Improvement of Left Ventricular Function under Cardiac Resynchronization Therapy Goes along with a Reduced Incidence of Ventricular Arrhythmia |
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Authors: | Christian Eickholt Marcus Siekiera Kiriakos Kirmanoglou Astrid Rodenbeck Nicole Heussen Patrick Schauerte Artur Lichtenberg Jan Balzer Tienush Rassaf Stefan Perings Malte Kelm Dong-In Shin Christian Meyer |
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Affiliation: | 1. Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmology and Angiology, Dusseldorf, Germany.; 2. Division of Cardiology, Pulmology and Angiology, University Hospital RWTH-Aachen, Aachen, Germany.; 3. Department of Medical Statistics, University Hospital RWTH-Aachen, Aachen, Germany.; 4. Heinrich-Heine-University Duesseldorf, Department of Cardiovascular Surgery, Dusseldorf, Germany.; Tokai University, Japan, |
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Abstract: | ObjectivesThe beneficial effects of cardiac resynchronization therapy (CRT) are thought to result from favorable left ventricular (LV) reverse remodeling, however CRT is only successful in about 70% of patients. Whether response to CRT is associated with a decrease in ventricular arrhythmias (VA) is still discussed controversially. Therefore, we investigated the incidence of VA in CRT responders in comparison with non-responders.MethodsIn this nonrandomized, two-center, observational study patients with moderate-to-severe heart failure, LV ejection fraction (LVEF) ≤35%, and QRS duration >120 ms undergoing CRT were included. After 6 months patients were classified as CRT responders or non-responders. Incidence of VA was compared between both groups by Kaplan-Meier analysis and Cox regression analysis. ROC analysis was performed to determine the aptitude of LVEF cut-off values to predict VA.ResultsIn total 126 consecutive patients (64±11years; 67%male) were included, 74 were classified as responders and 52 as non-responders. While the mean LVEF at baseline was comparable in both groups (25±7% vs. 24±8%; P = 0.4583) only the responder group showed an improvement of LVEF (36±6% vs. 24±7; p<0.0001) under CRT. In total in 56 patients VA were observed during a mean follow-up of 28±14 months, with CRT responders experiencing fewer VA than non-responders (35% vs. 58%, p<0.0061). Secondary preventive CRT implantation was associated with a higher likelihood of VA. As determined by ROC analysis an increase of LVEF by >7% was found to be a predictor of a significantly lower incidence of VA (AUC = 0.606).ConclusionsImprovement of left ventricular function under cardiac resynchronization therapy goes along with a reduced incidence of ventricular arrhythmia. |
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