PURPOSE: Few data are available on the effects of cardiac resynchronization therapy (CRT) in candidates for cardiac surgery and affected by severe heart failure (HF). The aim of our analysis is to evaluate the percentage of patients who maintain indication for CRT after surgery and the efficacy of CRT in those patients subsequently implanted. METHODS: We enrolled 124 HF patients with indication both to heart surgery and to CRT. During surgery, an epicardial left ventricular lead was implanted, tunneled to a subclavear pocket, and capped. Afterward, patients were periodically reassessed to confirm indication for CRT. RESULTS: CRT indication was confirmed within 1 month from surgery in 54 patients (group A) and in 33 patients within 6 months (group B). In group A and B, 63% and 71% of patients were considered responders according to an arbitrary five-point increase of left ventricular ejection fraction (LVEF), respectively. The assessment of clinical response at 1 year, based on the definitions proposed by Packer, identified 63% and 80% of responders in group A and B, respectively. CONCLUSIONS: Our data show that a remarkable percentage of patients maintain an indication for CRT after cardiac surgery (76%), while in the remaining 24% the lack of an indication is confirmed by a higher LVEF at last follow-up. In combination with surgery, CRT proved to be an effective therapy in those patients who were subsequently implanted. The suggested method is simple, without significant adjunctive risks, and allows easier CRT implantation with stable thresholds.
PURPOSE: Few data are available on the effects of cardiac resynchronization therapy (CRT) in candidates for cardiac surgery and affected by severe heart failure (HF). The aim of our analysis is to evaluate the percentage of patients who maintain indication for CRT after surgery and the efficacy of CRT in those patients subsequently implanted. METHODS: We enrolled 124 HF patients with indication both to heart surgery and to CRT. During surgery, an epicardial left ventricular lead was implanted, tunneled to a subclavear pocket, and capped. Afterward, patients were periodically reassessed to confirm indication for CRT. RESULTS: CRT indication was confirmed within 1 month from surgery in 54 patients (group A) and in 33 patients within 6 months (group B). In group A and B, 63% and 71% of patients were considered responders according to an arbitrary five-point increase of left ventricular ejection fraction (LVEF), respectively. The assessment of clinical response at 1 year, based on the definitions proposed by Packer, identified 63% and 80% of responders in group A and B, respectively. CONCLUSIONS: Our data show that a remarkable percentage of patients maintain an indication for CRT after cardiac surgery (76%), while in the remaining 24% the lack of an indication is confirmed by a higher LVEF at last follow-up. In combination with surgery, CRT proved to be an effective therapy in those patients who were subsequently implanted. The suggested method is simple, without significant adjunctive risks, and allows easier CRT implantation with stable thresholds.
Authors: Kenneth Dickstein; Alain Cohen-Solal; Gerasimos Filippatos; John J V McMurray; Piotr Ponikowski; Philip Alexander Poole-Wilson; Anna Strömberg; Dirk J van Veldhuisen; Dan Atar; Arno W Hoes; Andre Keren; Alexandre Mebazaa; Markku Nieminen; Silvia Giuliana Priori; Karl Swedberg Journal: Eur J Heart Fail Date: 2008-09-16 Impact factor: 15.534
Authors: Cheuk-Man Yu; Gabe B Bleeker; Jeffrey Wing-Hong Fung; Martin J Schalij; Qing Zhang; Ernst E van der Wall; Yat-Sun Chan; Shun-Ling Kong; Jeroen J Bax Journal: Circulation Date: 2005-09-06 Impact factor: 29.690
Authors: John G F Cleland; Jean-Claude Daubert; Erland Erdmann; Nick Freemantle; Daniel Gras; Lukas Kappenberger; Luigi Tavazzi Journal: N Engl J Med Date: 2005-03-07 Impact factor: 91.245
Authors: Michael Glikson; Mahmoud Suleiman; David M Luria; Marjorie L Martin; David O Hodge; Win-Kuang Shen; David J Bradley; Thomas M Munger; Robert F Rea; David L Hayes; Stephen C Hammill; Paul A Friedman Journal: Heart Rhythm Date: 2008-10-11 Impact factor: 6.343