Cardiac Resynchronization Therapy and Ventricular Arrhythmias

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Cardiac Resynchronization Therapy and Ventricular Arrhythmias

Cardiac Resynchronization Therapy and Ventricular Arrhythmias: Cardiac resynchronisation therapy (CRT) using biventricular pacing prolongs survival in patients with heart failure by improving the pump function of the ventricle. But reversal of normal sequence of myocardial activation :during epicardial pacing in CRT increases the transmural dispersion of repolarization (TDR), which is known to predispose to cardiac arrhythmias. Francisco Leyva and Paul Wx Foley has reviewed this aspect in Indian Pacing and Electrophysiology Journal [1].

The investigators of The InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry report that [2] in patients treated with CRT defibrillators, there is in fact a reduction in ventricular arrhythmic events during the initial 12 months after implantation. This has been correlated with the degree of reverse remodelling of the left ventricle induced by CRT. Those with reverse remodelling show a pronounced long term improvement and better survival. The recurrence rate of ventricular arrhythmias were significantly lesser in the responders than in non – responders to CRT (32% vs. 43%, p = 0.024). In this study of 398 patients, 227 (57%) were defined as responders as they showed 10% or more reduction in end systolic left ventricular volume. The minimum follow up period was 12 months.

References

  1. Francisco Leyva, Paul Wx Foley. Is cardiac resynchronisation therapy proarrhythmic? Indian Pacing Electrophysiol J. 2008;8(4):268-80.
  2. Luigi Di Biase, Maurizio Gasparini, Maurizio Lunati, Massimo Santini, Maurizio Landolina, Giuseppe Boriani, Antonio Curnis, Mario Bocchiardo, Antonio Vincenti, Alessandra Denaro, Sergio Valsecchi, Andrea Natale, Luigi Padeletti, InSync/InSync ICD Italian Registry Investigators. Antiarrhythmic effect of reverse ventricular remodeling induced by cardiac resynchronization therapy: the InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry. J Am Coll Cardiol. 2008 Oct 28;52(18):1442-9.