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Introduction: Right ventricular pacing (RVP) is associated with increased mortality in patients with left ventricular systolic dysfunction and heart failure. CRT is an accepted therapy in patients with >40% RVP. We hypothesized that CRT upgrade in pts with permanent pacemaker (PM) may increase mortality compared to patients undergoing de-novo CRT.
Methods: Patients who underwent CRT at Geisinger Health System from 01/01/2010 to 12/31/2015 were identified from NCDR ICD registry. Patients who underwent upgrade to CRT-D from prior PM (group I) were compared to de-no CRT-D patients. The primary outcome was 1, 3 and 5 year all-cause mortality. Patient data was collected by biostatistics broker and analyzed further by the research team.
Results: 463 patients underwent CRT-D implantation (mean age 72±12 years, male 68%, LVEF 25±7%, and 98% with either NYHA class II, III or IV. Group I (n=73, 16%) and Group II (n= 390, 84%) were similar in baseline characteristics except for age (78±10 vs 70±12 yrs, p<0.001) All-cause mortality in group I at 1, 3 and 5 years was 10.9%, 26% and 28.7% respectively compared to 8.7%, 20.5% and 24.6% respectively in group II (log-rank p= 0.0487).
Conclusions: Sixteen percent of patients undergoing CRT had device upgrade from PM. The all-cause mortality was higher in this group compared to de-novo CRT pts. The higher mortality in CRT-upgrade pts may be reflective of their older age and advanced co-morbidities.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Devices 4
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1278-077
- 2017 American College of Cardiology Foundation