Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review

2019 ◽  
Vol 41 (21) ◽  
pp. 1976-1986 ◽  
Author(s):  
Sérgio Barra ◽  
Rui Providência ◽  
Kumar Narayanan ◽  
Serge Boveda ◽  
Rudolf Duehmke ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sudden Cardiac Death ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Death ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Heart Failure Patients ◽  
The Difference ◽  
Over Time

Abstract Aims While data from randomized trials suggest a declining incidence of sudden cardiac death (SCD) among heart failure patients, the extent to which such a trend is present among patients with cardiac resynchronization therapy (CRT) has not been evaluated. We therefore assessed changes in SCD incidence, and associated factors, in CRT recipients over the last 20 years. Methods and results Literature search from inception to 30 April 2018 for observational and randomized studies involving CRT patients, with or without defibrillator, providing specific cause-of-death data. Sudden cardiac death was the primary endpoint. For each study, rate of SCD per 1000 patient-years of follow-up was calculated. Trend line graphs were subsequently constructed to assess change in SCD rates over time, which were further analysed by device type, patient characteristics, and medical therapy. Fifty-three studies, comprising 22 351 patients with 60 879 patient-years of follow-up and a total of 585 SCD, were included. There was a gradual decrease in SCD rates since the early 2000s in both randomized and observational studies, with rates falling more than four-fold. The rate of decline in SCD was steeper than that of all-cause mortality, and accordingly, the proportion of deaths which were due to SCD declined over the years. The magnitude of absolute decline in SCD was more prominent among CRT-pacemaker (CRT-P) patients compared to those receiving CRT-defibrillator (CRT-D), with the difference in SCD rates between CRT-P and CRT-D decreasing considerably over time. There was a progressive increase in age, use of beta-blockers, and left ventricular ejection fraction, and conversely, a decrease in QRS duration and antiarrhythmic drug use. Conclusion Sudden cardiac death rates have progressively declined in the CRT heart failure population over time, with the difference between CRT-D vs. CRT-P recipients narrowing considerably.

P1462Incidence of ventricular arrhythmias in cardiac resynchronization therapy and implantable cardioverter-defibrillator patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Roubicek ◽  
J Morava ◽  
J Stros ◽  
P Kucera ◽  
R Polasek
Keyword(s):  
Heart Failure ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Secondary Prevention ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Death ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardioverter Defibrillator

Abstract Introduction Implantation of a cardiac resynchronization therapy combined with cardioverter-defibrillator (CRT-D) is now common practice. Our study looked at the occurrence of the first adequate CRT-D therapy with respect to gender, treatment indication (primary or secondary prevention of sudden cardiac death) and the etiology of heart failure in long-term follow-up. Methods In the database of CRT-D patients implanted between 2005 and 2013 we analyzed the occurrence of treated episodes of ventricular arrhythmia (first shock or anti-tachycardic pacing). Results 250 patients (22.8% females) with left bundle branch block or non-specific interventricular conduction delay were enrolled. 80% of patients were implanted in the primary and 20% in the secondary prevention of sudden cardiac death. During the follow-up of 5.5 ± 2.5 years, 46.4% of patients died for cardiac (25.6%) or non-cardiac (20.8%) reasons. CRT-D therapy occurred in 33.2% of patients (20.8% shock). In patients implanted in the primary prevention of sudden cardiac death the incidence of therapies was 25.5% vs. 64.0% in patients implanted in the secondary prevention of sudden cardiac death (P˂0.00001). The incidence of therapies between the group of patients with coronary artery disease and other causes of heart failure did not differ (33.3% vs. 32.9%, P = NS). Women were at a significantly lower risk of adequate shock (women 10.5% vs. men 23.8%, P = 0.01). Conclusion Adequate CRT-D therapy occurred in a quarter of patients implanted in the primary prevention of sudden cardiac death. In patients implanted in the secondary prevention of sudden cardiac death the incidence of therapies is significantly more frequent. The female gender predicts significantly lower incidence of adequate shock. Abstract Figure. Adequate shock therapy

scholarly journals Sudden cardiac death after implantation of a cardiac resynchronization therapy pacemaker: a case report illustrating that not always less is more

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Dirk Vollmann ◽  
Claudius Hansen ◽  
Peter Hunold ◽  
Lars Lüthje
Keyword(s):  
Heart Failure ◽  
Sudden Cardiac Death ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Death ◽  
Patient Characteristics ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Less Is More

Abstract Background Cardiac resynchronization therapy (CRT) improves symptoms and survival in selected patients with systolic heart failure and ventricular conduction delay. In subjects without prior life-threatening ventricular arrhythmia, clinicians have to select between implanting a CRT pacemaker (CRT-P) or a more complex device with additional defibrillator capability (CRT-D). This individual decision can be challenging in light of the available evidence and the potential risks and benefits. Case summary A 76-year-old male with non-ischaemic cardiomyopathy, heart failure New York Heart Association Class III, left bundle branch block (QRS duration 185 ms) and a left ventricular ejection fraction of 30% despite optimal medical therapy was indicated for CRT. In light of the patient characteristics and clinical condition, a CRT-P device was implanted. No complication occurred, and the patient was discharged after an appropriate device function was confirmed. Despite the clinical improvement, he died suddenly without prior symptoms approximately 2 months thereafter. Post-mortem device interrogation provided no evidence for device malfunction and confirmed sudden cardiac death (SCD) due to spontaneous ventricular fibrillation. Discussion Patients indicated for CRT often have overlapping internal cardioverter defibrillator indication for the primary prevention of SCD. By weighing individual risks and potential benefits, clinicians have to decide whether to implant a CRT-P (less is more) or a more complex and costly CRT-D device. Despite careful consideration of patient characteristics and clinical conditions, however, SCD can occur in subjects categorized as low risk and implanted with a CRT-P. More data from randomized clinical trials are needed to better support physicians in the often challenging process of selecting the most appropriate device for CRT.

EFFICACY OF CARDIAC RESYNCHRONIZATION THERAPY IN HEART FAILURE AT HUE UNIVERSITY HOSPITAL

2012 ◽  
pp. 37-43
Author(s):  
Anh Tien Hoang ◽  
Anh Tuan Ho ◽  
Van Minh Huynh ◽  
Van Dien Nguyen
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Nyha Class ◽  
Pacemaker Implantation ◽  
University Hospital ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Heart Failure Patients ◽  
Ventricular Dyssynchrony

Background: Cardiac resynchronization therapy is one of new methods used to treating patients with heart failure who have ventricular dyssynchrony. Objectives: 1. To study clinical, laboratory characteristis of heart failure patients with ventricular dyssynchrony. 2. To study the efficacy of cardiac resynchronization therapy in treating such group of patients. Materials and method: From February 2009 to February 2011, we implanted biventricular pacemakers at Hue University Hospital for 15 patients who had NYHA class III and IV heart failure and had been treated with optimal medical therapy, LVEF ≤35%, QRS duration ≥ 120ms. Result: 14/15 cases succeeded, cardiac function improved after 1 year follow – up of biventricular pacemaker implantation, with significantly increased EF, decreased LVIDd, PAPs. At the cut off of EF <30%, the rate of patients with EF <30% declined chronologically (1 year of follow – up). Functional symptoms improved overtly according to NYHA class. The choice of A-V delay and V-V delay is very important. Optimal A-V delay and V-V delay after programming were (152±8.33)ms and (26.33±6.31)ms, retrospectively. Conclusion: Cardiac resynchronization therapy is effective in improving heart failure patients with ventricular dyssynchronization.

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