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Impact of synchronized left ventricular pacing rate on risk for ventricular tachyarrhythmias after cardiac resynchronization therapy in patients with heart failure

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Abstract

Background

The adaptive cardiac resynchronization therapy (aCRT) algorithm automatically produces synchronized left ventricular pacing (sLVP) with intrinsic atrioventricular conduction to improve clinical outcomes. However, relationship between sLVP percentage and risk for ventricular tachyarrhythmia (VT/VF) remains unclear. This study aimed to evaluate the clinical impact of sLVP rate on VT/VF occurrence.

Methods

In total, 1,419 device interrogation data from 42 consecutive patients who underwent new aCRT device implantation were retrospectively analyzed. The primary endpoint was the first time VT/VF episode after aCRT device implantation.

Results

During a median follow-up of 34 months, 15 patients had VT/VF episodes. Patients were divided into a high sLVP (the average sLVP percentage of ≥ 51.5%, n = 27) or low sLVP group (< 51.5%, n = 15). The high sLVP group had a significantly lower VT/VF incidence (22% vs. 60%; p = 0.014) and an independent predictor for VT/VF occurrence on multivariate analysis (hazard ratio 0.21; p = 0.007). LV ejection fraction improvements after 6 months (12.3 ± 8.7% vs. 2.8 ± 10.3%; p = 0.004) and 12 months (13.8 ± 9.3% vs. 6.2 ± 11.1%; p = 0.030) were significantly greater in the high sLVP group than in the low sLVP group. Age, PR interval, and left atrial diameter were significantly associated with the sLVP rate after aCRT.

Conclusions

Patients with high sLVP percentage after aCRT had lower long-term risk of VT/VF incidence with a favorable response to CRT. A synchronized pacing algorithm using intrinsic conduction may prevent malignant arrhythmias, as well as recover cardiac functions.

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Author information

Authors and Affiliations

  1. Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Takashi Okajima, Yasuya Inden, Satoshi Yanagisawa, Kazumasa Suga, Masafumi Shimojo, Toshifumi Nakagomi, Naoki Tsurumi, Ryo Watanabe, Noriyuki Suzuki, Rei Shibata & Toyoaki Murohara

  2. Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Satoshi Yanagisawa & Rei Shibata

Authors
  1. Takashi Okajima
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  2. Yasuya Inden
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  3. Satoshi Yanagisawa
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  4. Kazumasa Suga
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  5. Masafumi Shimojo
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  6. Toshifumi Nakagomi
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  11. Toyoaki Murohara
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Takashi Okajima, Satoshi Yanagisawa, and Yasuya Inden. The first draft of the manuscript was written by Takashi Okajima and all authors commented on previous versions of the manuscript. Rei Shibata and Toyoaki Murohara supervised this work. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yasuya Inden.

Ethics declarations

Ethics approval

Approval was obtained from the local ethics committee of Nagoya University Hospital. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

Drs. Yanagisawa and Shibata are affiliated with a department sponsored by Medtronic Japan. Other authors have no conflict of interest.

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Okajima, T., Inden, Y., Yanagisawa, S. et al. Impact of synchronized left ventricular pacing rate on risk for ventricular tachyarrhythmias after cardiac resynchronization therapy in patients with heart failure. J Interv Card Electrophysiol 65, 239–249 (2022). https://doi.org/10.1007/s10840-022-01284-z

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  • DOI: https://doi.org/10.1007/s10840-022-01284-z

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