Clinical outcomes after upgrading from pacemakers to cardiac resynchronization therapy

Leyva, Francisco; Zegard, Abbasin; Patel, Kiran; Panting, Jonathan; Marshall, Howard; Qiu, Tianyi

doi:10.1111/pace.13287

Cited by 9 publications

(9 citation statements)

References 25 publications

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“…Notably, not only the type of the implanted device but also the date of implantations might affect the outcomes due to the continuously improving device technology and drug treatment. However, neither the previously reported data 10 nor our results could confirm that the date of implantation has an impact on outcomes.…”

Section: Discussioncontrasting

confidence: 99%

“…Moreover, Leyva et al . observed a higher risk of mortality in upgrade patients receiving CRT-P devices than those being upgraded to a CRT-D. 10 Compared with our patient cohort, Leyva et al . included CRT upgrade recipients with no history of sustained ventricular arrhythmia, and they investigated the CRT upgrade in the context of primary prevention.…”

Section: Discussioncontrasting

confidence: 51%

“…However, after performing multivariable Cox proportional hazard analysis or propensity score matching, no differences could be observed in these endpoints. 10 Their univariable analysis proved that all-cause mortality was higher in upgrade than de novo patients in men and subgroups of patients with NYHA III functional class, CRT-P, non-ischaemic cardiomyopathy, non-diabetic status, LBBB, QRS ≥150ms, and LVEF ≤25%. These results are in line with ours, as we also found a higher risk of the composite endpoint in these subgroups among upgrade CRT patients.…”

Section: Discussionmentioning

confidence: 98%

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Long-term survival following upgrade compared with de novo cardiac resynchronization therapy implantation: a single-centre, high-volume experience

et al. 2021

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Aims Patients with a pacemaker or implantable cardioverter-defibrillator are often considered for cardiac resynchronization therapy (CRT). However, limited comprehensive data are available regarding their long-term outcomes. Methods and results Our retrospective registry included 2524 patients [1977 (78%) de novo, 547 (22%) upgrade patients] with mild to severe symptoms, left ventricular ejection fraction ≤35%, and QRS ≥ 130ms. The primary outcome was the composite of all-cause mortality, heart transplantation (HTX), or left ventricular assist device (LVAD) implantation; secondary endpoints were death from any cause and post-procedural complications. In our cohort, upgrade patients were older [71 (65–77) vs. 67 (59–73) years; P < 0.001], were less frequently females (20% vs. 27%; P = 0.002) and had more comorbidities than de novo patients. During the median follow-up time of 3.7 years, 1091 (55%) de novo and 342 (63%) upgrade patients reached the primary endpoint. In univariable analysis, upgrade patients exhibited a higher risk of mortality/HTX/LVAD than the de novo group [hazard ratio (HR): 1.41; 95% confidence interval (CI): 1.23–1.61; P < 0.001]. However, this difference disappeared after adjusting for covariates (adjusted HR: 1.12; 95% CI: 0.86–1.48; P = 0.402), or propensity score matching (propensity score-matched HR: 1.10; 95% CI: 0.95–1.29; P = 0.215). From device-related complications, lead dysfunction (3.1% vs. 1%; P < 0.001) and pocket infections (3.7% vs. 1.8%; P = 0.014) were more frequent in the upgrade group compared to de novo patients. Conclusion In our retrospective analysis, upgrade patients had a higher risk of all-cause mortality than de novo patients, which might be attributable to their more significant comorbidity burden. The occurrence of lead dysfunction and pocket infections was more frequent in the upgrade group.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 98%

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Long-term survival following upgrade compared with de novo cardiac resynchronization therapy implantation: a single-centre, high-volume experience

et al. 2021

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“…[19][20][21][22][23][24][25][26][27][28][29][30] Bogale et al 19 investigated 692 patients with upgrades to CRT/CRT-D and 1675 patients with de novo CRT/CRT-D, with follow-up of approximately 1 year, and did not find significant differences in survival (P ¼ 0.57) between the 2 groups. Similar results were reported by a few other studies 21,23,24,29,30 with similarly short follow-up periods (ranging from reporting at 290 days to 4 years) or upgrades solely from pacemaker devices. Vamos et al 28 conducted an observational prospective study with an average follow-up of 37 months and reported higher mortality in upgraded patients compared with patients with de novo CRT implants (HR, 1.79; 95% CI, 1.08-2.95; P ¼ 0.023), whereas Cheung et al 20 reported that CRT upgrades were independently associated with increased mortality (adjusted odds ratio, 1.91; 95% CI, 1.67-2.19; P < 0.001) compared with de novo CRT implants.…”

Section: Discussionmentioning

confidence: 99%

Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy

et al. 2019

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Background: Cardiac resynchronization therapy (CRT) is effective in treating advanced heart failure (HF), but data describing benefits and long-term outcomes for upgrades from a preexisting device are limited. This study sought to compare long-term outcomes in de novo CRT implants with those eligible for CRT with a prior device. Methods: This is a retrospective cohort study using data from a provincial registry (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). Patients were included if they had mildmoderate HF, left ventricular ejection fraction 35%, and QRS duration ! 130 ms. Patients were classified as de novo CRT or upgraded to CRT from a prior device. Outcomes were mortality and composite mortality and HF hospitalization. Results: There were 342 patients included in the study. In a multivariate model, patients in the upgraded cohort (n ¼ 233) had a higher 5-year mortality rate (adjusted hazard ratio, 2.86; 95% confidence interval, 1.59-5.15; P ¼ 0.0005) compared with the de novo cohort (n ¼ 109) and higher composite mortality and HF hospitalization (adjusted hazard ratio, 2.60; 95% confidence interval, 1.54-4.37; P ¼ 0.0003). Conclusions: Implantation of de novo CRTs was associated with lower mortality and HF hospitalization compared with upgraded CRTs from preexisting devices. It is unknown whether these differences are due to the timing of CRT implementation or other clinical factors. Further work in this area may be helpful to determine how to improve outcomes for these patients.Randomized trials have demonstrated that among patients with mild to moderate heart failure (HF), reduced ejection fraction, and left bundle branch block, cardiac resynchronization therapy (CRT) significantly reduces mortality and HF CJC Open 1 (2019) 93e99

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“…Outcomes were compared with a population of adult patients with NICM or ICM who also underwent CRT device implantation in the same time period. Some adult patients with NICM or ICM have been included in previous publications . The study was approved by the Clinical Audit Department at the Queen Elizabeth Hospital, which permits publication of clinical data for the purposes of service evaluation.…”

Section: Methodsmentioning

confidence: 99%

Long‐term outcomes of cardiac resynchronization therapy in adult congenital heart disease

Leyva

Zegard

Qiu

et al. 2019

Pacing Clinical Electrophis

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Background and AimsRandomized, controlled trials of cardiac resynchronization therapy (CRT) excluded patients with adult congenital heart disease (ACHD). We sought to explore long‐term clinical outcomes.Methods and ResultsIn this single‐center, observational study, events were collected from hospital records on patients with structural ACHD (sACHD) and adults with ischemic (ICM) or nonischemic (NICM) cardiomyopathy undergoing CRT. Patients with sACHD (n = 23, age: 41.6 ± 13.5 years [mean ± standard deviation]) and adults with ICM (n = 533) or NICM (n = 458) were followed‐up for 4.1 years (median; interquartile range: 2.2‐6.1). Total mortality was 5/23 (21.7%; 4.4 per 100 person‐years) in sACHD, 221/533 (41.5%; 11.8 per 100 person‐years) in ICM, and 154/458 (33.6%; 9.7 per 100 person‐years) in NICM. In univariate analyses, total mortality in sACHD was lower than in ICM (hazard ratio [HR]: 0.38; 95% confidence interval [CI] 0.15‐0.91), but similar to NICM (HR: 0.48, 95% CI 0.20‐1.16). Cardiac mortality in sACHD was similar to ICM (HR: 0.78, 95% CI 0.32‐1.92) and NICM (HR: 1.12, 95% CI 0.45‐2.78). Heart failure (HF) hospitalization rates were similar to ICM (HR: 0.44, 95% CI 0.11‐1.77) and NICM (HR: 0.75, 95% CI 0.18‐3.08). In multivariate analyses, no differences emerged in total mortality, cardiac mortality, or HF hospitalization between sACHD and NICM or ICM, after adjustment for age, sex, New York Heart Association class, diabetes, atrial rhythm, QRS duration, QRS morphology, systemic ventricular ejection fraction, and medical therapy.ConclusionTotal mortality, cardiac mortality, and HF hospitalization after CRT in patients with sACHD was similar to adults with ICM or NICM.

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Clinical outcomes after upgrading from pacemakers to cardiac resynchronization therapy

Cited by 9 publications

References 25 publications

Long-term survival following upgrade compared with de novo cardiac resynchronization therapy implantation: a single-centre, high-volume experience

Long-term survival following upgrade compared with de novo cardiac resynchronization therapy implantation: a single-centre, high-volume experience

Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy

Long‐term outcomes of cardiac resynchronization therapy in adult congenital heart disease

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