title: Time-dependent effect of cardiac resynchronization therapy on ventricular repolarization and ventricular arrhythmias.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) improves the clinical status of patients with congestive heart failure, although left ventricular epicardial pacing may increase transmural dispersion of repolarization (TDR). The aim of this study was to investigate the time-dependent effect of CRT on ventricular repolarization and ventricular arrhythmia at mid-term follow-up.
  
  
  RESULTS
  The study group consisted of 84 patients treated with CRT. Twelve-lead electrocardiogram was digitally recorded and Tpeak-to-Tend interval (Tp-e) was measured at baseline, 1 week, 1 month, and 3, 6, and 12 months after device implantation. We determined the time-dependent changes in Tp-e, ventricular tachycardia and ventricular fibrillation (VT/VF) during 12 months of follow-up, in both CRT responders and non-responders. Seventeen of 84 patients (20%) had VT/VF during first year. Six of those 17 patients (35%) experienced VT/VF within 1 month of implantation and diminished over time. Tp-e decreased significantly at 6 and 12 months after implantation compared with 1 week [108 ± 14 ms at 1 week vs. 97 ± 21 ms at 6 months (P = 0.03) and 95 ± 19 ms at 12 months (P = 0.01)]. Responders demonstrated a greater time-dependent reduction of Tp-e at 6 and 12 months of CRT and had a lower rate of VT/VF compared with non-responders (log-rank test, P = 0.004).
  
  
  CONCLUSIONS
  Transmural dispersion of repolarization and the number of patients with VT/VF decreased over time after CRT. Patients with reverse remodelling demonstrated a lower rate of VT/VF and a greater time-dependent reduction of TDR.
authors.affiliation: Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo 650-0017, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Itoh
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoshida
authors.forename: Koji
authors.initials: K
authors.lastname: Fukuzawa
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Kiuchi
authors.forename: Kimitake
authors.initials: K
authors.lastname: Imamura
authors.forename: Ryudo
authors.initials: R
authors.lastname: Fujiwara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Suzuki
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nakanishi
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yamashita
authors.forename: Akinori
authors.initials: A
authors.lastname: Matsumoto
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D018619:Echocardiography, Doppler, Pulsed; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: Cardiac resynchronization therapy; Responder; Tp–e interval; Transmural dispersion of repolarization; Ventricular arrhythmia