scholarly journals Device complications with addition of defibrillation to cardiac resynchronisation therapy for primary prevention

Heart ◽  
2018 ◽  
Vol 104 (18) ◽  
pp. 1529-1535 ◽  
Author(s):  
Sérgio Barra ◽  
Rui Providência ◽  
Serge Boveda ◽  
Rudolf Duehmke ◽  
Kumar Narayanan ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Cardiac Resynchronisation Therapy ◽  
Late Complications ◽  
Increased Risk ◽  
Significant Difference ◽  
Cardiac Resynchronisation ◽  
Acute Complications ◽  
Resynchronisation Therapy ◽  
History Of

ObjectiveIn patients indicated for cardiac resynchronisation therapy (CRT), the choice between a CRT-pacemaker (CRT-P) versus defibrillator (CRT-D) remains controversial and indications in this setting have not been well delineated. Apart from inappropriate therapies, which are inherent to the presence of a defibrillator, whether adding defibrillator to CRT in the primary prevention setting impacts risk of other acute and late device-related complications has not been well studied and may bear relevance for device selection.MethodsObservational multicentre European cohort study of 3008 consecutive patients with ischaemic or non-ischaemic dilated cardiomyopathy and no history of sustained ventricular arrhythmias, undergoing CRT implantation with (CRT-D, n=1785) or without (CRT-P, n=1223) defibrillator. Using propensity score and competing risk analyses, we assessed the risk of significant device-related complications requiring surgical reintervention. Inappropriate shocks were not considered except those due to lead malfunction requiring lead revision.ResultsAcute complications occurred in 148 patients (4.9%), without significant difference between groups, even after considering potential confounders (OR=1.20, 95% CI 0.72 to 2.00, p=0.47). During a mean follow-up of 41.4±29 months, late complications occurred in 475 patients, giving an annual incidence rate of 26 (95% CI 9 to 43) and 15 (95% CI 6 to 24) per 1000 patient-years in CRT-D and CRT-P patients, respectively. CRT-D was independently associated with increased occurrence of late complications (HR=1.68, 95% CI 1.27 to 2.23, p=0.001). In particular, when compared with CRT-P, CRT-D was associated with an increased risk of device-related infection (HR 2.10, 95% CI 1.18 to 3.45, p=0.004). Acute complications did not predict overall late complications, but predicted device-related infection (HR 2.85, 95% CI 1.71 to 4.56, p<0.001).ConclusionsCompared with CRT-P, CRT-D is associated with a similar risk of periprocedural complications but increased risk of long-term complications, mainly infection. This needs to be considered in the decision of implanting CRT with or without a defibrillator.

P181 Implantable cardioverter defibrillator and cardiac resynchronisation therapy use in New Zealand

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
F S Foo ◽  
M Lee ◽  
A J Kerr
Keyword(s):  
Heart Failure ◽  
New Zealand ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Cardiac Resynchronisation Therapy ◽  
Bundle Branch Block ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
History Of ◽  
Qrs Duration

Abstract Introduction The ANZACS-QI DEVICE registry is a national registry designed to collect data on all cardiac implantable electronic devices (CIED) implanted in New Zealand (NZ). This study aims to provide a contemporary analysis of the clinical characteristics and implant details of patients receiving implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT), including CRT-Pacemaker (CRT-P) and CRT-Defibrillator (CRT-D). Methods Complete datasets of ICD, CRT-D and CRT-P implants from the ANZACS-QI DEVICE registry from 1st January 2014 to 31st December 2017 were analysed.  Results A total of 1579 ICD implants were identified. Of the 1152 (73.0%) new implants, 565 (49.0%) were for primary prevention and 587 (51.0%) were for secondary prevention. The baseline demographics of both groups were similar, with a median age of 62 and predominantly male (79.2-81.4%), with European (63.7-66.8%) and Maori (21.1-24.8%) being the most common ethnicities. The mean BMI was 29.6-30.2 kg/m², with most patients (75.2-80.7%) being in sinus rhythm at the time of ICD implant. Compared to the secondary prevention group, the primary prevention group had more patients with a history of heart failure (80.4% vs 39.7%), worse heart failure symptoms (NYHA Class II-III 77.1% vs 47.3%), poorer left ventricular ejection fraction (LVEF) (mean 25.1% vs 30.3%) and the aetiology was more likely to be non-ischaemic (57.5% vs 44.2%). The mean QRS duration was longer (129.9ms vs 113.4ms), with a higher incidence of left bundle branch block (31.9% vs 16.0%) and a correspondingly higher rate of CRT-D implants (27.4% vs 8.3%).  In the 427 (27.0%) ICD replacements, over a mean duration of 6.27 years, 46.6% had delivered appropriate therapy (including 38.4% with appropriate ICD shocks) whilst 17.8% had delivered inappropriate therapy. Compared to primary prevention CRT-D (n = 155), patients receiving CRT-P (n = 175) were older (median age 74 vs 66) and more likely to be female (38.3% vs 19.4%). CRT-D patients had longer mean QRS duration (169.2ms vs 160.8ms) and poorer LVEF (mean 24.3% vs 28.7%). Conclusion This analysis provides contemporary data on ICD and CRT use in New Zealand. Primary prevention ICD patients were more likely to have a history of heart failure, worse heart failure symptoms, more prolonged QRS duration, left bundle branch block and poorer LV function compared to secondary prevention ICD. Compared to primary prevention CRT-D, patients receiving CRT-P were older and more likely to be female.

The Significance of Renal Function in Response to Cardiac Resynchronisation Therapy – The Piece of a Much Larger Puzzle

2020 ◽  
Vol 18 ◽  
Author(s):  
Agnieszka Dębska-Kozłowska ◽  
Izabela Warchoł ◽  
Marcin Książczyk ◽  
Andrzej Lubiński
Keyword(s):  
Renal Function ◽  
Nyha Class ◽  
Heart Association ◽  
Cardiac Resynchronisation Therapy ◽  
Study Groups ◽  
Creatinine Concentration ◽  
Significant Difference ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Background: Although cardiac resynchronisation therapy (CRT) is an important player in the treatment of heart failure (HF) patients, the proportion of CRT patients with no improvement in either echocardiographic or clinical parameters remains consistently high and accounts for about 30% despite meeting CRT implantation criteria. Furthermore, in patients suffering from HF, renal dysfunction accounts for as many as 30-60%. Accordingly, CRT may improve renal function inducing a systemic haemodynamic benefit leading to increased renal blood flow. Objectives: The aim of the present study was to evaluate the importance of renal function in response to resynchronisation therapy during a 12-month follow-up period. Materials and methods: The study consisted of 46 HF patients qualified for implantation of cardiac resynchronisation therapy defibrillator (CRT-D). A CRT responder is defined as a person without chronic HF exacerbations during observation whose physical efficiency has improved owing to New York Heart Association (NYHA) class improvement ≥1. Results: A statistically significant difference was noted between responders and non-responders regarding creatinine level at the 3rd month (p=0.04) and, particularly, at the 12th month (p=0.02) of follow-up (100±23 vs 139±78 μmol/l). Moreover, there was a remarkable difference between both study groups with regard to GFR CKD-EPI (glomerular filtration rate (GFR) assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula) at the 6th (p=0.03) and 12th month (p=0.01) of follow-up. The reference values for initial creatinine concentrations (101 μmol/l) as well as GFR CKD-EPI (63 ml/min/1.73m2 ) were empirically evaluated to predict favourable therapeutic CRT response. Conclusions: Predictive value of GFR CKD-EPI and creatinine concentration for a positive response to CRT were found relevant.

scholarly journals Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

2021 ◽  
Author(s):  
Philippe C. Wouters ◽  
Geert E. Leenders ◽  
Maarten J. Cramer ◽  
Mathias Meine ◽  
Frits W. Prinzen ◽  
...  
Keyword(s):  
Systolic Function ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Lv Function ◽  
Peak Strain ◽  
Cardiac Resynchronisation ◽  
Reverse Remodelling ◽  
Resynchronisation Therapy ◽  
Lv Systolic Function

AbstractPurpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.

Congenitally corrected transposition of the great arteries (CCTGA)

2021 ◽  
Vol 14 (6) ◽  
pp. e242069
Author(s):  
Neil Grech ◽  
Alexander Borg ◽  
Mark Adrian Sammut ◽  
Maryanne Caruana
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Resynchronisation Therapy ◽  
Ace Inhibition ◽  
Systemic Right Ventricle ◽  
Cardiac Resynchronisation ◽  
Transient Improvement ◽  
Resynchronisation Therapy ◽  
History Of ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

A 33-year-old man presented with a 3-week history of breathlessness and cough. He disclosed that he was informed regarding a heart defect as a child in his home country but was unaware of its nature and was never followed up. Examination revealed a pansystolic murmur (loudest at the apex), a hyperdynamic, displaced apex, and pulmonary oedema. An ECG showed atrial fibrillation with a regular broad-complex ventricular rhythm. Following electrical cardioversion, the ECG revealed complete heart block, therefore explaining the regular atrial fibrillation. An urgent transthoracic echocardiography (TTE) confirmed the anatomy of congenitally corrected transposition of the great arteries (CCTGA) with torrential tricuspid regurgitation and impaired systemic right ventricle. Cardiac MRI identified a ventricular septal defect which was not visible on TTE. The patient showed a transient improvement following fluid offloading and ACE inhibition, with a more definitive improvement after cardiac resynchronisation therapy (CRT).

P534Central sleep apnea in pacing-induced cardiomyopathy: prevalence, improvement by upgrading to cardiac resynchronisation therapy and impact on structural responder rates and long-term outcome

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Barbieri ◽  
A Adukauskaite ◽  
A Heidbreder ◽  
E Brandauer ◽  
M Bergmann ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Right Ventricular Pacing ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Abstract Funding Acknowledgements ÖNB Jubiläumsfondsprojekt Nr. 15974, ISR grant by Boston Scientific, St. Paul, MN, USA Background Central sleep apnea (CSA) in pacing induced cardiomyopathy (PICM) is poorly studied. Specifically, it is unknown whether upgrading from right ventricular pacing (RVP) to cardiac resynchronisation therapy (CRT) improves CSA. Methods Fifty-three patients with impaired left ventricular ejection fraction, frequent right ventricular pacing due to high-grade atrioventricular block and heart failure symptoms despite optimal medical therapy underwent upgrading to CRT. Within one month after left ventricular lead implantation (but still not activated), sleep apnea was assessed in all participants by single-night polysomnography (PSG). Nineteen patients with moderate or severe CSA defined by an apnea hypopnea index (AHI) &gt; 15 events per hour were re-scheduled for a follow up PSG 3-5 months after initiation of cardiac resynchronization therapy. Of this cohort, thirteen patients with stable mild heart failure agreed to be randomized to CRT versus RVP in a cross-over design. Results CSA (AHI &gt; 5 events per hour) was diagnosed in 26 (49.1%), OSA in 16 (30.2%) patients suffering from PICM . Eleven (20.8%) patients did not have any form of sleep apnea. Moderate to severe CSA (AHI &gt; 15 events per hour) was significantly improved (without specific CPAP therapy) by 102 (96-172) days of CRT: AHI decreased from 39.4 events per hour at baseline to 21.6 by CRT (p &lt; 0.001). Furthermore, CRT led to a substantial decrease in left ventricular endsystolic volumes: baseline 141 ml (103-155), significant improvement under CRT (102 ml, 65-138; p &lt; 0.001), whereas no effect with ongoing RV-pacing (147 ml, 130-161; p = 0.865). Preexistent CSA did not affect the structural response of CRT (56.5% in patients with CSA, 62.5% of patients with obstructive sleep apnea and 54.5% in patients without sleep apnea; p = 0.901) and had no impact on major adverse cardiac events (p = 0.412) and/or survival (p = 0.623) during long-term follow-up. Conclusions CSA is highly prevalent in patients with PICM and is significantly improved by upgrading to CRT. Preexistent CSA does not hamper structural improvement and long-term outcome after upgrading to CRT. Thus, CSA seems to occur as a consequence of PICM, rather than as a pathophysiological mediator. Abstract Figure.

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