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Cardiac resynchronization therapy in primary prevention patients: do we need to shock?

Session Poster session 3

Speaker Fernando Montenegro Sa

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Poster Session
  • FP Number : P1531

Authors : F Montenegro Sa (Leiria,PT), J Almeida (Vila Nova de Gaia,PT), P Fonseca (Vila Nova de Gaia,PT), M Oliveira (Vila Nova de Gaia,PT), H Goncalves (Vila Nova de Gaia,PT), F Rosas (Vila Nova de Gaia,PT), J Ribeiro (Vila Nova de Gaia,PT), E Santos (Vila Nova de Gaia,PT), J Primo (Vila Nova de Gaia,PT), P Braga (Vila Nova de Gaia,PT)

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Authors:
F Montenegro Sa1 , J Almeida2 , P Fonseca2 , M Oliveira2 , H Goncalves2 , F Rosas2 , J Ribeiro2 , E Santos2 , J Primo2 , P Braga2 , 1Hospital Santo Andre, Cardiology - Leiria - Portugal , 2Hospital Center of Vila Nova de Gaia/Espinho, Cardiology - Vila Nova de Gaia - Portugal ,

Citation:

Introduction: Cardiac resynchronization therapy (CRT) is an effective treatment for systolic heart failure (HF). After resynchronization, the recovery in cardiac function makes the benefit of an additional implantable cardioverter-defibrillator (ICD) for primary prevention unclear – hence, the decision to add an ICD (CRT-D) frequently relies in patient age and co-morbidities severity. The aim of our study was to evaluate the decision impact of implanting a CRT-D or a CRT-pacemaker (CRT-P) in cardiovascular (CV) and non-CV death and in a composed outcome (MACE) of CV death or sustained ventricular tachycardia (VT) / fibrillation (VF) occurrence.

Methods: We analyzed retrospectively 115 consecutive patients referred to CRT between 2007 and 2016. The decision to implant CRT-D or CRT-P was based on clinical judgment. During a mean follow-up time of 57.8±33.1 months, all patients were evaluated with device interrogation and transthoracic echo every 6 months. To compare survival, a Kaplan-Meier curve with log rank test was performed. In order to identify MACE predictors, we used a Cox-regression survival analysis including all baseline clinical, echo and electrocardiographic data.

Results: With a mean age at implant of 65.4±9.8 years and 86.1% (n=99) males, a CRT-D was implanted in 78 (67.2%) patients. CRT-P patients were older (72.9±6.3 vs. 62.1±9.0 years, p<0.01), had more chronic pulmonary (29.7% vs. 13.4%, p=0.03) and renal disease (35.1% vs. 18.3%, p=0.04). The rate of ischemic cardiomyopathy was similar (CRT-P 23.3% vs. CRT-D 32.4%, p=0.37), as was the responder rate (increase in 25% baseline LVEF: CRT-P 72.7% vs. CRT-D 65.8%, p=0.52). MACE occurred in 25 patients (21.7%), with 11 CV deaths and 16 VT/VF. Kaplan-Meier analysis showed that CRT-P patients had higher non-CV mortality with no differences in CV mortality (figure). On multivariate analysis, CRT-P (p=0.24) was not a MACE independent predictor (table).

Conclusion: In our study, the decision to implant a CRT-P on selected patients - older with more comorbidities - did not have an impact on CV death. Atrial fibrillation, ischemic cardiomyopathy and higher New York Heart Association (NYHA) class may aid on the decision to implant a CRT-D.

OR

95CI

p-value

Atrial fibrillation

3,28

1,38 - 7,81

0,007

Ischemic cardiomyopathy

6,23

2,09 - 9,32

<0,001

New York Heart Association class III

3,51

1,08 - 11,46

0,037

The free consultation period for this content is over.

It is now only available year-round to EHRA Ivory (& above) Members, Fellows of the ESC and Young combined Members



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