Ventricular tachycardia or ventricular fibrillation occurs less often in patients with left bundle branch block and combined resynchronization and defibrillators than in patients with narrow QRS and conventional defibrillators
Autor: | Aischa Nitardy, Alice Krebs, Thomas Knaus, Rainer Dietz, Martin Stockburger, Oezlem Celebi, Florian Blaschke, Dirk Habedank |
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Rok vydání: | 2011 |
Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Bundle-Branch Block Cardiac resynchronization therapy Comorbidity Ventricular tachycardia Risk Assessment Disease-Free Survival Sudden cardiac death Coronary artery disease Cardiac Resynchronization Therapy Risk Factors Physiology (medical) Internal medicine Germany medicine Prevalence Humans cardiovascular diseases Ejection fraction Left bundle branch block business.industry Incidence Middle Aged medicine.disease Combined Modality Therapy Survival Analysis Defibrillators Implantable Survival Rate Heart failure Case-Control Studies Ventricular fibrillation Ventricular Fibrillation cardiovascular system Cardiology Tachycardia Ventricular Female Cardiology and Cardiovascular Medicine business |
Zdroj: | Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 14(2) |
ISSN: | 1532-2092 |
Popis: | Aims Mortality in chronic heart failure (CHF) patients with left bundle branch block (LBBB) is high. Cardiac resynchronization therapy (CRT) reduces symptoms and mortality in CHF patients with LBBB. Whether CRT promotes or prevents ventricular tachycardia (VT)/ventricular fibrillation (VF) remains controversial, however. Therefore, we aimed to analyse arrhythmia-related CRT effects and characterized the VT/VF incidence in CRT-defibrillator patients and matched controls with conventional implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death. Methods and results We enrolled 134 patients [110 men, left ventricular ejection fraction (LVEF) 24 ± 8%, 71 coronary artery disease, CRT–ICD 67, conventional ICD matched controls 67, follow-up 31 ± 17 months] and monitored overall survival and the time to a first VT/VF episode. Controls did not have LBBB. They were otherwise matched for age, LVEF, and follow-up duration. Gender and underlying disease did not differ between the groups. Kaplan–Meier analysis revealed more favourable arrhythmia-free survival in CRT–ICD vs. conventional ICD patients [hazard ratio (HR) 2.26, confidence interval (CI) 1.09–4.67, log rank P = 0.023]. The difference persisted in the multivariate Cox regression analysis (HR 3.25, CI 1.18–8.93, P = 0.022). Overall survival was similar in both groups (HR 1.45, CI 0.55–3.82, P = 0.45). Conclusions Chronic heart failure patients with LBBB treated with CRT–ICD, experience less and delayed VT/VF episodes compared with matched controls without LBBB receiving conventional ICD. In the long-term, CRT appears to exert antiarrhythmic effects and to attenuate the particularly high arrhythmia-related risk of CHF patients with LBBB. The incremental benefit of adding the ICD option to CRT pacing in LBBB patients appears questionable. |
Databáze: | OpenAIRE |
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