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Postimplantation ventricular ectopic burden and clinical outcomes in cardiac resynchronization therapy-defibrillator patients: a MADIT-CRT substudy.
- Source :
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Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc [Ann Noninvasive Electrocardiol] 2018 Mar; Vol. 23 (2), pp. e12491. Date of Electronic Publication: 2017 Sep 20. - Publication Year :
- 2018
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Abstract
- Background: Frequent ventricular ectopy on preimplantation Holter has been associated with attenuated benefit from cardiac resynchronization therapy (CRT). However, it is unclear whether ectopic burden measured post-CRT implantation can be utilized to evaluate long-term prognosis. We aimed to describe the association between post-CRT implantation ectopic burden and subsequent risk of clinical outcomes.<br />Methods: At the 12-month follow-up visit, 24-hour Holter recordings were performed in 698 CRT-D patients from the MADIT-CRT study. The mean number of ventricular premature complexes (VPCs/hour) was calculated. High ectopic burden was defined as >10 VPCs/hour and low burden as ≤10 VPCs/hour. Multivariate Cox proportional hazards models were utilized to assess the association between 12-month ectopic burden and the risk of the end points of heart failure (HF) or death and ventricular tachyarrhythmias (VT/VF).<br />Results: At 12 months, 282 (40%) patients presented with low ectopic burden and 416 (60%) patients presented with high ectopic burden. The 3-year risk of HF/death and VT/VF was lower in patients with a low burden (7% and 8%) and significantly higher (25% and 24%) in patients with high burden. In multivariate analyses, patients with a high ectopic burden had approximately threefold increased risk of both HF/death (HR=2.76 [1.62-4.70], p < .001) and VT/VF (HR=2.79 [1.69-4.58], p < .001).<br />Conclusion: In CRT-D patients with mild heart failure, high ectopic burden at 12-month follow-up was associated with a high 3-year risk of HF/death and VT/VF and threefold increased risk as compared to patients with low burden. Ectopic burden at 12 months may be a valuable approach for evaluating long-term prognosis.<br /> (© 2017 Wiley Periodicals, Inc.)
- Subjects :
- Aged
Cardiac Resynchronization Therapy adverse effects
Electrocardiography methods
Female
Heart Failure etiology
Humans
Incidence
Internationality
Male
Middle Aged
Prognosis
Risk Assessment
Severity of Illness Index
Survival Rate
Tachycardia, Ventricular diagnostic imaging
Tachycardia, Ventricular therapy
Ventricular Fibrillation diagnosis
Ventricular Fibrillation etiology
Ventricular Premature Complexes etiology
Defibrillators, Implantable adverse effects
Electrocardiography, Ambulatory methods
Heart Failure mortality
Ventricular Fibrillation mortality
Ventricular Premature Complexes diagnostic imaging
Ventricular Premature Complexes epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1542-474X
- Volume :
- 23
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
- Publication Type :
- Academic Journal
- Accession number :
- 28940909
- Full Text :
- https://doi.org/10.1111/anec.12491