57 Comparison of Upgraded Versus de-novo Cardiac Resynchronisation Therapy (CRT) Devices on Cardiovascular Outcomes and Response. (6th June 2015)

• Record Type: Journal Article
• Authors: McAloon, Christopher; Heining, Domonic; Barker, Jethro; Atherton, Gavin; Anderson, Benjamin; Osman, Faizel
• Is Part Of: Heart. Volume 101(2015)Supplement 4
• Page Start: A31
• Page End: A32
• Publication Date: 2015-06-06
• Subjects: Cardiac Resynchronisation Therapy -- Heart Failure -- Arrhythmia; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2015-308066.57
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Background: CRT is an effective therapy in HF. Pacemakers and defibrillators are implanted for arrhythmogenic indications. Pacing dependency can induce HF and is an established CRT upgrade criterion [LVEF <35% and ventricular pacing >40%]. We aimed to compare cardiovascular outcomes between upgraded and de-novo CRT's. Methodology: A retrospective study of all consecutive CRT implants over five years (Jan 2009 – Dec 2013) in a UK tertiary centre. Data was collected on baseline demographics, co-morbidities and indications (NYHA class, ECG, echocardiogram). Comparisons were made for these outcomes: acute response [<2 mths], long-term response [>2 mths], all-cause mortality and first hospitalisation. CRT response was defined as >1 NYHA class increase. Results: 373 CRT implants were performed (79 upgrades). Upgrade and de-novo patients were matched for all comorbidities. Table 1 demonstrates baseline demographics, indications and CRT response. A Kaplan-Meier analysis was performed on all-cause mortality and time to first hospitalisation, with three year rates demonstrated in the table. A significantly worse long-term response (p 0.002) and all-cause mortality (p 0.043) was demonstrated for upgrade patients. Conclusion: Upgraded CRT patients have a worse long-term response and higher all-cause mortality. The potential worse outcome for upgrade patients should be considered before implant.