Predicting Ventricular Tachyarrhythmias in Patients With Left Ventricular Ejection Fraction Improvement Following Cardiac Resynchronization Therapy

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology Pub Date : 2025-04-08 DOI:10.1111/anec.70059

Adam Visca, Saadia Sherazi, Ilan Goldenberg, Scott McNitt, Nikhila Rao, Nilesh Rao, Ahmed Shah, Mehmet Aktas, Valentina Kutyifa, Wojciech Zareba, Krishna Rao

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引用次数: 0

Abstract

Background

Patients undergoing cardiac resynchronization therapy with a defibrillator (CRT-D) often experience improvements in the left ventricular ejection fraction (LVEF). This study aimed to identify predictors of ventricular tachyarrhythmias (VTA) in patients with CRT-D devices and LVEF improvement beyond guideline recommendations for a defibrillator.

Methods

Patients randomized to the CRT-D arm of the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy trial who improved their LVEF to > 35% at 12 months following CRT-D implant were included in this analysis (N = 651). Predictors of an appropriate implantable cardioverter defibrillator (ICD) Rx VTA were evaluated by Cox proportional hazards regression modeling.

Results

We identified three predictors of VTA among patients treated with CRT-D subsequent to LVEF improvement > 35%: Lower range improvement in LVEF 36%–40% versus improvement to > 40% (HR, 1.97; 95% CI, 1.21–3.20; p = 0.006); Baseline non-LBBB ECG morphology (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.23–3.04; p = 0.004); Occurrence of VTA during the first year post-CRT-D (HR, 4.91; 95% CI, 2.99–8.07; p < 0.001).

Conclusions

We identified a sub-group of patients with risk factors who remain at high risk of VTA despite improvement in LVEF following CRT implant. These patients require close monitoring despite improvement in LVEF beyond guideline recommendations for an ICD.

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来源期刊

Annals of Noninvasive Electrocardiology 医学-心血管系统

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.