Cardiology News / Recent Literature Review / Second Quarter 2017

Abstract

ESC Congress: Barcelona, 26-30/8/2017

HCS 2017, 28^th Panhellenic Cardiology Congress: Athens, 19-21/10/2017

TCT Congress: Denver, Colorado, 29/10-2/11/2017

AHA Meeting: Anaheim, Ca, 11-15/11/2017

ACC.18 Congress: Orlando, FL, 10-12/3/2018

Rhythmos 2017;12(3):53-57

In CRT-Eligible Heart Failure Patients with no History of Ventricular Arrhythmias, Addition of ICD Conveys Survival Benefit in Patients with Ischemic Cardiomyopathy (CM) but not in Those with Nonischemic CM

According to an observational, multicenter, European cohort study of 5,307 consecutive patients with dilated or ischemic CM, no history of sustained ventricular arrhythmias, who underwent CRT implantation with (n=4,037) or without (n=1,270) a defibrillator, over 41.4 ± 29.0 months, patients with ischemic (not dilated) CM had better survival when receiving CRT-D compared with those who received CRT-P (hazard ratio-HR: 0.76; p=0.005). Compared with recipients of ICD, the excess mortality in patients who did not receive ICDs was related to sudden cardiac death in 8% among those with ischemic CM but in only 0.4% of those with dilated CM (Barra S et al, J Am Coll Cardiol 2017; 69:1669-1678).

SELECT-LV Study: In a Population of Failed Conventional CRT Patients, Cardiac Resynchroniza-tion With Endocardial LV Stimulation via a Novel Leadless Pacing Electrode was Technically Feasible and Efficacious

Among 35 patients indicated for CRT who had “failed” conventional CRT, implantation of an LV endocardial leadless pacing electrode and a subcutaneous pulse generator was successful in 97.1% (n=34). The most common indications for endocardial LV pacing were difficult CS anatomy (n=12), failure to respond to conventional CRT (n=10), and a high CS pacing threshold or phrenic nerve stimulation (n=5). The primary performance endpoint, biventricular pacing on the 12-lead ECG at 1 month, was achieved in 33 of 34 patients. A total of 28 patients (84.8%) had improvement in the clinical composite score at 6 months, and 21 (66%) demonstrated a positive echocardiographic CRT response (≥5% absolute increase in LV ejection fraction). There were no pericardial effusions, but serious procedure/device-related events occurred in 3 patients (8.6%) within 24 h, and 8 patients (22.9%) between 24 h and 1 month (Reddy VY et al, J Am Coll Cardiol 2017;69:2119-29).

Improvements in both Survival and Heart Failure Hospitalizations with CRT-D were Greatest in Patients with a QRSD ≥180 ms with or without LBBB

Analysis of 24,960 patients receiving CRT-D and matched to patients with ICD indicated that among those with LBBB, patients with a QRSD ≥180 ms had a greater survival benefit with CRT-D vs standard ICD (hazard ration -HR for death: 0.65) compared with those having a QRSD 120 to 149 ms (HR: 0.85) and 150 to 179 ms (HR: 0.87). CRT-D vs ICD was associated with an improvement in survival in those with non-LBBB and a QRSD≥180 ms (HR for death: 0.78), but not in those with non-LBBB and a QRSD 150 to 179 ms (HR for death: 1.06) (Sundaram V et al, J Am Coll Cardiol 2017;69: 2026–36)... (excerpt)