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Effect of single ventricular premature contractions on response to cardiac resynchronization therapy

Session Poster session 3

Speaker Assistant Professor Annamaria Kosztin

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Poster Session
  • FP Number : P1534

Authors : A Kosztin (Budapest,HU), A Kovacs (Budapest,HU), W Schwertner (Budapest,HU), VK Nagy (Budapest,HU), B Lakatos (Budapest,HU), G Szeplaki (Budapest,HU), L Geller (Budapest,HU), V Kutyifa (Rochester,US), B Merkely (Budapest,HU)

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Authors:
A Kosztin1 , A Kovacs1 , W Schwertner1 , VK Nagy1 , B Lakatos1 , G Szeplaki1 , L Geller1 , V Kutyifa2 , B Merkely1 , 1Semmelweis University, Heart Center - Budapest - Hungary , 2University of Rochester, Cardiology Division - Rochester - United States of America ,

Citation:

Background: Data on the effect of single premature ventricular contractions (PVCs) on clinical and echocardiographic response after cardiac resynchronization therapy (CRT) implantation is scarce.

Purpose: To assess the predictive value of single PVCs 1 month after CRT implantation to the mid-term clinical response and long-term all-cause mortality

Methods: In our prospective, single-center study, 125 symptomatic heart failure (HF) patients (NYHA II-IVa) with reduced left ventricular ejection fraction (EF =35%) and wide QRS (=120ms) underwent CRT implantation and were followed for 2 years. The primary endpoint was all-cause mortality, the secondary endpoints were echocardiographic reverse remodelling assessed by =15% improvement in EF, left ventricular end-systolic volume (ESV) or left atrial volume (LAV) after 6 months. The number of PVCs were assessed by device interrogation at 1 month after CRT implantation.

Results: During the mean time of follow up (2.2 years) 26 patients died and reached the primary endpoint. Those 67 patients who attended 1 month follow up, median number of PVCs was 11401. Patients with higher number of PVCs than this median showed a higher risk of all-cause mortality (p=0.034), which was also confirmed by multivariate analysis (HR: 3.00; 95% CI: 1.34-6.74; p=0.01) as an independent predictor after adjusting for left bundle branch block.  When secondary endpoints were investigated, patients with less PVCs than the median had a 4.8 times higher odds for developing LAV reverse remodelling 6 months after CRT implantation.

Conclusions: In patients underwent CRT implantation, greater amount of PVCs are associated with higher all-cause mortality and predicts atrial remodelling. Our results are pointing at the importance of PVCs as a response marker and warrant further investigations.



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