04 Sep Increased Ectopic Heart Beats Linked to Less Effective Pacing with CRT Therapy

MedicalResearch.com Interview with:
Martin Huth Ruwald, MD, PhD
Post doctoral research fellow
Heart Research Follow-up Program
University of Rochester Medical Center
Rochester, NY, US

Medical Research: What are the main findings of the study?

Dr. Ruwald: A high percentage of biventricular pacing is required for optimal outcome in patients treated with cardiac resynchronization therapy (CRT), but the influence of ectopic beats on the success of biventricular pacing has not been well established.

We found that patients with increasing amount of ectopic beats (the ectopic burden) (≥0.1%) were more likely to achieve low biventricular pacing <97% and had higher risk of heart failure or death and ventricular arrhythmias. Similarly the study identified patients with a very low amount of ectopic beats, less than 1 in 1000, who are very likely to obtain high biventricular pacing and who have very low risk of adverse outcomes.

Medical Research: Were any of the findings unexpected?

Dr. Ruwald: It was unexpected that such a relatively low burden of ectopic beats independently influenced and reduced the biventricular pacing percentage and resulted in adverse outcomes to such a degree.

Medical Research: What should clinicians and patients take away from your report?

Dr. Ruwald: A 24-hour Holter recording can help identify both patients who are less likely to obtain high biventricular pacing percentage and those who will achieve improved clinical outcome based on evaluation of pre-implantation ectopic beats. This information can help guide clinicians selecting patients who potentially will not respond to cardiac resynchronization therapy or alternatively identify patients who require additional therapies such as ablations or antiarrhythmic therapy in order to benefit from this device

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Ruwald: Studies establishing a threshold of ectopic burden where CRT treatment is no longer beneficial because of ineffective biventricular pacing is needed. Further we need a trial or documentation of whether or not aggressive treatment with ablation or anti-arrhythmic drugs can actually improve outcome for these patients with CRT indication and a burden of ectopic beats above 0.1% of all beats.

Citation:

Last Updated on September 4, 2014 by Marie Benz MD FAAD