Abstract
Background: Cardiac resynchronizationtherapy (CRT) has recently emerged as a new modality for the treatment of patients with advanced heart failure (HF).
Hypothesis: Cardiac resynchronization therapy reduces atrial and ventricular arrhythmia burdens.
Methods: We analyzed the clinical data of patients who underwent an upgrade from a dual‐chamber to a biventricular implantable cardioverter‐defibrillator (ICD) at a tertiary care center.
Results: Nineteen patients (age 67 ± 10years, 18 men, left ventricular [LV] ejection fraction 0.24 ± 0.07) underwent an upgrade to CRT‐ICD. The LV lead was placed in a lateral position in 11, posterolateral in 4, and anterolateral in 3 patients. Baseline New York Heart Association class of HF improved in 11 (58%) patients who were considered “responders.” After adjusting for the duration of follow‐up before and after the upgrade, the number of patients receiving any ICD therapy decreased significantly from 13 to 4 (p = 0.004) and the total number of therapies decreased from 72 to 17 (p = 0.067). Also, the number of detections of sustained ventricular arrhythmias decreased from 40 to 11 episodes (p = 0.05), but the decrease in the number of detected supraventricular arrhythmias and mode switch episodes was not significant. The reductionin the ventricular arrhythmia load was independent of whether or not the patient responded to CRT.
Conclusion: Our data suggest that CRT reduces ventricular but not atrial arrhythmia burden in patients with HF irrespective of their clinical response. This suggests that the reduction in arrhythmia is primarily an electrical phenomenon. Further studies are needed to confirm these findings and to uncover their underlying mechanisms.
Keywords: biventricular pacing, ventricular tachycardia, supraventricular tachycardia
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References
- 1. Varma C, Sharma S, Firoozi S, McKenna WJ, Daubert JC: Multisite Stimulation in Cardiomyopathy (MUSTIC) Study Group: Atrioventricular pacing improves exercise capacity in patients with heart failure and intra‐ventricular conduction delay. J Am Coll Cardiol 2003; 41: 582–588 [DOI] [PubMed] [Google Scholar]
- 2. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J: MIRACLE Study Group: Cardiac resynchronization in chronic heart failure. N Engl J Med 2002; 346: 1845–1853 [DOI] [PubMed] [Google Scholar]
- 3. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM: Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators: Cardiac‐resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140–2150 [DOI] [PubMed] [Google Scholar]
- 4. Young JB, Abraham WT, Smith AL, Leon AR, Lieberman R, Wilkoff B, Canby RC, Schroeder JS, Liem LB, Hall S, Wheelan K: Multicenter InSync ICD Randomized Clinical Evaluation (MIRACLEICD) Trial Investigators: Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure. J Am Med Assoc 2003; 289: 2685–2694 [DOI] [PubMed] [Google Scholar]
- 5. Kies P, Bax JJ, Molhoek SG, Bleeker GB, Zeppenfeld K, Bootsma M, St John Sutton M, van Erven L, van der Wall EE, Schalij MJ: Effect of left ventricular remodeling after cardiac resynchronization therapy on frequency of ventricular arrhythmias. Am J Cardiol 2004; 94: 130–132 [DOI] [PubMed] [Google Scholar]
- 6. Kanzaki H, Bazaz R, Schwartzman D, Dohi K, Sade LE, Gorcsan J III: A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization: Insights from mechanical activation strain mapping. J Am Coll Cardiol 2004; 44: 1619–1625 [DOI] [PubMed] [Google Scholar]
- 7. Lau CP, Yu CM, Chau E, Fan K, Tse HF, Lee K, Tang MO, Wan SH, Law TC, Lee PY, Lam YM, Hill MR: Reversal of left ventricular remodeling by synchronous biventricular pacing in heart failure. Pacing Clin Electrophysiol 2000; 23: 1722–1725 [DOI] [PubMed] [Google Scholar]
- 8. Sinha AM, Filzmaier K, Breithardt OA, Kunz D, Graf J, Markus KU, Hanrath P, Stellbrink C: Usefulness of brain natriuretic peptide release as a surrogate marker of the efficacy of long‐term cardiac resynchronization therapy in patients with heart failure. Am J Cardiol 2003; 91: 755–758 [DOI] [PubMed] [Google Scholar]
- 9. Adamson PB, Kleckner MS, Vanhout WL, Srinivasan S, Abraham WT: Cardiac resynchronization therapy improves heart rate variability in patients with symptomatic heart failure. Circulation 2003; 108: 266–272 [DOI] [PubMed] [Google Scholar]
- 10. Tanabe Y, Chinushi M, Washizuka T, Minagawa S, Furushima H, Watanabe H, Hosaka Y, Komura S, Aizawa Y: Suppression of electrical storm by biventricular pacing in a patient with idiopathic dilated cardiomyopathy and ventricular tachycardia. Pacing Clin Electrophysiol 2003; 26: 101–102 [DOI] [PubMed] [Google Scholar]
- 11. Malinowski K: Spontaneous conversion of permanent atrial fibrillation into stable sinus rhythm after 17 months of biventricular pacing. Pacing Clin Electrophysiol 2003; 26: 1554–1555 [DOI] [PubMed] [Google Scholar]
- 12. Dizon J, Horn E, Neglia J, Medina N, Garan H. Loss of left bundle‐branch block following biventricular pacing therapy for heart failure: Evidence for ventricular remodeling? J Cardiovasc Electrophysiol 2004; 10: 47–50 [DOI] [PubMed] [Google Scholar]