In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

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

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)


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 ,


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.




Atrial fibrillation


1,38 - 7,81


Ischemic cardiomyopathy


2,09 - 9,32


New York Heart Association class III


1,08 - 11,46


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

Based on your interests

Three reasons why you should become a member

Become a member now
  • 1Access your congress resources all year-round on the New ESC 365
  • 2Get a discount on your next congress registration
  • 3Continue your professional development with free access to educational tools
Become a member now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim, Bristol-Myers Squibb and Pfizer Alliance, and Novartis Pharma AG. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are