Ventricular Arrhythmia Risk Stratification Among Patients With Cardiac Resynchronization Therapy Devices
Nobuhiko Ueda1, Kohei Ishibashi1, Takashi Noda1,2
1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Osaka Japan.
Insights
A new ventricular arrhythmia (VA) risk score effectively identifies patients at higher risk who are candidates for cardiac resynchronization therapy (CRT). This score aids in selecting appropriate CRT devices for patients with left ventricular dysfunction.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Patients with left ventricular (LV) dysfunction face increased risk of ventricular arrhythmia (VA).
- Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are used for prevention, but CRT device selection is challenging.
- CRT can reduce VA risk, necessitating better patient stratification.
Purpose of the Study:
- To evaluate a novel VA risk score for stratifying risk in patients with LV dysfunction receiving CRT or ICD therapy.
- To determine the score's utility in predicting VA events in primary prevention cohorts.
Main Methods:
- A cohort of 678 patients with LV dysfunction and CRT/ICD devices were analyzed.
- VA events were recorded, and a VA risk score was calculated based on clinical factors.
- The score's ability to stratify VA risk was assessed in CRT and ICD patient groups.
Main Results:
- The VA risk score significantly stratified VA risk in CRT patients (P<0.01) but not in ICD patients (P=0.24).
- Patients with a VA risk score ≥4 demonstrated a significantly higher risk of VA in the CRT group (log rank P<0.01).
- No significant difference in VA risk was observed for ICD patients based on the score.
Conclusions:
- The developed VA risk score shows promise as a tool for identifying patients who may benefit from CRT.
- This score could improve the selection process for CRT candidates, optimizing treatment strategies.
- Further validation is needed, but the score offers a potential method for risk stratification in CRT candidates.
Background:
Patients with left ventricular (LV) dysfunction have a higher risk of ventricular arrhythmia (VA) compared with those without, and are candidates for implantable cardioverter defibrillator (ICD). Response to cardiac resynchronization therapy (CRT) decreases the risk of VA; however, selection of a suitable CRT device remains challenging.
Methods And Results:
In 678 patients with a CRT/ICD device and LV dysfunction, we investigated 325 CRT and 142 ICD patients for primary prevention. VA was defined as lasting ≥30 s or being treated with an ICD. CRT non-responders were defined as patients without reduced LV end-systolic volume ≥15%. During the follow-up period, 98 (21%) patients had a VA event (CRT 71 [22%] vs. ICD 27 [19%]; P=0.49). The VA risk score was calculated by summing values for non-left bundle branch block, left atrial diameter >45 mm, persistent atrial fibrillation, male sex, LV ejection fraction <25%, and ischemic cardiomyopathy. Our results showed that the VA risk score stratified the risk of VA among CRT patients (P<0.01), but was not significant for ICD patients (P=0.24). Patients with a VA risk score ≥4 (divided by receiver operating characteristic analysis) had a higher risk of VA among CRT patients (log rank P<0.01); however, it was not significant for ICD patients (log rank P=0.71).
Conclusions:
The VA risk score could be a useful indicator for VA among CRT candidates.
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