ICD in cardiac resinhronization therapy
Abstract
Background: Patients with advanced heart failure bears bad prognosis, despite modern medical treatment year mortality rate spans from 30 up to 70%. Besides terminal heart failure the second most frequent cause is sudden death due to ventricular tachyarrhythmias as ventricular tachycardia and fibrillation. Ventricular fibrillation is very frequent cause of mortality of terminal heart failure especially in ischemic subgroup. Clinical studies have presented improvement of heart function by use of biventricular stimulation of patients with advanced heart failure and intraventricular conduction defects as left bundle branch block. Method very successfully improves acute hemodynamic parameters due to resynchronization of septal and lateral wall of left ventricle and improves economy of the heart contraction. Although these effects are present immediately after implantation they persist also through longer period. Method improves quality of life and also decreases mortality rate proved by clinical studies. Despite successful therapy mortality rate due to sudden death remains high. Implantable cardioverters defibrillators successfully prevent sudden cardiac death due to ventricular tachyarrhythmia. They are successful due to straightforward recognition of ventricular tachycardia or fibrillation and immediate electrical schock delivery. Cardiovertes defibrillators are successful in prevention of sudden cardiac death but they do not improve quality of life of heart failure patients like resynchronization therapy. Thus, combined therapy resynchronization and cardioverter defibrillator as a single implantable device has been developed.
Conclusions: Due to very successful combined therapy the application of biventricular cardioverters defibrillators into clinical practice has increased. Implantation of biventricular cardioverter defibrillator is complex but very successful procedure. It is economically acceptable when proper indication has been stated. Large multicentric randomized clinical trials have proved better quality of life and reduced mortality rate in advanced heart failure patients especially when combined with cardioverter defibrillators.
Downloads
References
Ericson H. Heart failure: a growing public health problem. J Intern Med 1995; 237: 135–41.
America Heart Association. 2002 Heart and stroke statistical update. Dallas, Tex: American Heart Association; 2001.
Hare JM. Cardiac-resynhronization therapy for heart failure. N Engl J Med 2002; 346: 1902–05.
Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M, et al. Italian Network on Congestive Heart Failure Investigators. Left bundlebranch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J 2002; 143: 398–405.
Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, et al. Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001; 344: 873–80.
Ezekowitz JA, Armstrong PW, McAlister FA. Implantable cardioverter defibrillators in primary and secondary prevention: a systematic review of randomized, controlled trials. Ann Intern Med 2003 Mar 18; 138: 445–52.
Schron EB, Exner DV, Yao Q, Jenkins LS, Steinberg JS, Cook JR, et al. Quality of life in the antiarrhythmics versus implantable defibrillators trial: impact of therapy and influence of adverse symptoms and defibrillator shocks. Circulation 2002; 105: 589–94.
Bradley DJ. Combining resynchronization and defibrillation therapies for heart failure. JAMA 2003; 289: 2719–21.
Batista RJV, Santos JLV, Takeshita N, Bocchino L, Lima PN, Cunha MA. Partial left ventriculothomy to improve left ventricular function in endstage heart disease. J Card Surg 1996; 11: 96–7.
Cazeau S, Ritter P, Bakdach S, Lazarus A, Limousin M, Henao L, et al. Four chamber pacing in dilated cardiomyopathy. Pacing Clin Electrophysiol. 1994;17:1974–9.
Daubert JC, Ritter P, Le Breton H, Gras D, Leclercq C, Lazarus A, et al. Permanent left ventricular pacing with transvenous leads inserted into the coronary veins. Pacing Clin Electrophysiol 1998; 21: 239–45.
Nelson GS, Berger RD, Fetics BJ, Talbot M, Spinelli JC, Hare JM, Kass DA. Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation 2000; 102: 3053–9.
Morgan JM. The MADIT II and COMPANION studies: will they affect uptake of device treatment? Heart 2004; 90: 243–5.
MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL randomised intervention trial in congestive heart failure (MERIT-HF). Lancet 1999; 353: 2001–7.
Higgins SL, Yong P, Sheck D, McDaniel M, Bollinger F, Vadecha M, et al. Biventricular pacing diminishes the need for implantable cardioverter defibrillator therapy. Ventak CHF Investigators. J Am Coll Cardiol 2000; 36: 824–7.
Cleland JG, Thackray S, Goodge L, Kaye G, Cooklin M. Outcome studies with device therapy in patients with heart failure. J Cardiovasc Electrophysiol. 2002; 13 1 Suppl: S73–91.
Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. for Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002; 346: 877–83.
Bansch D, Antz M, Boczor S, Volkmer M, Tebbenjohanns J, Seidl K, et al. Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT). Circulation 2002; 105: 1453–8.
Rothman SA, Hsia HH, Cossu SF, Chmielewski IL, Buxton AE, Miller JM. Radiofrequency catheter ablation of postinfarction ventricular tachycardia: long-term success and the significance of inducible nonclinical arrhythmias. Circulation 1997; 96: 3499–508.
Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, et al. Improved survival with an implanted defibrillator in patients with coronarydisease at high risk for ventricular arrhythmia. N Engl J Med 1996; 335: 1933–40.
Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G. A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med 1999; 341: 1882–90.
Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure, the comparison of medical therapy, pacing, and defibrillation in heart failure. N Engl J Med 2004; 350: 2140–50.
Brignole M, Menozzi C, Gianfranchi L, Musso G, Mureddu R, Bottoni N, Lolli G. Assessment of atrioventricular junction ablation and VVIR pacemaker versus pharmacological treatment in patients with heart failure and chronic atrial fibrillation: a randomized, controlled study. Circulation 1998; 98: 953–60.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
