PETER, BIRGERSDOTTER-GREEN ULRIKA. The Occurrence of Implantable Cardioverter Defibrillator Therapies After Generator Replacement in Patients Who No Longer Meet Primary Prevention Indications. J Cardiovasc Electrophysiol 2016; 27:724-9. [DOI: 10.1111/jce.12961] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/30/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Affiliation(s)
- HIRO KAWATA
- Department of Medicine; Good Samaritan Hospital; Cincinnati Ohio USA
| | - TAISHI HIRAI
- Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine; Loyola University Medical Center; Maywood Illinois USA
| | - DEMETRIOS DOUKAS
- Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine; Loyola University Medical Center; Maywood Illinois USA
| | - RIE HIRAI
- Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine; Loyola University Medical Center; Maywood Illinois USA
| | | | - JOHN WILSON
- Department of Medicine; Good Samaritan Hospital; Cincinnati Ohio USA
| | - TAKASHI NODA
- National Cerebral and Cardiovascular Center; Suita Osaka Japan
| | - JONATHAN HSU
- University of California, San Diego; Sulpizio Family Cardiovascular Center; La Jolla California USA
| | - DAVID KRUMMEN
- University of California, San Diego; Sulpizio Family Cardiovascular Center; La Jolla California USA
| | - GREGORY FELD
- University of California, San Diego; Sulpizio Family Cardiovascular Center; La Jolla California USA
| | - DAVID WILBER
- Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine; Loyola University Medical Center; Maywood Illinois USA
| | - PETER SANTUCCI
- Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine; Loyola University Medical Center; Maywood Illinois USA
| | | |
Collapse
|
40
|
Zhang Y, Guallar E, Weiss RG, Stillabower M, Gerstenblith G, Tomaselli GF, Wu KC. Associations between scar characteristics by cardiac magnetic resonance and changes in left ventricular ejection fraction in primary prevention defibrillator recipients. Heart Rhythm 2016; 13:1661-6. [PMID: 27108939 DOI: 10.1016/j.hrthm.2016.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) improves over time in 25%-40% of patients with cardiomyopathy with primary prevention implantable cardioverter-defibrillator (ICD). The determinants of LVEF improvement, however, are not well characterized. OBJECTIVES We sought to examine the associations of clinical risk factors and cardiac imaging markers with changes in LVEF after ICD implantation. METHODS We conducted a retrospective analysis of cardiac magnetic resonance images in 202 patients who underwent primary prevention ICD implantation to quantify the amount of heterogeneous myocardial tissue (gray zone), dense core, and total scar. LVEF was reassessed at least once after ICD implantation. RESULTS Over a mean follow-up of 3 years, LVEF decreased in 43 (21.3%), improved in 88 (43.6%), and was unchanged in 71 (35.1%) of the patients. Baseline LVEF and myocardial scar characteristics were the strongest determinants of LVEF trajectory with high scar burden and increasing lack of myocardial viability associated with a greater decline in LVEF. There was a trend toward an association between both changes in LVEF and scar extent with subsequent appropriate ICD shock. Changes in LVEF were also strongly associated with heart failure hospitalizations. CONCLUSION Scar burden and characteristics were strong determinants, independent of baseline LVEF and other traditional cardiovascular risk factors, of changes in LVEF. Both worsened LVEF and high scar extent were associated with a trend toward increased risk of appropriate shock. These findings suggest that baseline cardiac magnetic resonance imaging of the myocardial substrate may provide important prognostic information on subsequent left ventricular remodeling and adverse events.
Collapse
Affiliation(s)
- Yiyi Zhang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eliseo Guallar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | |
Collapse
|
41
|
Ter Horst IAH, van 't Sant J, Wijers SC, Vos MA, Cramer MJ, Meine M. The risk of ventricular arrhythmias in a Dutch CRT population: CRT-defibrillator versus CRT-pacemaker. Neth Heart J 2016; 24:204-13. [PMID: 26797979 PMCID: PMC4771627 DOI: 10.1007/s12471-015-0800-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Patients eligible for cardiac resynchronisation therapy (CRT) have an indication for primary prophylactic implantable cardioverter defibrillator (ICD) therapy. However, response to CRT might influence processes involved in arrhythmogenesis and therefore change the necessity of ICD therapy in certain patients. Method In 202 CRT-defibrillator patients, the association between baseline variables, 6-month echocardiographic outcome (volume response: left ventricular end-systolic volume decrease < ≥15 % and left ventricular ejection fraction (LVEF) ≤ >35 %) and the risk of first appropriate ICD therapy was analysed retrospectively. Results Fifty (25 %) patients received appropriate ICD therapy during a median follow-up of 37 (23–52) months. At baseline ischaemic cardiomyopathy (hazard ratio (HR) 2.0, p = 0.019) and a B-type natriuretic peptide level > 163 pmol/l (HR 3.8, p < 0.001) were significantly associated with the risk of appropriate ICD therapy. After 6 months, 105 (52 %) patients showed volume response and 51 (25 %) reached an LVEF > 35 %. Three (6 %) patients with an LVEF > 35 % received appropriate ICD therapy following echocardiography at ± 6 months compared with 43 patients (29 %) with an LVEF ≤ 35 % (p = 0.001). LVEF post-CRT was more strongly associated to the risk of ventricular arrhythmias than volume response (LVEF > 35 %, HR 0.23, p = 0.020). Conclusion Assessing the necessity of an ICD in patients eligible for CRT remains a challenge. Six months post-CRT an LVEF > 35 % identified patients at low risk of ventricular arrhythmias. LVEF might be used at the time of generator replacement to identify patients suitable for downgrading to a CRT-pacemaker.
Collapse
Affiliation(s)
- I A H Ter Horst
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, PO Box 85500, Utrecht, The Netherlands.
| | - J van 't Sant
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - S C Wijers
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, PO Box 85500, Utrecht, The Netherlands.,Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J Cramer
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, PO Box 85500, Utrecht, The Netherlands
| | - M Meine
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, PO Box 85500, Utrecht, The Netherlands
| |
Collapse
|
42
|
Normalization of Left Ventricular Ejection Fraction and Incidence of Appropriate Antitachycardia Therapy in Patients With Implantable Cardioverter Defibrillator for Primary Prevention of Sudden Death. J Card Fail 2016; 22:125-32. [DOI: 10.1016/j.cardfail.2015.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 10/09/2015] [Accepted: 10/22/2015] [Indexed: 11/23/2022]
|
43
|
Contemporary rates of appropriate shock therapy in patients who receive implantable device therapy in a real-world setting: From the Israeli ICD Registry. Heart Rhythm 2015; 12:2426-33. [DOI: 10.1016/j.hrthm.2015.08.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Indexed: 11/23/2022]
|
44
|
Gonzalez JE, Sauer WH. Generator exchange in a primary prevention cardiac resynchronziation responder: do you reimplant a defibrillator? Card Electrophysiol Clin 2015; 7:487-96. [PMID: 26304529 DOI: 10.1016/j.ccep.2015.05.017] [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: 11/29/2022]
Abstract
This case-based review discusses the benefits of cardiac resynchronization therapy (CRT) and whether defibrillation function is necessary in CRT responders. An evaluation of the literature and evidence to date is discussed. Recommendations based on these data, expert opinion, and recently published appropriate use criteria are given.
Collapse
Affiliation(s)
- Jaime E Gonzalez
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - William H Sauer
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.
| |
Collapse
|
45
|
Chatterjee NA, Roka A, Lubitz SA, Gold MR, Daubert C, Linde C, Steffel J, Singh JP, Mela T. Reduced appropriate implantable cardioverter-defibrillator therapy after cardiac resynchronization therapy-induced left ventricular function recovery: a meta-analysis and systematic review. Eur Heart J 2015; 36:2780-9. [PMID: 26264552 DOI: 10.1093/eurheartj/ehv373] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 07/15/2015] [Indexed: 01/25/2023] Open
Abstract
AIMS For patients undergoing cardiac resynchronization therapy (CRT) with implantable cardioverter-defibrillator (ICD; CRT-D), the effect of an improvement in left ventricular ejection fraction (LVEF) on appropriate ICD therapy may have significant implications regarding management at the time of ICD generator replacement. METHODS AND RESULTS We conducted a meta-analysis to determine the effect of LVEF recovery following CRT on the incidence of appropriate ICD therapy. A search of multiple electronic databases identified 709 reports, of which 6 retrospective cohort studies were included (n = 1740). In patients with post-CRT LVEF ≥35% (study n = 4), the pooled estimated rate of ICD therapy (5.5/100 person-years) was significantly lower than patients with post-CRT LVEF <35% [incidence rate difference (IRD): -6.5/100 person-years, 95% confidence interval (95% CI): -8.8 to -4.2, P < 0.001]. Similarly, patients with post-CRT LVEF ≥45% (study n = 4) demonstrated lower estimated rates of ICD therapy (2.3/100 person-years) compared with patients without such recovery (IRD: -5.8/100 person-years, 95% CI: -7.6 to -4.0, P < 0.001). Restricting analysis to studies discounting ICD therapies during LVEF recovery (study n = 3), patients with LVEF recovery (≥35 or ≥45%) had significantly lower rates of ICD therapy compared with patients without such recovery (P for both <0.001). Patients with primary prevention indication for ICD, regardless of LVEF recovery definition, had very low rates of ICD therapy (0.4 to 0.8/100-person years). CONCLUSION Recovery of LVEF post-CRT is associated with significantly reduced appropriate ICD therapy. Patients with improvement of LVEF ≥45% and those with primary prevention indication for ICD appear to be at lowest risk.
Collapse
Affiliation(s)
- Neal A Chatterjee
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| | - Attila Roka
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| | - Steven A Lubitz
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Claude Daubert
- Cardiology Division, Rennes University Hospital, Rennes, France
| | - Cecilia Linde
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jagmeet P Singh
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| | - Theofanie Mela
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| |
Collapse
|
46
|
Zhang Y, Guallar E, Blasco-Colmenares E, Butcher B, Norgard S, Nauffal V, Marine JE, Eldadah Z, Dickfeld T, Ellenbogen KA, Tomaselli GF, Cheng A. Changes in Follow-Up Left Ventricular Ejection Fraction Associated With Outcomes in Primary Prevention Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Device Recipients. J Am Coll Cardiol 2015; 66:524-31. [PMID: 26227190 PMCID: PMC4522701 DOI: 10.1016/j.jacc.2015.05.057] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Heart failure patients with primary prevention implantable cardioverter-defibrillators (ICD) may experience an improvement in left ventricular ejection fraction (LVEF) over time. However, it is unclear how LVEF improvement affects subsequent risk for mortality and sudden cardiac death. OBJECTIVES This study sought to assess changes in LVEF after ICD implantation and the implication of these changes on subsequent mortality and ICD shocks. METHODS We conducted a prospective cohort study of 538 patients with repeated LVEF assessments after ICD implantation for primary prevention of sudden cardiac death. The primary endpoint was appropriate ICD shock defined as a shock for ventricular tachyarrhythmias. The secondary endpoint was all-cause mortality. RESULTS Over a mean follow-up of 4.9 years, LVEF decreased in 13.0%, improved in 40.0%, and was unchanged in 47.0% of the patients. In the multivariate Cox models comparing patients with an improved LVEF with those with an unchanged LVEF, the hazard ratios were 0.33 (95% confidence interval: 0.18 to 0.59) for mortality and 0.29 (95% confidence interval: 0.11 to 0.78) for appropriate shock. During follow-up, 25% of patients showed an improvement in LVEF to >35% and their risk of appropriate shock decreased but was not eliminated. CONCLUSIONS Among primary prevention ICD patients, 40.0% had an improved LVEF during follow-up and 25% had LVEF improved to >35%. Changes in LVEF were inversely associated with all-cause mortality and appropriate shocks for ventricular tachyarrhythmias. In patients whose follow-up LVEF improved to >35%, the risk of an appropriate shock remained but was markedly decreased.
Collapse
MESH Headings
- Aged
- Cardiac Resynchronization Therapy/methods
- Cardiac Resynchronization Therapy/statistics & numerical data
- Cohort Studies
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock/instrumentation
- Electric Countershock/methods
- Female
- Heart Failure/complications
- Heart Failure/therapy
- Humans
- Incidence
- Male
- Middle Aged
- Proportional Hazards Models
- Prospective Studies
- Risk Assessment
- Severity of Illness Index
- Stroke Volume
- United States/epidemiology
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/mortality
Collapse
Affiliation(s)
- Yiyi Zhang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Eliseo Guallar
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Barbara Butcher
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanaz Norgard
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Victor Nauffal
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Timm Dickfeld
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Gordon F Tomaselli
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alan Cheng
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
47
|
Rijnierse MT, van der Lingen ALCJ, Weiland MTD, de Haan S, Nijveldt R, Beek AM, van Rossum AC, Allaart CP. Clinical Impact of Cardiac Magnetic Resonance Imaging Versus Echocardiography-Guided Patient Selection for Primary Prevention Implantable Cardioverter Defibrillator Therapy. Am J Cardiol 2015; 116:406-12. [PMID: 26050137 DOI: 10.1016/j.amjcard.2015.04.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 11/19/2022]
Abstract
The main eligibility criterion for primary prevention implantable cardioverter defibrillator (ICD) therapy, that is, left ventricular ejection fraction (LVEF), is based on large clinical trials using primarily 2-dimensional echocardiography (2DE). Presently, cardiac magnetic resonance imaging (MRI) is considered the gold standard for LVEF assessment. It has been demonstrated that cardiac MRI assessment results in lower LVEFs compared with 2DE. Consequently, cardiac MRI-LVEF assessment may lead to more patients eligible for ICD implantation with potential clinical consequences. The aim of this study was to evaluate the clinical impact of cardiac MRI-LVEF versus 2DE-LVEF assessment for ICD eligibility. A total of 149 patients with cardiac MRI-LVEF ≤35% referred for primary prevention ICD implantation who underwent both 2DE and cardiac MRI-LVEF assessment were retrospectively included. 2DE-LVEF was computed by Simpson's biplane method. Cardiac MRI-LVEF was computed after outlining the endocardial contours in short-axis cine images. Appropriate device therapy (ADT) and all-cause mortality were evaluated during 2.9 ± 1.7 years of follow-up. The present study found that cardiac MRI-LVEF was significantly lower compared with 2DE-LVEF (23 ± 8% vs 30 ± 8%, respectively, p <0.001), resulting in 29 (19%) more patients eligible for ICD implantation according to the current guidelines (LVEF ≤35%). Patients with 2DE-LVEF >35% but cardiac MRI-LVEF ≤35% experienced a lower ADT rate compared with patients having 2DE-LVEF ≤35% (2.1% vs 10.4% per year, respectively, p = 0.02). Application of cardiac MRI-LVEF cutoff of 30% resulted in 119 eligible patients experiencing 9.9% per year ADT, comparable with 2DE-LVEF cut-off value of 35%. In conclusion, cardiac MRI-LVEF assessment resulted in more patients eligible for ICD implantation compared with 2DE who showed a relatively low event rate during follow-up. The event rate in patients with cardiac MRI-LVEF ≤30% was comparable with patients having a 2DE-LVEF ≤35%. This study suggests the need for re-evaluation of cardiac MRI-based LVEF cut-off values for ICD eligibility.
Collapse
Affiliation(s)
- Mischa T Rijnierse
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Anne-Lotte C J van der Lingen
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Marjolein T D Weiland
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Stefan de Haan
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Aernout M Beek
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
48
|
Jacobson JT, Iwai S, Aronow W. Management of ventricular arrhythmias in structural heart disease. Postgrad Med 2015; 127:549-59. [PMID: 25971427 DOI: 10.1080/00325481.2015.1045816] [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: 10/22/2022]
Abstract
Ventricular arrhythmias (VA) are a source of significant morbidity and mortality in patients with structural heart disease (SHD). The advent of the implantable cardiac defibrillator (ICD) has had a positive effect on mortality, but the associated morbidity remains a significant problem. Modern treatment of VA has advanced far beyond medical therapy and includes strategies as simple as intelligent ICD programming and as complex as catheter ablation (CA). In these pages, the spectrum of management strategies will be discussed; from anti-arrhythmic drugs and ICD implantation and programming to CA and autonomic modulation. The focus of this review will be on strategies for secondary prevention of VA in patients with SHD, supported by clinical evidence for their utilization.
Collapse
Affiliation(s)
- Jason T Jacobson
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College , Valhalla, New York , USA
| | | | | |
Collapse
|
49
|
|
50
|
Cygankiewicz I, Ptaszynski P. Restratification at time of implantable cardioverter defibrillator replacement. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 67:971-973. [PMID: 25444380 DOI: 10.1016/j.rec.2014.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/04/2014] [Indexed: 06/04/2023]
Affiliation(s)
| | - Pawel Ptaszynski
- Department of Electrocardiology, Medical University of Lodz, Poland
| |
Collapse
|