Antiarrhythmic effect of reverse electrical remodeling associated with cardiac resynchronization therapy

Larisa Tereshchenko, Charles Henrikson, Peter Stempniewicz, Lichy Han, Ronald D. Berger

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Antiarrhythmic and proarrhythmic effects of cardiac resynchronization therapy (CRT) remain controversial. We hypothesized that reverse electrical remodeling (RER) with CRT is associated with reduced frequency of ventricular tachyarrhythmias (VTs). Methods: The width of native and paced QRS was measured in lead II electrocardiogram before and 13 ± 7 months after implantation of a CRT defibrillator device in 69 patients (mean age 66.3 ± 13.9; 39 males [83%]) with bundle branch block (BBB) (41 patients with left BBB and three patients with bifascicular block) or nonspecific intraventricular conduction delay (25 patients, 36%), and New York Heart Association class III-IV heart failure. Biventricular pacing was inhibited for 10 seconds to record native QRS. RER was defined as a decrease in the native QRS duration ≥10 ms compared to preimplant. Patients were followed prospectively 24 ± 13 months after assessment for electrical remodeling. Results: RER was observed in 22 patients (32%), among whom QRS duration decreased by 30.9 ± 14.1 ms (P <0.00001) with similar heart rate and QRS morphology. Native QRS duration increased by 10.3 ± 16.6 ms in the other 47 patients (68%) (P = 0.0001). Baseline mean ejection fraction did not differ between patients with and those without RER (24.9 ± 10.0 vs 24.2 ± 8.6%, NS). During 2 ± 1 years of further follow-up, 19 patients had VTs and 12 patients died. RER was associated with a fourfold decrease in the risk of death or sustained VTs requiring appropriate implantable cardioverter-defibrillator therapies, whichever came first (hazard ratio 0.25; 95% confidence interval 0.08-0.85; P = 0.026). Conclusion: RER of the native conduction with CRT is associated with decreased mortality and antiarrhythmic effect of CRT. (PACE 2011; 34:357-364)

Original languageEnglish (US)
Pages (from-to)357-364
Number of pages8
JournalPACE - Pacing and Clinical Electrophysiology
Volume34
Issue number3
DOIs
StatePublished - Mar 2011
Externally publishedYes

Fingerprint

Atrial Remodeling
Cardiac Resynchronization Therapy
Tachycardia
Bundle-Branch Block
Cardiac Resynchronization Therapy Devices
Defibrillators
Implantable Defibrillators
Electrocardiography
Heart Failure
Heart Rate

Keywords

  • cardiac resynchronization therapy
  • electrical remodeling
  • heart failure
  • ventricular tachyarrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Antiarrhythmic effect of reverse electrical remodeling associated with cardiac resynchronization therapy. / Tereshchenko, Larisa; Henrikson, Charles; Stempniewicz, Peter; Han, Lichy; Berger, Ronald D.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 34, No. 3, 03.2011, p. 357-364.

Research output: Contribution to journalArticle

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abstract = "Background: Antiarrhythmic and proarrhythmic effects of cardiac resynchronization therapy (CRT) remain controversial. We hypothesized that reverse electrical remodeling (RER) with CRT is associated with reduced frequency of ventricular tachyarrhythmias (VTs). Methods: The width of native and paced QRS was measured in lead II electrocardiogram before and 13 ± 7 months after implantation of a CRT defibrillator device in 69 patients (mean age 66.3 ± 13.9; 39 males [83{\%}]) with bundle branch block (BBB) (41 patients with left BBB and three patients with bifascicular block) or nonspecific intraventricular conduction delay (25 patients, 36{\%}), and New York Heart Association class III-IV heart failure. Biventricular pacing was inhibited for 10 seconds to record native QRS. RER was defined as a decrease in the native QRS duration ≥10 ms compared to preimplant. Patients were followed prospectively 24 ± 13 months after assessment for electrical remodeling. Results: RER was observed in 22 patients (32{\%}), among whom QRS duration decreased by 30.9 ± 14.1 ms (P <0.00001) with similar heart rate and QRS morphology. Native QRS duration increased by 10.3 ± 16.6 ms in the other 47 patients (68{\%}) (P = 0.0001). Baseline mean ejection fraction did not differ between patients with and those without RER (24.9 ± 10.0 vs 24.2 ± 8.6{\%}, NS). During 2 ± 1 years of further follow-up, 19 patients had VTs and 12 patients died. RER was associated with a fourfold decrease in the risk of death or sustained VTs requiring appropriate implantable cardioverter-defibrillator therapies, whichever came first (hazard ratio 0.25; 95{\%} confidence interval 0.08-0.85; P = 0.026). Conclusion: RER of the native conduction with CRT is associated with decreased mortality and antiarrhythmic effect of CRT. (PACE 2011; 34:357-364)",
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