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.