scholarly journals Evaluation of potential underuse of cardiac resynchronization therapy for heart failure with reduced ejection fraction

2021 ◽  
Author(s):  
Makoto Takano ◽  
Yui Nakayama ◽  
Hisao Matsuda ◽  
Tomoo Harada ◽  
Yoshihiro J. Akashi
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Reduced Ejection Fraction

scholarly journals Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy in the Treatment of Heart Failure with Reduced Ejection Fraction

2017 ◽  
Vol 10 ◽  
Author(s):  
Ilaria Spoletini ◽  
Andrew Coats
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Resynchronization Therapy ◽  
Device Therapy ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Cardioverter Defibrillators

It has been long acknowledged that electrical-conduction disturbances may be both a cause of heart failure and a consequence of it. In fact, many patients with heart failure have an asynchronous contraction pattern of the heart muscle that further reduces the heart ability to pump blood. Electrical disturbances may therefore result in progressive left ventricular dysfunction, due to the added effects of HF-related electrical dyssynchrony. For this reason, device therapy may play a key role in the management of patients with heart failure and reduced ejection fraction (HFrEF). In particular, Implantable Cardioverter- Defibrillators (ICD) and Cardiac Resynchronization Therapy (CRT) may improve ejection fraction by reestablishing mechanical synchrony, possibly reversing symptoms and signs of heart failure, in addition to the more obvious role of ICD in terminating ventricular arrhythmias that threaten sudden death. Recommendations on device therapy from the current guidelines on heart failure management put out by the ESC/HFA in 2016 update our understanding of the evidence base for the use of ICD and CRT in HFrEF. We review these recommendations and the evidence behind them.

scholarly journals Cardiac resynchronization therapy with or without defibrillator in patients with heart failure

EP Europace ◽  
2021 ◽  
Author(s):  
Benedikt Schrage ◽  
Lars H Lund ◽  
Michael Melin ◽  
Lina Benson ◽  
Alicia Uijl ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Outpatient Clinic ◽  
Cox Regression ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Abstract Aims Randomized data on the efficacy/safety of cardiac resynchronization therapy with vs. without defibrillator (CRT-D,-P) in heart failure with reduced ejection fraction (HFrEF) are scarce. We aimed to evaluate survival associated with use of CRT-D vs. CRT-P in a contemporary cohort with HFrEF. Methods and results Patients from Swedish HF Registry treated with CRT-D/CRT-P and fulfilling criteria for primary prevention defibrillator use were included. Logistic regression was used to evaluate predictors of CRT-D non-use. All-cause mortality was compared in CRT-D vs. CRT-P by Cox regression in a 1 : 1 propensity-score-matched cohort. Of 1988 patients with CRT, 1108 (56%) had CRT-D and 880 (44%) CRT-P. Older age, higher ejection fraction (EF), female sex, and the lack of referral to HF nurse-led outpatient clinic were major determinants of CRT-D non-use. After matching, 645 CRT-D patients were compared with 645 with CRT-P. The CRT-D use was associated with lower 1- and 3-year all-cause mortality [hazard ratio (HR):0.76, 95% confidence interval (CI):0.58–0.98; HR: 0.82, 95% CI: 0.68–0.99, respectively]. Results were consistent in all pre-specified subgroups except for CRT-D use being associated with lower 3-year mortality in patients with an EF < 30% but not in those with an EF ≥ 30% (HR: 0.73, 95% CI: 0.59–0.89 and HR: 1.24, 95% CI: 0.83–1.85, respectively; P-interaction = 0.02). Conclusion In a contemporary HFrEF cohort, CRT-D was associated with lower mortality compared with CRT-P. The CRT-D use was less likely in older patients, females, and in patients not referred to HF nurse-led outpatient clinic. Our findings support the use of CRT-D vs. CRT-P in HFrEF, in particular with severely reduced EF.

scholarly journals Beta Blockers Up-Titration in Patients with Heart Failure Reduced Ejection Fraction and Cardiac Resynchronization Therapy, a Single Center Study

2019 ◽  
Vol 7 (6) ◽  
pp. 71
Author(s):  
Daniele Masarone ◽  
Marina Verrengia ◽  
Ernesto Ammendola ◽  
Rita Gravino ◽  
Fabio Valente ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Β Blockers ◽  
Group 2 ◽  
Group 1

Clinical trials have shown the benefits of β-blockers therapy in patients with heart failure reduced ejection fraction. These benefits include improved survival and a reduced need for hospitalization. Cardiac resynchronization therapy has emerged as an essential device-based therapy for symptomatic patients with heart failure reduced ejection fraction despite optimal pharmacologic treatment. The extent to which β-blockers are being utilized in patients receiving cardiac resynchronization therapy is not well known. In this study, we evaluate the possibility of increasing β-blockers doses in an unselected cohort of heart failure reduced ejection patients after cardiac resynchronization therapy capable defibrillator system implantation and the correlation between β-blockers treatments and clinical outcome. Methods and results: Patients with heart failure reduced ejection fraction in β-blockers therapy that underwent cardiac resynchronization therapy capable defibrillator system implantation between July 2008, and December 2016 were enrolled in the study. The β-blockers dose was determined at the time of discharge and during follow-up. Cardiovascular mortality, hospitalization for worsening heart failure or arrhythmic storm and appropriate intervention of the device, were recorded. The study cohort included 480 patients, 289 patients (60.3%) had β-blockers doses equal to the dose before CRT (Group 1), 191 patients (39.7%) had higher β-blockers doses than those before the CRT implant (Group 2). Comparing the two groups, Group 2 have lower cardiovascular mortality, heart failure-related hospitalization, and arrhythmic events than Group 1. Conclusion: After initiating CRT, β-blockers could be safely up-titrated at higher doses with the reduction in mortality, heart failure-related hospitalization, and arrhythmic events.

P1496Impact of electrical reverse remodeling by cardiac resynchronization therapy on adverse cardiac events in patients of heart failure with reduced ejection fraction

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
H Kobayashi ◽  
A Okada ◽  
H Tabata ◽  
W Shoin ◽  
T Okano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Primary Endpoint ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Resynchronization Therapy ◽  
Cardiac Events ◽  
Reduced Ejection Fraction ◽  
Adverse Cardiac Events

Abstract Background Recently, structural reverse remodeling (SRR) and electrical reverse remodeling (ERR) after cardiac resynchronization therapy (CRT) have been reported in patients of heart failure with reduced ejection fraction (HFrEF). However the relationship between ERR and subsequent adverse cardiac events is still unknown. We aimed to elucidate the impact of ERR after CRT on the occurrence of heart failure events and ventricular arrhythmias. Methods A total of 36 HFrEF patients who underwent newly CRT implantation were investigated retrospectively. The intrinsic QRS duration (iQRSd) had been recorded before and more than 6 months after CRT implantation. Biventricular pacing was temporarily turned off during measurement of iQRSd. ERR was defined as positive shortening of iQRSd and SRR was defined as reduction of left ventricular end systolic volume by more than 15% after CRT implantation. The primary endpoint was a composite of all cause death, heart failure hospitalizations and ventricular tachyarrhythmia events. Results ERR was observed in 17 patients (47.2%) and SRR in 22 patients (61.1%). The group with ERR included more patients with lower NYHA class prior to CRT and patients with SRR. The primary endpoint was observed in 15 patients (51.4 %) for a median of 181 [63, 367] days during follow-up. Kaplan-Meier analysis revealed that the group without ERR was poor prognosis compared with the group with ERR (p = 0.022, Log-rank test). Conclusion Patients of HFrEF with ERR after CRT may have fewer adverse cardiac events such as worsening heart failure or ventricular arrhythmia events from this short-term study. Abstract Figure. Adverse cardiac events and ERR

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