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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

Implantable cardioverter-defibrillator and cardiac resynchronization therapy in patients with left ventricular

Richard Kobza¹, Jan Steffel, Paul Erne

¹Division of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland. richard.kobza@ksl.ch

|May 25, 2010

Insights

Implantable cardioverter-defibrillators (ICD) effectively treat life-threatening arrhythmias in patients with left ventricular noncompaction (LVNC). Cardiac resynchronization therapy also improves heart function in these individuals.

Area of Science:

Cardiology
Electrophysiology
Heart Failure

Background:

Left ventricular noncompaction (LVNC) is associated with a high risk of ventricular arrhythmias.
Previous studies on implantable cardioverter-defibrillators (ICD) in LVNC patients were limited by small sample sizes.

Purpose of the Study:

To evaluate the clinical outcomes of a larger cohort of LVNC patients treated with ICDs.
To assess the effectiveness of ICDs for primary and secondary prevention of sudden cardiac death in LVNC.

Main Methods:

Retrospective analysis of 30 LVNC patients (mean age 48 ± 14) who received ICD implantation.
Follow-up duration averaged 40 ± 34 months, assessing appropriate ICD therapies and functional class.
Subgroup analysis included patients receiving biventricular ICDs for cardiac resynchronization therapy.

Main Results:

37% (11/30) of patients experienced appropriate ICD therapies (pacing or shocks) during follow-up.
ICD therapy was effective for both primary (n=18) and secondary (n=12) prevention.
In patients with biventricular ICDs, New York Heart Association (NYHA) functional class improved significantly (2.5 ± 0.5 to 1.6 ± 0.8).

Conclusions:

ICD therapy is effective in preventing sudden cardiac death in LVNC patients.
No specific clinical predictors for appropriate ICD therapy were identified in this cohort.
Cardiac resynchronization therapy can improve NYHA class in LVNC patients with reduced ejection fraction and dyssynchrony.

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Abstract

Background:

Patients with left ventricular noncompaction (LVNC) have an increased risk for life-threatening ventricular arrhythmias. The benefit from implantable cardioverter-defibrillators (ICD) in these patients has been investigated only in small series. Therefore, the aim of the present study was to analyze the clinical outcome of a larger population of patients with LVNC who were treated with an ICD.

Methods:

Thirty patients (mean age 48 ± 14) with LVNC who underwent ICD implantation for secondary (n = 12) or primary (n = 18) prevention were included in the study. The mean follow-up period was 40 ± 34 months.

Results:

During follow-up, 11 patients (37%) presented with appropriate ICD therapies: three with antitachycardia pacing, four with ICD shocks, and four with both antitachycardia pacing and ICD shocks. Of these 11 patients, five received the ICD for secondary prevention and six for primary prevention. In six patients, in whom a biventricular ICD was implanted, functional New York Heart Association (NYHA) class improved from 2.5 ± 0.5 to 1.6 ± 0.8.

Conclusions:

In the present study, with the largest cohort of LVNC patients with ICD to date, we demonstrate that such therapy is effective in these patients with an indication for secondary or primary prevention of sudden cardiac death. However, no clinical predictors for appropriate ICD therapy could have been elaborated in these patients. Cardiac resynchronization therapy improves functional NYHA class in patients with LVNC and may hence be considered in patients with a left ventricular ejection fraction ≤35% and signs of ventricular dyssynchrony.

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