Double chamber cross-talk, the ultimate double-cross.

Cross-talk is a well-described phenomenon in a dual-chamber cardiovascular implantable electronic device. Far-field ventricular events are more commonly sensed in the atrial channel, the reverse is uncommon, and seeing both at the same time has never been reported. We present a case of double cross-talk in a dual-chamber Medtronic ® implantable cardioverter-defibrillator. In this report, we decipher an unusual device response to the cross-talk and describe the programming changes required to resolve it.

Objective criteria for septal fibrosis in non-ischemic dilated cardiomyopathy: validation for the prediction of future cardiovascular events.

BACKGROUND: Expert subjective reporting of mid-wall septal fibrosis on late gadolinium enhancement (LGE) images has been shown to predict major cardiovascular outcomes in patients with non-ischemic dilated cardiomyopathy (NIDCM). This study aims to establish objective criteria for non-experts to report clinically relevant septal fibrosis and compare its performance by such readers versus experts for the prediction of cardiovascular events. METHODS: LGE cardiovascular magnetic resonance (CMR) was performed in 118 consecutive patients with NIDCM (mean age 57 ± 14, 42 % female) and the presence of septal fibrosis scored by expert readers. CMR-naive readers performed signal threshold-based LGE quantification by referencing mean values of remote tissue and applying these to a pre-defined anatomic region to measure septal fibrosis. All patients were followed for the primary composite outcome of cardiac mortality or appropriate implantable cardioverter-defibrillator (ICD) therapy. RESULTS: The mean LVEF was 32 ± 12 %. At a median follow-up of 1.9 years, 20 patients (17 %) experienced a primary composite outcome. Expert visual scoring identified 55 patients with septal fibrosis. Non-expert septal fibrosis quantification was highly reproducible and identified mean septal fibrosis burden for three measured thresholds as follows; 5SD: 2.9 ± 3.6 %, 3SD: 6.9 ± 6.3 %, and 2SD: 11.1 ± 7.5 % of the left ventricular (LV) mass, respectively. By ROC analysis, optimal thresholds for prediction of the primary outcome were; 5SD: 2.74 % (HR 8.7, p < 0.001), 3SD: 6.63 % (HR 5.7, p = 0.001) and 2SD: 10.15 % (HR 6.1, p = 0.001). By comparison, expert visual scoring provided a HR of 5.3 (p = 0.001). In adjusted analysis, objective quantification by a novice reader (>5SD threshold) was the strongest independent predictor of the primary outcome (HR 8.7) and provided improved risk reclassification beyond LVEF alone (NRI 0.54, 95 % CI 0.16-0.92, p = 0.005). CONCLUSIONS: Novice readers were able to achieve superior risk prediction for future cardiovascular events versus experts using objective criteria for septal fibrosis in patients with NIDCM. Patients with a septal fibrosis burden >2.74 % of the LV mass (>5SD threshold) were at a 9-fold higher risk of cardiac death or appropriate ICD therapy versus those not meeting this criteria. As such, this study validates reproducible criteria applicable to all levels of expertise to identify NIDCM patients at high risk of future cardiovascular events.

Numerical and experimental investigation of heat transfer enhancement in double tube heat exchanger using nail rod inserts.

The Double-tube heat exchanger (DTHX) is widely favored across various industries due to its compact size, low maintenance requirements, and ability to operate effectively in high-pressure applications. This study explores methods to enhance heat transfer within a DTHX using both experimental and numerical approaches, specifically by integrating a nail rod insert (NRI). A steel nails rod insert, 1000 mm in length, is introduced into the DTHX, which is subjected to turbulent flows characterized by Reynolds numbers ranging from 3200 to 5700. Three different pitches of NRI (100 mm, 50 mm, and 25 mm) are investigated. The results indicate a significant increase in the Nusselt (Nu) number upon the insertion of nail rods, with further improvements achievable by reducing the pitch length. Particularly noteworthy is the Nu number enhancement ratio for the 25 mm pitch NRI, which is 1.81-1.9 times higher than that for the plain tube. However, it is observed that pressure drop increases in all configurations with NRI due to heightened turbulence and obstruction by the NRI. Among the various pitch lengths, the 25 mm pitch exhibits the highest pressure drop values. Moreover, exergy efficiency is found to improve across all cases with NRI, corresponding to increased heat transfer, with the 25 mm pitch length showing a remarkable 128% improvement. Numerical analysis reveals that the novel insert enhances flow turbulence through the generation of secondary flows, thereby enhancing heat transfer within the DTHX. This study provides a comprehensive analysis, including temperature, velocity, and pressure drop distributions derived from numerical simulations.

Experimental Investigation on the Energy and Exergy Efficiency of the Vacuum Membrane Distillation System with Its Various Configurations.

This paper addresses a retrofitting vacuum membrane distillation (VMD) setup to reduce the accumulated pressure inside the permeated side. This modification is necessary to extend the operation of the VMD to extreme operation conditions of higher hot water temperatures. This modification, denoted as a hybrid configuration, proposes the injection of a cold water stream into the VMD cell without mixing it with the permeate. Energy and exergy efficiency analyses were performed to assess the effectiveness of the hybrid configuration. The performance of the modified system indicated an improvement in terms of permeate flux (J), the gain output ratio (GOR), and the utilitarian exergetic efficiency (ηex,u), which reach up to two and three times that of the base configuration of the VMD system. However, the exergetic efficiency (ηex) of the hybrid system showed marginal improvement compared to the base case over the tested range of hot water temperatures. This is because the enhanced vapor production is penalized by excess energy consumption. Moreover, the highest exergy destruction percentages occurred in the operational components (e.g., heater and chillers) which fall in the range of 19.0-68.9%. The exergy destruction percentage in the original components (e.g., the VMD cell and condenser) did not exceed 8.3%. Furthermore, this study indicated that the hybrid configuration requires additional tuning and optimization to perform efficiently over wide operating conditions.

Anomalous Coronary Arteries: A Cause for Malignant Arrhythmias.

Anomalous aortic origin of a coronary artery (AAOCA) is a congenital condition that can lead to sudden cardiac death (SCD), particularly among young individuals. The cause of SCD is thought to be ischemia, primarily related to the course of the anomalous coronary artery. Surgical intervention, such as unroofing or coronary revascularization, is the preferred management modality for patients with evidence of ischemia or concomitant fixed obstruction. Herein, we presented a case of a 24-year-old male admitted to the emergency department with a history of palpitations, dyspnea, diaphoresis, and syncope. The patient had no prior medical diseases and was eventually diagnosed with an anomalous right coronary artery (ARCA) originating from the left coronary sinus. The patient underwent surgical unroofing of the ARCA to prevent further episodes of ischemia and ventricular arrhythmias. The case highlights that coronary artery anomalies can be life-threatening and lead to SCD, especially in young individuals with no risk factors. Investigating coronary anomalies in medically free patients presenting with cardiac symptoms and arrhythmias is crucial.

Numerical investigation of the effect of rectangular and semicircular cavities filled with phase change materials installed on the solar wall.

The use of alternative energy sources, particularly solar energy, in buildings is rising and spreading around the globe. In this paper, a solar wall is analyzed using a numerical method. On the wall, a number of obstacles are placed in two shapes, rectangular (REC) and semicircular (SEC). The cavities are filled with organic phase-change materials. This study was performed in 7 h in the absence of solar radiation on the wall for different dimensions of obstacles in 5 different modes. Various temperatures have been investigated, including exhaust air temperature (TAR), Trombe wall temperature (TWL), and mean volume % of molten PCM in cavities. COMSOL software is used to carry out this numerical study. The results of this study showed that the use of SECs compared to RECs causes the TWL to be higher. In the most extreme case, at a 16 cm aspect ratio, the use of SECs gives a 2.1 °C increase in TWL relative to the REC one. The outlet TAR is also increased by the usage of SECs. The use of larger dimensions of the cavities has increased the TAR leaving the wall so that the TAR after 7 h of the absence of solar radiation, in the most significant case of SECs, was more than 295.5 K. The use of SECs also increases the PCM freezing time. In the largest case of cavities, using SECs increases the freezing time by 15 min compared to RECs.

Tacrolimus-Induced Diffuse Coronary Artery Spasm.

Prinzmetal angina, also known as vasospastic angina, is defined as an intermittent focal or diffuse coronary artery narrowing, which is often associated with transient ST-segment elevation on an electrocardiogram. Also, it could be associated with an atherosclerotic lesion at the site of the spasm. Vasospastic angina might be induced by medications, most commonly with cocaine and other examples which include catecholamines such as epinephrine, norepinephrine, isoproterenol, dopamine, and dobutamine. Parasympathomimetic agents include acetylcholine, methacholine, and pilocarpine. It is rarely caused by tacrolimus. The clinical evaluation includes an electrocardiogram and echocardiogram. The confirmed diagnosis is done by coronary angiography. Cardiac catheterization is indicated in such cases to rule out coronary artery disease.

Performance Comparison of Cross- and Forward-Flow Configurations for Multiple-Effect Vacuum Membrane Distillation.

This work addresses retrofitting the infrastructure of multiple-effect vacuum membrane distillation (V-MEMD) units by using cross-flow configuration (CFC). In this configuration, the feed water is evenly divided and distributed over the effects. In this case, the feed water stream for each effect is kept at a high temperature and low flow rate. This will lead to an increase in the vapor pressure gradient across the hydrophobic membrane and can also maintain the thermal energy of the stream inside the individual effect. It is found that CFC improves internal and global performance indicators of productivity, energy, and exergy. A mathematical model was used to investigate the performance of such a modification as compared to the forward-flow configuration (FFC). The cross-flow configuration led to a clear improvement in the internal performance indicators of the V-MEMD unit, where specifically the mass flux, recovery ratio, gain output ratio, and heat recovery factor were increased by 2 to 3 folds. Moreover, all the global performance indicators were also enhanced by almost 2 folds, except for the performance indicators related to the heat pump, which is used to cool the cold water during the operation of the V-MEMD unit. For the heat pump system, the specific electrical energy consumption, SEEC, and the exergy destruction percentage, Ψdes, under the best-operating conditions, were inferior when the feed water flow was less than 159 L/h. This can be attributed to the fact that the heat rejected from the heat pump system is not fully harnessed.

Investigating the Effect of Tube Diameter on the Performance of a Hybrid Photovoltaic-Thermal System Based on Phase Change Materials and Nanofluids.

The finite element (FEM) approach is used in this study to model the laminar flow of an eco-friendly nanofluid (NF) within three pipes in a solar system. A solar panel and a supporting phase change material (PCM) that three pipelines flowed through made up the solar system. An organic, eco-friendly PCM was employed. Several fins were used on the pipes, and the NF temperature and panel temperature were measured at different flow rates. To model the NF flow, a two-phase mixture was used. As a direct consequence of the flow rate being raised by a factor of two, the maximum temperature of the panel dropped by 1.85 °C, and the average temperature dropped by 1.82 °C. As the flow rate increased, the temperature of the output flow dropped by up to 2 °C. At flow rates ranging from low to medium to high, the PCM melted completely in a short amount of time; however, at high flow rates, a portion of the PCM remained non-melted surrounding the pipes. An increase in the NF flow rate had a variable effect on the heat transfer (HTR) coefficient.

Numerical Analysis of the Effect of Nanoparticles Size and Shape on the Efficiency of a Micro Heatsink.

In this paper, two novel micro heat sinks (MHSs) were designed and subjected to thermal analysis using a numerical method. The fluid used was Boehmite alumina-water nanofluid (NFs) with high volume fractions (VOFs). Studies were conducted to determine the influence of a variety of nanoparticle (NP) shapes, such as platelet brick, blade, cylinder, and Os. The heatsink (HS) was made of copper, and the NFs entered it through the middle and exited via four outlets at the side of the HS. The finite element method was used to simulate the NFs flow and heat transfer in the HSs. For this purpose, Multi Physics COMSOL software was used. The maximum and middle values of HS temperature (T-MAX and T-Mid), thermal resistance (TH-R), heat transfer coefficient (h), FOM, etc., were studied for different NP shapes, and with Reynolds numbers (Re) of 300, 1000, and 1700, and VOFs of 0, 3, and 6%. One of the important outcomes of this work was the better thermal efficiency of the HS with rectangular fins. Moreover, it was discovered that a rise in Re increased the heat transfer. In general, adding NPs with high VOFs to MHSs is not appropriate in terms of heat. The Os shape was the best NP shape, and the platelet shape was the worst NP shape for high NPVOF. When NPs were added to an MHS, the temperature of the MHS dropped by an average of 2.8 or 2.19 K, depending on the form of the pin-fins contained inside the MHS (circular or square). The addition of NPs in the MHS with circular and square pin-fins enhanced the pressure drop by 13.5% and 13.3%, respectively, when the Re = 1700.

The Utility of Sodium Channel Provocation in Unexplained Cardiac Arrest Survivors and Electrocardiographic Predictors of Ventricular Fibrillation Recurrence.

BACKGROUND: The implications of a drug-induced type 1 Brugada ECG pattern following sodium channel blocker provocation (SCBP) are not fully understood. METHODS: Baseline clinical and ECG data were obtained from consecutive unexplained cardiac arrest survivors undergoing SCBP at 3 centers. A further 15 SCBP positive (SCBP+) unexplained cardiac arrest survivors were recruited from 3 additional centers to explore ventricular fibrillation recurrence. RESULTS: A total of 121 consecutive unexplained cardiac arrest survivors underwent SCBP. The yield of the drug-induced type 1 Brugada ECG pattern was 17%. A baseline type 2/3 Brugada pattern (T2/3BP) (adjusted odds ratio, 19.36 [2.74-136.61]; P=0.003) and PR interval (odds ratio, 1.03 [1.01-1.05] per ms; P=0.017) were independent predictors of SCBP+ response. A pathogenic SCN5A variant was identified in 36% of the SCBP+ group versus 0% in the SCBP- group (P<0.001). Amongst SCBP+ patients, a spontaneous type 1 Brugada pattern was identified in 19% during follow up and in 24% a type 1 Brugada pattern was identified in a relative. Prior syncope (adjusted hazard ratio, 3.83 [1.36-10.78]; P=0.011) and the presence of global early repolarization (hazard ratio, 7.91 [3.22-19.44]; P<0.001) were independent predictors of 5-year ventricular fibrillation recurrence. There was a nonsignificant trend toward greater 5-year ventricular fibrillation recurrence in the SCBP- group (23/95 [24%] versus 3/34 [9%]; P=0.055). CONCLUSIONS: The yield of the drug-induced type 1 Brugada ECG pattern in consecutive unexplained cardiac arrest survivors undergoing SCBP is 17%. A baseline T2/3BP and PR interval were independent predictors of the drug-induced type 1 Brugada ECG pattern. Greater heritability of BrS phenotype in this group was evidenced by a greater prevalence of pathogenic SCN5A variants and relatives with a type 1 Brugada pattern. A history of prior syncope and the presence of global early repolarization were independent predictors of ventricular fibrillation recurrence.

Design and Energy Requirements of a Photovoltaic-Thermal Powered Water Desalination Plant for the Middle East.

Seawater or brackish water desalination is largely powered by fossil fuels, raising concerns about greenhouse gas emissions, particularly in the arid Middle East region. Many steps have been taken to implement solar resources to this issue; however, all attempts for all processing were concentrated on solar to electric conversion. To address these challenges, a small-scale reverse-osmosis (RO) desalination system that is in part powered by hybrid photovoltaic/thermal (PVT) solar collectors appropriate for a remote community in the Kingdom of Saudi Arabia (KSA) was designed and its power requirements calculated. This system provides both electricity to the pumps and low-temperature thermal energy to pre-heat the feedwater to reduce its viscosity, and thus to reduce the required pumping energy for the RO process and for transporting the feedwater. Results show that both thermal and electrical energy storage, along with conventional backup power, is necessary to operate the RO continuously and utilize all of the renewable energy collected by the PVT. A cost-optimal sizing of the PVT system is developed. It displays for a specific case that the hybrid PVT RO system employs 70% renewable energy while delivering desalinized water for a cost that is 18% less than the annual cost for driving the plant with 100% conventional electricity and no pre-heating of the feedwater. The design allows for the sizing of the components to achieve minimum cost at any desired level of renewable energy penetration.

The Quality of Life in Patients With Implantable Cardiac Devices: A Single-Center Cross-Sectional Study.

Background Cardiovascular diseases (CVDs) and their complications are one of the most common causes of death worldwide. Implantable cardiac assistive devices (CADs) play a significant role in preventing dreadful outcomes, and the complication rate of these implanting procedures is minimal. These cardiac devices require some adaptation and could affect the patients' quality of life psychosocially and financially. This study is aimed to identify the impact of implantable cardiac assistive devices on patients' quality of life in the National Guard Hospital, Jeddah, Saudi Arabia. Methods This is an observational cross-sectional questionnaire-based study. It was conducted on patients who underwent cardiac assistive device implantation in National Guard Hospital. The patients were interviewed face-to-face and were requested to fill the Implanted Device Adjustment Scale (IDAS). Descriptive statistics were carried out. Chi-square test for independence was conducted to examine the associations between qualitative variables with the level of significance was taken as p-value <0.05. Results There was a statistically significant association between IDAS score and gender (p=0.03), monthly income (p=0.009), and type of cardiac implantation device (p=0.041). Females with an implantable cardiac defibrillator (ICD) and individuals with low socioeconomic status reported alongside divorced participants have higher IDAS scores, which correlates to worse adjustment. However, most of our patients scored 21-50 in IDAS score, which indicates a mild psychosocial effect after the cardiac assistive device implantation. Conclusion This study confirmed that most individuals adjust positively to implanted devices. It showed a significant association of gender, type of device, monthly income, and duration. Attention must be drawn to females and divorced patients in regards to psychological and emotional support.

Para-Hisian Pacing During Sinus Rhythm: Establishing Threshold Values to Distinguish Nodal From Septal Pathway Conduction.

OBJECTIVES: This study sought to identify minimum threshold values below which conduction over the atrioventricular (AV) node would be unexpected. BACKGROUND: Para-Hisian pacing is used to evaluate for the presence of a septal accessory pathway (AP); however, threshold values to differentiate nodal from AP conduction are unknown. METHODS: The authors performed high- and low-output para-Hisian pacing during sinus rhythm to capture the His and para-Hisian ventricular myocardium (H+V) and para-Hisian ventricular myocardium (V) alone, respectively. The change in stimulation (stim)-to-atrial electrogram interval after loss of His bundle capture in patients with (AP+) and without (AP-) a septal AP was evaluated. Stim-to-proximal coronary sinus (PCS) and stim-to-high right atrium (HRA) intervals were measured and within-patient differences (△) for V and H+V capture were calculated. RESULTS: A total of 23 AP+ and 45 AP- patients were evaluated. The difference in stimulus to earliest atrial signal in the high right atrial catheter seen with the loss of His bundle capture (△-stim-HRA) (21 ms; interquartile range [IQR]: 3 to 43 ms vs. 64 ms; IQR: 56 to 73 ms; p < 0.001) and difference in stimulus to earliest atrial signal in the proximal coronary sinus catheter seen with the loss of His Bundle capture (△-stim-PCS) (11 ms; IQR: 0 to 30 ms vs. 61 ms; IQR: 52 to 72 ms; p < 0.001) were shorter in AP+ patients. The shortest △-stim-PCS and △-stim-HRA in AP- patients were 37 ms and 32 ms, respectively, whereas the longest corresponding intervals in AP+ patients were 51 ms and 75 ms, respectively. CONCLUSIONS: A △-stim-PCS <37 ms or △-stim-HRA <32 ms confirmed the presence of a septal AP, whereas a value >51 ms for △-stim-PCS or >75 ms for △-stim-HRA excluded it. Alternatively, the minimum △-stim-PCS with loss of His capture compatible with AV nodal conduction in isolation was 37 ms, and a △-stim-PCS >51 ms effectively ruled out the presence of a septal AP.

Glycated Haemoglobin and Outcomes of Percutaneous Coronary Intervention Among Type Two Diabetic Patients in Saudi Arabia.

BACKGROUND: Glycated haemoglobin (HbA1c) is a marker that reflects the control of diabetes mellitus (DM) over a three-month period. We sought to compare cardiovascular outcomes of diabetic patients with and without controlled levels of HbA1c post percutaneous coronary intervention (PCI) presenting to King Faisal Cardiac Center.   Methods: A retrospective single-center study of all patients with type two DM who were treated with PCI during the period between January 2015 and January 2018. All data were obtained from health informatics system. Demographics, clinical data, and major adverse cardiovascular and cerebrovascular events (MACCE) were collected to compare outcomes among diabetic patients with and without controlled HbA1c. RESULTS: The study included 177 patients with type two DM who underwent PCI. The mean age was 63.3 (SD±12). Males represented 73.4% and 26.6% were females. The mean HbA1c on admission was 8.7%. At presentation 31% of the patients had relatively controlled blood sugar (HbA1c mean 7.5%, SD±0.5) and 69% presented with poorly controlled type two DM (mean HbA1c 9.1%, SD±0.25). The prevalence of hypertension and dyslipidaemia were higher among the uncontrolled group, but there were no differences between both groups in the control of blood pressure or dyslipidaemia. Patients in the uncontrolled group had higher rate of prior PCI (36.6%) compared to the controlled arm (16%, p=0.0195) The prevalence of cerebrovascular, cardiovascular, and renal impairment was similar. The use of insulin was higher among the uncontrolled arm. Patients in the controlled arm had lower incidence of composite endpoints of death and non-fatal myocardial infarction and stroke (MACCE) (14% vs 41%, p=0.001) compared to the uncontrolled arm. CONCLUSION: Among patients with type two DM that were treated with PCI, achieving targets of blood sugar control reflected by glycated haemoglobin is associated with improved survival and lower incidence of composite MACCE.

Health Care Utilization After Ventricular Tachycardia Ablation: A Propensity Score-Matched Cohort Study.

BACKGROUND: Catheter ablation of ventricular tachycardia (VT) can reduce the burden of ventricular arrhythmia (VA) but its effect on health care utilization and costs after such therapy is poorly known. We sought to compare the rates of cardiovascular (CV)-related hospitalizations, survival, and health care costs in patients with recurrent VT treated either with VT ablation or with medical therapy. METHODS: One-hundred implantable cardioverter-defibrillator patients with structural heart disease who underwent VT ablation were included. Propensity score-matched patients with recurrent VT treated with medical therapy were identified from a prospective registry of approximately 7000 de novo implantable cardioverter-defibrillator patients. Outcomes and costs were ascertained using health administrative databases. RESULTS: Among patients who underwent VT ablation, the cumulative rates of VA-related hospitalizations were lower in the 2 years after their ablation procedure compared with the year before (rate ratio, 0.3; 95% confidence interval [CI], 0.22-0.43). Rates of CV-related hospitalization and hospitalization because of VA post index date were similar between the VT ablation and medical therapy groups (hazard ratio [HR], 0.94; 95% CI, 0.57-1.54 and HR, 1.04; 95% CI, 0.57-1.91, respectively). Health care costs in the VT ablation patients were not increased post-ablation compared with the medical management group. The risk of all-cause mortality was lower among patients in the VT ablation group relative to the medical therapy group (HR, 0.64; 95% CI, 0.4-0.99). CONCLUSIONS: Patients who underwent VT ablation experienced a significant reduction in their rate of VA-related hospitalizations. Patients treated with VT ablation had similar rates of CV-related hospitalization compared with those treated with medical therapy without increased health care-related costs.

Should Single-Coil Implantable Cardioverter Defibrillator Leads Be Used in all Patients?

The historical preference for dual-coil implantable cardioverter defibrillator leads stems from high defibrillation thresholds associated with old device platforms. The high safety margins generated by contemporary devices have rendered the modest difference in defibrillation efficacy between single- and dual-coil leads clinically insignificant. Cohort data demonstrating worse lead extraction outcomes and higher all-cause mortality have brought the incremental utility of an superior vena cava coil into question. This article summarizes the current literature and re-evaluates the utility of dual-coil leads in the context of modern device technology.

Coronary vasospasm-induced polymorphic ventricular tachycardia: a case report and literature review.

INTRODUCTION: Coronary vasospasm is an uncommon but important cause of myocardial ischaemia and ventricular arrhythmias. CASE PRESENTATION: In this report, we present a striking example of vasospasm manifesting as ST-segment elevation and ventricular tachycardia on Holter monitoring. Later, spasm occurred during a procainamide challenge performed for suspected Brugada syndrome. The patient underwent implantable cardioverter-defibrillator insertion and was successfully treated with oral calcium channel blocker. DISCUSSION: We review contemporary data regarding management and outcomes in coronary vasospasm and discuss the use of implantable defibrillator therapy in patients who have sustained a significant arrhythmic event.

Cardiac resynchronization is pro-arrhythmic in the absence of reverse ventricular remodelling: a systematic review and meta-analysis.

Aims: Cardiac resynchronization therapy (CRT) has been shown to reduce mortality and heart failure (HF) hospitalization but its effects on the rate of ventricular arrhythmias (VAs) appears to be neutral. We hypothesize that CRT with LV epicardial stimulation is inherently pro-arrhythmic and increases VA rates in the absence of reverse ventricular remodelling while conferring an anti-arrhythmic effect in mechanical responders. Methods and results: In this systematic review and meta-analysis, we considered retrospective cohort, prospective cohort, and randomized controlled trials comparing VA rates between cardiac resynchronization therapy-defibrillator (CRT-D) non-responders, CRT-D responders and those with implantable cardioverter-defibrillator (ICD) only. Studies were eligible if they defined CRT-D responders using a discrete left ventricular volumetric value as assessed by any imaging modality. Studies were identified through searching electronic databases from their inception to July 2017. We identified 2579 citations, of which 23 full-text articles were eligible for final analysis. Our results demonstrated that CRT-D responders were less likely to experience VA than CRT-D non-responders, relative risk (RR) 0.49 [95% confidence interval (CI) 0.41-0.58, P < 0.01] and also less than patients with ICD only: RR 0.59 (95% CI 0.50-0.69, P < 0.01). However, CRT-D mechanical non-responders had a greater likelihood of VA compared with ICD only, RR 0.76 (95% CI 0.63-0.92, P = 0.004). Conclusion: CRT-D non-responders experienced more VA than CRT-D responders and also more than those with ICD only, suggesting that CRT with LV epicardial stimulation may be inherently pro-arrhythmic in the absence of reverse remodelling.