Anne-Christine Ruwald1,2, Mehmet K Aktas1, Martin H Ruwald1,3, Valentina Kutyifa1, Scott McNitt1, Christian Jons4, Suneet Mittal5, Jonathan S Steinberg1,5, James P Daubert6, Arthur J Moss1, Wojciech Zareba1. 1. Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA. 2. Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. 3. Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark. 4. Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. 5. Arrhythmia Institute, Valley Health System New York, New York, Ridgewood, NJ, USA. 6. Cardiology Division, Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Abstract
BACKGROUND: Frequent ventricular ectopy on preimplantation Holter has been associated with attenuated benefit from cardiac resynchronization therapy (CRT). However, it is unclear whether ectopic burden measured post-CRT implantation can be utilized to evaluate long-term prognosis. We aimed to describe the association between post-CRT implantation ectopic burden and subsequent risk of clinical outcomes. METHODS: At the 12-month follow-up visit, 24-hour Holter recordings were performed in 698 CRT-D patients from the MADIT-CRT study. The mean number of ventricular premature complexes (VPCs/hour) was calculated. High ectopic burden was defined as >10 VPCs/hour and low burden as ≤10 VPCs/hour. Multivariate Cox proportional hazards models were utilized to assess the association between 12-month ectopic burden and the risk of the end points of heart failure (HF) or death and ventricular tachyarrhythmias (VT/VF). RESULTS: At 12 months, 282 (40%) patients presented with low ectopic burden and 416 (60%) patients presented with high ectopic burden. The 3-year risk of HF/death and VT/VF was lower in patients with a low burden (7% and 8%) and significantly higher (25% and 24%) in patients with high burden. In multivariate analyses, patients with a high ectopic burden had approximately threefold increased risk of both HF/death (HR=2.76 [1.62-4.70], p < .001) and VT/VF (HR=2.79 [1.69-4.58], p < .001). CONCLUSION: In CRT-D patients with mild heart failure, high ectopic burden at 12-month follow-up was associated with a high 3-year risk of HF/death and VT/VF and threefold increased risk as compared to patients with low burden. Ectopic burden at 12 months may be a valuable approach for evaluating long-term prognosis.
RCT Entities:
BACKGROUND: Frequent ventricular ectopy on preimplantation Holter has been associated with attenuated benefit from cardiac resynchronization therapy (CRT). However, it is unclear whether ectopic burden measured post-CRT implantation can be utilized to evaluate long-term prognosis. We aimed to describe the association between post-CRT implantation ectopic burden and subsequent risk of clinical outcomes. METHODS: At the 12-month follow-up visit, 24-hour Holter recordings were performed in 698 CRT-D patients from the MADIT-CRT study. The mean number of ventricular premature complexes (VPCs/hour) was calculated. High ectopic burden was defined as >10 VPCs/hour and low burden as ≤10 VPCs/hour. Multivariate Cox proportional hazards models were utilized to assess the association between 12-month ectopic burden and the risk of the end points of heart failure (HF) or death and ventricular tachyarrhythmias (VT/VF). RESULTS: At 12 months, 282 (40%) patients presented with low ectopic burden and 416 (60%) patients presented with high ectopic burden. The 3-year risk of HF/death and VT/VF was lower in patients with a low burden (7% and 8%) and significantly higher (25% and 24%) in patients with high burden. In multivariate analyses, patients with a high ectopic burden had approximately threefold increased risk of both HF/death (HR=2.76 [1.62-4.70], p < .001) and VT/VF (HR=2.79 [1.69-4.58], p < .001). CONCLUSION: In CRT-D patients with mild heart failure, high ectopic burden at 12-month follow-up was associated with a high 3-year risk of HF/death and VT/VF and threefold increased risk as compared to patients with low burden. Ectopic burden at 12 months may be a valuable approach for evaluating long-term prognosis.
Authors: William T Abraham; Westby G Fisher; Andrew L Smith; David B Delurgio; Angel R Leon; Evan Loh; Dusan Z Kocovic; Milton Packer; Alfredo L Clavell; David L Hayes; Myrvin Ellestad; Robin J Trupp; Jackie Underwood; Faith Pickering; Cindy Truex; Peggy McAtee; John Messenger Journal: N Engl J Med Date: 2002-06-13 Impact factor: 91.245
Authors: Rutger J Van Bommel; Sjoerd A Mollema; C Jan Willem Borleffs; Matteo Bertini; Claudia Ypenburg; Nina Ajmone Marsan; Victoria Delgado; Ernst E Van Der Wall; Martin J Schalij; Jeroen J Bax Journal: J Am Coll Cardiol Date: 2011-02-01 Impact factor: 24.094
Authors: Ilan Goldenberg; Valentina Kutyifa; Helmut U Klein; David S Cannom; Mary W Brown; Ariela Dan; James P Daubert; N A Mark Estes; Elyse Foster; Henry Greenberg; Josef Kautzner; Robert Klempfner; Malte Kuniss; Bela Merkely; Marc A Pfeffer; Aurelio Quesada; Sami Viskin; Scott McNitt; Bronislava Polonsky; Ali Ghanem; Scott D Solomon; David Wilber; Wojciech Zareba; Arthur J Moss Journal: N Engl J Med Date: 2014-03-30 Impact factor: 91.245
Authors: Ilan Goldenberg; Arthur J Moss; W Jackson Hall; Elyse Foster; Jeffrey J Goldberger; Peter Santucci; Timothy Shinn; Scott Solomon; Jonathan S Steinberg; David Wilber; Alon Barsheshet; Scott McNitt; Wojciech Zareba; Helmut Klein Journal: Circulation Date: 2011-09-06 Impact factor: 29.690
Authors: Rutger J van Bommel; Jeroen J Bax; William T Abraham; Eugene S Chung; Luis A Pires; Luigi Tavazzi; Peter J Zimetbaum; Bart Gerritse; Nina Kristiansen; Stefano Ghio Journal: Eur Heart J Date: 2009-08-30 Impact factor: 29.983
Authors: Martin H Ruwald; Suneet Mittal; Anne-Christine Ruwald; Mehmet K Aktas; James P Daubert; Scott McNitt; Amin Al-Ahmad; Christian Jons; Valentina Kutyifa; Jonathan S Steinberg; Paul Wang; Arthur J Moss; Wojciech Zareba Journal: J Am Coll Cardiol Date: 2014-09-09 Impact factor: 24.094
Authors: Bruce A Koplan; Andrew J Kaplan; Stan Weiner; Paul W Jones; Milan Seth; Shelly A Christman Journal: J Am Coll Cardiol Date: 2009-01-27 Impact factor: 24.094
Authors: Anne-Christine Ruwald; Mehmet K Aktas; Martin H Ruwald; Valentina Kutyifa; Scott McNitt; Christian Jons; Suneet Mittal; Jonathan S Steinberg; James P Daubert; Arthur J Moss; Wojciech Zareba Journal: Ann Noninvasive Electrocardiol Date: 2017-09-20 Impact factor: 1.468