Author + information
- Xuping Li1,2,
- Dachun Yang2,
- Fred Kusumoto Fred3,
- Win-Guang Shen4,
- Siva Mulpuru4,
- Zhenghua Zhou1,
- Gang Wu2,
- Mei Yang2,
- Jin-Qu Liu5,
- Zhuo Li, MS6,
- Paul A. Friedman2 and
- Yong-Mei Cha2∗
- 1Department of Cardiovascular medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- 2Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- 3Department of Cardiovascular Diseases, Mayo Clinic, Florida, FL, USA
- 4Department of Cardiovascular Diseases, Mayo Clinic, Arizona, AZ, USA
- 5Cardiovascular Center, Dalian University Hospital, Dalian, China
- 6Division of Biomedical Statistics and Informatics, Mayo Clinic, Florida, FL, USA
A proportion of patients who received CRT-D lived to a second generator. There has been a controversial whether an ICD should be offered to patients who have had a normalized or near normalized LVEF at the time of generator change.
1) to evaluate the incidence of appropriate ICD therapy after CRT-D generator replacement and 2) to identify the predictors of CRT-D generator replacement (GR).
A consecutive 1026 patients who underwent CRT with a defibrillator (CRT-D) implantation between January 2002 and December 2012 were included in the study. Echocardiographies were assessed before the initial device implant and before the generator replacement (GR).
Of 1,026 patients who received CRT-D, 227 (22.1%) underwent CRT-D GR in our institution. Approximately 48% of patients who received new CRT-D generators were no longer meeting the guideline indication for ICD use at the time of GR. These patients received subsequent appropriate ICD therapies at a significantly lower rate compared to those whose LVEF remained to be below 35% (12% vs 35%, P<0.001). Lower LVEF (2.54[1.29–5]; P=0.007) was independently associated with the first appropriate ICD therapy after the GR. Forty-seven (20.7%) of 227 patients had LVEF improved to ≥50% at the time of GR. ICD therapy for ventricular arrhythmia in ischemic group was 18.2%, and none in nonischemic group from the second generator.
The improvement in LVEF after CRT-D is associated with significantly reduced incidence of appropriate ICD therapy. Normalized LVEF in nonischemic cardiomyopathy is less likely to develop ventricular arrhythmia.