47CRT-D versus CRT-P: are we on the right track?

Autor: Pieter Koopman, D Dilling, Johan Vijgen, PH J Timmermans, J Stassen, M Scherrenberg, Joris Schurmans, Lieven Herbots, Jan Verwerft
Rok vydání: 2020
Předmět:
Zdroj: EP Europace. 22
ISSN: 1532-2092
1099-5129
DOI: 10.1093/europace/euaa162.067
Popis: Introduction Implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) have both proven to reduce mortality in patients with heart failure (HF). However, randomised trials comparing CRT-pacemaker (CRT-P) vs CRT-defibrillator (CRT-D) are lacking. Understanding a patient’s primary mode of death is therefore important as this may guide the proper use of CRT systems and avoid risks that are associated with under -or overtreatment with an ICD. Purpose This study aims to analyse the mode of death and the occurrence of life-threatening ventricular arrhythmias (VAs) in patients who received a CRT-P or CRT-D. This may help in the future selection for an appropriate cardiac device in patients with HF. Methods Patients with HF undergoing CRT-P or CRT-D implantation in a tertiary hospital between January 2008 and December 2018 were retrospectively evaluated. CRT indications were in compliance with the ESC guidelines. The decision to implant CRT-D or CRT-P in primary prevention was left at the discretion of the treating physician but was based on ESC clinical guidance. Life threatening VAs (sustained ventricular tachycardia > 30s not requiring therapy or appropriate therapy for VAs) and mode of death were analysed. Results 511 patients were implanted with a CRT (CRT-D/CRT-P; n = 311/200) of which 410 (CRT-D/CRT-P; n= 245/165) were followed in our centre for 63,5 ± 38,1 months. Patients with CRT-P were older (77,6 ± 8,1 vs 66,8 ± 9,5 years; p Main reasons to choose for CRT-P were RV-pacing induced cardiomyopathy (CMP) (26,1%), multiple comorbidities (18,8%), HF complicated by high degree AV block or AV junction ablation (18,2%), non-ischaemic CMP with suspected good CRT response (10,3%), age (7,3%), other (19,3%). 6/165 patients with CRT-P (3,6%), of which 5 were detected by remoted telemonitoring, vs 51/245 with CRT-D (20,8%) experienced episodes of life-threatening arrhythmias (p Conclusions Guided by clinical parameters and presence of competitive non-cardiac causes of death, adequate decision between CRT-P or CRT-D implantation can be made. In our cohort, sudden cardiac death in the CRT-P group occurred only once. Remote monitoring is able to identify a subgroup of patients potentially benefiting from an upgrade from CRT-P to CRT-D.
Databáze: OpenAIRE
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