An individualized left ventricular lead-targeting strategy improves long-term survival of cardiac resynchronization therapy patients and influences the benefit of the implantable cardioverter-defibrillator

2017 ◽  
Vol 18 (7) ◽  
pp. 553-555
Author(s):  
Sergio Barra ◽  
Emma Yu ◽  
Fakhar Khan ◽  
David Dutka ◽  
Munmohan Virdee
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Implantable Cardioverter Defibrillator ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Term Survival ◽  
Cardioverter Defibrillator ◽  
Ventricular Lead ◽  
Targeting Strategy

Upgrade from implantable cardioverter-defibrillator vs. de novo implantation of cardiac resynchronization therapy: long-term outcomes

EP Europace ◽  
2020 ◽  
Author(s):  
Ewa Jędrzejczyk-Patej ◽  
Michał Mazurek ◽  
Agnieszka Kotalczyk ◽  
Wiktoria Kowalska ◽  
Aleksandra Konieczny-Kozielska ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Implantable Cardioverter Defibrillator ◽  
De Novo ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Urban Region ◽  
Resynchronization Therapy ◽  
Cardioverter Defibrillator ◽  
All Cause Mortality

Abstract Aims  To assess and compare long-term mortality and predictors thereof in de novo cardiac resynchronization therapy defibrillators (CRT-D) vs. upgrade from an implantable cardioverter-defibrillator (ICD) to CRT-D. Methods and results  Study population consisted of 595 consecutive patients with CRT-D implanted between 2002 and 2015 in a tertiary care, university hospital, in a densely inhabited, urban region of Poland [480 subjects (84.3%) with CRT-D de novo implantation; 115 patients (15.7%) upgraded from ICD to CRT-D]. In a median observation of 1692 days (range 457–3067), all-cause mortality for de novo CRT-D vs. CRT-D upgrade was 35.5% vs. 43.5%, respectively (P = 0.045). On multivariable regression analysis including all CRT recipients, the previously implanted ICD was an independent predictor for death [hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.10–2.29, P = 0.02]. For those, who were upgraded from ICD to CRT-D, the independent predictors for all-cause death were as follows: creatinine level (HR 1.01, 95% CI 1.00–1.02, P = 0.01), left ventricular end-systolic diameter (HR 1.07, 95% CI 1.02–1.11, P = 0.002), New York Heart Association (NYHA) IV class at baseline (HR 2.36, 95% CI 1.00–5.53, P = 0.049) and cardiac device-related infective endocarditis during follow-up (HR 2.42, 95% CI 1.02–5.75, P = 0.046). A new CRT scale (Creatinine ≥150 μmol/L; Remodelling, left ventricular end-systolic ≥59 mm; Threshold for NYHA, NYHA = IV) showed high prediction for mortality in CRT-D upgrades (AUC 0.70, 95% CI 0.59–0.80, P = 0.0007). Conclusion  All-cause mortality in patients upgraded from ICD is significantly higher compared with de novo CRT-D implantations and reaches almost 45% within 4.5 years. A new CRT scale (Creatinine; Remodelling; Threshold for NYHA) has been proposed to help survival prediction following CRT upgrade.

P3805Mortality predictors and outcome in patients after upgrade from implantable cardioverter-defibrillator to cardiac resynchronization therapy in comparison to CRT-D de novo implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Jedrzejczyk-Patej ◽  
M Mazurek ◽  
W Kowalska ◽  
M Bugajski ◽  
A Konieczny-Kozielska ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Cardiac Resynchronization Therapy ◽  
Implantable Cardioverter Defibrillator ◽  
De Novo ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardioverter Defibrillator ◽  
Mortality Predictors

Abstract Background Over a quarter of all cardiac resynchronization therapy (CRT) implants are upgrades from previous devices, mainly from implantable cardioverter-defibrillator (ICD). In comparison to CRT with defibrillator (CRT-D) de novo implantation, upgrade from ICD to CRT-D carries higher risk of complications. Limited number of studies evaluated predictors of death in patients undergoing upgrade from ICD to CRT-D. Aim To determine mortality predictors and outcome in patients undergoing upgrade from ICD to CRT-D in comparison to subjects with CRT-D de novo implantation. Methods Study population consisted of 595 consecutive patients with CRT-D implanted between 2002 and 2015 in tertiary care university hospital, in a densely inhabited, urban region of Poland (480 subjects [84.3%] with CRT-D de novo implantation; 115 patients [15.7%] upgraded from ICD to CRT-D). Results The median follow-up was 1692 days (range: 457–3067). All-cause mortality in patients upgraded from ICD was significantly higher than in subjects with CRT-D implanted de novo (43.5% vs. 35.5%, P=0.045). On multivariable regression analysis, left ventricular end-systolic diameter (HR 1.07, 95% CI 1.02–1.11, P=0.002), creatinine level at baseline (HR 1.01, 95% CI 1.00–1.02, P=0.01), NYHA IV class at baseline (HR 2.36, 95% CI 1.00–5.53, P=0.049) and cardiac device-related infective endocarditis (CDRIE) during follow up (HR 2.42, 95% CI 1.02–5.75, P=0.046) were identified as independent predictors of higher mortality in patients with CRT-D upgraded from ICD. Conclusions Mortality rate in patients upgraded from ICD is higher in comparison to CRT-D de novo implanted subjects, and reaches almost 45% within 4.5 years. Left ventricular dimensions, creatinine level, high NYHA class at baseline and infective endocarditis during follow up are independent mortality predictors in patients with CRT-D upgraded from ICD.

scholarly journals The incidence of frailty and its relationship with long-term survival in patients with heart failure and implanted cardiac resynchronization therapy devices

2020 ◽  
Vol 25 (8) ◽  
pp. 3685
Author(s):  
A. M. Soldatova ◽  
V. A. Kuznetsov ◽  
D. S. Bogdanova ◽  
F. T. Benzineb
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Term Survival ◽  
Long Term Survival ◽  
Cardiac Resynchronization Therapy Devices ◽  
Patients With Heart Failure ◽  
Group 2

Aim. To assess long-term survival depending on the presence and severity of frailty in patients with heart failure (HF) and implanted cardiac resynchronization therapy devices.Material and methods. We examined 77 patients (men — 74%, women — 26%, mean age 58,7±10,7 years) with NYHA class II-IV HF. The follow-up period was 42,4±27,1 months. On the basis of 31 parameters (medical history, diagnostic tests, questionnaire survey of physical activity limitations), a frailty index was calculated. Depending on the index value, the patients were divided into 2 groups: group 1 (n=41) — <0,375 (no frailty), group 2 (n=36) — ≥0,375 (patients with frailty).Results. Long-term survival of patients in group 1 was 87,8%, in group 2 — 52,8% (Log rank p<0,001). According to the univariate analysis, the presence of frailty was significantly associated with long-term mortality (odds ratio (OR) 6,108; 95% confidence interval (CI) 2,207-16,907; p<0,001). When sex, age, left ventricular ejection fraction, left bundle branch block, QRS duration, left ventricular volume were included in the multivariate analysis, the presence of frailty remained a significant predictor of long-term mortality (OR 5,763; 95% CI 1,837-18,083; p=0,003).Conclusion. Frailty has an independent effect on the long-term all-cause death risk in patients with HF and implanted cardiac resynchronization therapy devices.

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