Key result
Upgrading from an ICD to a CRT-D was associated with a reduction in total ventricular arrhythmia episodes (from 305 to 193) and ICD therapies (from 157 to 74).
Why the study?
Reports regarding the pro-arrhythmic or anti-arrhythmic potential of CRT are controversial, and little is known about the relationship between VA and LV-lead threshold.
Does upgrading from ICD to CRT-D reduce ventricular arrhythmias in patients with implantable cardioverter-defibrillators?
Cohort (n=102)
Does upgrading from ICD to CRT-D reduce ventricular arrhythmias in patients with implantable cardioverter-defibrillators?
Upgrading from ICD to CRT-D is generally associated with a reduction in ventricular arrhythmias and ICD therapies, though a subset of patients may experience a pro-arrhythmic effect potentially linked to LV lead threshold changes.
Answers are grounded in this paper and cite their sources.
May support CRT-D upgrade consideration in select ICD patients; leaves open randomized confirmation and pro-arrhythmic subset identification.
BACKGROUND: There are some controversial reports related to the pro-arrhythmic or anti-arrhythmic potential of cardiac resynchronization therapy (CRT) and little is known about the relationship between ventricular arrhythmia (VA) and left ventricular (LV)-lead threshold. HYPOTHESIS: Upgrade CRT is anti-arrhythmic effect of VA with implantable cardioverter-defibrillator (ICD) patients and has a relationship with the incident of VA and LV-lead threshold. METHODS: Among 384 patients with the implantation of CRT-defibrillator (CRT-D), 102 patients underwent an upgrade from ICD to CRT-D. We divided patients into three groups; anti-arrhythmic effect after upgrade (n = 22), pro-arrhythmic effect (n = 14), and unchanging-VA events (n = 66). The VA event was determined by device reports. We described the electrocardiography parameters, LV-lead characteristics, and clinical outcomes. RESULTS: Before upgrade, the numbers of VA were 305 episodes and the numbers of ICD therapy were 157 episodes. While after upgrade, the numbers of VA were 193 episodes and the number of ICD therapy were 74 episodes. Ventricular tachycardia cycle length (VT-CL) after upgrade was significantly slower as compared to those with before upgrade. Pro-arrhythmic group was significantly higher with delta LV-lead threshold (after 1 month-baseline) as compared to those with anti-arrhythmic group (0.74 vs -0.21 V). Furthermore, pro-arrhythmic group was significantly bigger with delta VT-CL (after 3 months-before 3 months) as compared to those with anti-arrhythmic group (P = .03). CONCLUSIONS: We described upgrade-CRT was associated with reduction of VA, ICD therapies and VT-CL. While 14 patients had a pro-arrhythmic effect and LV lead threshold might be associated with VA-incidents.
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Kawamura et al. (2019) conducted a cohort in Ventricular arrhythmias in patients with implantable cardioverter-defibrillators (n=102). Upgrade to cardiac resynchronization therapy-defibrillator (CRT-D) vs. Before upgrade (baseline) was evaluated on Ventricular arrhythmia (VA) episodes and ICD therapies. Upgrading from an ICD to a CRT-D was associated with a reduction in total ventricular arrhythmia episodes (from 305 to 193) and ICD therapies (from 157 to 74).
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