Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy in Women

It has been long acknowledged that electrical-conduction disturbances may be both a cause of heart failure and a consequence of it. In fact, many patients with heart failure have an asynchronous contraction pattern of the heart muscle that further reduces the heart ability to pump blood. Electrical disturbances may therefore result in progressive left ventricular dysfunction, due to the added effects of HF-related electrical dyssynchrony. For this reason, device therapy may play a key role in the management of patients with heart failure and reduced ejection fraction (HFrEF). In particular, Implantable Cardioverter- Defibrillators (ICD) and Cardiac Resynchronization Therapy (CRT) may improve ejection fraction by reestablishing mechanical synchrony, possibly reversing symptoms and signs of heart failure, in addition to the more obvious role of ICD in terminating ventricular arrhythmias that threaten sudden death. Recommendations on device therapy from the current guidelines on heart failure management put out by the ESC/HFA in 2016 update our understanding of the evidence base for the use of ICD and CRT in HFrEF. We review these recommendations and the evidence behind them.

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Cardiac resynchronization therapy: Interventricular delay during ventricular and supraventricular tachyarrhythmia

10.22541/au.161477135.50917344/v1 ◽

2021 ◽

Author(s):

Roland Stroobandt ◽

Andreas Kucher

Keyword(s):

Cardiac Resynchronization Therapy ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Simultaneous Occurrence ◽

Conduction Delay ◽

Implantable Cardioverter Defibrillators ◽

Resynchronization Therapy ◽

The Right ◽

Supraventricular Tachycardias ◽

Cardioverter Defibrillators

Abstract Introduction Implantable cardioverter-defibrillators (ICDs) for cardiac resynchronization therapy (CRT-D) with the capability of LV sensing enable the assessment of interventricular delays in ventricular (VT) and supraventricular tachycardias (SVT). Methods and Results In total, 1078 EGM recordings of VT or VF episodes were investigated that have been transmitted via Home MonitoringⓇ. Only those EGM recordings showing the onset of the tachyarrhythmia were used for investigation. In the 623 cases eligible for evaluation left-sided VTs could be identified in 349 cases, right-sided VTs in 252 cases. SVTs with a 1:1 antegrade conduction were found in 22 cases. VT can present three different interventricular delays whereby the right-ventricular sensed event (RVs) is either preceding the left-ventricular sensed event (LVs), or the LVs is preceding RVs, or there can be a simultaneous occurrence of RVs and LVs. In SVTs, either the LVs events were delayed or occurred simultaneously with the RVs events. SVT cases with LVs preceding the RVs events were not found. Conclusion The LV-EGM channel enables to distinguish between left- and right-sided premature ventricular complexes. The assessment of the interventricular delay in VTs is useful to differentiate between a possible apical-, left- or right-sided origin of the VT but not to identify SVTs. Key Words Implantable Cardioverter Defibrillator (ICD), Cardiac resynchronization therapy (CRT), LV sensing, RV sensing, Ventricular tachycardia, Supraventricular tachycardia, Left bundle branch block, Heart failure, Interventricular conduction delay

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