Vol. 18 No. 4 (2014): Heart Rhythm Disoders (Special Issue)
CARDIORESYNCHRONIZING THERAPY

Effect of cardiac resynchronization therapy on ventricular tachycardias in patients with dilated cardiomyopathy and severe heart failure

PDF (Русский)
  • D. Lebedev,
  • R. Batalov,
  • G. Savenkova,
  • S. Minin,
  • S. Krivolapov,
  • Yu. Lishmanov,
  • S. Popov
D. Lebedev
Federal State Budget Institute 'Research Institute of Cardiology'
Bio
R. Batalov
Federal State Budget Institute 'Research Institute of Cardiology'
Bio
G. Savenkova
Federal State Budget Institute 'Research Institute of Cardiology'
Bio
S. Minin
Federal State Budget Institute 'Research Institute of Cardiology'
Bio
S. Krivolapov
Federal State Budget Institute 'Research Institute of Cardiology'
Bio
Yu. Lishmanov
Federal State Budget Institute 'Research Institute of Cardiology'
Bio
S. Popov
Federal State Budget Institute 'Research Institute of Cardiology'
Bio
DOI: https://doi.org/10.21688/1681-3472-2014-4-144-150

Published 2014-10-28

Keywords

  • CARDIAC RESYNCHRONIZATION THERAPY,
  • VENTRICULAR TACHYCARDIAS,
  • DILATED CARDIOMYOPATHY

How to Cite

Lebedev, D., Batalov, R., Savenkova, G., Minin, S., Krivolapov, S., Lishmanov, Y., & Popov, S. (2014). Effect of cardiac resynchronization therapy on ventricular tachycardias in patients with dilated cardiomyopathy and severe heart failure. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 18(4), 144–150. https://doi.org/10.21688/1681-3472-2014-4-144-150

Copyright (c) 2014 Lebedev D.I., Batalov R.Ye., Savenkova G.M., Minin S.M., Krivolapov S.N., Lishmanov Yu.B., Popov S.V.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

The aim of the study was to elucidate the effects of cardiac resynchronization therapy (CRT) on ventricular tachycardias in patients with dilated cardiomyopathy and to analyze the prospects of radionuclide diagnostic methods for prediction of life-threatening arrhythmias in the presence of therapy. The study included 70 patients (mean age 55±12 years) aged 32 to 75 years with dilated cardiomyopathy, NYHA FC III heart failure, left ventricular (LV) ejection fraction (EF) of 30.1±3.8%, and end-diastolic volume (EDV) of 220.7±50.9 mL. Group 1 comprised 35 patients (50%) diagnosed with paroxysms of ventricular tachycardia, while Group 2 consisted of 35 patients (50%) without episodes of ventricular tachycardia. After one year of CRT, positive clinical changes were documented in all patients: LV EF increased to 42.8±4.8% (p 0.001); functional class of heart failure decreased to II; LV EDV decreased to 197.9±47.8 mL (p 0.005). The patients whose EF increased by 14% and EDV decreased by 35 mL during one-year CRT had no episodes of ventricular tachycardia. The patients, whose paroxysms of ventricular tachycardia persisted during the entire period of the study, showed EF increase by 9% and EDV decrease by 13 mL. The second stage of the study consisted in evaluating the effects of myocardial metabolism defects (MMD). No ventricular tachycardia episodes were registered in patients whose MMD became less than 15% during CRT; if the size of DMM exceeded 15%, paroxysms of ventricular tachycardia were observed. Thus, efficacious CRT in patients with dilated cardiomyopathy results in a statistically significant reduction of the number of ventricular tachycardia episodes. The improvement of fatty acid metabolism contributes to a decrease in the number of ventricular tachycardia episodes in the course of CRT.

PDF (Русский)

References

  1. Levy D., Kechaiah S., Larson M.G., et al. Long-term trends in the incidence of and survival with heart failure. N. Engl. J. Med. 2002; 347: 1397-402.
  2. Johnson R.A., Palacios I. Dilated cardiomyopathies of the adult (first of two parts). N. Engl. J. Med. 1982; 307: 1051-58.
  3. 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.
  4. Cleland J., Daubert J.C., Erdmann E., et al. Longer-term effects of cardiac resynchronization therapy on mortality in heart failure . Eur. Heart J. 2006; 27: 1928-32.
  5. Мареев В.Ю. и др. Российские национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (четвертый пересмотр). Сердечная недостаточность. 2013; 14 (4): 64-103.
  6. Faran А., et al. Cardiac resynchronisation therapy in patients with endstage heart failure -long-term follow-up. Kardiologia Polska. 2008; 66 (1): 19-26.
  7. McAlister F.A., Ezekowitz J.A., Wiebe N., et al. Systematic Review: Cardiac Resynchronization in Patients with Symptomatic Heart Failure. Ann. Intern. Med. 2004; 141: 381-90.
  8. Bax J.J., Abraham T., Barold S.S., et al. Cardiac resynchronization therapy: part 1 -issues before device implantation; Part 2 -Issues During and After Device Implantation and Unresolved Questions. J. Am. Coll. Cardiol. 2005; 46: 2153-67.
  9. Bax J.J., Abraham T., Barold S.S., et al. Cardiac resynchronization therapy: part 1 -issues before device implantation; Part 2 -Issues During and After Device Implantation and Unresolved Questions. J. Am. Coll. Cardiol. 2005; 46: 2168-82.
  10. Bristow M.R., Saxon L.A., Boehmer J., et al. Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N. Engl. J. Med. 2004; 350: 2140-50.
  11. Cleland J., Daubert J.C., Erdmann E., et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N. Engl. J. Med. 2005; 352: 1539^9.
  12. Kies P., Bax J.J., Molhoek S.G., et al. Effect of cardiac resynchronization therapy on inducibility of ventricular tachyarrhythmias in cardiac arrest survivors with either ischemic or idiopathic dilated cardiomyopathy. Am. J. Cardiol. 2005; 95: 1111-14.
  13. Garrigue S., Barold S.S., Hocini M., Jaes P., et al. Treatment of drug refractory ventricular tachycardia by biventricular pacing. Pacing Clin. Electrophysiol. 2000; 23: 1700-2.
  14. Thackray S., Coletta A., Jones P., Dunn A., Clark A.L., Cleland J.G. Clinical trails update: Highlights of the Scientific Sessions of Heart Failure 2001, a meeting of the Working Group on Heart Failure of the European Society of Cardiology. CONTAK-CD, CHRISTMAS, OPTIME-CHF. Eur. J. Heart Fail. 2001; 3: 491-94.
  15. Arya A., Haghjoo M., Dehghani M.R., et al. Effect of cardiac resynchronization therapy on the incidence of ventricular arrhythmias in patients with an implantable cardioverter-defibrillator. Heart Rhythm 2005; 2: 1094-98.