Author + information
- Pieter Martens,
- Frederik Verbrugge,
- Petra Nijst,
- Matthias Dupont and
- Wilfried Mullens
Background: Both Cardiac resynchronization therapy (CRT) and implantable cardio-defibrillators (ICD) reduce mortality. However, the incremental value to one-other remains a topic of debate.
Methods: Baseline characteristics, mode of death and device interrogations were retrospectively evaluated in consecutive CRT-Pacemaker (CRT-P) and CRT-Defibrillator (CRT-D) patients implanted between October, 2008, and August, 2015. Preference for implant of CRT-P was given in older patients with multiple comorbidities or pacing induced non-ischemic cardiomyopathies. For patients with a primary prevention indication of the CRT-D, independent predictors associated with a clinical context of reduced benefit of the ICD-component were determined, defined as absence of non- lethal (detected on device interrogation) and lethal ventricular tachy-arrhythmias (mode of death analysis) during follow-up.
Results: A total of 687 patients were followed for 38±22 months. CRT-P was implanted in 361 (52.5%) and CRT-D in 326 (47.5%). CRT-P recipients were older (75.7±9.1 versus 71.8±9.3; <0.001) and had more often atrial fibrillation (p=0.015), anemia (p=0.039), stroke (p=0.009), cachexia (p=0.009), history of valve surgery (p=0.016) and were more often upgraded from a pacemaker (p<0.001). During remote tele-monitoring follow-up, 4 CRT-P patients were detected with episodes of sustained ventricular tachycardia for which semi-elective upgrade to CRT-D occurred. All-cause mortality was higher in CRT-P versus CRT-D patients (p=0.003). However, mode of death analysis revealed a predominant non-cardiac mode of death in CRT-P recipients (70% versus 38% in CRT-D, p=0.002) with only one patient dying from tachy-arrithmic death in the CRT-P group. Regression analyses revealed that the presence of advanced age, NYHA class IV, intolerance to beta-blockers and underlying non-ischemic cardiomyopathy independently associates with a reduced benefit of the primary prevention CRT-D on top of CRT-P.
Conclusions: The majority of contemporary heart failure patients as currently selected for CRT-P exhibit mainly non-cardiac driven mortality, suggesting little incremental value of the addition of a defibrillator.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Heart Failure: Evaluating Strategies to Prevent Readmissions
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1163-277
- 2017 American College of Cardiology Foundation