Ventricular high-rate episodes predict increased mortality in heart failure patients treated with cardiac
Jonatan Jacobsson1, Christian Reitan, Pyotr G Platonov
1Lund University, Arrhythmia Clinic, Skane University Hospital , Lund , Sweden.
Insights
High rates of ventricular tachycardia in patients with cardiac resynchronization therapy-pacemaker (CRT-P) predict worse outcomes. Ventricular high-rate episodes within the first year post-implant indicate higher 5-year mortality in heart failure patients.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Cardiac Resynchronization Therapy (CRT) improves heart failure outcomes but high mortality persists.
- Prognostic value of device-detected events in CRT patients requires further investigation.
Purpose of the Study:
- To determine if ventricular high-rate (VHR) episodes post-implant predict mortality in CRT-pacemaker (CRT-P) patients.
- To assess the prognostic significance of VHR episodes in heart failure management.
Main Methods:
- Retrospective analysis of 220 CRT-P patients' clinical and device data.
- Defined VHR as ventricular rate ≥ 180 bpm; primary outcome was 5-year mortality.
- Multivariate analysis to identify independent predictors of mortality.
Main Results:
- 5-year mortality was 52%; 77% for patients with VHR in year 1 vs. 48% for those without (p=0.001).
- VHR episodes were an independent predictor of 5-year mortality (HR 9.96, p=0.022).
- Heart failure was the most common cause of death; no difference in arrhythmia-related deaths.
Conclusions:
- VHR episodes within the first year post-CRT-P implantation predict increased 5-year mortality.
- VHR occurrence indicates inferior long-term survival but not specifically death from malignant arrhythmia.
- Device-derived VHR data offers valuable prognostic information for CRT-P patients.
Objectives:
Cardiac Resynchronization Therapy (CRT) for heart-failure patients has a well-documented positive effect, but the overall mortality in this group remains high. This study aimed to explore whether additional information from the device post-implant (occurrence of ventricular high-rate episodes), could add prognostic value for patients on CRT-pacemaker (CRT-P) treatment.
Design:
Clinical data and device-interrogation data were retrospectively gathered from the medical records of 220 patients treated with CRT-P. Ventricular high-rate (VHR) episodes were defined as a ventricular rate ≥ 180 beats per minute. The primary outcome was 5-year mortality.
Results:
During follow-up, 132 patients (60%) died or underwent heart transplant. Overall, the 5-year mortality rate was 52%; 77% for patients with VHR during the first year of follow-up and 48% for patients without VHR during the first year of follow-up (p = 0.001). In a multivariate model, the occurrence of VHR episodes was an independent predictor of 5-year mortality (HR 9.96, p = 0.022). The most common cause of death was heart failure, and death from arrhythmia did not differ between groups (p = 0.065).
Conclusions:
In heart-failure patients with CRT-P therapy, occurrence of VHR episodes within the first year post-implant was an independent predictor of higher 5-year mortality and inferior long-term survival, but not of death from malignant arrhythmia.
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