Association Between Frequency of Atrial and Ventricular Ectopic Beats and Biventricular Pacing Percentage and Outcomes in Patients With Cardiac Resynchronization Therapy

• Published in: Journal of the American College of Cardiology 2014-09, Vol.64 (10), p.971-981
• Main Authors: Ruwald, Martin H., MD, PhD, Mittal, Suneet, MD, Ruwald, Anne-Christine, MD, Aktas, Mehmet K., MD, Daubert, James P., MD, McNitt, Scott, MS, Al-ahmad, Amin, MD, Jons, Christian, MD, PhD, Kutyifa, Valentina, MD, PhD, Steinberg, Jonathan S., MD, Wang, Paul, MD, Moss, Arthur J., MD, Zareba, Wojciech, MD, PhD
• Format: Article
• Language: English
• Subjects: Age Distribution; Aged; Atrial Premature Complexes - epidemiology; Atrial Premature Complexes - etiology; Biological and medical sciences; biventricular pacing; Cardiac arrhythmia; cardiac resynchronization therapy; Cardiac Resynchronization Therapy - adverse effects; Cardiac Resynchronization Therapy - methods; Cardiology; Cardiology. Vascular system; Cardiomyopathy; Cardiovascular; Confidence Intervals; Defibrillators, Implantable - adverse effects; Echocardiography - methods; ectopic beats; Electrocardiography; Electrocardiography, Ambulatory - methods; Female; Heart; Heart attacks; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - therapy; Holter monitoring; Humans; Incidence; Internal Medicine; Kaplan-Meier Estimate; Laboratories; Male; Medical sciences; Middle Aged; Mortality; Odds Ratio; Prognosis; Proportional Hazards Models; Questioning; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); reverse remodeling; Risk Assessment; Severity of Illness Index; Sex Distribution; Survival Rate; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - mortality; Tachycardia, Ventricular - therapy; Treatment Outcome; Ultrasonic imaging; Ventricular Premature Complexes - epidemiology; Ventricular Premature Complexes - etiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2014.06.1177

Abstract Background A high percentage of biventricular pacing is required for optimal outcome in patients treated with cardiac resynchronization therapy (CRT), but the influence of ectopic beats on the success of biventricular pacing has not been well established. Objectives This study sought to determine if increased ectopic beats reduce the chance of high biventricular pacing percentage and are associated with subsequent adverse outcomes. Methods From the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy), 801 patients with an implanted CRT-defibrillator device with data available on biventricular pacing percentage and pre-implantation 24-h Holter recordings were included. Using logistic regression, we estimated the influence of ectopic beats on the percentage of biventricular pacing. Reverse remodeling was measured as reductions in atrial and left ventricular end-systolic volumes (LVESV) at 1 year. Cox models were used to assess the influence of ectopic beats on the outcomes of heart failure (HF) or death, ventricular tachyarrhythmias (VTAs), and death. Results In the pre-implantation Holter recording, ectopic beats accounted for a mean 3.2 ± 5.5% of all beats. The probability of subsequent low biventricular pacing percentage (1.5% ectopic beats compared with those with