Predictors and outcomes of cardiac resynchronization therapy extended to the second generator

Xuping Li, Dachun Yang, Fred Kusumoto, Win Kuang Shen, Siva Mulpuru, Shenghua Zhou, Jinjun Liang, Gang Wu, Mei Yang, Jin Qu Liu, Paul Andrew Friedman, Yong-Mei Cha

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background A proportion of patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) live to receive a second generator. Controversy exists on whether an implantable cardioverter-defibrillator (ICD) should be offered to patients who have normalized or near-normalized left ventricular ejection fraction (LVEF) at the time of generator replacement (GR). Objective The purpose of this study was to evaluate incidence of appropriate ICD therapy after CRT-D GR. Methods This series involved 1026 consecutive patients who underwent CRT-D implant between January 1, 2002 and December 31, 2012. Echocardiography was assessed before the initial device implant and before GR. ICDs were monitored at our device clinic in person or remotely, or both. Results Of the cohort, 227 patients (22.1%) underwent CRT-D GR at our institution. Approximately 48% of the patients who received new CRT-D generators were no longer meeting the guidelines indication for ICD use at the time of GR. These patients received subsequent appropriate ICD therapies at a significantly lower rate than those with LVEF <35% (12% vs 35%; P <.001). Of these patients, 47 (20.7%) had LVEF improvement to ≥50% at the time of GR. ICD therapy for ventricular arrhythmia in the ischemic group was 18.2%, while no patient in the nonischemic group received ICD therapy from the second generator after GR. Conclusion Improvement in LVEF after CRT-D GR is associated with significantly reduced incidence of appropriate ICD therapy. Ventricular arrhythmia is less likely to develop with normalized LVEF in nonischemic cardiomyopathy.

Original languageEnglish (US)
Pages (from-to)1793-1800
Number of pages8
JournalHeart Rhythm
Volume14
Issue number12
DOIs
StatePublished - Dec 1 2017

Fingerprint

Cardiac Resynchronization Therapy
Implantable Defibrillators
Defibrillators
Stroke Volume
Cardiac Arrhythmias
Therapeutics
Equipment and Supplies
Incidence
Cardiomyopathies
Echocardiography
Guidelines

Keywords

  • Cardiac resynchronization therapy
  • Defibrillator therapy
  • Generator replacement
  • Mortality
  • Outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Predictors and outcomes of cardiac resynchronization therapy extended to the second generator. / Li, Xuping; Yang, Dachun; Kusumoto, Fred; Shen, Win Kuang; Mulpuru, Siva; Zhou, Shenghua; Liang, Jinjun; Wu, Gang; Yang, Mei; Liu, Jin Qu; Friedman, Paul Andrew; Cha, Yong-Mei.

In: Heart Rhythm, Vol. 14, No. 12, 01.12.2017, p. 1793-1800.

Research output: Contribution to journalArticle

Li, X, Yang, D, Kusumoto, F, Shen, WK, Mulpuru, S, Zhou, S, Liang, J, Wu, G, Yang, M, Liu, JQ, Friedman, PA & Cha, Y-M 2017, 'Predictors and outcomes of cardiac resynchronization therapy extended to the second generator', Heart Rhythm, vol. 14, no. 12, pp. 1793-1800. https://doi.org/10.1016/j.hrthm.2017.09.002
Li, Xuping ; Yang, Dachun ; Kusumoto, Fred ; Shen, Win Kuang ; Mulpuru, Siva ; Zhou, Shenghua ; Liang, Jinjun ; Wu, Gang ; Yang, Mei ; Liu, Jin Qu ; Friedman, Paul Andrew ; Cha, Yong-Mei. / Predictors and outcomes of cardiac resynchronization therapy extended to the second generator. In: Heart Rhythm. 2017 ; Vol. 14, No. 12. pp. 1793-1800.
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abstract = "Background A proportion of patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) live to receive a second generator. Controversy exists on whether an implantable cardioverter-defibrillator (ICD) should be offered to patients who have normalized or near-normalized left ventricular ejection fraction (LVEF) at the time of generator replacement (GR). Objective The purpose of this study was to evaluate incidence of appropriate ICD therapy after CRT-D GR. Methods This series involved 1026 consecutive patients who underwent CRT-D implant between January 1, 2002 and December 31, 2012. Echocardiography was assessed before the initial device implant and before GR. ICDs were monitored at our device clinic in person or remotely, or both. Results Of the cohort, 227 patients (22.1{\%}) underwent CRT-D GR at our institution. Approximately 48{\%} of the patients who received new CRT-D generators were no longer meeting the guidelines indication for ICD use at the time of GR. These patients received subsequent appropriate ICD therapies at a significantly lower rate than those with LVEF <35{\%} (12{\%} vs 35{\%}; P <.001). Of these patients, 47 (20.7{\%}) had LVEF improvement to ≥50{\%} at the time of GR. ICD therapy for ventricular arrhythmia in the ischemic group was 18.2{\%}, while no patient in the nonischemic group received ICD therapy from the second generator after GR. Conclusion Improvement in LVEF after CRT-D GR is associated with significantly reduced incidence of appropriate ICD therapy. Ventricular arrhythmia is less likely to develop with normalized LVEF in nonischemic cardiomyopathy.",
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T1 - Predictors and outcomes of cardiac resynchronization therapy extended to the second generator

AU - Li, Xuping

AU - Yang, Dachun

AU - Kusumoto, Fred

AU - Shen, Win Kuang

AU - Mulpuru, Siva

AU - Zhou, Shenghua

AU - Liang, Jinjun

AU - Wu, Gang

AU - Yang, Mei

AU - Liu, Jin Qu

AU - Friedman, Paul Andrew

AU - Cha, Yong-Mei

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background A proportion of patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) live to receive a second generator. Controversy exists on whether an implantable cardioverter-defibrillator (ICD) should be offered to patients who have normalized or near-normalized left ventricular ejection fraction (LVEF) at the time of generator replacement (GR). Objective The purpose of this study was to evaluate incidence of appropriate ICD therapy after CRT-D GR. Methods This series involved 1026 consecutive patients who underwent CRT-D implant between January 1, 2002 and December 31, 2012. Echocardiography was assessed before the initial device implant and before GR. ICDs were monitored at our device clinic in person or remotely, or both. Results Of the cohort, 227 patients (22.1%) underwent CRT-D GR at our institution. Approximately 48% of the patients who received new CRT-D generators were no longer meeting the guidelines indication for ICD use at the time of GR. These patients received subsequent appropriate ICD therapies at a significantly lower rate than those with LVEF <35% (12% vs 35%; P <.001). Of these patients, 47 (20.7%) had LVEF improvement to ≥50% at the time of GR. ICD therapy for ventricular arrhythmia in the ischemic group was 18.2%, while no patient in the nonischemic group received ICD therapy from the second generator after GR. Conclusion Improvement in LVEF after CRT-D GR is associated with significantly reduced incidence of appropriate ICD therapy. Ventricular arrhythmia is less likely to develop with normalized LVEF in nonischemic cardiomyopathy.

AB - Background A proportion of patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) live to receive a second generator. Controversy exists on whether an implantable cardioverter-defibrillator (ICD) should be offered to patients who have normalized or near-normalized left ventricular ejection fraction (LVEF) at the time of generator replacement (GR). Objective The purpose of this study was to evaluate incidence of appropriate ICD therapy after CRT-D GR. Methods This series involved 1026 consecutive patients who underwent CRT-D implant between January 1, 2002 and December 31, 2012. Echocardiography was assessed before the initial device implant and before GR. ICDs were monitored at our device clinic in person or remotely, or both. Results Of the cohort, 227 patients (22.1%) underwent CRT-D GR at our institution. Approximately 48% of the patients who received new CRT-D generators were no longer meeting the guidelines indication for ICD use at the time of GR. These patients received subsequent appropriate ICD therapies at a significantly lower rate than those with LVEF <35% (12% vs 35%; P <.001). Of these patients, 47 (20.7%) had LVEF improvement to ≥50% at the time of GR. ICD therapy for ventricular arrhythmia in the ischemic group was 18.2%, while no patient in the nonischemic group received ICD therapy from the second generator after GR. Conclusion Improvement in LVEF after CRT-D GR is associated with significantly reduced incidence of appropriate ICD therapy. Ventricular arrhythmia is less likely to develop with normalized LVEF in nonischemic cardiomyopathy.

KW - Cardiac resynchronization therapy

KW - Defibrillator therapy

KW - Generator replacement

KW - Mortality

KW - Outcome

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