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Deak A, Zaidi SM, Gangireddy C, Cronin E, Hamad E, Fabrizio C, Bhatia-Patel S, Rakita V, Whitman IR. Mid-term clinical outcomes and cardiac function in patients receiving cardiac contractility modulation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01900-0. [PMID: 39210240 DOI: 10.1007/s10840-024-01900-0] [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: 06/06/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES To describe the mid-term clinical and functional cardiac contractility modulation therapy (CCM) recipients in an urban population with heart failure. BACKGROUND CCM is a non-excitatory electrical therapy for patients with systolic heart failure with NYHA class III symptoms and ejection fraction (EF) 25-45%. How CCM affects a broad range of clinical measures, including diastolic dysfunction (DD) and weight change, is unexplored. METHODS We reviewed 31 consecutive patients at our center who underwent CCM implant. NYHA class, hospitalizations, ejection fraction (EF), diastolic function, and weight were compared pre- and post-CCM implant. RESULTS Mean age and follow-up time was 63 ± 10 years and 1.4 ± 0.8 years, respectively. Mean NYHA class improved by 0.97 functional classes (p < 0.001), and improvement occurred in 68% of patients. Mean annualized hospitalizations improved (0.8 ± 0.8 vs. 0.4 ± 1.0 hospitalizations/year, p = 0.048), and after exclusion of a single outlier, change in annualized days hospitalized also improved (total cohort 3.8 ± 4.7 vs. 3.7 ± 14.8 days/year; p = 0.96; after exclusion, 3.8 ± 4.7 vs. 1.1 ± 1.9 days/year, p < 0.001). Mean EF improved by 8% (p = 0.002), and among those with DD pre-CCM, mean DD improvement was 0.8 "grades" (p < 0.001). Mean weight change was 8.5 pounds lost, amounting to 4% of body weight (p = 0.002, p = 0.002, respectively), with 77% of patients having lost weight after CCM. Five patients (16%) experienced procedural complications; incidence skewed toward early implants. CONCLUSION In an observational cohort, CCM therapy resulted in improvement in NYHA class, hospitalizations, systolic and diastolic function, and weight.
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Affiliation(s)
- Andrew Deak
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Syed M Zaidi
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Chethan Gangireddy
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Edmond Cronin
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Eman Hamad
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Carly Fabrizio
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Sanjana Bhatia-Patel
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Val Rakita
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Isaac R Whitman
- Department of Medicine, Section of Cardiology, Parkinson Pavilion, 9th Floor, 3401 North Broad Street, Philadelphia, PA, 19140, USA.
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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: 1] [Impact Index Per Article: 1.0] [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.
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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
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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
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Maass AH, Daniëls F, Roseboom E, Vernooy K, Rienstra M. Special Issue: Latest Advances in Delivery and Outcomes of Cardiac Resynchronization Therapy and Conduction System Pacing. J Clin Med 2023; 12:jcm12103453. [PMID: 37240559 DOI: 10.3390/jcm12103453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiac Resynchronization Therapy (CRT) is an established technique to improve morbidity and mortality in selected heart failure patients [...].
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Affiliation(s)
- Alexander H Maass
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Fenna Daniëls
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
- Department of Cardiology, Isala Hospital, 8000 GK Zwolle, The Netherlands
| | - Eva Roseboom
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
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Khanra D, Manivannan S, Mukherjee A, Deshpande S, Gupta A, Rashid W, Abdalla A, Patel P, Padmanabhan D, Basu-Ray I. Incidence and Predictors of Implantable Cardioverter-defibrillator Therapies After Generator Replacement-A Pooled Analysis of 31,640 Patients' Data. J Innov Card Rhythm Manag 2022; 13:5278-5293. [PMID: 37293556 PMCID: PMC10246925 DOI: 10.19102/icrm.2022.13121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/28/2022] [Indexed: 02/16/2024] Open
Abstract
Among primary prevention implantable cardioverter-defibrillator (ICD) recipients, 75% do not experience any appropriate ICD therapies during their lifetime, and nearly 25% have improvements in their left ventricular ejection fraction (LVEF) during the lifespan of their first generator. The practice guidelines concerning this subgroup's clinical need for generator replacement (GR) remain unclear. We conducted a proportional meta-analysis to determine the incidence and predictors of ICD therapies after GR and compared this to the immediate and long-term complications. A systematic review of existing literature on ICD GR was performed. Selected studies were critically appraised using the Newcastle-Ottawa scale. Outcomes data were analyzed by random-effects modeling using R (R Foundation for Statistical Computing, Vienna, Austria), and covariate analyses were conducted using the restricted maximum likelihood function. A total of 31,640 patients across 20 studies were included in the meta-analysis with a median (range) follow-up of 2.9 (1.2-8.1) years. The incidences of total therapies, appropriate shocks, and anti-tachycardia pacing post-GR were approximately 8, 4, and 5 per 100 patient-years, respectively, corresponding to 22%, 12%, and 12% of patients of the total cohort, with a high level of heterogeneity across the studies. Greater anti-arrhythmic drug use and previous shocks were associated with ICD therapies post-GR. The all-cause mortality was approximately 6 per 100 patient-years, corresponding to 17% of the cohort. Diabetes mellitus, atrial fibrillation, ischemic cardiomyopathy, and the use of digoxin were predictors of all-cause mortality in the univariate analysis; however, none of these were found to be significant predictors in the multivariate analysis. The incidences of inappropriate shocks and other procedural complications were 2 and 2 per 100 patient-years, respectively, which corresponded to 6% and 4% of the entire cohort. Patients undergoing ICD GR continue to require therapy in a significant proportion of cases without any correlation with an improvement in LVEF. Further prospective studies are necessary to risk-stratify ICD patients undergoing GR.
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Affiliation(s)
| | | | | | - Saurabh Deshpande
- Sri Jayadeva Institute of Cardiac Sciences and Research, Bengaluru, India
| | - Anunay Gupta
- Vardhman Mahavir Medical College, and Safdarjung Hospital, New Delhi, India
| | | | - Ahmed Abdalla
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Peysh Patel
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Deepak Padmanabhan
- Sri Jayadeva Institute of Cardiac Sciences and Research, Bengaluru, India
| | - Indranill Basu-Ray
- Cardiovascular Research, Memphis Veteran Administration Hospital, Memphis, TN, USA
- School of Public Health, The University of Memphis, Memphis TN, USA
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