PMID- 25398405 OWN - NLM STAT- MEDLINE DCOM- 20151021 LR - 20150130 IS - 1532-2092 (Electronic) IS - 1099-5129 (Linking) VI - 17 IP - 2 DP - 2015 Feb TI - Cardiac resynchronization therapy reduces T-wave alternans in patients with heart failure. PG - 281-8 LID - 10.1093/europace/euu258 [doi] AB - AIMS: T-wave alternans (TWA) represents myocardial instability. The present study was to determine the impact of cardiac resynchronization therapy (CRT) on TWA and left ventricular ejection fraction (LVEF) in heart failure patients. METHODS AND RESULTS: T-wave alternans was analysed using a spectral method in 27 CRT-ICD patients. Ambulatory device electrograms were collected and LVEF and New York Heart Association (NYHA) classification were assessed at baseline prior to CRT and 3 months following CRT. Patients were followed for 6 months to monitor cardiac events. Spectral TWA of device electrograms was measured during AAI and CRT pacing tests. Each pacing mode had the up-titration pacing rate from 90 to 105 b.p.m. with 90 s for each pacing rate. At baseline, 20 (76.9%) patients had TWA during AAI pacing tests and 13 (50%) during CRT pacing tests (P = 0.044 between two pacing modes). Following 3-month CRT, TWA was identified in 11 patients (45.8%) during AAI pacing tests (a 31.1% reduction from the baseline value, P = 0.023) and 7 patients (28%) during CRT pacing tests (a 22% reduction, P = 0.108). Six of seven patients who had cardiac events had TWA (three patients had arrhythmic events, two died of heart failure, one received heart transplant). Overall, LVEF improved from 27.3 +/- 5.8 to 35.9 +/- 10.5% (P < 0.001) and NYHA classification improved from 2.8 +/- 0.6 to 1.6 +/- 0.6 after 3-month CRT (P < 0.001). CONCLUSION: In heart failure patients who receive a CRT-ICD, CRT reduces TWA that is associated to cardiac events, suggesting that CRT promotes clinically significant reverse electrical and mechanical remodelling. CI - Published on behalf of the European Society of Cardiology. All rights reserved. (c) The Author 2014. For permissions please email: journals.permissions@oup.com. FAU - Hua, Wei AU - Hua W AD - Arrhythmic Center and Clinical EP Lab, Beijing Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, China. FAU - Chen, Keping AU - Chen K AD - Arrhythmic Center and Clinical EP Lab, Beijing Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, China. FAU - Zhou, Xiaohong AU - Zhou X AD - CRDM, Medtronic (Shanghai) Management Co., Ltd., Blk 11, No. 3000 Long Dong Ave, Shanghai 201203, China. FAU - Dai, Yan AU - Dai Y AD - Arrhythmic Center and Clinical EP Lab, Beijing Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, China. FAU - Chen, Ruohan AU - Chen R AD - Arrhythmic Center and Clinical EP Lab, Beijing Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, China. FAU - Wang, Jing AU - Wang J AD - Arrhythmic Center and Clinical EP Lab, Beijing Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, China. FAU - Ding, Ligang AU - Ding L AD - Arrhythmic Center and Clinical EP Lab, Beijing Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, China. FAU - Liu, Zhiming AU - Liu Z AD - Arrhythmic Center and Clinical EP Lab, Beijing Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, China. FAU - Feng, Tianjie AU - Feng T AD - Arrhythmic Center and Clinical EP Lab, Beijing Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, China. FAU - Yu, Jun AU - Yu J AD - Arrhythmic Center and Clinical EP Lab, Beijing Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, China. FAU - Cheng, Jianwei AU - Cheng J AD - CRDM, Medtronic (Shanghai) Management Co., Ltd., Blk 11, No. 3000 Long Dong Ave, Shanghai 201203, China. FAU - Liu, Cherry AU - Liu C AD - CRDM, Medtronic (Shanghai) Management Co., Ltd., Blk 11, No. 3000 Long Dong Ave, Shanghai 201203, China. FAU - Zhang, Shu AU - Zhang S AD - Arrhythmic Center and Clinical EP Lab, Beijing Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, China zsfuwai@vip.163.com. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20141114 PL - England TA - Europace JT - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology JID - 100883649 SB - IM MH - Aged MH - Cardiac Resynchronization Therapy/*methods MH - Cardiac Resynchronization Therapy Devices MH - Cohort Studies MH - Defibrillators, Implantable MH - Electrocardiography MH - Electrocardiography, Ambulatory MH - Female MH - Heart Failure/physiopathology/*therapy MH - Humans MH - Male MH - Middle Aged MH - Prospective Studies MH - Stroke Volume MH - Tachycardia, Ventricular/physiopathology MH - Treatment Outcome MH - Ventricular Dysfunction, Left/physiopathology/*therapy MH - Ventricular Fibrillation/physiopathology OTO - NOTNLM OT - Cardiac resynchronization therapy OT - Chronic heart failure OT - Implantable cardioverter-defibrillator OT - T-wave alternans OT - Ventricular tachyarrhythmia EDAT- 2014/11/16 06:00 MHDA- 2015/10/22 06:00 CRDT- 2014/11/16 06:00 PHST- 2014/11/16 06:00 [entrez] PHST- 2014/11/16 06:00 [pubmed] PHST- 2015/10/22 06:00 [medline] AID - euu258 [pii] AID - 10.1093/europace/euu258 [doi] PST - ppublish SO - Europace. 2015 Feb;17(2):281-8. doi: 10.1093/europace/euu258. Epub 2014 Nov 14.