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43 results on '"Roka, Attila"'

28. Reduced appropriate implantable cardioverter-defibrillator therapy after cardiac resynchronization therapy-induced left ventricular function recovery: a meta-analysis and systematic review

Author

Chatterjee, Neal A., Roka, Attila, Lubitz, Steven A., Gold, Michael R., Daubert, Claude, Linde, Cecilia, Steffel, Jan, Singh, Jagmeet P., Mela, Theofanie, Chatterjee, Neal A., Roka, Attila, Lubitz, Steven A., Gold, Michael R., Daubert, Claude, Linde, Cecilia, Steffel, Jan, Singh, Jagmeet P., and Mela, Theofanie

Abstract

Aims For patients undergoing cardiac resynchronization therapy (CRT) with implantable cardioverter-defibrillator (ICD; CRT-D), the effect of an improvement in left ventricular ejection fraction (LVEF) on appropriate ICD therapy may have significant implications regarding management at the time of ICD generator replacement. Methods and results We conducted a meta-analysis to determine the effect of LVEF recovery following CRT on the incidence of appropriate ICD therapy. A search of multiple electronic databases identified 709 reports, of which 6 retrospective cohort studies were included (n = 1740). In patients with post-CRT LVEF ≥35% (study n = 4), the pooled estimated rate of ICD therapy (5.5/100 person-years) was significantly lower than patients with post-CRT LVEF <35% [incidence rate difference (IRD): −6.5/100 person-years, 95% confidence interval (95% CI): −8.8 to −4.2, P < 0.001]. Similarly, patients with post-CRT LVEF ≥45% (study n = 4) demonstrated lower estimated rates of ICD therapy (2.3/100 person-years) compared with patients without such recovery (IRD: −5.8/100 person-years, 95% CI: −7.6 to −4.0, P < 0.001). Restricting analysis to studies discounting ICD therapies during LVEF recovery (study n = 3), patients with LVEF recovery (≥35 or ≥45%) had significantly lower rates of ICD therapy compared with patients without such recovery (P for both <0.001). Patients with primary prevention indication for ICD, regardless of LVEF recovery definition, had very low rates of ICD therapy (0.4 to 0.8/100-person years). Conclusion Recovery of LVEF post-CRT is associated with significantly reduced appropriate ICD therapy. Patients with improvement of LVEF ≥45% and those with primary prevention indication for ICD appear to be at lowest risk

Published
2017

29. Rationale and design of the BUDAPEST-CRT Upgrade Study: a prospective, randomized, multicentre clinical trial

Author

Merkely, Bela, primary, Kosztin, Annamaria, additional, Roka, Attila, additional, Geller, Laszlo, additional, Zima, Endre, additional, Kovacs, Attila, additional, Boros, Andras Mihaly, additional, Klein, Helmut, additional, Wranicz, Jerzy K., additional, Hindricks, Gerhard, additional, Clemens, Marcell, additional, Duray, Gabor Z., additional, Moss, Arthur J., additional, Goldenberg, Ilan, additional, and Kutyifa, Valentina, additional

Published
2016
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30. Reduced appropriate implantable cardioverter-defibrillator therapy after cardiac resynchronization therapy-induced left ventricular function recovery: a meta-analysis and systematic review

Author

Chatterjee, Neal A, Roka, Attila, Lubitz, Steven A, Gold, Michael R, Daubert, Claude, Linde, Cecilia, Steffel, Jan, Singh, Jagmeet P, Mela, Theofanie, Chatterjee, Neal A, Roka, Attila, Lubitz, Steven A, Gold, Michael R, Daubert, Claude, Linde, Cecilia, Steffel, Jan, Singh, Jagmeet P, and Mela, Theofanie

Abstract

Aims For patients undergoing cardiac resynchronization therapy (CRT) with implantable cardioverter-defibrillator (ICD; CRT-D), the effect of an improvement in left ventricular ejection fraction (LVEF) on appropriate ICD therapy may have significant implications regarding management at the time of ICD generator replacement. Methods and results We conducted a meta-analysis to determine the effect of LVEF recovery following CRT on the incidence of appropriate ICD therapy. A search of multiple electronic databases identified 709 reports, of which 6 retrospective cohort studies were included (n = 1740). In patients with post-CRT LVEF ≥35% (study n = 4), the pooled estimated rate of ICD therapy (5.5/100 person-years) was significantly lower than patients with post-CRT LVEF <35% [incidence rate difference (IRD): −6.5/100 person-years, 95% confidence interval (95% CI): −8.8 to −4.2, P < 0.001]. Similarly, patients with post-CRT LVEF ≥45% (study n = 4) demonstrated lower estimated rates of ICD therapy (2.3/100 person-years) compared with patients without such recovery (IRD: −5.8/100 person-years, 95% CI: −7.6 to −4.0, P < 0.001). Restricting analysis to studies discounting ICD therapies during LVEF recovery (study n = 3), patients with LVEF recovery (≥35 or ≥45%) had significantly lower rates of ICD therapy compared with patients without such recovery (P for both <0.001). Patients with primary prevention indication for ICD, regardless of LVEF recovery definition, had very low rates of ICD therapy (0.4 to 0.8/100-person years). Conclusion Recovery of LVEF post-CRT is associated with significantly reduced appropriate ICD therapy. Patients with improvement of LVEF ≥45% and those with primary prevention indication for ICD appear to be at lowest risk

Published
2015

42. Reduced appropriate implantable cardioverter-defibrillator therapy after cardiac resynchronization therapy-induced left ventricular function recovery: a meta-analysis and systematic review

Author

Chatterjee, Neal A., Roka, Attila, Lubitz, Steven A., Gold, Michael R., Daubert, Claude, Linde, Cecilia, Steffel, Jan, Singh, Jagmeet P., Mela, Theofanie, Chatterjee, Neal A., Roka, Attila, Lubitz, Steven A., Gold, Michael R., Daubert, Claude, Linde, Cecilia, Steffel, Jan, Singh, Jagmeet P., and Mela, Theofanie

Abstract

Aims For patients undergoing cardiac resynchronization therapy (CRT) with implantable cardioverter-defibrillator (ICD; CRT-D), the effect of an improvement in left ventricular ejection fraction (LVEF) on appropriate ICD therapy may have significant implications regarding management at the time of ICD generator replacement. Methods and results We conducted a meta-analysis to determine the effect of LVEF recovery following CRT on the incidence of appropriate ICD therapy. A search of multiple electronic databases identified 709 reports, of which 6 retrospective cohort studies were included (n = 1740). In patients with post-CRT LVEF ≥35% (study n = 4), the pooled estimated rate of ICD therapy (5.5/100 person-years) was significantly lower than patients with post-CRT LVEF <35% [incidence rate difference (IRD): −6.5/100 person-years, 95% confidence interval (95% CI): −8.8 to −4.2, P < 0.001]. Similarly, patients with post-CRT LVEF ≥45% (study n = 4) demonstrated lower estimated rates of ICD therapy (2.3/100 person-years) compared with patients without such recovery (IRD: −5.8/100 person-years, 95% CI: −7.6 to −4.0, P < 0.001). Restricting analysis to studies discounting ICD therapies during LVEF recovery (study n = 3), patients with LVEF recovery (≥35 or ≥45%) had significantly lower rates of ICD therapy compared with patients without such recovery (P for both <0.001). Patients with primary prevention indication for ICD, regardless of LVEF recovery definition, had very low rates of ICD therapy (0.4 to 0.8/100-person years). Conclusion Recovery of LVEF post-CRT is associated with significantly reduced appropriate ICD therapy. Patients with improvement of LVEF ≥45% and those with primary prevention indication for ICD appear to be at lowest risk

43. Rationale and design of the BUDAPEST-CRT Upgrade Study: a prospective, randomized, multicentre clinical trial.

Author

Merkely B, Kosztin A, Roka A, Geller L, Zima E, Kovacs A, Boros AM, Klein H, Wranicz JK, Hindricks G, Clemens M, Duray GZ, Moss AJ, Goldenberg I, and Kutyifa V

Subjects
Chronic Disease, Clinical Protocols, Device Removal, Electric Countershock adverse effects, Electric Countershock mortality, Europe, Exercise Tolerance, Heart Failure diagnosis, Heart Failure mortality, Heart Failure physiopathology, Humans, Israel, Prospective Studies, Recovery of Function, Research Design, Time Factors, Treatment Outcome, Walk Test, Cardiac Pacing, Artificial adverse effects, Cardiac Pacing, Artificial mortality, Cardiac Resynchronization Therapy adverse effects, Cardiac Resynchronization Therapy mortality, Cardiac Resynchronization Therapy Devices, Defibrillators, Implantable, Electric Countershock instrumentation, Heart Failure therapy, Pacemaker, Artificial, Stroke Volume, Ventricular Function, Left
Abstract

Aims: There is lack of conclusive evidence from randomized clinical trials on the efficacy and safety of upgrade to cardiac resynchronization therapy (CRT) in patients with implanted pacemakers (PM) or defibrillators (ICD) with reduced left ventricular ejection fraction (LVEF) and chronic heart failure (HF). The BUDAPEST-CRT Upgrade Study was designed to compare the efficacy and safety of CRT upgrade from conventional PM or ICD therapy in patients with intermittent or permanent right ventricular (RV) septal/apical pacing, reduced LVEF, and symptomatic HF., Methods and Results: The BUDAPEST-CRT study is a prospective, randomized, multicentre, investigator-sponsored clinical trial. A total of 360 subjects will be enrolled with LVEF ≤ 35%, NYHA functional classes II-IVa, paced QRS ≥ 150 ms, and a RV pacing ≥ 20%. Patients will be followed for 12 months. Randomization is performed in a 3:2 ratio (CRT-D vs. ICD). The primary composite endpoint is all-cause mortality, a first HF event, or less than 15% reduction in left ventricular (LV) end-systolic volume at 12 months. Secondary endpoints are all-cause mortality, all-cause mortality or HF event, and LV volume reduction at 12 months. Tertiary endpoints include changes in quality of life, NYHA functional class, 6 min walk test, natriuretic peptides, and safety outcomes., Conclusion: The results of our prospective, randomized, multicentre clinical trial will provide important information on the role of cardiac resynchronization therapy with defibrillator (CRT-D) upgrade in patients with symptomatic HF, reduced LVEF, and wide-paced QRS with intermittent or permanent RV pacing., Clinical Trials.gov Identifier: NCT02270840., (© The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2017
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