Description
Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by James O'Hara, PhD, PA, Virginia Heart and Shunmuga Sundaram Ponnusamy, MBBS, MD, CEPS-A, Velammal Medical College Hospital and Research Institute to discuss a study that evaluated the impact of QRS morphology on the risk of life-threatening ventricular arrhythmias in heart failure patients treated with cardiac resynchronization therapy with a defibrillator (CRT-D). The analysis included 2,862 patients from five major ICD trials, focusing on those with a QRS duration of ≥130 ms. Patients were categorized into those receiving ICD-only or CRT-D. Key findings: Among patients with left bundle branch block (LBBB), those with CRT-D showed a significant 44% reduction in the risk of fast ventricular tachycardia (VT)/ventricular fibrillation (VF) compared to ICD-only patients. They also had a lower burden of fast VT/VF and fewer appropriate shocks. In patients with non-left bundle branch block (NLBBB), CRT-D did not reduce the risk of fast VT/VF and was associated with a significant increase in the burden of fast VT/VF events compared to ICD-only patients. The study concludes that CRT-D effectively reduces life-threatening ventricular arrhythmias in LBBB patients but may increase the risk in NLBBB patients.
Learning Objectives
- Learn how cardiac resynchronization therapy with a defibrillator (CRT-D) significantly reduces the risk of fast ventricular tachycardia (VT) and ventricular fibrillation (VF) in heart failure patients with left bundle branch block (LBBB) but may increase the risk of these arrhythmias in patients with non-left bundle branch block (NLBBB).
- Explore the importance of QRS morphology in predicting outcomes of CRT-D therapy, including the reduction in the burden of fast VT/VF and appropriate shocks in LBBB patients, contrasted with the increased burden of arrhythmic events in NLBBB patients.
Article Authors and Podcast Contributors
Article Authors
Ido Goldenberg, Mehmet K. Aktas, Wojciech Zareba, David Tsu-Chau Huang, Spencer Z. Rosero, Arwa Younis, Scott McNitt, Martin Stockburger, Jonathan S. Steinberg, Rupinder S. Buttar, Bela Merkely, Valentina Kutyifa
Podcast Contributors
Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital
James O'Hara, PhD, PA, Virginia Heart
Shunmuga Sundaram Ponnusamy, MBBS, MD, CEPS-A, Velammal Medical College Hospital and Research Institute
Faculty and Disclosures
All relevant financial relationships have been mitigated.
Host Disclosure(s):
D. Varghese: Nothing to disclose.
Contributor Disclosure(s):
J. O'Hara: Honoraria, Speaking, and Consulting: Medtronic Inc., Boston Scientific
S. Ponnusamy: Honoraria, Speaking, and Consulting: Medtronic Inc.
Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):
S. Sailor: No relevant financial relationships with ineligible companies to disclose.
S. Colbert: No relevant financial relationships with ineligible companies to disclose.
ACE Statements
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Physicians AMA Designation Statement
The Heart Rhythm Society designates this internet-enduring activity for a maximum of .25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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The Heart Rhythm Society is committed to the provision of Accredited Continuing Education (formerly known as Continuing Medical Education (CME)) that is balanced, objective, and evidence based. HRS adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME) which require that those individuals in a position to control the content of an educational activity (including, but not limited to, planners, faculty, authors, committee members, content reviewers, editors, and staff) disclose all financial relationships with an ACCME-defined ineligible company* within the 24 months prior to the disclosure.
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ACCME Definition:
*An ineligible company is one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
Examples of such organizations include:
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