Relationship between mechanical and electrical remodelling in patients with cardiac resynchronization implanted defibrillators
Por:
Lellouche, N, De Diego, C, Boyle, N, Wiener, I, Akopyan, G, Child, J and Shivkumar, K
Publicada:
1 ago 2011
Resumen:
Aims Cardiac resynchronization therapy (CRT) is associated with reverse left ventricular (LV) remodelling. However, the effects of CRT-induced mechanical remodelling on electrical remodelling, and the occurrence of ventricular arrhythmias have not been clearly established. We studied the relationship between mechanical remodelling, electrical remodelling, and the occurrence of appropriate implantable cardioverter-defibrillator (ICD) therapy 1 year after CRT.
Methods and results We analysed data from 45 patients who underwent ICD-CRT implantation at our centre. Significant LV reverse remodelling was defined by a minimum 10% decrease in the LV end-diastolic diameter (LVEDd) at 1 year of follow-up. Electrocardiographic indices of dispersion of repolarization [ QTc, Tpeak-Tend (Tp-e) and their dispersion] were measured immediately and 1 year post-CRT implantation. The occurrence of appropriate ICD therapy was noted for each patient. Patients with (n = 21) and without (n = 24) significant LV reverse remodelling had similar baseline characteristics. At 1 year of follow-up, patients with mechanical reverse LV remodelling exhibited a significant decrease in QTc (505 +/- 42 vs. 485 +/- 52 ms, P < 0.05) and Tp-e (107 +/- 26 vs. 92 +/- 22 ms, P < 0.0001). However, patients without mechanical LV reverse remodelling exhibited a significant increase in QT dispersion (29 +/- 43 vs. 98 +/- 47 ms, P = 0.002) and Tp-e dispersion (22 +/- 21 vs. 54 +/- 36 ms, P = 0.0001). Finally patients with mechanical LV reverse remodelling experienced a lower rate of ICD therapy (P = 0.0025) after a mean follow-up of 19 months.
Conclusion Reverse LV mechanical remodelling is associated with reversal of electrical remodelling and a lower rate of appropriate ICD therapy following CRT.
Filiaciones:
Lellouche, N:
Univ Calif Los Angeles, David Geffen Sch Med, UCLA Cardiac Arrhythmia Ctr, Div Cardiol,Dept Med, Los Angeles, CA 90095 USA
APHP Univ Hosp Henri Mondor, F-94000 Creteil, France
INSERM, U 841, F-94000 Creteil, France
:
Univ Calif Los Angeles, David Geffen Sch Med, UCLA Cardiac Arrhythmia Ctr, Div Cardiol,Dept Med, Los Angeles, CA 90095 USA
Boyle, N:
Univ Calif Los Angeles, David Geffen Sch Med, UCLA Cardiac Arrhythmia Ctr, Div Cardiol,Dept Med, Los Angeles, CA 90095 USA
Wiener, I:
Univ Calif Los Angeles, David Geffen Sch Med, UCLA Cardiac Arrhythmia Ctr, Div Cardiol,Dept Med, Los Angeles, CA 90095 USA
Akopyan, G:
Univ Calif Los Angeles, David Geffen Sch Med, UCLA Cardiac Arrhythmia Ctr, Div Cardiol,Dept Med, Los Angeles, CA 90095 USA
Child, J:
Univ Calif Los Angeles, David Geffen Sch Med, UCLA Cardiac Arrhythmia Ctr, Div Cardiol,Dept Med, Los Angeles, CA 90095 USA
Shivkumar, K:
Univ Calif Los Angeles, David Geffen Sch Med, UCLA Cardiac Arrhythmia Ctr, Div Cardiol,Dept Med, Los Angeles, CA 90095 USA
Green Published, Bronze
|