The Impact Of Cardiac Reverse Remodeling On The Incidence Of Ventricular Arrhythmias After Cardiac Resynchronization Therapy Defibrillator

Objective We aimed to evaluate incidence of postoperative ventricular arrhythmias in patients who received cardiac resynchronization therapy defibrillator(CRT-D)with reverse remodeling.Methods The patients received CRT-D who had complete follow-up data in Anhui Provincial Hospital from June 2014 to June 2017 were included and electrical reverse remodeling(ERR)was defined as baseline intrinsic QRS duration(i QRSd)shortening?10ms 12 months after CRT-D implantation,and mechanical reverse remodeling(MRR)was defined as a decrease in left ventricular end-systolic volume(LVESV)?15% after at least 12 months after CRT-D implantation.According to the definition,patients were classified as ERR only,MRR only,ERR-MRR-,or ERR+MRR.And ventricular arrhythmia(VA),implantable cardioverter-defibrillator(ICD)shocks treatment,antitachycardia pacing therapy(ATP),and other indicator of the four groups were compared.Results Of the 222 patients enrolled in the study,ERR only(n=31),MRR only(n=62),non-responder(ERR-MRR-,n=59),or ERR+MRR(n=70),and there were no significant differences in baseline characteristics between the four groups.Follow-up showed that compared with the ERR group,the ERR+MRR+ group had VA[(0.34±1.09)per person VS(1.29±2.42)per person,P=0.04] and VA load [(0.14±0.42)per person-year VS(0.51±0.98)per person-year,P=0.03],ATP[(0.59±1.71)per person VS(1.74±3.19)per person,P=0.04].The difference was statistically significant,and Shock[(0.13 ± 0.38)per person VS(0.32 ± 0.60)per person,P = 0.06],Shock load [(0.06 ± 0.22)per person-year VS(0.16 ± 0.24)per person-year,P = 0.07],The ATP load [(0.26±0.79)per person-year VS(0.72±1.37)per person-year,P=0.05] was not statistically significant.In addition,the VA burden(P=0.04)was statistically significant in the ERR group compared with the non-ERR group,with VA(P=0.05),Shock(P=0.06),Shock load(P=0.10),and ATP(P=0.07).There was no statistically significant difference in ATP load(P=0.05);in the MRR group and non-MRR group,VA(P=0.14),VA load(P=0.07),Shock(P=0.08),and Shock load(P=0.09).There was no significant difference in ATP,ATP(P=0.12),and ATP load(P=0.07).Conclusions Only mechanical reverse remodeling can not reduce the VA load;only electrical reverse remodeling can reduce the VA load to a certain extent;electrical reverse remodeling and mechanical reverse remodeling can occur to further reduce the VA load.