Lead complications, device infections, and clinical outcomes in the first year after implantation of cardiac resynchronization therapy-defibrillator and cardiac resynchronization therapy-pacemaker

Abstract

Cardiac resynchronization therapy-defibrillator was implanted in 57% of candidates for CRT. Within 1 year after device implant, the incidence of loss of capture at any lead was nearly three-fold greater among CRT-D than among CRT-P recipients. System-related infections were infrequent and clinical outcomes were similar in both groups.

Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: a systematic review and proportional meta-analysis

“…However, our results suggest that the ICD may be more cost-effective in primary prevention in young male CRT patients with ischemic cardiomyopathy who are on stable NYHA class III despite optimal medical treatment and have few comorbidities, while the cost-effectiveness ratio of routine CRT-D implantation (compared with CRT-P) in elderly patients or those with mild heart failure may be less attractive. Considering that CRT-D associates with a higher risk of complications 44,55,56 and a significantly higher cost compared with CRT-P, our results reinforce the importance of selecting the right patient for the procedure and suggest that providing every CRT candidate with an ICD is unlikely to be clinically beneficial or costeffective.…”

“…As such, the addition of the ICD may in theory provide incremental protection. Nevertheless, this comes at the expense of an increased risk of device-related complications 44,55,56 and significantly higher cost; therefore this question merits careful scrutiny.…”

Patients upgraded to cardiac resynchronization therapy due to pacing-induced cardiomyopathy are at low risk of life-threatening ventricular arrhythmias: a long-term cause-of-death analysis

“…Fourth, none of the trials assessing the role of the ICD in primary prevention heart failure patients addressed individuals with pacinginduced cardiomyopathy and therefore there are no guidelines supporting or opposing the use of the defibrillator in this specific patient population. Finally, implanting a CRT-D device associates with higher risk of follow-up complications compared with CRT-P, mostly a result of a higher risk of lead-related complications (15,16).…”

Cardiac rehabilitation in pacing patient complications: an increasing scenario requiring a collaborative vision of a multi-disciplinary treatment team

“…Epicardial patches are placed at the sides of the heart through Cardiac Surgery approach under general anesthesia, while subcutaneous single-finger cardioverter-defibrillator (ICD) system is placed through subcutaneous tunneling technique in general or local anesthesia by interventional cardiologist but also in this case, complications are demonstrated necessitating removal and subcutaneous Finger system removal has been performed successfully too [78]. In addition, the improved patients' survival, the progressively younger implanted population and the increase in device and procedure complexity have raised the risk of system component structural failures [79]. For these reasons, the necessity of extraction has become increasingly higher and the development of specific techniques and tools to reduce morbidity and mortality associated with pacing devices' removal has played an important role representing the cornerstone of the modern clinical cardiac electrophysiology as well as efficacious cardiac devices' implantation and management.…”