BACKGROUND: Cardiac resynchronisation therapy (CRT) is a validated treatment for heart failure (HF) patients in NYHA class III-IV despite optimal medical therapy. We aimed to assess the beneficial effects of CRT in patients with catecholamine-dependent overt HF (CDOHF). METHODS: We studied 20 CDOHF patients who had undergone CRT implantation. Patients had a mean baseline QRS duration of 174+/-25 ms and/or echocardiographic asynchrony, and LVEF of 18+/-3%. Mean follow-up was 18+/-12 months. Dependence on catecholamine agents was defined as the inability to stop or reduce drug infusion without re-occurrence of hypotension, low urine output and hypoxaemia. RESULTS: After CRT implantation, catecholamine agents were mostly withdrawn within 2 days and blood pressure, urine output and BNP rapidly improved within 24 h. During follow-up, survival rates were 85% at 3 months, 80% at 6 months and 55% at 18 months. Among the 9 deaths, 5 were related to overt HF, 3 to sudden cardiac death and 1 to non-cardiac death. LVEF improved from 18+/-3% to 21+/-4% three months after CRT implantation. CONCLUSION: "Rescue" CRT implantation in CDOHF patients allowed a rapid and successful catecholamine weaning in all studied patients. Furthermore, this immediate beneficial effect is sustained for more than one year in surviving patients.
BACKGROUND: Cardiac resynchronisation therapy (CRT) is a validated treatment for heart failure (HF) patients in NYHA class III-IV despite optimal medical therapy. We aimed to assess the beneficial effects of CRT in patients with catecholamine-dependent overt HF (CDOHF). METHODS: We studied 20 CDOHFpatients who had undergone CRT implantation. Patients had a mean baseline QRS duration of 174+/-25 ms and/or echocardiographic asynchrony, and LVEF of 18+/-3%. Mean follow-up was 18+/-12 months. Dependence on catecholamine agents was defined as the inability to stop or reduce drug infusion without re-occurrence of hypotension, low urine output and hypoxaemia. RESULTS: After CRT implantation, catecholamine agents were mostly withdrawn within 2 days and blood pressure, urine output and BNP rapidly improved within 24 h. During follow-up, survival rates were 85% at 3 months, 80% at 6 months and 55% at 18 months. Among the 9 deaths, 5 were related to overt HF, 3 to sudden cardiac death and 1 to non-cardiac death. LVEF improved from 18+/-3% to 21+/-4% three months after CRT implantation. CONCLUSION: "Rescue" CRT implantation in CDOHFpatients allowed a rapid and successful catecholamine weaning in all studied patients. Furthermore, this immediate beneficial effect is sustained for more than one year in surviving patients.
Authors: Aamir Jeewa; Alexander F Pitfield; James E Potts; Wendy Soulikias; Eustace S DeSouza; A J Hollinger; George G S Sandor; Jacques G LeBlanc; Andrew M Campbell; Shubhayan Sanatani Journal: Pediatr Cardiol Date: 2010-02 Impact factor: 1.655
Authors: Faisal Zaeem; Dalia Giedriemiene; Craig Coleman; Eric Crespo; Joseph Radojevic; Steven Zweibel; Jeffrey Kluger; Christopher A Clyne Journal: Cardiol Res Pract Date: 2012-07-30 Impact factor: 1.866