Aims: Trials have shown that cardiac resynchronization therapy (CRT) is effective in patients with 'non-ischaemic cardiomyopathy'. Patients with post-surgical valvular cardiomyopathy (PSVCM) have been excluded from such trials. We sought to compare the clinical outcome of CRT in patients with PSVCM, idiopathic dilated cardiomyopathy (IDCM), or ischaemic cardiomyopathy (ICM).
Methods And Results: Clinical events and response to CRT were quantified in 556 patients (PSVCM = 38; IDCM = 165; ICM = 353) over 4.52 years [median, inter-quartile range (IQR): 4.42]. Response to CRT was defined as survival for ≥1 year free of hospitalizations plus improvement by ≥1 NYHA class or ≥25% in 6-min walking distance. Cardiac resynchronization therapy was initiated at 5.86 years (median, IQR: 9.86) after aortic valve replacement (73.7%) or mitral valve replacement/repair (44.7%). Compared with PSVCM, IDCM was associated with a lower total mortality [hazards ratio, HR: 0.54 (95% confidence interval, CI 0.34-0.84)], cardiac mortality [HR: 0.43 (95% CI 0.26-0.70)], and total mortality or major adverse cardiovascular events [HR: 0.57 (95% CI 0.37-0.87)], independent of known confounders. Compared with PSVCM, ICM was associated with a similar risk of death from pump failure [HR: 0.83 (95% CI 0.50-1.37)] and IDCM was associated with a lower risk [HR: 0.46 (95% CI 0.26-0.82)]. Response to CRT was similar across the groups.
Conclusions: Compared with IDCM, PSVCM was associated with a worse outcome after CRT. Outcomes from PSVCM were similar to ICM. These findings indicate that PSVCM behaves very differently to IDCM after CRT.
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http://dx.doi.org/10.1093/europace/euv287 | DOI Listing |
Cureus
December 2024
Cardiology, Quillen College of Medicine, East Tennessee State University, Johnson City, USA.
Cardiac implantable electronic devices (CIEDs), including pacemakers, implantable cardiac defibrillators (ICD), and cardiac resynchronization therapy (CRT) devices, regulate heart rate and rhythm in patients with cardiac conditions. With an aging population, CIED-related complications, especially pacemaker pocket infections, are rising. Risk factors include frailty, older age, and superficial device fixation, while risk mitigation involves larger pocket sizes, submuscular fixation, and absorbable antibacterial envelopes.
View Article and Find Full Text PDFJ Mol Cell Cardiol Plus
March 2024
Department of Physiology and Cardiology, the Netherlands.
This paper reviews the literature on assessing electrical dyssynchrony for patient selection in cardiac resynchronization therapy (CRT). The guideline-recommended electrocardiographic (ECG) criteria for CRT are QRS duration and morphology, established through inclusion criteria in large CRT trials. However, both QRS duration and LBBB morphology have their shortcomings.
View Article and Find Full Text PDFJ Clin Med
December 2024
Division of Cardiovascular Medicine, Tufts Medical Center, Boston, MA 02111, USA.
: Heart failure is the leading cause of hospital admission and mortality. Racial disparities have been demonstrated in various cardiovascular disorders; however, the data for in-hospital outcomes, complications, and procedural rates are limited. : Utilizing the National Inpatient Sample (NIS) database, this retrospective cohort study included adult patients admitted with a principal diagnosis of heart failure.
View Article and Find Full Text PDFStrahlenther Onkol
January 2025
TUM School of Medicine and Health, Department of Radiation Oncology, Technische Universität München (TUM), Klinikum rechts der Isar, Munich, Germany.
Purpose: Increasing life expectancy and advances in cancer treatment will lead to more patients needing both radiation therapy (RT) and cardiac implantable electronic devices (CIEDs). CIEDs, including pacemakers and defibrillators, are essential for managing cardiac arrhythmias and heart failure. Telemetric monitoring of CIEDs checks battery status, lead function, settings, and diagnostic data, thereby identifying software deviations or damage.
View Article and Find Full Text PDFAnn Thorac Surg Short Rep
December 2024
Department of Pediatric Cardiothoracic Surgery, Children's Hospital of New Orleans, New Orleans, Louisiana.
An infant with DiGeorge syndrome, multiple comorbidities, and truncus arteriosus type II underwent repair complicated by heart block necessitating placement of a dual-chamber bipolar pacing system with right ventricular leads and subsequent resynchronization with placement of left ventricular apical pacing leads. Resynchronization therapy improved QRS duration from 180 ms to 100 ms and ejection fraction from 25% to 54% over the course of 4 weeks with gradual return to normal function and eventual discharge.
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