Short-term outcome of cardiac resynchronization therapy – a comparison between newly implanted and chronically right ventricle-paced patients

Lipar, Luka; Srivathsan, Komandoor; Scott, Luis R.

doi:10.1016/j.ijcard.2016.06.054

Cited by 14 publications

(6 citation statements)

References 30 publications

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“…Prior studies have reported similar HF rates between patients with de novo CRT vs CRT upgrades. 19,22,23 Our study demonstrated lower mortality and lower composite end point of mortality and HF hospitalization in patients receiving de novo CRT implants compared with those who received CRT upgrades.…”

Section: Discussionmentioning

confidence: 62%

“…[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%

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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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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy

et al. 2019

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“…Most of them were observational, retrospective [ 17 – 28 ] or observational prospective [ 29 – 32 ] cohort studies. The vast majority were single-centre observations [ 17 , 19 – 21 , 23 – 26 , 29 , 30 ] with the exception of four dual/multicentre studies [ 18 , 22 , 28 , 32 ] and two based on high volume registries (European survey [ 27 ] and United States National Database [ 28 ]). Four [ 26 , 29 , 31 , 32 ] from the 16 studies proved to be high-quality reports (average MINORS score 11.4, Supplementary Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Crude mortality rates were available in 489,197 patients from 11 studies [ 17 , 19 , 21 , 22 , 24 , 26 – 29 , 31 , 32 ], while unadjusted or adjusted hazard ratios were available for 1734 and 1229 patients in 4 [ 19 , 26 , 31 , 32 ] and 3 [ 19 , 31 , 32 ] studies, respectively. All-cause mortality did not differ following upgrade compared to de novo implantations (RR 1.19, 95% CI 0.88 to 1.60, p = 0.27, I 2 = 90.1%, Fig.…”

Section: Resultsmentioning

confidence: 99%

De novo implantation vs. upgrade cardiac resynchronization therapy: a systematic review and meta-analysis

et al. 2017

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Patients with conventional pacemakers or implanted defibrillators are often considered for cardiac resynchronization therapy (CRT). Our aim was to summarize the available evidences regarding the clinical benefits of upgrade procedures. A systematic literature search was performed from studies published between 2006 and 2017 in order to compare the outcome of CRT upgrade vs. de novo implantations. Outcome data on all-cause mortality, heart failure events, New York Heart Association (NYHA) Class, QRS narrowing and echocardiographic parameters were analysed. A total of 16 reports were analysed comprising 489,568 CRT recipients, of whom 468,205 patients underwent de novo and 21,363 upgrade procedures. All-cause mortality was similar after CRT upgrade compared to de novo implantations (RR 1.19, 95% CI 0.88–1.60, p = 0.27). The risk of heart failure was also similar in both groups (RR 0.96, 95% CI 0.70–1.32, p = 0.81). There was no significant difference in clinical response after CRT upgrade compared to de novo implantations in terms of improvement in left ventricular ejection fraction (ΔEF de novo − 6.85% vs. upgrade − 9.35%; p = 0.235), NYHA class (ΔNYHA de novo − 0.74 vs. upgrade − 0.70; p = 0.737) and QRS narrowing (ΔQRS de novo − 9.6 ms vs. upgrade − 29.5 ms; p = 0.485). Our systematic review and meta-analysis of currently available studies reports that CRT upgrade is associated with similar risk for all-cause mortality compared to de novo resynchronization therapy. Benefits on reverse remodelling and functional capacity improved similarly in both groups suggesting that CRT upgrade may be safely and effectively offered in routine practice. Clinical Trial Registration: Prospero Database—CRD42016043747Electronic supplementary materialThe online version of this article (10.1007/s10741-017-9652-1) contains supplementary material, which is available to authorized users.

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“…Furthermore, the severity of mitral regurgitation, LV hemodynamic parameters and mechanical function are likely to get better after an upgrade to CRT [ 56 , 57 ]. Additionally, chronically RV-paced subjects receiving CRT display similar short-term benefits versus patients with newly implanted CRTs [ 58 ]. Finally, as demonstrated by Lieberman et al in their study, RV pacing does worsen LV function in patients with and without LV dysfunction unless the RV pacing site is optimized [ 23 ].…”

Section: Minimizing the Deleterious Effects Of Rv Apical Pacingmentioning

confidence: 99%

Adverse Consequences of Right Ventricular Apical Pacing and Novel Strategies to Optimize Left Ventricular Systolic and Diastolic Function

Khurwolah

Yao

Kong

2019

CCR

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Several studies have focused on the deleterious consequences of Right Ventricular Apical (RVA) pacing on Left Ventricular (LV) function, mediated by pacing-induced ventricular dyssynchrony. Therapeutic strategies to reduce the detrimental consequences of RVA pacing have been proposed, that includes upgrading of RVA pacing to Cardiac Resynchronization Therapy (CRT), alternative Right Ventricular (RV) pacing sites, minimal ventricular pacing strategies, as well as atrial-based pacing. In developing countries, single chamber RV pacing still constitutes a majority of cases of permanent pacing, and assessment of the optimal RV pacing site is of paramount importance. In chronically-paced patients, it is crucial to maintain as close and normal LV physiological function as possible, by minimizing ventricular dyssynchrony, reducing the chances for heart failure and other complications to develop. This review provides an analysis of the deleterious immediate and long-term consequences of RVA pacing, and the most recent available evidence regarding improvements in pacing options and strategies to optimize LV diastolic and systolic function. Furthermore, the place of advanced echocardiography in the identification of patients with pacing-induced LV dysfunction, the potential role of a new predictor of LV dysfunction in RV-paced subjects, and the long- term outcomes of patients with RV septal pacing will be explored.

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Short-term outcome of cardiac resynchronization therapy – a comparison between newly implanted and chronically right ventricle-paced patients

Cited by 14 publications

References 30 publications

Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy

Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy

De novo implantation vs. upgrade cardiac resynchronization therapy: a systematic review and meta-analysis

Adverse Consequences of Right Ventricular Apical Pacing and Novel Strategies to Optimize Left Ventricular Systolic and Diastolic Function

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