Impact of cardiac reverse remodeling after cardiac resynchronization therapy assessed by myocardial perfusion imaging on ventricular arrhythmia
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Although cardiac resynchronization therapy (CRT) has been a useful treatment of heart failure, patients with CRT are still in risk of sudden cardiac death due to ventricular arrhythmia. The aim of this study was to investigate the impact of cardiac reverse remodeling after CRT on the prevalence of ventricular tachycardia or fibrillation (VT/VF).
Methods and Results
Forty-one heart failure patients (26 men, age 66 ± 10 years), who were implanted with CRT for at least 12 months, were enrolled. All patients received myocardial perfusion imaging (MPI) under CRT pacing to evaluate left ventricle (LV) function, dyssynchrony, and scar. VT/VF episodes during the follow-up period after MPI were recorded by the CRT devices. Sixteen patients (N = 16/41, 39%) were found to have VT/VF. Multivariate Cox regression analysis and receiver operating characteristic curve analysis showed that five risk factors were significant predictors of VT/VF, including increased left ventricle ejection fraction (LVEF) by ≤7% after CRT, low LVEF after CRT (≤30%), change of intrinsic QRS duration (iQRSd) by ≤7 ms, wide iQRSd after CRT (≥121 ms), and high systolic dyssynchrony after CRT (phase standard deviation ≥45.6°). For those patients with all of the 5 risk factors, 85.7% or more developed VT/VF.
The characteristics of cardiac reverse remodeling after CRT as assessed by MPI are associated with the prevalence of ventricular arrhythmia.
KeywordsHeart failure cardiac resynchronization therapy phase analysis reverse remodeling
Left bundle branch block
Mechanical reverse remodeling
Electrical reverse remodeling
Intrinsic QRS duration before CRT
Intrinsic QRS duration after CRT with transient turn-off of CRT pacing
Phase standard deviation
Phase histogram bandwidth
Change of LVEF after CRT by echography
Change of iQRSd during CRT pacing
Change of iQRSd during CRT off
This study was supported in part by grants from the Taiwan National Science Council (NSC-100-2314-B-075A-005-MY3, 101-2314-B-758-002-, 102-2314-B-758-001-, 103-2314-B-758-001- and NSC-100-2314-B-075A-005-MY3) and grants from the Taichung Veterans General Hospital (TCVGH-1023105C, 1033106C, 1043106C, 1043102B, 1053106C).
Dr. Chen receives royalties from the sale of the Emory Cardiac Toolbox with SyncTool. The terms of this arrangement have been approved by Emory University in accordance with its conflict-of-interest practice. All authors declare that they have no conflict of interest.
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