Antiarrhythmic Effect of Reverse Ventricular Remodeling Induced by Cardiac Resynchronization Therapy. The InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry

Luigi Di Biase, Maurizio Gasparini, Maurizio Lunati, Massimo Santini, Maurizio Landolina, Giuseppe Boriani, Antonio Curnis, Mario Bocchiardo, Antonio Vincenti, Alessandra Denaro, Sergio Valsecchi, Andrea Natale, Luigi Padeletti

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Objectives: We investigated whether the reverse remodeling after cardiac resynchronization therapy (CRT) might reduce the occurrence of ventricular arrhythmias (VAs). Background: It is currently debated whether CRT has an effect on the burden of VAs. Methods: The study included 398 patients treated with a CRT defibrillator and with a follow-up of at least 12 months. Spontaneous VAs detected by the device were reviewed and validated. Results: A significant reduction in VA episodes and shock therapies was evident during the follow-up with greater decrease after 1 month. After 6 months of CRT, 227 patients (57%) showed a reduction in end-systolic volume of ≥10% and were defined as "responders." The baseline characteristics were similar between the responders and the nonresponders. Nonetheless, the proportion of patients with recurrence of VA after 1 month of CRT was significantly lower in responders (32% vs. 43%, p = 0.024). Among baseline variables no parameters emerged as predictors of tachyarrhythmia recurrence. However, receiver-operating curve analysis recognized a reduction of left ventricular end-systolic volume at 6 months of 13% as the best cutoff to identify the reduction of VAs (with a sensitivity of 58% and a specificity of 54%). Conclusions: In patients treated with CRT defibrillators, a reduction in ventricular arrhythmic events occurs during the initial 12 months after implant and is correlated with the degree of ventricular remodeling induced by the therapy. Patients demonstrating reverse remodeling at midterm follow-up show a reduction in arrhythmias soon after the implant, pronounced improvements at long-term, and a better survival.

Original languageEnglish (US)
Pages (from-to)1442-1449
Number of pages8
JournalJournal of the American College of Cardiology
Volume52
Issue number18
DOIs
StatePublished - Oct 28 2008
Externally publishedYes

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Cardiac Resynchronization Therapy
Ventricular Remodeling
Implantable Defibrillators
Registries
Cardiac Arrhythmias
Defibrillators
Convulsive Therapy
Recurrence
Tachycardia
Stroke Volume
Equipment and Supplies
Survival

Keywords

  • cardiac resynchronization therapy
  • defibrillators
  • reverse remodelling
  • ventricular arrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Antiarrhythmic Effect of Reverse Ventricular Remodeling Induced by Cardiac Resynchronization Therapy. The InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry. / Di Biase, Luigi; Gasparini, Maurizio; Lunati, Maurizio; Santini, Massimo; Landolina, Maurizio; Boriani, Giuseppe; Curnis, Antonio; Bocchiardo, Mario; Vincenti, Antonio; Denaro, Alessandra; Valsecchi, Sergio; Natale, Andrea; Padeletti, Luigi.

In: Journal of the American College of Cardiology, Vol. 52, No. 18, 28.10.2008, p. 1442-1449.

Research output: Contribution to journalArticle

Di Biase, L, Gasparini, M, Lunati, M, Santini, M, Landolina, M, Boriani, G, Curnis, A, Bocchiardo, M, Vincenti, A, Denaro, A, Valsecchi, S, Natale, A & Padeletti, L 2008, 'Antiarrhythmic Effect of Reverse Ventricular Remodeling Induced by Cardiac Resynchronization Therapy. The InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry', Journal of the American College of Cardiology, vol. 52, no. 18, pp. 1442-1449. https://doi.org/10.1016/j.jacc.2008.07.043
Di Biase, Luigi ; Gasparini, Maurizio ; Lunati, Maurizio ; Santini, Massimo ; Landolina, Maurizio ; Boriani, Giuseppe ; Curnis, Antonio ; Bocchiardo, Mario ; Vincenti, Antonio ; Denaro, Alessandra ; Valsecchi, Sergio ; Natale, Andrea ; Padeletti, Luigi. / Antiarrhythmic Effect of Reverse Ventricular Remodeling Induced by Cardiac Resynchronization Therapy. The InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry. In: Journal of the American College of Cardiology. 2008 ; Vol. 52, No. 18. pp. 1442-1449.
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abstract = "Objectives: We investigated whether the reverse remodeling after cardiac resynchronization therapy (CRT) might reduce the occurrence of ventricular arrhythmias (VAs). Background: It is currently debated whether CRT has an effect on the burden of VAs. Methods: The study included 398 patients treated with a CRT defibrillator and with a follow-up of at least 12 months. Spontaneous VAs detected by the device were reviewed and validated. Results: A significant reduction in VA episodes and shock therapies was evident during the follow-up with greater decrease after 1 month. After 6 months of CRT, 227 patients (57{\%}) showed a reduction in end-systolic volume of ≥10{\%} and were defined as {"}responders.{"} The baseline characteristics were similar between the responders and the nonresponders. Nonetheless, the proportion of patients with recurrence of VA after 1 month of CRT was significantly lower in responders (32{\%} vs. 43{\%}, p = 0.024). Among baseline variables no parameters emerged as predictors of tachyarrhythmia recurrence. However, receiver-operating curve analysis recognized a reduction of left ventricular end-systolic volume at 6 months of 13{\%} as the best cutoff to identify the reduction of VAs (with a sensitivity of 58{\%} and a specificity of 54{\%}). Conclusions: In patients treated with CRT defibrillators, a reduction in ventricular arrhythmic events occurs during the initial 12 months after implant and is correlated with the degree of ventricular remodeling induced by the therapy. Patients demonstrating reverse remodeling at midterm follow-up show a reduction in arrhythmias soon after the implant, pronounced improvements at long-term, and a better survival.",
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AU - Di Biase, Luigi

AU - Gasparini, Maurizio

AU - Lunati, Maurizio

AU - Santini, Massimo

AU - Landolina, Maurizio

AU - Boriani, Giuseppe

AU - Curnis, Antonio

AU - Bocchiardo, Mario

AU - Vincenti, Antonio

AU - Denaro, Alessandra

AU - Valsecchi, Sergio

AU - Natale, Andrea

AU - Padeletti, Luigi

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N2 - Objectives: We investigated whether the reverse remodeling after cardiac resynchronization therapy (CRT) might reduce the occurrence of ventricular arrhythmias (VAs). Background: It is currently debated whether CRT has an effect on the burden of VAs. Methods: The study included 398 patients treated with a CRT defibrillator and with a follow-up of at least 12 months. Spontaneous VAs detected by the device were reviewed and validated. Results: A significant reduction in VA episodes and shock therapies was evident during the follow-up with greater decrease after 1 month. After 6 months of CRT, 227 patients (57%) showed a reduction in end-systolic volume of ≥10% and were defined as "responders." The baseline characteristics were similar between the responders and the nonresponders. Nonetheless, the proportion of patients with recurrence of VA after 1 month of CRT was significantly lower in responders (32% vs. 43%, p = 0.024). Among baseline variables no parameters emerged as predictors of tachyarrhythmia recurrence. However, receiver-operating curve analysis recognized a reduction of left ventricular end-systolic volume at 6 months of 13% as the best cutoff to identify the reduction of VAs (with a sensitivity of 58% and a specificity of 54%). Conclusions: In patients treated with CRT defibrillators, a reduction in ventricular arrhythmic events occurs during the initial 12 months after implant and is correlated with the degree of ventricular remodeling induced by the therapy. Patients demonstrating reverse remodeling at midterm follow-up show a reduction in arrhythmias soon after the implant, pronounced improvements at long-term, and a better survival.

AB - Objectives: We investigated whether the reverse remodeling after cardiac resynchronization therapy (CRT) might reduce the occurrence of ventricular arrhythmias (VAs). Background: It is currently debated whether CRT has an effect on the burden of VAs. Methods: The study included 398 patients treated with a CRT defibrillator and with a follow-up of at least 12 months. Spontaneous VAs detected by the device were reviewed and validated. Results: A significant reduction in VA episodes and shock therapies was evident during the follow-up with greater decrease after 1 month. After 6 months of CRT, 227 patients (57%) showed a reduction in end-systolic volume of ≥10% and were defined as "responders." The baseline characteristics were similar between the responders and the nonresponders. Nonetheless, the proportion of patients with recurrence of VA after 1 month of CRT was significantly lower in responders (32% vs. 43%, p = 0.024). Among baseline variables no parameters emerged as predictors of tachyarrhythmia recurrence. However, receiver-operating curve analysis recognized a reduction of left ventricular end-systolic volume at 6 months of 13% as the best cutoff to identify the reduction of VAs (with a sensitivity of 58% and a specificity of 54%). Conclusions: In patients treated with CRT defibrillators, a reduction in ventricular arrhythmic events occurs during the initial 12 months after implant and is correlated with the degree of ventricular remodeling induced by the therapy. Patients demonstrating reverse remodeling at midterm follow-up show a reduction in arrhythmias soon after the implant, pronounced improvements at long-term, and a better survival.

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