Influence of vitamin D on the percentage time of cardiac resynchronization in patients with heart failure, premature ventricular complexes, and chronic kidney disease

Abstract

Introduction

Recent studies have shown that in chronic kidney disease (CKD) 25(OH)D deficiency or insufficiency are a significant risk factor for cardiovascular diseases, sudden cardiac death and mortality. The high incidence of premature ventricular complexes (PVCs) have increasingly been recognized as a primary cause for worsening left ventricular systolic function and heart failure in some patients, specialty when these subjects are under optimal treatment and have implantable cardiac defibrillator (ICD) with cardiac resynchronization therapy (CRT), because the great amount of PVCs reduces the percentage of cardiac resynchronization.

Aim

Our aim was to evaluate the influence of reposition of cholecalciferol in patients with deficiency of vitamin D in the changes of the numbers of PVCs, and consequently in the percentage of cardiac resynchronization time, during 6 months of follow-up.

Methods and results

We conducted a prospective, longitudinal study of 56 patients with high incidence of PVCs, heart failure under optimal treatment, ICD + CRT, deficiency of vitamin D (≤ 20 ng/mL) and CKD (estimated glomerular filtration rate measured by MDRD equation, between 16 and 59 mL/min/1.73 m²). All patients were treated with cholecalciferol. We observed significant ameliorating after cholecalciferol onset in the number of PVCs, CRT % time, renal function, vitamin D levels and plasmatic ions at the 6th month of follow-up vs. baseline.

Conclusions

We suggest that the effectiveness of cholecalciferol reposition for subjects with high incidence of PVCs, heart failure under optimal treatment, ICD + CRT, deficiency of vitamin D and CKD, restoring the function of the CRT, bringing the biventricular pacing to nearby 97%.