title: Ventricular high-rate episodes predict increased mortality in heart failure patients treated with cardiac resynchronization therapy.
abstract: OBJECTIVE
  Cardiac Resynchronization Therapy (CRT) for heart-failure patients has a well-documented positive effect, but the overall mortality in this group remains high. This study aimed to explore whether additional information from the device post-implant (occurrence of ventricular high-rate episodes), could add prognostic value for patients on CRT-pacemaker (CRT-P) treatment.
  
  
  METHODS
  Clinical data and device-interrogation data were retrospectively gathered from the medical records of 220 patients treated with CRT-P. Ventricular high-rate (VHR) episodes were defined as a ventricular rate ≥ 180 beats per minute. The primary outcome was 5-year mortality.
  
  
  RESULTS
  During follow-up, 132 patients (60%) died or underwent heart transplant. Overall, the 5-year mortality rate was 52%; 77% for patients with VHR during the first year of follow-up and 48% for patients without VHR during the first year of follow-up (p = 0.001). In a multivariate model, the occurrence of VHR episodes was an independent predictor of 5-year mortality (HR 9.96, p = 0.022). The most common cause of death was heart failure, and death from arrhythmia did not differ between groups (p = 0.065).
  
  
  CONCLUSIONS
  In heart-failure patients with CRT-P therapy, occurrence of VHR episodes within the first year post-implant was an independent predictor of higher 5-year mortality and inferior long-term survival, but not of death from malignant arrhythmia.
authors: Lund University, Arrhythmia Clinic, Skane University Hospital , Lund , Sweden.
authors: Jonatan
authors: J
authors: Jacobsson
authors: Christian
authors: C
authors: Reitan
authors: Pyotr G
authors: PG
authors: Platonov
authors: Rasmus
authors: R
authors: Borgquist
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality*; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D016027:Heart Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: cardiac resynchronization therapy; long-term prognosis; mortality