Michael Döring1, Micaela Ebert2, Nikolaos Dagres3, Andreas Müssigbrodt3, Kerstin Bode3, Helge Knopp3, Michael Kühl3, Gerhard Hindricks3, Sergio Richter3. 1. Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany. Electronic address: michael.doering@medizin.uni-leipzig.de. 2. Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. 3. Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
Abstract
BACKGROUND: Cardiac resynchronization therapy (CRT) is an effective treatment option for systolic heart failure, but the benefit of an additional implantable cardioverter-defibrillator (ICD) in elderly patients is not well established. The aim of our study was to evaluate the impact of an additional ICD on survival in elderly CRT recipients. METHODS: Patients aged ≥75 years with an indication for CRT and primary preventive ICD therapy, which underwent implantation of either a CRT-pacemaker (CRT-P) or CRT-defibrillator (CRT-D) were included in the study. Patient characteristics, procedural and follow-up data, and subsequent all-cause mortality were analyzed. RESULTS: A total of 775 consecutive patients underwent CRT implantation, whereof 177 patients fulfilled the inclusion criteria. Of these, 80 patients with CRT-P and 97 with CRT-D formed the two study groups. Patients in the CRT-P group were significantly older (82.6 ± 4.5 vs. 77.8 ± 1.9 years, p < 0.001) and more often female (44 vs. 25%; p < 0.001), had a better left ventricular ejection fraction (29.5 ± 5.7 vs. 27.4 ± 6.0%; p = 0.019) and narrower QRS-complex (150 ± 19 vs. 158 ± 18 ms; p = 0.025). During a mean follow-up of 26 ± 19 months, 62 (35%) study patients died, 28 (35%) in the CRT-P and 34 (35%) in the CRT-D group (p = 0.994). The Kaplan-Meier analysis of survival probability showed no significant difference between the two groups (p = 0.562). CONCLUSION: In our study, an additional ICD had no impact on survival in elderly patients undergoing implantation of a CRT device. Randomized controlled trials have to confirm this finding.
BACKGROUND: Cardiac resynchronization therapy (CRT) is an effective treatment option for systolic heart failure, but the benefit of an additional implantable cardioverter-defibrillator (ICD) in elderly patients is not well established. The aim of our study was to evaluate the impact of an additional ICD on survival in elderly CRT recipients. METHODS:Patients aged ≥75 years with an indication for CRT and primary preventive ICD therapy, which underwent implantation of either a CRT-pacemaker (CRT-P) or CRT-defibrillator (CRT-D) were included in the study. Patient characteristics, procedural and follow-up data, and subsequent all-cause mortality were analyzed. RESULTS: A total of 775 consecutive patients underwent CRT implantation, whereof 177 patients fulfilled the inclusion criteria. Of these, 80 patients with CRT-P and 97 with CRT-D formed the two study groups. Patients in the CRT-P group were significantly older (82.6 ± 4.5 vs. 77.8 ± 1.9 years, p < 0.001) and more often female (44 vs. 25%; p < 0.001), had a better left ventricular ejection fraction (29.5 ± 5.7 vs. 27.4 ± 6.0%; p = 0.019) and narrower QRS-complex (150 ± 19 vs. 158 ± 18 ms; p = 0.025). During a mean follow-up of 26 ± 19 months, 62 (35%) study patients died, 28 (35%) in the CRT-P and 34 (35%) in the CRT-D group (p = 0.994). The Kaplan-Meier analysis of survival probability showed no significant difference between the two groups (p = 0.562). CONCLUSION: In our study, an additional ICD had no impact on survival in elderly patients undergoing implantation of a CRT device. Randomized controlled trials have to confirm this finding.
Authors: Moritz Hadwiger; Nikolaos Dagres; Janina Haug; Michael Wolf; Ursula Marschall; Jan Tijssen; Alexander Katalinic; Fabian Simon Frielitz; Gerhard Hindricks Journal: Eur Heart J Date: 2022-07-14 Impact factor: 35.855
Authors: Moritz Hadwiger; Fabian-Simon Frielitz; Nora Eisemann; Christian Elsner; Nikolaos Dagres; Gerhard Hindricks; Alexander Katalinic Journal: Appl Health Econ Health Policy Date: 2021-01 Impact factor: 2.561