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Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key?

BACKGROUND: The role of atrial rate‐responsive (RR) pacing in cardiac resynchronization therapy (CRT) is unclear due to the favorable effect of rate lowering in systolic heart failure. Atrial high rate episodes (AHREs) in CRT recipients are particularly worrisome since they cause loss of CRT, beyond...

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Autores principales: Biffi, Mauro, D'Onofrio, Antonio, Pignalberi, Carlo, Pisanò, Ennio C., Iacopino, Saverio, Curnis, Antonio, Senatore, Gaetano, Capucci, Alessandro, Della Bella, Paolo, Calvi, Valeria, Zanotto, Gabriele, Caravati, Fabrizio, Maglia, Giampiero, Manzo, Michele, Santamaria, Matteo, Ziacchi, Matteo, Lissoni, Fabio, Giacopelli, Daniele, Gargaro, Alessio, Solimene, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wiley Periodicals, Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727874/
https://www.ncbi.nlm.nih.gov/pubmed/31282000
http://dx.doi.org/10.1002/clc.23227
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author Biffi, Mauro
D'Onofrio, Antonio
Pignalberi, Carlo
Pisanò, Ennio C.
Iacopino, Saverio
Curnis, Antonio
Senatore, Gaetano
Capucci, Alessandro
Della Bella, Paolo
Calvi, Valeria
Zanotto, Gabriele
Caravati, Fabrizio
Maglia, Giampiero
Manzo, Michele
Santamaria, Matteo
Ziacchi, Matteo
Lissoni, Fabio
Giacopelli, Daniele
Gargaro, Alessio
Solimene, Francesco
author_facet Biffi, Mauro
D'Onofrio, Antonio
Pignalberi, Carlo
Pisanò, Ennio C.
Iacopino, Saverio
Curnis, Antonio
Senatore, Gaetano
Capucci, Alessandro
Della Bella, Paolo
Calvi, Valeria
Zanotto, Gabriele
Caravati, Fabrizio
Maglia, Giampiero
Manzo, Michele
Santamaria, Matteo
Ziacchi, Matteo
Lissoni, Fabio
Giacopelli, Daniele
Gargaro, Alessio
Solimene, Francesco
author_sort Biffi, Mauro
collection PubMed
description BACKGROUND: The role of atrial rate‐responsive (RR) pacing in cardiac resynchronization therapy (CRT) is unclear due to the favorable effect of rate lowering in systolic heart failure. Atrial high rate episodes (AHREs) in CRT recipients are particularly worrisome since they cause loss of CRT, beyond representing a stroke risk factor. HYPOTHESIS: The presence of an association between RR and the incidence of AHREs. METHODS: Daily remote transmissions from 836 CRT recipients were analyzed. AHREs were classified by duration: ≥15 minutes, ≥5 hours, and ≥ 24 hours. Variables possibly associated to AHREs were included in time‐dependent proportional‐hazard models, averaging over 30‐day periods and adjusting for main baseline variables. RESULTS: After a median follow‐up of 23.9 (12.2‐36.0) months, 507 (60.6%) patients experienced at least one 15‐minute AHRE. RR function was programmed in 166 (19.8%) patients and was associated with an increased AHRE occurrence rate with hazard ratio (HR) ranging from 1.45 to 1.78 for the 3 cutoffs of episode duration. The negative effect of RR function was not observed in the subset of patients with low mean heart rate (<68 bpm). Higher mean heart rates increased AHRE risk (HR:1.02, P = .01), while CRT amount decreased it (HR:0.98, P < .01). The extent of atrial pacing did not predict AHRE occurrence. CONCLUSIONS: RR pacing in CRT recipients is associated with increased AHRE occurrence, especially when an average heart rate > 68 bpm is attained.
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spelling pubmed-67278742019-09-12 Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key? Biffi, Mauro D'Onofrio, Antonio Pignalberi, Carlo Pisanò, Ennio C. Iacopino, Saverio Curnis, Antonio Senatore, Gaetano Capucci, Alessandro Della Bella, Paolo Calvi, Valeria Zanotto, Gabriele Caravati, Fabrizio Maglia, Giampiero Manzo, Michele Santamaria, Matteo Ziacchi, Matteo Lissoni, Fabio Giacopelli, Daniele Gargaro, Alessio Solimene, Francesco Clin Cardiol Clinical Investigations BACKGROUND: The role of atrial rate‐responsive (RR) pacing in cardiac resynchronization therapy (CRT) is unclear due to the favorable effect of rate lowering in systolic heart failure. Atrial high rate episodes (AHREs) in CRT recipients are particularly worrisome since they cause loss of CRT, beyond representing a stroke risk factor. HYPOTHESIS: The presence of an association between RR and the incidence of AHREs. METHODS: Daily remote transmissions from 836 CRT recipients were analyzed. AHREs were classified by duration: ≥15 minutes, ≥5 hours, and ≥ 24 hours. Variables possibly associated to AHREs were included in time‐dependent proportional‐hazard models, averaging over 30‐day periods and adjusting for main baseline variables. RESULTS: After a median follow‐up of 23.9 (12.2‐36.0) months, 507 (60.6%) patients experienced at least one 15‐minute AHRE. RR function was programmed in 166 (19.8%) patients and was associated with an increased AHRE occurrence rate with hazard ratio (HR) ranging from 1.45 to 1.78 for the 3 cutoffs of episode duration. The negative effect of RR function was not observed in the subset of patients with low mean heart rate (<68 bpm). Higher mean heart rates increased AHRE risk (HR:1.02, P = .01), while CRT amount decreased it (HR:0.98, P < .01). The extent of atrial pacing did not predict AHRE occurrence. CONCLUSIONS: RR pacing in CRT recipients is associated with increased AHRE occurrence, especially when an average heart rate > 68 bpm is attained. Wiley Periodicals, Inc. 2019-07-07 /pmc/articles/PMC6727874/ /pubmed/31282000 http://dx.doi.org/10.1002/clc.23227 Text en © 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Investigations
Biffi, Mauro
D'Onofrio, Antonio
Pignalberi, Carlo
Pisanò, Ennio C.
Iacopino, Saverio
Curnis, Antonio
Senatore, Gaetano
Capucci, Alessandro
Della Bella, Paolo
Calvi, Valeria
Zanotto, Gabriele
Caravati, Fabrizio
Maglia, Giampiero
Manzo, Michele
Santamaria, Matteo
Ziacchi, Matteo
Lissoni, Fabio
Giacopelli, Daniele
Gargaro, Alessio
Solimene, Francesco
Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key?
title Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key?
title_full Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key?
title_fullStr Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key?
title_full_unstemmed Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key?
title_short Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key?
title_sort rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: is low heart rate the key?
topic Clinical Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727874/
https://www.ncbi.nlm.nih.gov/pubmed/31282000
http://dx.doi.org/10.1002/clc.23227
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