Risk factors for ventricular tachyarrhythmic events in patients without left bundle branch block who receive cardiac resynchronization therapy
Abstract Introduction Cardiac resynchronization therapy (CRT) may be pro‐arrhythmic in patients with non‐left bundle branch block (non‐LBBB). We hypothesized that combined assessment of risk factors (RF) for ventricular tachyarrhythmias (VTAs) can be used to stratify non‐LBBB patients for CRT implan...
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doaj-d5ccff380d7946da93b515df637246762021-07-21T11:22:45ZengWileyAnnals of Noninvasive Electrocardiology1082-720X1542-474X2021-07-01264n/an/a10.1111/anec.12847Risk factors for ventricular tachyarrhythmic events in patients without left bundle branch block who receive cardiac resynchronization therapyArwa Younis0Mehmet K. Aktas1Wojciech Zareba2Scott McNitt3Valentina Kutyifa4Ilan Goldenberg5Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY USAClinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY USAClinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY USAClinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY USAClinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY USAClinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY USAAbstract Introduction Cardiac resynchronization therapy (CRT) may be pro‐arrhythmic in patients with non‐left bundle branch block (non‐LBBB). We hypothesized that combined assessment of risk factors (RF) for ventricular tachyarrhythmias (VTAs) can be used to stratify non‐LBBB patients for CRT implantation. Methods The study comprised 412 non‐LBBB patients from MADIT‐CRT randomized to CRT‐D (n = 215) versus ICD only (n = 197). Best‐subset regression analysis was performed to identify RF associated with increased VTA risk in CRT‐D patients without LBBB. The primary end point was first occurrence of sustained VTA during follow‐up. Secondary end points included VTA/death and appropriate shock. Results Four RFs were associated with increased VTA risk: blood urea nitrogen >25mg/dl, ejection fraction <20%, prior nonsustained VT, and female gender. Among CRT‐D patients, 114 (53%) had no RF, while 101 (47%) had ≥1 RF. The 4‐year cumulative probability of VTA was higher among those with ≥1 RF compared with those without RF (40% vs. 14%, p < .001). Multivariate analysis showed that in patients without RF, treatment with CRT‐D was associated with a 61% reduction in VTA compared with ICD‐only therapy (p = .002), whereas among patients with ≥1 RF, treatment with CRT‐D was associated with a corresponding 73% (p = .025) risk increase. Consistent results were observed when the secondary end points of VTA/death and appropriate ICD shocks were assessed. Conclusion Combined assessment of factors associated with increased risk for VTA can be used for improved selection of non‐LBBB patients for CRT‐D.https://doi.org/10.1111/anec.12847cardiac resynchronization therapynon‐left bundle branch blockpro‐arrhythmic effectrisk factorsventricular tachycardia |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Arwa Younis Mehmet K. Aktas Wojciech Zareba Scott McNitt Valentina Kutyifa Ilan Goldenberg |
spellingShingle |
Arwa Younis Mehmet K. Aktas Wojciech Zareba Scott McNitt Valentina Kutyifa Ilan Goldenberg Risk factors for ventricular tachyarrhythmic events in patients without left bundle branch block who receive cardiac resynchronization therapy Annals of Noninvasive Electrocardiology cardiac resynchronization therapy non‐left bundle branch block pro‐arrhythmic effect risk factors ventricular tachycardia |
author_facet |
Arwa Younis Mehmet K. Aktas Wojciech Zareba Scott McNitt Valentina Kutyifa Ilan Goldenberg |
author_sort |
Arwa Younis |
title |
Risk factors for ventricular tachyarrhythmic events in patients without left bundle branch block who receive cardiac resynchronization therapy |
title_short |
Risk factors for ventricular tachyarrhythmic events in patients without left bundle branch block who receive cardiac resynchronization therapy |
title_full |
Risk factors for ventricular tachyarrhythmic events in patients without left bundle branch block who receive cardiac resynchronization therapy |
title_fullStr |
Risk factors for ventricular tachyarrhythmic events in patients without left bundle branch block who receive cardiac resynchronization therapy |
title_full_unstemmed |
Risk factors for ventricular tachyarrhythmic events in patients without left bundle branch block who receive cardiac resynchronization therapy |
title_sort |
risk factors for ventricular tachyarrhythmic events in patients without left bundle branch block who receive cardiac resynchronization therapy |
publisher |
Wiley |
series |
Annals of Noninvasive Electrocardiology |
issn |
1082-720X 1542-474X |
publishDate |
2021-07-01 |
description |
Abstract Introduction Cardiac resynchronization therapy (CRT) may be pro‐arrhythmic in patients with non‐left bundle branch block (non‐LBBB). We hypothesized that combined assessment of risk factors (RF) for ventricular tachyarrhythmias (VTAs) can be used to stratify non‐LBBB patients for CRT implantation. Methods The study comprised 412 non‐LBBB patients from MADIT‐CRT randomized to CRT‐D (n = 215) versus ICD only (n = 197). Best‐subset regression analysis was performed to identify RF associated with increased VTA risk in CRT‐D patients without LBBB. The primary end point was first occurrence of sustained VTA during follow‐up. Secondary end points included VTA/death and appropriate shock. Results Four RFs were associated with increased VTA risk: blood urea nitrogen >25mg/dl, ejection fraction <20%, prior nonsustained VT, and female gender. Among CRT‐D patients, 114 (53%) had no RF, while 101 (47%) had ≥1 RF. The 4‐year cumulative probability of VTA was higher among those with ≥1 RF compared with those without RF (40% vs. 14%, p < .001). Multivariate analysis showed that in patients without RF, treatment with CRT‐D was associated with a 61% reduction in VTA compared with ICD‐only therapy (p = .002), whereas among patients with ≥1 RF, treatment with CRT‐D was associated with a corresponding 73% (p = .025) risk increase. Consistent results were observed when the secondary end points of VTA/death and appropriate ICD shocks were assessed. Conclusion Combined assessment of factors associated with increased risk for VTA can be used for improved selection of non‐LBBB patients for CRT‐D. |
topic |
cardiac resynchronization therapy non‐left bundle branch block pro‐arrhythmic effect risk factors ventricular tachycardia |
url |
https://doi.org/10.1111/anec.12847 |
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