Scientific Evidences Supporting the Benefits of Cardiac Resynchronization Therapy: History of Cardiac Resynchronization Therapy

The article provides new insights to cardiac resynchronization therapy (CRT), a method of treating chronic heart failure with cardiac biventricular pacing. The article covers the history of its development starting with the first attempts to eliminate heart dyssynchrony up to the present advances. Over the last decades, CRT has significantly improved, including both implantable devices and electrodes, and current CRT guidelines and indications. The article discusses serial changes in indications and selection criteria for patients based on the results of the recent clinical trials assessing its effectiveness. Evidence-based knowledge is presented for the CRT application in the routine clinical practice. Novel approaches and technologies aimed at improving the effectiveness of CRT are presented.

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Futility risk model for predicting outcome after cardiac resynchronization therapy defibrillator implantation: data from a nationwide analysis

EP Europace ◽

10.1093/europace/euab116.449 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

B Maille ◽

A Bodin ◽

A Bisson ◽

J Herbert ◽

F Franceschi ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Risk Model ◽

Cardiac Resynchronization ◽

First Year ◽

Resynchronization Therapy ◽

Derivation Cohort ◽

Funding Sources ◽

History Of ◽

Predicting Outcome ◽

One Year

Abstract Funding Acknowledgements Type of funding sources: None. Objective. Risk-benefit assessment for cardiac resynchronization therapy defibrillator (CRT-D) over a CRT pacemaker (CRT-P) is still a matter of debate. We aimed to identify patients with a bad outcome within one year after CRT-D implantation, and to develop a Futile CRT-D score. Methods. Based on the administrative hospital-discharge database, all consecutive patients treated with CRT-D implantation in France between 2010 and 2019 were included. A prediction model was derived and validated for one-year all-cause death after CRT-D implantation (considered as futility) by using split-sample validation. Results. 28,503 patients were included in the analysis (mean age 68 ± 10 years); 2,139 (7.5%) deaths were recorded in the first year. In the derivation cohort (n = 14,252), the final logistic regression model included as main predictors of futility older age, diabetes, mitral regurgitation, history of hospital stay with heart failure, history of pulmonary oedema, atrial fibrillation, renal, pulmonary, liver, or thyroid disease, denutrition and anemia. Based on Futile CRT-D score, 17% of these patients were categorized at high risk (Futile CRT-D score ≥13) and predicted futility at 17%. Conclusion. The futility CRT-D score, established from a large nationwide cohort of patients treated with CRT-D may provide a relevant tool for optimizing healthcare decision. Death at one year in patients with CRTD OR (95%CI)pPointsAge (quartile)1.353 (1.266-1.446)<0.00012Diabetes mellitus1.413 (1.225-1.629)<0.00012Heart failure with congestion1.908 (1.501-2.423)<0.00013History of pulmonary edema1.445 (1.194-1.749)<0.00012Mitral regurgitation1.259 (1.074-1.475)0.0042Atrial fibrillation1.601 (1.395-1.838)<0.00012Left BBB0.803 (0.698-0.924)0.002-1Dyslipidemia0.809 (0.696-0.940)0.006-1Denutrition1.709 (1.360-2.147)<0.00012Chronic kidney disease1.574 (1.321-1.875)<0.00012Lung disease1.230 (1.052-1.437)0.0092Sleep apnea syndrome0.740 (0.596-0.919)0.007-1Liver disease1.747 (1.384-2.206)<0.00012Anaemia1.325 (1.105-1.589)0.0022BBB = bundle branch block.; * age quartile: 1 point when age >61, 2 points when age >69, 3 points when age >75.Abstract Figure. AUC and incidences of all-causes death

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Reducing Mortality With Device Therapy in Heart Failure Patients Without Ventricular Arrhythmias

American Journal of Critical Care ◽

10.4037/ajcc2008.17.5.443 ◽

2008 ◽

Vol 17 (5) ◽

pp. 443-452 ◽

Cited By ~ 2

Author(s):

Deborah W. Chapa ◽

Hyeon-Joo Lee ◽

Chi-Wen Kao ◽

Erika Friedmann ◽

Sue A. Thomas ◽

...

Keyword(s):

Heart Failure ◽

Clinical Trials ◽

Cardiac Resynchronization Therapy ◽

Severe Heart Failure ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Device Therapy ◽

Optimal Drug ◽

Patients With Heart Failure ◽

History Of

Use of device therapy to prevent sudden cardiac death in patients with heart failure is expanding on the basis of evidence from recent clinical trials. Three multicenter prospective clinical trials—Sudden Cardiac Death in Heart Failure (SCD-HeFT); Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION); and Cardiac Resynchronization-Heart Failure (CARE-HF)—were conducted to determine the effectiveness of devices in reducing mortality in patients with heart failure who did not have a history of ventricular arrhythmias. The 3 trials varied in the devices used, the population of patients included, and the study designs. In SCD-HeFT, implantable cardioverter defibrillators were more effective than pharmacological therapy in preventing mortality among patients with mild to moderate heart failure. In COMPANION, cardiac resynchronization therapy alone and cardiac resynchronization therapy plus an implantable cardioverter defibrillator were more effective than optimal drug treatment in reducing morbidity and all-cause mortality in patients with moderate to severe heart failure. In CARE-HF, cardiac resynchronization therapy alone was more effective than optimal drug treatment in reducing all-cause mortality in patients with moderate to severe heart failure. No direct comparison of the devices used has been done. These 3 clinical trials provide clear evidence that device therapy is beneficial for some patients with heart failure, even patients who do not have a history of ventricular arrhythmia.

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