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Long‐Term Results of Cardiac Resynchronization Therapy: A Comparison between CRT‐Pacemakers versus Primary Prophylactic CRT‐Defibrillators
Author(s) -
REITAN CHRISTIAN,
CHAUDHRY UZMA,
BAKOS ZOLTAN,
BRANDT JOHAN,
WANG LINGWEI,
PLATONOV PYOTR G.,
BORGQUIST RASMUS
Publication year - 2015
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12631
Subject(s) - medicine , cardiac resynchronization therapy , heart failure , cardiology , clinical endpoint , ejection fraction , randomized controlled trial
Background Cardiac resynchronization therapy (CRT) with or without a defibrillator has a positive effect on mortality and morbidity for patients with heart failure. However, comparisons between CRT‐defibrillators (CRT‐D) and CRT‐pacemakers (CRT‐P) are relatively scarce outside the clinical trial setting. This study aimed to assess baseline characteristics in relation to long‐term prognosis in patients treated with CRT, and to investigate the potential benefit of CRT‐D versus CRT‐P. Methods Data were retrospectively collected from the medical records of all consecutive patients treated with CRT‐P or primary prophylactic CRT‐D at a large tertiary care center between 1999 and 2012. Predictors of mortality were investigated, and time‐dependent analysis was performed with all‐cause mortality as the primary end point. Results A total of 705 patients were included (69.6 ± 10 years, 78% New York Heart Association classes III–IV, left ventricular ejection fraction median 25%, 16% female, 36% CRT‐D). The patients were followed for a median of 59 months. Annual mortality differed between CRT‐D primary prophylactic and CRT‐P groups (5.3% and 11.8%, respectively), but when adjusted for covariates, CRT‐D treatment (compared to CRT‐P) was not associated with better long‐term survival. Independent predictors of survival were: age, use of loop diuretics, hemoglobin levels, and use of renin angiotensin aldosterone system blockers. Conclusions In CRT treatment outside of the clinical trial setting, CRT‐D treatment was not an independent predictor of long‐term survival. Future research should focus on correct selection of the patients who receive enough benefit of an added defibrillator to justify CRT‐D implantation instead of CRT‐P treatment only.