scholarly journals Use of myocardial scar characterization to predict ventricular arrhythmia in cardiac resynchronization therapy

EP Europace ◽  
2012 ◽  
Vol 14 (11) ◽  
pp. 1578-1586 ◽  
Author(s):  
J. Fernandez-Armenta ◽  
A. Berruezo ◽  
L. Mont ◽  
M. Sitges ◽  
D. Andreu ◽  
...  
Keyword(s):  
Ventricular Arrhythmia ◽  
Cardiac Resynchronization Therapy ◽  
Myocardial Scar ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy

Ventricular arrhythmia risk is associated with myocardial scar but not with response to cardiac resynchronization therapy

EP Europace ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. 1391-1400
Author(s):  
Markus Linhart ◽  
Adelina Doltra ◽  
Juan Acosta ◽  
Roger Borràs ◽  
Beatriz Jáuregui ◽  
...  
Keyword(s):  
Ventricular Arrhythmia ◽  
Cardiac Resynchronization Therapy ◽  
Primary Outcome ◽  
Left Ventricular ◽  
Myocardial Scar ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Ischaemic Cardiomyopathy ◽  
Crt Response

Abstract Aims Sudden cardiac death (SCD) risk estimation in patients referred for cardiac resynchronization therapy (CRT) remains a challenge. By CRT-mediated improvement of left ventricular ejection fraction (LVEF), many patients loose indication for primary prevention implantable cardioverter-defibrillator (ICD). Increasing evidence shows the importance of myocardial scar for risk prediction. The aim of this study was to investigate the prognostic impact of myocardial scar depending on the echocardiographic response in patients undergoing CRT. Methods and results Patients with indication for CRT were prospectively enrolled. Decision about ICD or pacemaker implantation was based on clinical criteria. All patients underwent delayed-enhancement cardiac magnetic resonance imaging. Median follow-up duration was 45 (24–75) months. Primary outcome was a composite of sustained ventricular arrhythmia, appropriate ICD therapy, or SCD. A total of 218 patients with LVEF 25.5 ± 6.6% were analysed [158 (73%) male, 64.9 ± 10.7 years]. Myocardial scar was observed in 73 patients with ischaemic cardiomyopathy (ICM) (95% of ICM patients); in 62 with non-ischaemic cardiomyopathy (45% of these patients); and in all but 1 of 36 (17%) patients who reached the primary outcome. Myocardial scar was the only significant predictor of primary outcome [odds ratio 27.7 (3.8–202.7)], independent of echocardiographic CRT response. A total of 55 (25%) patients died from any cause or received heart transplant. For overall survival, only a combination of the absence of myocardial scar with CRT response was associated with favourable outcome. Conclusion Malignant arrhythmic events and SCD depend on the presence of myocardial scar but not on CRT response. All-cause mortality improved only with the combined absence of myocardial scar and CRT response.

The anatomic and electrical location of the left ventricular lead predicts ventricular arrhythmia in cardiac resynchronization therapy

Heart Rhythm ◽  
2013 ◽  
Vol 10 (5) ◽  
pp. 668-675 ◽  
Author(s):  
Daniel J. Friedman ◽  
Gaurav A. Upadhyay ◽  
Robert K. Altman ◽  
Mary Orencole ◽  
Conor D. Barrett ◽  
...  
Keyword(s):  
Ventricular Arrhythmia ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Left Ventricular Lead ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Ventricular Lead

Cardiac resynchronization therapy: selection of candidates

2015 ◽  
pp. 405-419
Author(s):  
Victoria Delgado ◽  
Jeroen J. Bax
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Myocardial Scar ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Venous Anatomy ◽  
Ventricular Ejection Fraction ◽  
Left Ventricular Mechanics ◽  
Selection Of

Cardiac resynchronization therapy (CRT) is an established treatment for heart failure patients who remain symptomatic despite optimal medical treatment, with left ventricular ejection fraction <35% and QRS complex with left bundle branch block morphology or duration ≥150 ms. Non-invasive imaging modalities contribute in the evaluation and selection of patients who are candidates for CRT. Evaluation of left ventricular mechanics and dyssynchrony, extent and location of myocardial scar and cardiac venous anatomy are important to estimate the likelihood of favourable response to CRT. This chapter will review the ‘why and how’ to assess cardiac dyssynchrony, myocardial scar, and cardiac venous anatomy, prior to CRT implantation.

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