Restoration of sinus rhythm as a predictor of the effectiveness of cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy and severe drug refractory heart failure
Abstract
Background. Cardiac resynchronization therapy method (CRT) is one of the effective ways to treat chronic heart failure (CHF). Sustained and effective biventricular stimulation is crucial for achieving the best results from cardiac resynchronization therapy, with up to 31% of non-responders being patients with atrial fibrillation (AF).
Aim – to evaluate the effect of recovery and maintenance of sinus rhythm (SR) on the effectiveness of cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy and severe heart failure.
Material and methods. The study included 150 patients with CHF III of the NYHA functional class, with the main diagnosis of non-ischemic cardiomyopathy and a registered permanent form of AF. The CRT devices had been implanted to all patients. Control tests on the background of biventricular stimulation were carried out after 60 months. Retrospectively patients were divided into 4 groups: the 1st group included patients with reconstructed SR during implantation of the device, the 2nd group included patients with spontaneously recovered SR during the first year of CRT, the 3rd group one included with reconstructed SR after 1 year of CRT, the 4th group included patients with a permanent form of AF.
Results. Within 60 months, positive clinical dynamics was observed: LVEF increased from 27.9± 4.08% to 41.35±6.29% (p<0.00001), FC NYHA decreased from III to II, 6-minute walk test (6 MWT) distance increased from 264.73±60.5 m to 398.33±49.23 m (p<0.00001), the size of EDV was reduced from 235.8±53.9 ml to 198.76±46, 7 ml (p<0.0001). We compared the results between the groups and found that in patients of group 1 the increase in LV EF was 14%, the EDV decreased for 33 ml, 6 MWT distance increased for 157 meters; in the 2nd group the increase in LV EF was 14%; EDV decreased for 42 ml, 6 MWT distance increased for 130 meters. In the 3rd group, the increase in LV EF was 20%, the EDV decreased for 45 ml, and 6 MWT distance increased for 138 meters. In the 4th group, the increase in LV EF was 7%, the EDV decreased for 25 ml, 6 MWT distance increased for 93 meters.
Conclusion. Restoration and maintenance of SR in patients with CRT with AF can improve the effectiveness of the treatment.
Keywords:cardiac resynchronization therapy, atrial fibrillation, non-ischemic cardiomyopathy, chronic heart failure
For citation: Lebedev D.I., Lebedeva M.V., Krivolapov S.N., Batalov R.E., Popov S.V. Restoration of sinus rhythm as a predictor of the effectiveness of cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy and severe drug refractory heart failure. Clin Experiment Surg. Petrovsky J. 2019; 7 (3): 79–87. doi: 10.24411/2308-1198-2019-13009 (in Russian)
Received 01.07.2019. Accepted 25.07.2019.
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