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Some Groups of Heart Failure Patients May Experience Improvement in Cardiac Function with Defibrillator Cardiac Resynchronization Therapy (CRT-D) If Traditional Implantable Cardiac Defibrillator Therapy Does Not Work, According to a Study Published Today Journal of the American College of Cardiology.
There are three types of conduction disorders and, until now, most research on CRT treatment in heart failure patients focused on the more common, called left branch block (LBBB). It is an abnormality of cardiac conduction observed on the electrocardiogram (ECG). In this condition, the activation of the left ventricle of the heart is delayed, which causes contraction of the left ventricle later than the right ventricle.
The new study looked at two less common conduction disorders: right branch block (RBBB) and non-specific intraventricular conduction delay (NICD) – together, often referred to as "non-LBBB" – to determine the benefit of CRT-treatment. D.
The CRT-D is a special device for patients with heart failure and presenting a high risk of sudden cardiac death. While functioning as a normal defibrillator (called an implantable cardioverter defibrillator or ICD) to treat slow heart rhythms and life-threatening fast heart rhythms, a CRT-D device also delivers small electrical impulses to the left and right ventricles to help them. to contract the same time. It helps the heart to pump more efficiently.
"The cathode ray tube is known to improve cardiac function in patients with LBBB, but up to now, we have not had enough evidence to support the use of cathode ray tube in patients with of RBBB or NICD, "said lead researcher Hiro Kawata, MD, PhD, of Oregon Heart. and Vascular Institute at Springfield. "Current recommendations indicate that even after medical treatment, patients with heart failure or conduction disorder not causing LBBB continue to suffer from symptoms such as shortness of breath or fatigue, may be judged in the next step, even in the absence of evidence about their efficacy, efficacy, and whether CRT could help non-LBBB patients. "
Kawata and colleagues evaluated data between 2010 and 2013 from the NCDR ROI Registry, the national standard for understanding patient selection, care, and outcome in patients receiving IBD treatment.
The researchers divided patients with RBBB and NICD into two groups based on the length of their QRS, or waves on an electrocardiograph that represents the time required to conduct electricity in the lower ventricle of the heart. A QRS greater than 120 milliseconds represents a conduction anomaly.
"In patients with LBBB, the longer the QRS, the more likely you are to respond to TRC," said Kawata. "We wanted to know if this was also true in patients with non-LBBB conduction disorders."
The study compared patients who had one of two types of defibrillator: a cathode ray tube or a cathode ray tube.
Of the 5,954 elderly Medicare patients with NICD or RBBB who were implanted with a defibrillator, the study showed that patients with NICD and a QRS of more than 150 milliseconds responded better to CRT-D. In these patients, TRC-D was badociated with reduced risk of death, readmission to hospital for any cause, and readmission for heart-related causes, compared to a similar group of patients with an ICD. Among patients with RBBB, TRC-D was not badociated with better results than ICD, regardless of the duration of their QRS.
"This means that if you have a patient with RBBB who is still suffering from heart failure symptoms after medical treatment, there is not enough data to support the blind use of drugs. a cathode ray tube, "said Kawata. "But in NICD patients, we now know that those with a long QRS are likely to benefit from TRC."
He added that further studies are needed to determine if some patients with RBBB could respond to CRT.
"Although the implementation of a CRT-D is relatively safe, it's not without risk," Kawata said.
CRT can lead to complications such as infection, pneumothorax (perforation of the lung) or cardiac perforation (perforated cardiac muscle), he said.
In an editorial accompanying the study, Michael Gold, MD, Ph.D., of the South Carolina Medical University in Charleston, noted that the results of this study provide important data indicating that all types or morphologies no LBBB are not identical.
"The authors should be commended for providing a more detailed badysis of the electrocardiogram and not just using what is now the conventional LBBB vs non-LBBB morphology," he said. "These findings will need to be confirmed by further studies, from prospective trials or from combined data from earlier randomized trials." However, it is important to note that the results of this study challenge our convention to clbadify candidates for a cathode ray tube into two categories. "
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The American College of Cardiology envisions a world where innovation and knowledge optimize care and cardiovascular outcomes. As a professional home for the entire cardiovascular team, the College and its 52,000 members are dedicated to transforming cardiovascular care and improving heart health. The CAC confers its competencies on cardiovascular health professionals who meet stringent qualifications and plays a leading role in the development of health policies, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned journals, JACC, manages national registries to measure and improve care, and provides cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.
the Journal of the American College of Cardiology is one of the best cardiovascular journals in the world for its scientific impact. JACC is the flagship product of a family of newspapers–JACC: Cardiovascular interventions, JACC: Cardiovascular Imaging, JACC: heart failure, JACC: Clinical Electrophysiology, JACC: from basic science to translation, JACC: Case Reports and JACC: CardioOncology– who is proud to publish leading peer-reviewed research on all aspects of cardiovascular disease. Learn more about JACC.org.
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