Managing arrhythmia in cardiac resynchronisation therapy

Felicity de Vere; Nadeev Wijesuriya; Mark K. Elliott; Vishal Mehta; Sandra Howell; Martin Bishop; Marina Strocchi; Steven A. Niederer; Christopher A. Rinaldi

doi:10.3389/fcvm.2023.1211560

Managing arrhythmia in cardiac resynchronisation therapy

Felicity de Vere^*, Nadeev Wijesuriya, Mark K. Elliott, Vishal Mehta, Sandra Howell, Martin Bishop, Marina Strocchi, Steven A. Niederer, Christopher A. Rinaldi

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

Abstract

Arrhythmia is an extremely common finding in patients receiving cardiac resynchronisation therapy (CRT). Despite this, in the majority of randomised trials testing CRT efficacy, patients with a recent history of arrhythmia were excluded. Most of our knowledge into the management of arrhythmia in CRT is therefore based on arrhythmia trials in the heart failure (HF) population, rather than from trials dedicated to the CRT population. However, unique to CRT patients is the aim to reach as close to 100% biventricular pacing (BVP) as possible, with HF outcomes greatly influenced by relatively small changes in pacing percentage. Thus, in comparison to the average HF patient, there is an even greater incentive for controlling arrhythmia, to achieve minimal interference with the effective delivery of BVP. In this review, we examine both atrial and ventricular arrhythmias, addressing their impact on CRT, and discuss the available evidence regarding optimal arrhythmia management in this patient group. We review pharmacological and procedural-based approaches, and lastly explore novel ways of harnessing device data to guide treatment of arrhythmia in CRT.

Original language	English
Article number	1211560
Journal	Frontiers in Cardiovascular Medicine
Volume	10
DOIs	https://doi.org/10.3389/fcvm.2023.1211560
Publication status	Published - 2023

Keywords

AF ablation
arrhythmia (any)
atrial fibillation
AV node ablation
cardiac resynchronisation therapy (CRT)
heart failure
supraventricular arrhythmias
ventricular arrhythmia (VAs)

Access to Document

10.3389/fcvm.2023.1211560

Cite this

@article{8d24f7953a6b4a77a0a1fdafcf30fc8e,

title = "Managing arrhythmia in cardiac resynchronisation therapy",

abstract = "Arrhythmia is an extremely common finding in patients receiving cardiac resynchronisation therapy (CRT). Despite this, in the majority of randomised trials testing CRT efficacy, patients with a recent history of arrhythmia were excluded. Most of our knowledge into the management of arrhythmia in CRT is therefore based on arrhythmia trials in the heart failure (HF) population, rather than from trials dedicated to the CRT population. However, unique to CRT patients is the aim to reach as close to 100% biventricular pacing (BVP) as possible, with HF outcomes greatly influenced by relatively small changes in pacing percentage. Thus, in comparison to the average HF patient, there is an even greater incentive for controlling arrhythmia, to achieve minimal interference with the effective delivery of BVP. In this review, we examine both atrial and ventricular arrhythmias, addressing their impact on CRT, and discuss the available evidence regarding optimal arrhythmia management in this patient group. We review pharmacological and procedural-based approaches, and lastly explore novel ways of harnessing device data to guide treatment of arrhythmia in CRT.",

keywords = "AF ablation, arrhythmia (any), atrial fibillation, AV node ablation, cardiac resynchronisation therapy (CRT), heart failure, supraventricular arrhythmias, ventricular arrhythmia (VAs)",

author = "{de Vere}, Felicity and Nadeev Wijesuriya and Elliott, {Mark K.} and Vishal Mehta and Sandra Howell and Martin Bishop and Marina Strocchi and Niederer, {Steven A.} and Rinaldi, {Christopher A.}",

note = "Publisher Copyright: 2023 de Vere, Wijesuriya, Elliott, Mehta, Howell, Bishop, Strocchi, Niederer and Rinaldi.",

year = "2023",

doi = "10.3389/fcvm.2023.1211560",

language = "English",

volume = "10",

journal = "Frontiers in Cardiovascular Medicine",

issn = "2297-055X",

publisher = "Frontiers Media S.A.",

}

TY - JOUR

T1 - Managing arrhythmia in cardiac resynchronisation therapy

AU - de Vere, Felicity

AU - Wijesuriya, Nadeev

AU - Elliott, Mark K.

AU - Mehta, Vishal

AU - Howell, Sandra

AU - Bishop, Martin

AU - Strocchi, Marina

AU - Niederer, Steven A.

AU - Rinaldi, Christopher A.

N1 - Publisher Copyright: 2023 de Vere, Wijesuriya, Elliott, Mehta, Howell, Bishop, Strocchi, Niederer and Rinaldi.

PY - 2023

Y1 - 2023

N2 - Arrhythmia is an extremely common finding in patients receiving cardiac resynchronisation therapy (CRT). Despite this, in the majority of randomised trials testing CRT efficacy, patients with a recent history of arrhythmia were excluded. Most of our knowledge into the management of arrhythmia in CRT is therefore based on arrhythmia trials in the heart failure (HF) population, rather than from trials dedicated to the CRT population. However, unique to CRT patients is the aim to reach as close to 100% biventricular pacing (BVP) as possible, with HF outcomes greatly influenced by relatively small changes in pacing percentage. Thus, in comparison to the average HF patient, there is an even greater incentive for controlling arrhythmia, to achieve minimal interference with the effective delivery of BVP. In this review, we examine both atrial and ventricular arrhythmias, addressing their impact on CRT, and discuss the available evidence regarding optimal arrhythmia management in this patient group. We review pharmacological and procedural-based approaches, and lastly explore novel ways of harnessing device data to guide treatment of arrhythmia in CRT.

AB - Arrhythmia is an extremely common finding in patients receiving cardiac resynchronisation therapy (CRT). Despite this, in the majority of randomised trials testing CRT efficacy, patients with a recent history of arrhythmia were excluded. Most of our knowledge into the management of arrhythmia in CRT is therefore based on arrhythmia trials in the heart failure (HF) population, rather than from trials dedicated to the CRT population. However, unique to CRT patients is the aim to reach as close to 100% biventricular pacing (BVP) as possible, with HF outcomes greatly influenced by relatively small changes in pacing percentage. Thus, in comparison to the average HF patient, there is an even greater incentive for controlling arrhythmia, to achieve minimal interference with the effective delivery of BVP. In this review, we examine both atrial and ventricular arrhythmias, addressing their impact on CRT, and discuss the available evidence regarding optimal arrhythmia management in this patient group. We review pharmacological and procedural-based approaches, and lastly explore novel ways of harnessing device data to guide treatment of arrhythmia in CRT.

KW - AF ablation

KW - arrhythmia (any)

KW - atrial fibillation

KW - AV node ablation

KW - cardiac resynchronisation therapy (CRT)

KW - heart failure

KW - supraventricular arrhythmias

KW - ventricular arrhythmia (VAs)

UR - http://www.scopus.com/inward/record.url?scp=85168395082&partnerID=8YFLogxK

U2 - 10.3389/fcvm.2023.1211560

DO - 10.3389/fcvm.2023.1211560

M3 - Review article

AN - SCOPUS:85168395082

SN - 2297-055X

VL - 10

JO - Frontiers in Cardiovascular Medicine

JF - Frontiers in Cardiovascular Medicine

M1 - 1211560

ER -

Managing arrhythmia in cardiac resynchronisation therapy

Abstract

Keywords

Access to Document

Other files and links

Cite this