Sacubitril/Valsartan in the Management of Heart Failure Patients with Cardiac Implantable Electronic Devices

AbstractFor heart failure patients with cardiac implantable electronic devices (CIEDs), especially those who remain symptomatic after implantation, the best management strategy is still unclear. Although there are several concerns regarding the clinical utilization of sacubitril/valsartan, it has improved the prognosis of patients with heart failure compared with the use of renin-angiotensin system inhibitors in recent years. Recent real-world observational studies and post hoc analyses demonstrated that sacubitril/valsartan might have effects in patients with CIEDs. Given its potential underlying mechanisms, sacubitril/valsartan could improve outcomes of mortality and sudden cardiac death incidence, as well as clinical and echocardiographic evaluations. The possible antiarrhythmic effect of sacubitril/valsartan is still debated. Moreover, given that hypotension is the critical limitation of uptitration, the rise in systolic blood pressure attributed to cardiac resynchronization therapy might support the use of sacubitril/valsartan, with improved tolerance. The clinical utility of sacubitril/valsartan in heart failure patients with CIEDs requires further investigation to determine the actual effects, optimal target populations, and underlying mechanisms.
Source: American Journal of Cardiovascular Drugs - Category: Cardiology Source Type: research

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AbstractAimsWe tested the hypothesis that shortening of time-to-peak left ventricular pressure rise (Td) reflect resynchronization in an animal model and that Td measured in patients will be helpful to identify long-term volumetric responders [end-systolic volume (ESV) decrease>15%] in cardiac resynchronization therapy (CRT).MethodsTd was analysed in an animal study (n = 12) of left bundle-branch block (LBBB) with extensive instrumentation to detect left ventricular myocardial deformation, electrical activation, and pressures during pacing. The sum of electrical delays from the onset of pacing to four intracar...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
AbstractAimsThere are conflicting data on the benefit of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with permanent atrial fibrillation (AF). We aimed to compare patient outcomes according to the presence or absence of permanent AF at device implantation.Methods and resultsWe retrospectively analysed remote monitoring data from 1141 CRT defibrillators. Propensity score with inverse-probability weighting method was used to balance AF and sinus rhythm (SR) groups. Analysis endpoints included total mortality, appropriate defibrillation shocks, and CRT percentage. There were 229 patients (20.1%) in t...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
ConclusionsLeft bundle branch block-induced cardiomyopathy emerges as a distinct pathological entity, promptly identifiable in a minority but not negligible proportion of patients with newly diagnosed DCM and LBBB, using a series of diagnostic criteria including CMR and genetic testing. Further studies are needed to better elucidate the clinical course of LBBB-ICMP.
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Short Communication Source Type: research
Conclusion CRT implantation is associated with increased ARV, but the effect of this improvement on cardiovascular outcome needs more investigation.
Source: Blood Pressure Monitoring - Category: Cardiology Tags: Clinical Methods and Pathophisiology Source Type: research
Cardiac resynchronization therapy is a well-established treatment of heart failure with reduced left ventricular ejection fraction and a wide QRS complex. Cardiac contractility modulation therapy is an emerging electrical treatment indicated for use in patients with symptomatic heart failure caused by moderate-to-severe systolic left ventricular dysfunction (left ventricular ejection fraction ranging from 25% to 45%), with no indication for cardiac resynchronization therapy. Cardiac contractility modulation therapy improves functional status, exercise capacity, quality of life, and possibly prevents hospital admissions in ...
Source: Heart Failure Clinics - Category: Cardiology Authors: Source Type: research
Nature Reviews Cardiology, Published online: 10 September 2021; doi:10.1038/s41569-021-00616-2Ablation plus cardiac resynchronization therapy is superior to pharmacological therapy in reducing mortality in patients with atrial fibrillation and a narrow QRS complex who were hospitalized with heart failure.
Source: Nature Reviews Cardiology - Category: Cardiology Authors: Source Type: research
We present a 66-year-old male patient with heart failure, mid-range ejection fraction and QRS widening suffering from recurrent hospitalization due to acute heart failure. We measured intra-cardiac pressure by cardiac catheterization to clearly demonstrate the augmentation of afterload by a vasoconstricting drug induced increase of left ventricular end-diastolic blood pressure and pulmonary capillary wedge pressure with pulmonary arterial V-wave augmentation (indicator of worsening of mitral regurgitation). Because the patient was considered as refractory to optimal medication, cardiac resynchronization therapy (CRT) was p...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Case Report Source Type: research
ConclusionsIn patients with HFrEF and CI implanted with a CRT-D, peak HR, peak VO2, and 6MWD were equivalent, while there was a trend toward improved quality of life in CLS as compared to DDDR.Clinical trial registrationURL: Unique identifier: NCT02693262.
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
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Source: Medicina (Kaunas) - Category: Universities & Medical Training Authors: Source Type: research
J Cardiol. 2021 Aug 20:S0914-5087(21)00195-7. doi: 10.1016/j.jjcc.2021.07.012. Online ahead of print.ABSTRACTBACKGROUND: Indication for de novo cardiac resynchronization therapy (CRT) has been recommended in mild heart failure (HF) patients with left ventricular (LV) ejection fraction (LVEF)
Source: Journal of Cardiology - Category: Cardiology Authors: Source Type: research
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