Background CRT is an effective therapy in HF. Pacemakers and defibrillators are implanted for arrhythmogenic indications. Pacing dependency can induce HF and is an established CRT upgrade criterion [LVEF <35% and ventricular pacing >40%]. We aimed to compare cardiovascular outcomes between upgraded and de-novo CRT’s.
Methodology A retrospective study of all consecutive CRT implants over five years (Jan 2009 – Dec 2013) in a UK tertiary centre. Data was collected on baseline demographics, co-morbidities and indications (NYHA class, ECG, echocardiogram). Comparisons were made for these outcomes: acute response [<2 mths], long-term response [>2 mths], all-cause mortality and first hospitalisation. CRT response was defined as >1 NYHA class increase.
Results 373 CRT implants were performed (79 upgrades). Upgrade and de-novo patients were matched for all comorbidities. Table 1 demonstrates baseline demographics, indications and CRT response. A Kaplan-Meier analysis was performed on all-cause mortality and time to first hospitalisation, with three year rates demonstrated in the table. A significantly worse long-term response (p 0.002) and all-cause mortality (p 0.043) was demonstrated for upgrade patients.
Conclusion Upgraded CRT patients have a worse long-term response and higher all-cause mortality. The potential worse outcome for upgrade patients should be considered before implant.
- Cardiac Resynchronisation Therapy
- Heart Failure
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