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57 Comparison of Upgraded Versus de-novo Cardiac Resynchronisation Therapy (CRT) Devices on Cardiovascular Outcomes and Response
  1. Christopher McAloon1,
  2. Domonic Heining1,
  3. Jethro Barker2,
  4. Gavin Atherton1,
  5. Benjamin Anderson1,
  6. Faizel Osman1
  1. 1University Hospital Coventry and Warwickshire
  2. 2Wawick Medical School, University of Warwick

Abstract

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.

Abstract 57 Table 1

De-Novo vs. upgrade cardiac resynchronisation therapy device: Demographics, indications, response and outcomes

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
  • Arrhythmia

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