1. Implantable Cardioverter Defibrillator and Resynchronization Therapy in Patients With Overt Chronic Kidney Disease: JACC State-of-the-Art Review.
- Author
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Varga, Cecilia R., Cleland, John G.F., Abraham, William T., Lip, Gregory Y.H., Leyva, Francisco, and Hatamizadeh, Parta
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CHRONIC kidney failure , *CARDIO-renal syndrome , *CARDIAC pacing , *PATIENT selection , *ARRHYTHMIA , *IMPLANTABLE cardioverter-defibrillators - Abstract
Heart failure and chronic kidney disease are common and clinically important conditions that regularly coexist. Electrophysiologic changes of advanced heart failure often result in abnormal conduction, causing dyssynchronous contraction, and development of ventricular arrhythmias, which can lead to sudden cardiac arrest. In the last 2 decades, implantable cardioverter-defibrillator and cardiac resynchronization therapy devices have been developed to address these complications. However, when the coexisting chronic kidney disease is advanced, the associated pathophysiologic cardiovascular changes can alter the efficacy and safety of those interventions and complicate the management. This review explores the impact of comorbid advanced heart failure and advanced chronic kidney disease on the efficacy and safety of implantable cardioverter-defibrillator and cardiac resynchronization therapy, the currently available evidence, and potential future directions. [Display omitted] • The efficacy and safety of ICD and CRT devices have not been established for patients with advanced CKD, and available data suggest that they may be less favorable than in patients without advanced CKD. • Factors limiting the effectiveness of these devices in patients with advanced CKD include the frequency of nonshockable arrhythmias, increased defibrillation thresholds, noncapture, myocardial fibrosis, coexisting atrial fibrillation, limited use of guideline-directed therapies for heart failure, and relatively high rates of nonarrhythmic mortality. • Randomized trials are needed to improve selection of patients with advanced CKD for these device-based therapies. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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