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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Antiarrhythmic Effect of Reverse Ventricular Remodeling Induced by Cardiac Resynchronization Therapy

The InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry

Luigi Di Biase, MD^_*,, Maurizio Gasparini, MD, Maurizio Lunati, MD, Massimo Santini, MD^||, Maurizio Landolina, MD^¶, Giuseppe Boriani, MD^#, Antonio Curnis, MD^_**, Mario Bocchiardo, MD, Antonio Vincenti, MD, Alessandra Denaro, MS, Sergio Valsecchi, PhD, Andrea Natale, MD^{||||,##,¶¶,_*}, Luigi Padeletti, MD^_*** on behalf of the InSync/InSync ICD Italian Registry Investigators

^_* University of Foggia, Foggia, Italy
Cleveland Clinic, Cleveland, Ohio
IRCCS Istituto Clinico Humanitas, Rozzano (Milan), Italy
Niguarda Hospital, Milan, Italy
^|| S. Filippo Neri Hospital, Rome, Italy
^¶ Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy
^# University of Bologna and Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy
^_** Ospedali Civili, Brescia, Italy
Ospedale Civile, Asti, Italy
S. Gerardo dei Tintori, Monza, Italy
Medtronic Italia, Rome, Italy
^|||| Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
^¶¶ Division of Cardiology, Stanford University, Palo Alto, California
^## Case Western Reserve University, Cleveland, Ohio
^_*** University of Florence, Florence, Italy

Manuscript received January 15, 2008; revised manuscript received June 27, 2008, accepted July 9, 2008.

^_* Reprint requests and correspondence: Dr. Andrea Natale, Executive Medical Director of the Texas Cardiac Arrhythmia Institute at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, Texas 78705 (Email: dr.natale{at}gmail.com).

Objectives: We investigated whether the reverse remodeling after cardiac resynchronization therapy (CRT) might reduce the occurrence of ventricular arrhythmias (VAs).

Background: It is currently debated whether CRT has an effect on the burden of VAs.

Methods: The study included 398 patients treated with a CRT defibrillator and with a follow-up of at least 12 months. Spontaneous VAs detected by the device were reviewed and validated.

Results: A significant reduction in VA episodes and shock therapies was evident during the follow-up with greater decrease after 1 month. After 6 months of CRT, 227 patients (57%) showed a reduction in end-systolic volume of 10% and were defined as "responders." The baseline characteristics were similar between the responders and the nonresponders. Nonetheless, the proportion of patients with recurrence of VA after 1 month of CRT was significantly lower in responders (32% vs. 43%, p = 0.024). Among baseline variables no parameters emerged as predictors of tachyarrhythmia recurrence. However, receiver-operating curve analysis recognized a reduction of left ventricular end-systolic volume at 6 months of 13% as the best cutoff to identify the reduction of VAs (with a sensitivity of 58% and a specificity of 54%).

Conclusions: In patients treated with CRT defibrillators, a reduction in ventricular arrhythmic events occurs during the initial 12 months after implant and is correlated with the degree of ventricular remodeling induced by the therapy. Patients demonstrating reverse remodeling at midterm follow-up show a reduction in arrhythmias soon after the implant, pronounced improvements at long-term, and a better survival.

Key Words: cardiac resynchronization therapy • defibrillators • reverse remodelling • ventricular arrhythmias

Abbreviations and Acronyms   CRT = cardiac resynchronization therapy   HF = heart failure   ICD = implantable cardioverter-defibrillator   IVMD = interventricular mechanical delay   LV = left ventricle/ ventricular   LVEDD = left ventricular end-diastolic diameter   LVEDV = left ventricular end-diastolic volume   LVEF = left ventricular ejection fraction   LVESD = left ventricular end-systolic diameter   LVESV = left ventricular end-systolic volume   NYHA = New York Heart Association   VA = ventricular arrhythmia

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