2015


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2015/№6

Ventricular arrhythmias and survival of patients after cardiac resynchronization therapy in the setting of real-life clinical practice

Rychkov A. Yu., Kuznetsov V. A., Khorkova N. Yu., Dyuryagina E. L., Kharats V. E.
Branch of the Federal State Budgetary Science Institution, “Research Institute of Cardiology” at the Siberian Branch of the Russian Academy of Medical Sciences, “Tyumen Cardiology Center”, Melnikaite 111, Tyumen 625026

Keywords: ventricular arrhythmia, cardiac resynchronization therapy

DOI: 10.18087/rhj.2015.6.2114

Background. Chronic HF increases the risk for sudden cardiac death (SCD) from life-threatening ventricular tachyarrhythmia. An important method of treatment for CHF is cardiac resynchronization therapy (CRT). Aim. To study the rate of ventricular arrhythmias and survival of patients with CHF and implanted systems with a function of cardioverter defibrillator (CRT-D and ICD) in real-life clinical practice. Materials and methods. We performed a retrospective analysis of data on outpatient management of 95 patients with ICD and 104 patients with CRT-D. Post-implantation periods up to 36 months were analyzed. Results. Appropriate ICD discharges were recorded in 33 (17 %) patients (reasons for discharge were ventricular fibrillation in 9 patients and frequent ventricular tachycardia in 24 patients). Cumulative survival to the first appropriate discharge was 88 % for 12 months, 78 % for 24 months, and 74 % for 36 months in the ICD group and 96, 90, and 86 %, respectively, in the implantable CRT-D group (log-rank p=0.028). 31 patients died for the entire period of observation. Cumulative survival was 99 % for 12 months, 90 % for 24 months, and 86 % for 36 months in the ICD group and 97, 81, 78 %, respectively, in the implantable CRT-D group (log-rank p=0.041). There were no differences in the incidence of composite endpoint in these groups. Cox regression analysis revealed interrelations of differences in frequencies and CHF FC (p=0.027). Conclusion. The frequency of ventricular arrhythmias is lower in patients with CRT-D than in patients with ICD. Survival of patients with CRT-D was lower than in the ICD group due to more severe CHF in real-life clinical practice.
  1. Effect of metoprolol CR / XL in chronic heart failure: Metoprolol CR / XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999 Jun 12;353 (9169):2001–7.
  2. Сапельников О. В., Алтыпов Р. С., Гришин И. Р., Мареев Ю. В., Саидова М. А., Акнурин Р. С. Антитахикардитические и ресинхронизирующие устройства в лечении сердечной недостаточности и профилактике внезапной смерти. Кардиология. 2011;51 (9):60–7.
  3. Кузнецов В. А. Сердечная ресинхронизирующая терапия: избранные вопросы. – М.: Абис, 2007. – 128с.
  4. Мареев В. Ю., Агеев Ф. Т., Арутюнов Г. П., Коротеев А. В., Мареев Ю. В., Овчинников А. Г. и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Журнал Сердечная Недостаточность. 2013;14 (7):379–472.
  5. Ревишвили А. Ш., Ардашев А. В., Бойцов С. А., Бокерия О. Л., Голухова Е. З., Давтян К. В. и др. Клинические рекомендации по проведению электрофизиологических исследований, катетерной абляции и применению имплантируемых антиаритмических устройств. 3‑е издание. – М.: МАКС Пресс, 2013. – 596 с.
  6. Barsheshet A, Wang PJ, Moss AJ, Solomon SD, Al-Ahmad A, McNitt S et al. Reverse remodeling and the risk of ventricular tachyarrhythmias in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). J Am Coll Cardiol. 2011 Jun 14;57 (24):2416–23.
  7. Kutyifa V, Pouleur AC, Knappe D, Al-Ahmad A, Gibinski M, Wang PJ et al. Dyssynchrony and the risk of ventricular arrhythmias. JACC Cardiovasc Imaging. 2013 Apr;6 (4):432–44.
  8. Cleland JG, Pellicori P, Dicken B. Why does CRT reduce the risk of arrhythmias? JACC Cardiovasc Imaging. 2013 Apr;6 (4):445–7.
  9. Ruwald MH, Solomon SD, Foster E, Kutyifa V, Ruwald AC, Sherazi S et al. Left ventricular ejection fraction normalization in cardiac resynchronization therapy and risk of ventricular arrhythmias and clinical outcomes: results from the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT) trial. Circulation. 2014 Dec 23;130 (25):2278–86.
  10. Tompkins CM, Kutyifa V, Arshad A, McNitt S, Polonsky B, Wang PJ et al. Sex differences in device therapies for ventricular arrhythmias or death in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) Trial. J Cardiovasc Electrophysiol. 2015 Aug;26 (8):862–71.
  11. Кузнецов В. А., Чуркевич Т. О., Колунин Г. В., Харац В. Е., Павлов А. В., Криночкин Д. В. и др. Отдаленные результаты влияния сердечной ресинхронизирующей терапии на выживаемость пациентов с хронической сердечной недостаточностью и низкой фракцией выброса левого желудочка. Журнал Сердечная Недостаточность. 2010;11 (4):203–5.
  12. Masoudi FA, Mi X, Curtis LH, Peterson PN, Curtis JP, Fonarow GC et al. Comparative effectiveness of cardiac resynchronization therapy with an implantable cardioverter-defibrillator versus defibrillator therapy alone: a cohort study. Ann Intern Med. 2014 May 6;160 (9):603–11.
Rychkov A. Yu., Kuznetsov V. A., Khorkova N. Yu., Dyuryagina E. L., Kharats V. E. Ventricular arrhythmias and survival of patients after cardiac resynchronization therapy in the setting of real-life clinical practice. Russian Heart Journal. 2015;14 (6):397–401

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