PMID- 25190230
OWN - NLM
STAT- MEDLINE
DCOM- 20141029
LR  - 20141210
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 64
IP  - 10
DP  - 2014 Sep 9
TI  - Association between frequency of atrial and ventricular ectopic beats and 
      biventricular pacing percentage and outcomes in patients with cardiac 
      resynchronization therapy.
PG  - 971-81
LID - S0735-1097(14)04436-2 [pii]
LID - 10.1016/j.jacc.2014.06.1177 [doi]
AB  - 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 
      (<97%) was increased 3-fold (odds ratio: 3.37; 95% confidence interval: 1.74 to 
      6.50; p < 0.001) in patients with 0.1% to 1.5% ectopic beats and 13-fold (odds 
      ratio: 13.42; 95% confidence interval: 7.02 to 25.66; p < 0.001) in patients with 
      >1.5% ectopic beats compared with those with <0.1% ectopic beats. Patients with 
      >/=0.1% ectopic beats had significantly less reverse remodeling (percent reduction 
      in LVESV 31 +/- 15%) than patients with <0.1% ectopic beats (percent reduction in 
      LVESV 39 +/- 14%; p < 0.001). The risk of HF/death and VTA was increased 
      significantly in those with 0.1% to 1.5% ectopic beats (hazard ratio: 3.13 and 
      1.84, respectively) and for >1.5% ectopic beats (hazard ratio: 2.38 and 2.74, 
      respectively). CONCLUSIONS: Relatively low frequencies of ectopic beats (>/=0.1%) 
      dramatically increase the probability of low biventricular pacing (<97%), with 
      reduced CRT efficacy by less reverse remodeling and higher risk of HF/death and 
      VTA. This supports pre-implantation Holter monitoring of patients selected for 
      CRT for optimal outcome. (MADIT-CRT: Multicenter Automatic Defibrillator 
      Implantation With Cardiac Resynchronization Therapy; NCT00180271).
CI  - Copyright (c) 2014 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Ruwald, Martin H
AU  - Ruwald MH
AD  - Heart Research Follow-up Program, University of Rochester Medical Center, 
      Rochester, New York; Department of Cardiology, Gentofte Hospital, Hellerup, 
      Denmark. Electronic address: mruwald@hotmail.com.
FAU - Mittal, Suneet
AU  - Mittal S
AD  - Arrhythmia Institute, Valley Health System of New York and New Jersey, New York, 
      New York and Ridgewood, New Jersey.
FAU - Ruwald, Anne-Christine
AU  - Ruwald AC
AD  - Heart Research Follow-up Program, University of Rochester Medical Center, 
      Rochester, New York; Department of Cardiology, Gentofte Hospital, Hellerup, 
      Denmark.
FAU - Aktas, Mehmet K
AU  - Aktas MK
AD  - Heart Research Follow-up Program, University of Rochester Medical Center, 
      Rochester, New York.
FAU - Daubert, James P
AU  - Daubert JP
AD  - Cardiology Division, Department of Medicine and Duke Clinical Research Institute, 
      Duke University Medical Center, Durham, North Carolina.
FAU - McNitt, Scott
AU  - McNitt S
AD  - Heart Research Follow-up Program, University of Rochester Medical Center, 
      Rochester, New York.
FAU - Al-Ahmad, Amin
AU  - Al-Ahmad A
AD  - Texas Cardiac Arrhythmia Institute, Austin, Texas.
FAU - Jons, Christian
AU  - Jons C
AD  - Department of Cardiology, Gentofte Hospital, Hellerup, Denmark.
FAU - Kutyifa, Valentina
AU  - Kutyifa V
AD  - Heart Research Follow-up Program, University of Rochester Medical Center, 
      Rochester, New York.
FAU - Steinberg, Jonathan S
AU  - Steinberg JS
AD  - Arrhythmia Institute, Valley Health System of New York and New Jersey, New York, 
      New York and Ridgewood, New Jersey.
FAU - Wang, Paul
AU  - Wang P
AD  - Division of Cardiovascular Medicine, Stanford University, Stanford, California.
FAU - Moss, Arthur J
AU  - Moss AJ
AD  - Heart Research Follow-up Program, University of Rochester Medical Center, 
      Rochester, New York.
FAU - Zareba, Wojciech
AU  - Zareba W
AD  - Heart Research Follow-up Program, University of Rochester Medical Center, 
      Rochester, New York.
LA  - eng
SI  - ClinicalTrials.gov/NCT00180271
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2014 Sep 9;64(10):982-4. PMID: 25190231
MH  - Age Distribution
MH  - Aged
MH  - Atrial Premature Complexes/epidemiology/*etiology
MH  - Cardiac Resynchronization Therapy/*adverse effects/methods
MH  - Confidence Intervals
MH  - Defibrillators, Implantable/*adverse effects
MH  - Echocardiography/methods
MH  - Electrocardiography, Ambulatory/methods
MH  - Female
MH  - Heart Failure/diagnosis/mortality/therapy
MH  - Humans
MH  - Incidence
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Sex Distribution
MH  - Survival Rate
MH  - Tachycardia, Ventricular/diagnosis/mortality/*therapy
MH  - Treatment Outcome
MH  - Ventricular Premature Complexes/epidemiology/*etiology
OTO - NOTNLM
OT  - Holter monitoring
OT  - biventricular pacing
OT  - cardiac resynchronization therapy
OT  - ectopic beats
OT  - prognosis
OT  - reverse remodeling
EDAT- 2014/09/06 06:00
MHDA- 2014/10/30 06:00
CRDT- 2014/09/06 06:00
PHST- 2014/03/14 00:00 [received]
PHST- 2014/06/06 00:00 [revised]
PHST- 2014/06/10 00:00 [accepted]
PHST- 2014/09/06 06:00 [entrez]
PHST- 2014/09/06 06:00 [pubmed]
PHST- 2014/10/30 06:00 [medline]
AID - S0735-1097(14)04436-2 [pii]
AID - 10.1016/j.jacc.2014.06.1177 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2014 Sep 9;64(10):971-81. doi: 10.1016/j.jacc.2014.06.1177.