Balancing between clinical efficacy and economic expediency: choosing a device for cardiac resynchronization therapy
D. A. Zorin,
A. A. Nechepurenko,
A. A. Demidov,
O. N. Dyakova,
N. N. Ilov,
N. P. Zorina,
K. N. Ivankova https://doi.org/10.35336/VA-1467
Abstract
The article focuses on the analysis of device selection for cardiac resynchronization therapy based on the stratification of sudden cardiac death risk. Various diagnostic methods and clinical-anamnestic data are considered, along with their role in predicting arrhythmogenic events and making implantation decisions. Differences in implantation approaches for patients with ischemic and non-ischemic cardiomyopathy are discussed, emphasizing the importance of a combined risk assessment and the use of prognostic models. Unresolved issues related to optimal patient selection, timing for evaluating CRT effectiveness, and potential implantation strategies considering both economic and clinical factors are also reviewed.
About the Authors
D. A. Zorin
FSBEI of HE Astrakhan State Medical University, MH RF ; FSBI “Federal Center for Cardiovascular Surgery” of the MH RF
Russian Federation
Russian Federation
Zorin Dmitry
Astrakhan, 121 Bakinskaya str
Astrakhan, 4 Pokrovskaya Roscha str
A. A. Nechepurenko
FSBI “Federal Center for Cardiovascular Surgery” of the MH RF
Russian Federation
Russian Federation
Astrakhan, 4 Pokrovskaya Roscha str
A. A. Demidov
FSBEI of HE Astrakhan State Medical University, MH RF
Russian Federation
Russian Federation
Astrakhan, 121 Bakinskaya str
O. N. Dyakova
FSBEI of HE Astrakhan State Medical University, MH RF
Russian Federation
Russian Federation
Astrakhan, 121 Bakinskaya str
N. N. Ilov
FSBEI of HE Astrakhan State Medical University, MH RF ; FSBI “Federal Center for Cardiovascular Surgery” of the MH RF
Russian Federation
Russian Federation
Astrakhan, 121 Bakinskaya str
Astrakhan, 4 Pokrovskaya Roscha str
N. P. Zorina
SBHO AR «City polyclinic №10»
Russian Federation
Russian Federation
Astrakhan, 26 Silikatnaya str.
K. N. Ivankova
FSBEI of HE Astrakhan State Medical University, MH RF
Russian Federation
Russian Federation
Astrakhan, 121 Bakinskaya str
References
1. Polyakov DS, Fomin IV, Belenkov YuN, et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Kardiologiia. 2021;61(4): 4-14 (in Russ.). https://doi.org/10.18087/cardio.2021.4.n1628.
2. Vaduganathan M, Patel RB, Michel A, et al. Mode of Death in Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol. 2017;69: 556-69. https://doi.org/10.1016/j.jacc.2016.10.078.
3. Ilov NN, Palnikova OV, Stompel DR, et al. Risk stratification of sudden cardiac death in heart failure patients: is left ventricular ejection fraction alone sufficient? Russian Journal of Cardiology. 2021;26(1): 3959. (In Russ.). https://doi.org/10.15829/1560-4071-2021-3959.
4. Ilov NN, Palnikova OV, Stompel DR, et al. Clinical Predictors of Occurrence of Ventricular Tachyarrhythmias in Patients with Reduced Left Ventricle Ejection Fraction. Results of Single-Center Prospective Study. Kardiologiia. 2021;61(5): 32-40 (in Russ.). https://doi.org/10.18087/cardio.2021.5.n1480.
5. Revishvili ASh, Shlyahto EV, Popov SV, et al. Klinicheskie rekomendacii po primeneniyu kardioverterov-defibrillyatorov. In. Klinicheskie rekomendacii po provedeniyu elektrofiziologicheskih issledovanij, kateternoj ablyacii i primeneniyu implantiruemyh antiaritmicheskih ustrojstv. (Ed. Revishvili ASh, Shlyahto EV, Popov SV, et al.). Moscow 2017: 55-86 (in Russ.) ISBN 978-5-9500922-0-6.
6. Zaman S, Goldberger JJ, Kovoor P. Sudden Death Risk-Stratification in 2018-2019: The Old and the New. Heart Lung Circ. 2019;28: 57-64. https://doi.org/10.1016/j.hlc.2018.08.027.
7. Postol AS, Neminushchiy NM, Antipov GN, et al. Factors that Determined a Positive Response to Resynchronization Therapy in Patients With Chronic Heart Failure and Cardiac Dyssynchrony. One Center Experience. Kardiologiia. 2024;64(7): 31-39. (In Russ.) https://doi.org/10.18087/cardio.2024.7.n2627.
8. Glikson M, Israel C, Denmark C, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. EHJ. 2021: 1-94. https://doi.org/10.1093/eurheartj/ehab364.
9. Yamamoto N, Noda T, Nakano M, et al. Clinical utility of QRS duration normalized to left ventricular volume for predicting cardiac resynchronization therapy efficacy in patients with “mid-range” QRS duration. Heart Rhythm. 2024;21: 855-62. https://doi.org/10.1016/j.hrthm.2024.02.019.
10. Amara N, Boveda S, Defaye P, et al. Implantable cardioverter-defibrillator therapy among patients with non-ischaemic vs. ischaemic cardiomyopathy for primary prevention of sudden cardiac death. Europace. 2018;20: 65-72. https://doi.org/10.1093/europace/euw379.
11. Galyavich A.S., Tereshchenko S.N., Uskach T.M. et al. 2024 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2024;29(11): 6162. (In Russ.). https://doi.org/10.15829/1560-4071-2024-6162.
12. Wallentin L, Stenestrand U, Tabrizi F, et al. Influence of left bundle branch block on long-term mortality in a population with heart failure. EHJ. 2007:2449-55. https://doi.org/10.1093/eurheartj/ehm262.
13. Moustafa AT, Tang ASL, Khan HR. Conduction system pacing on track to replace CRT ? Review of conduction system pacing. Front Cardiovasc Med. 2023: 1-12. https://doi.org/10.3389/fcvm.2023.1220709.
14. Ilov NN, Stompel DR, Palnikova OV, et al. Echocardiography parameter for evaluation of various effects of cardiac resynchronization therapy. Russian Journal of Cardiology and Cardiovascular Surgery. 2022;15(1): 19‑25. (in Russ.). https://doi.org/10.17116/kardio20221501119
15. Nakai T, Ikeya Y, Kogawa R, et al. What Are the Expectations for Cardiac Resynchronization Therapy ? A Validation of Two Response Definitions. Journal of clinical medicine 2021;10(3): 514. https://doi.org/10.3390/jcm10030514.
16. Bazoukis G, Naka KK, Alsheikh-Ali A, et al. Association of QRS narrowing with response to cardiac resynchronization therapy - a systematic review and meta-analysis of observational studies. Heart Failure Reviews 2020;25: 745-56. https://doi.org/10.1007/s10741-019-09839-5.
17. Stewart RA, Young AA, Anderson C et al. Relationship between QRS duration and left ventricular mass and volume in patients at high cardiovascular risk. Heart 2011;97: 1766-70. https://doi.org/10.1136/heartjnl-2011-300297.
18. Stankovic I, Belmans A, Prinz C, et al. The association of volumetric response and long-term survival after cardiac resynchronization therapy European Heart Journal - Cardiovascular Imaging. 2017;18(10): 1109-17. https://doi.org/10.1093/ehjci/jex188.
19. Kuznetsov V.A., Soldatova A.M., Enina T.N. et al. Does the lack of left ventricular reverse remodeling always mean non - response to cardiac resynchronization therapy? Terapevticheskii arkhiv. 2019;91: 10-5 (in Russ.). https://doi.org/10.26442/00403660.2019.12.000102.
20. van der Heijden AC, Höke U, Thijssen J, et al. Super-responders to cardiac resynchronization therapy remain at risk for ventricular arrhythmias and benefit from defibrillator treatment. European Journal of Heart Failure. 2014;16: 1104-11. https://doi.org/10.1002/ejhf.152.
21. Linhart M, Doltra A, Acosta J, et al. Ventricular arrhythmia risk is associated with myocardial scar but not with response to cardiac resynchronization therapy. EP Europace. 2020;22: 1391-400. https://doi.org/10.1093/europace/euaa142.
22. Nakamura T, Fukuzawa K, Kiuchi K et al. Ventricular arrhythmia events in heart failure patients with cardiac resynchronization therapy with or without a defibrillator for primary prevention. J Arrhythmia. 2022;38: 1056-62. https://doi.org/10.1002/joa3.12795.
23. Cvijić M, Antolič B, Klemen L, et al. Repolarization heterogeneity in patients with cardiac resynchronization therapy and its relation to ventricular tachyarrhythmias. Heart Rhythm. 2018;15: 1784-90. https://doi.org/10.1016/j.hrthm.2018.06.023.
24. Deif B, Ballantyne B, Almehmadi F, et al. Cardiac resynchronization is pro-arrhythmic in the absence of reverse ventricular remodelling: a systematic review and meta-analysis. Cardiovascular Research. 2018;114(11): 1435-44. https://doi.org/10.1093/cvr/cvy182.
25. Schrage B, Lund LH, Melin M, et al. Cardiac resynchronization therapy with or without defibrillator in patients with heart failure. EP Europace. 2022;24: 48-57. https://doi.org/10.1093/europace/euab233.
26. Bristow MR, Saxon LA, Boehmer J, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. The New England journal of medicine. 2004;350(21): 2140-50. https://doi.org/10.1056/NEJMoa032423.
27. Linde C, Abraham WT, Gold MR et al. Randomized Trial of Cardiac Resynchronization in Mildly Symptomatic Heart Failure Patients and in Asymptomatic Patients With Left Ventricular Dysfunction and Previous Heart Failure Symptoms. JACC. 2008;52(23): 1834-43. https://doi.org/10.1016/j.jacc.2008.08.027.
28. Kober L, Thune JJ, Nielsen JC et al. Defibrillator implantation in patients with nonischemic systolic heart failure. The New England journal of medicine. 2016;375: 1221-30. https://doi.org/10.1056/NEJMoa1608029.
29. Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA). European Heart Journal. 2021;42: 3427-520. https://doi.org/10.1093/eurheartj/ehab364.
30. Ramalho D, Freitas J. Drug-induced life-threatening arrhythmias and sudden cardiac death: A clinical perspective of long QT, short QT and Brugada syndromes. Revista Portuguesa de Cardiologia. 2018;37: 435-46. https://doi.org/10.1016/j.repc.2017.07.010.
31. Tse G, Gong M, Wong WT, et al. The T(peak) - T(end) interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: A systematic review and meta-analysis. Heart Rhythm. 2017;14: 1131-7. https://doi.org/10.1016/j.hrthm.2017.05.031.
32. Pranata R, Yonas E, Vania R, et al. Electrocardiographic early repolarization is associated with future ventricular arrhythmia after acute myocardial infarction-Systematic Review and Meta-Analysis. Journal of Arrhythmia. 2019;35: 626-35. https://doi.org/10.1002/joa3.12196.
33. Aro AL, Reinier K, Rusinaru C, et al. Electrical risk score beyond the left ventricular ejection fraction: prediction of sudden cardiac death in the Oregon Sudden Unexpected Death Study and the Atherosclerosis Risk in Communities Study. European Heart Journal. 2017;38: 3017-25. https://doi.org/10.1093/eurheartj/ehx331.
34. van der Bijl P, Delgado V, Bax JJ. Imaging for sudden cardiac death risk stratification: Current perspective and future directions. Progress in cardiovascular diseases. 2019;62: 205-11. https://doi.org/10.1016/j.pcad.2019.04.005.
35. Chatterjee S, Bavishi C, Sardar P et al. Meta-analysis of left ventricular hypertrophy and sustained arrhythmias. American Journal of Cardiology. 2014;114: 1049-52. https://doi.org/10.1016/j.amjcard.2014.07.015.
36. Golukhova E.Z., Bulaeva N.I., Mrikaev D.V. et al. Prognostic value of left ventricular global longitudinal strain and mechanical dispersion by speckle tracking echocardiography in patients with ischemic and nonischemic cardiomyopathy: a systematic review and meta-analysis. Russian Journal of Cardiology. 2022;27(3S): 5034 (in Russ.). https://doi.org/10.15829/1560-4071-2022-5034.
37. Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal. 2022;43: 3997-4126. https://doi.org/10.1093/eurheartj/ehac262.
38. Golukhova EZ, Aleksandrova SA, Berdibekov BS. Predictive role of quantification of myocardial fibrosis using delayed contrast-enhanced magnetic resonance imaging in nonischemic dilated cardiomyopathies: a systematic review and meta-analysis. Russian Journal of Cardiology. 2021;26: 189-97 (in Russ.). https://doi.org/10.15829/1560-4071-2021-4776.
39. Shlevkov NB, Zhambeev AA, Gasparyan AZ, et al. Characteristic of fibrotic myocardiallesions associated with life-threatening ventricular tachyarrhythmias in patients with ischemic and non-ischemic cardiomyopathies. Terapevticheskii arkhiv. 2018;90(9): 42-7 (in Russ.). https://doi.org/10.26442/terarkh201890942-47.
40. Bazylev V.V., Ushakov R.Yu., Durmanov S.S. et al. Prognostic value of delayed gadolinium enhancement on cardiac magnetic resonance imaging in patients with ischemic cardiomyopathy and an implanted cardioverter-defibrillator. Journal of Arrhythmology. 2024;31(2): 35-43 (in Russ.). https://doi.org/10.35336/VA-1260.
41. Narins CR, Aktas MK, Chen AY, et al. Arrhythmic and Mortality Outcomes Among Ischemic Versus Nonischemic Cardiomyopathy Patients Receiving Primary ICD Therapy. JACC Clinical Electrophysiology. 2022;8: 1-11. https://doi.org/10.1016/j.jacep.2021.06.020.
42. Jaiswal V, Taha AM, Joshi A, et al. Impl*фяыantable cardioverter defibrillators for primary prevention in patients with ischemic and non-ischemic cardiomyopathy: A meta-analysis. Current Problems in Cardiology. 2024;49: 102198. https://doi.org/10.1016/j.cpcardiol.2023.102198.
43. Burke AP, Virmani R. Pathophysiology of acute myocardial infarction. Medical Clinics of North America. 2007;91(4): 553-72; ix. https://doi.org/10.1016/j.mcna.2007.03.005.
44. Køber L, Thune JJ, Nielsen JC, et al. Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. The New England Journal of Medicine. 2016;375: 1221-30. https://doi.org/10.1056/NEJMoa1608029.
45. Kadish A, Dyer A, Daubert JP et al. Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy. The New England Journal of Medicine. 2004;350: 2151-8. https://doi.org/10.1056/NEJMoa033088.
46. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. The New England Journal of Medicine. 2002;346: 877-83. https://doi.org/10.1056/NEJMoa013474.
47. Gulati A, Jabbour A, Ismail TF, et al. Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy.JAMA2013;309: 896-908. https://doi.org/10.1001/jama.2013.1363.
48. Gold MR, Daubert J-C, Abraham WT, et al. Implantable Defibrillators Improve Survival in Patients With Mildly Symptomatic Heart Failure Receiving Cardiac Resynchronization Therapy. Circulation Arrhythmia and Electrophysiology. 2013;6: 1163-8. https://doi.org/10.1161/CIRCEP.113.000570.
49. Younis A, Goldberger JJ, Kutyifa V, et al. Predicted benefit of an implantable cardioverter-defibrillator: the MADIT-ICD benefit score. European Heart Journal 2021;42: 1676-84. https://doi.org/10.1093/eurheartj/ehaa1057.
50. Li X, Fan X, Li S, et al. A Novel Risk Stratification Score for Sudden Cardiac Death Prediction in Middle-Aged, Nonischemic Dilated Cardiomyopathy Patients: The ESTIMATED Score. Canadian Journal of Cardiology. 2020;36: 1121-9. https://doi.org/10.1016/j.cjca.2019.11.009.
51. Reeder HT, Shen C, Buxton AE, et al. Joint Shock/ Death Risk Prediction Model for Patients Considering Implantable Cardioverter-Defibrillators. Circulation Cardiovascular Quality and Outcomes. 2019;12: e005675. https://doi.org/10.1161/CIRCOUTCOMES.119.005675.
52. Mozaffarian D, Anker SD, Anand I, et al. Prediction of mode of death in heart failure: the Seattle Heart Failure Model. Circulation. 2007;116: 392-8. https://doi.org/10.1161/CIRCULATIONAHA.106.687103.
53. Moss AJ, Hall WJ, Cannom DS, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. The New England Journal of Medicine. 2009;361: 1329-38. https://doi.org/10.1056/NEJMoa0906431.
54. Goldenberg I, Aktas MK, Zareba W, et al. QRS Morphology and the Risk of Ventricular Tachyarrhythmia in Cardiac Resynchronization Therapy Recipients. JACC Clinical Electrophysiology. 2024;10: 16-26. https://doi.org/10.1016/j.jacep.2023.09.018.
55. Ilov NN, Boytsov SA, Nechepurenko A.A. Whether to implant a defibrillator or not? The Possibility of Using the MADIT-ICD Benefit Score Calculator in Real Practice. Kardiologiia. 2024;64(2): 27-33. (in Russ.). https://doi.org/10.18087/cardio.2024.2.n2447.
56. Mei DA, Gerra L, Imberti JF, et al. Cardiac resynchronization therapy ( CRT ) nonresponders in the contemporary era : A state-of-the-art review. Heart Rhythm. 2024: 1-11. https://doi.org/10.1016/j.hrthm.2024.05.057.
57. Cleland J, Freemantle N, Ghio S, et al. Predicting the Long-Term Effects of Cardiac Resynchronization Therapy on Mortality From Baseline Variables and the Early Response. JACC. 2008;52. https://doi.org/10.1016/j.jacc.2008.04.036.
58. Chumarnaya TV, Lyubimtseva TA, Solodushkin SI et al. Evaluation of the long-term effectiveness of cardiac resynchronization therapy. Russian Journal of Cardiology. 2021;26(7): 4531 (in Russ.). https://doi.org/10.15829/1560-4071-2021-4531.
59. Szabó KM, Tóth A, Nagy L, et al. Add-on Sacubitril/ Valsartan Therapy Induces Left Ventricular Remodeling in Non-responders to Cardiac Resynchronization Therapy to a Similar Extent as in Heart Failure Patients Without Resynchronization. Cardiology and Therapy. 2024;13: 149- 61. https://doi.org/10.1007/s40119-023-00346-1.
60. Jastrzębski M, Moskal P, Huybrechts W, et al. Left bundle branch-optimized cardiac resynchronization therapy (LOT-CRT): Results from an international LBBAP collaborative study group. Heart Rhythm. 2022;19: 13-21. https://doi.org/10.1016/j.hrthm.2021.07.057.
61. Strauss DG. Differentiation between left bundle branch block and left ventricular hypertrophy: Implications for cardiac resynchronization therapy. Journal of Electrocardiology. 2012;45: 635-9. https://doi.org/10.1016/j.jelectrocard.2012.09.001.
Review
For citations:
Zorin D.A., Nechepurenko A.A., Demidov A.A., Dyakova O.N., Ilov N.N., Zorina N.P., Ivankova K.N. Balancing between clinical efficacy and economic expediency: choosing a device for cardiac resynchronization therapy. Journal of Arrhythmology. 2025;32(3):55-63. (In Russ.) https://doi.org/10.35336/VA-1467
Views:
345
Email this article 