Management of premature ventricular ectopy in cardiac resynchronization therapy: Treatment strategies for an optimized cardiac resynchronization

被引：1
作者：
Rath B. [1 ]
Köbe J. [1 ]
Reinke F. [1 ]
Eckardt L. [1 ]
机构：
[1] Klinik für Kardiologie II: Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, Münster
来源：
Herzschrittmachertherapie + Elektrophysiologie | 2021年 / 32卷 / 1期
关键词：
Ablation; Cardiac resynchronization therapy; Heart failure; Left ventricular dysfunction; Premature ventricular ectopy;
D O I：
10.1007/s00399-021-00745-8
中图分类号：
学科分类号：
摘要：
Cardiac resynchronization therapy (CRT) is an integral part in the treatment of chronic heart failure. However, a high degree of biventricular pacing is essential for the effectiveness of this therapy. In addition to atrial fibrillation, premature ventricular contractions (PVC) are a common cause of reduced biventricular stimulation in CRT. In addition to the prognostically unfavorable reduction of biventricular pacing, PVC are generally associated with reduced outcome in the presence of structural heart disease. Options to increase biventricular stimulation percentage by reprogramming the CRT devices are limited in the majority of cases. Due to the mutual relationship between cardiomyopathy and ventricular arrhythmias, adequate heart failure therapy is essential for the reduction of ventricular ectopy. In addition to beta-blocker therapy, specific antiarrhythmic medication is mostly limited to class III antiarrhythmic drugs due to the structural heart disease usually present in CRT patients. Catheter ablation is superior to pharmacological therapy especially in the field of idiopathic PVC, but promising data are also available for catheter ablation of PVC in structural heart disease and CRT nonresponders. © 2021, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
引用
收藏
页码：41 / 47
页数：6
相关论文
共 42 条
  • [1] Cleland J.G., Daubert J.C., Erdmann E., Freemantle N., Gras D., Kappenberger L., Et al., The effect of cardiac resynchronization on morbidity and mortality in heart failure, N Engl J Med, 352, 15, pp. 1539-1549, (2005)
  • [2] Daubert C., Behar N., Martins R.P., Mabo P., Leclercq C., Avoiding non-responders to cardiac resynchronization therapy: a practical guide, Eur Heart J, 38, 19, pp. 1463-1472, (2017)
  • [3] Hayes D.L., Boehmer J.P., Daygilliam J.D., Heidenreich P.A., Seth M., Et al., Cardiac resynchronization therapy and the relationship of percent biventricular pacing to symptoms and survival, Heart Rhythm, 8, 9, pp. 1469-1475, (2011)
  • [4] Cheng A., Landman S.R., Stadler R.W., Reasons for loss of cardiac resynchronization therapy pacing: Insights from 32 844 patients, Circ Arrhythm Electrophysiol, 5, 5, pp. 884-888, (2012)
  • [5] Ruwald A.C., Aktas M.K., Ruwald M.H., Kutyifa V., McNitt S., Jons C., Et al., Postimplantation ventricular ectopic burden and clinical outcomes in cardiac resynchronization therapy-defibrillator patients: A MADIT-CRT substudy, Ann Noninvasive Electrocardiol, 23, 2, (2018)
  • [6] Aktas M.K., Mittal S., Kutyifa V., McNitt S., Polonsky B., Steinberg J., Et al., The burden and morphology of premature ventricular contractions and their impact on clinical outcomes in patients receiving biventricular pacing in the multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT), Ann Noninvasive Electrocardiol, 21, 1, pp. 41-48, (2016)
  • [7] Ruwald M.H., Mittal S., Ruwald A.C., Aktas M.K., Daubert J.P., McNitt S., Et al., Association between frequency of atrial and ventricular ectopic beats and biventricular pacing percentage and outcomes in patients with cardiac resynchronization therapy, J am Coll Cardiol, 64, 10, pp. 971-981, (2014)
  • [8] Ghosh S., Stadler R.W., Mittal S., Automated detection of effective left-ventricular pacing: Going beyond percentage pacing counters, Europace, 17, 10, pp. 1555-1562, (2015)
  • [9] Bhushan M., Asirvatham S.J., The conundrum of ventricular arrhythmia and cardiomyopathy: which abnormality came first?, Curr Heart Fail Rep, 6, 1, pp. 7-13, (2009)
  • [10] St John Sutton M., Lee D., Rouleau J.L., Goldman S., Plappert T., Braunwald E., Et al., Left ventricular remodeling and ventricular arrhythmias after myocardial infarction, Circulation, 107, 20, pp. 2577-2582, (2003)
12345