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CLINICAL RESEARCH: ARRHYTHMIAS, RIGHT VENTRICULAR FUNCTION, AND MITRAL REGURGITATION

Impact of Upgrade to Cardiac Resynchronization Therapy on Ventricular Arrhythmia Frequency in Patients With Implantable Cardioverter-Defibrillators

Cengiz Ermis, MD^_*, Ryan Seutter, MD^_*, Alan X. Zhu, MD^_*, Lauren C. Benditt, BA^_*, Laura VanHeel, RN, Scott Sakaguchi, MD, FACC^_*,, Keith G. Lurie, MD, FACC^_*,, Fei Lu, MD, PhD^_*, and David G. Benditt, MD, FACC^_*,,_*

^_* Cardiac Arrhythmia Center, University of Minnesota Medical School, Minneapolis, Minnesota
Central Minnesota Heart Center, St. Cloud Hospital, St. Cloud, Minnesota.

Manuscript received March 13, 2005; revised manuscript received April 2, 2005, accepted April 13, 2005.

^_* Reprint requests and correspondence: Dr. David G. Benditt, MMC 508, University of Minnesota Hospital-Fairview, 420 Delaware Street SE, Minneapolis, Minnesota 55455. (Email: bendi001{at}umn.edu).

OBJECTIVES: This study compared cardiac resynchronization therapy’s (CRT) impact on ventricular tachyarrhythmia susceptibility in patients who, due to worsening heart failure (HF) symptoms, underwent a replacement of a conventional implantable cardioverter-defibrillator (ICD) with a CRT-ICD.

BACKGROUND: Cardiac resynchronization therapy is an effective addition to conventional treatment of HF in many patients with left ventricular systolic dysfunction. However, whether CRT-induced improvements in HF status also reduce susceptibility to life-threatening arrhythmias is less certain.

METHODS: Clinical and ICD electrogram data were evaluated in 18 consecutive ICD patients who underwent an upgrade to CRT-ICD. Pharmacologic HF therapy was not altered during follow-up. The definition of ventricular tachycardia (VT) and ventricular fibrillation (VF) for each patient was as determined by device programming. Statistical comparisons used paired t tests.

RESULTS: Findings were recorded during two time periods: 47 ± 21 months (range 24 to 70 months) before and 14 ± 2 months (range 9 to 18 months) after CRT upgrade. At time of upgrade, patient age was 69 ± 11 years and ejection fraction was 21 ± 8%. Before CRT the frequency of VT, VF, and appropriate ICD shocks was 0.31 ± 1.23, 0.047 ± 0.083, and 0.048 ± 0.085 episodes/month/patient, respectively. After CRT-ICD, VT and VF arrhythmia burdens and frequency of shocks were respectively 0.13 ± 0.56, 0.001 ± 0.004, and 0.003 ± 0.016 episodes/month/patient (p = 0.59, 0.03, and 0.05 vs. pre-CRT).

CONCLUSIONS: Arrhythmia frequency and number of appropriate ICD treatments were reduced after upgrade to CRT-ICD for HF treatment. Thus, apart from hemodynamic benefits, CRT may also ameliorate ventricular tachyarrhythmia susceptibility in HF patients.

Abbreviations and Acronyms   ATP = antitachycardia pacing   CARE-HF = Cardiac Resynchronization Heart Failure trial   COMPANION = Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure trial   CRT = cardiac resynchronization therapy   HF = heart failure   ICD = implantable cardioverter-defibrillator   LVEF = left ventricular ejection fraction   MIRACLE = Multicenter InSync Randomized Clinical Evaluation trial   NYHA = New York Heart Association   VF = ventricular fibrillation   VT = ventricular tachycardia

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