Outcome of patients with cardiac resynchronisation defibrillator therapy and a follow-up of at least five years after implant

• Published in: Swiss medical weekly 2014-02, Vol.144 (910), p.w13938-w13938
• Main Authors: Bossard, Matthias, Sticherling, Christian, Kühne, Michael, Frey, Simon, Osswald, Stefan, Schaer, Beat
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cardiac Pacing, Artificial; Cardiac resynchronization therapy; Coronary Artery Disease - complications; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable; Device longevity; Equipment Failure; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Lead defects; Lead dislodgment; Long-term follow-up; Male; Middle Aged; Myocardial Ischemia - complications; Phrenic nerve stimulation; Retrospective Studies; Severity of Illness Index; Stroke Volume; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - prevention & control; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left - physiopathology
• ISSN: 1424-7860; 1424-3997
• DOI: 10.4414/smw.2014.13938

Cardiac resynchronisation therapy with defibrillator backup (CRT-D) is an established therapeutic option in selected heart failure patients. Data on its pronounced long-term outcome are scarce. We evaluated the long-term outcome (>5 years) of patients with the main focus on device-associated events. Out of a prospective CRT-D registry with 219 patients, all 49 patients (22%) who survived for at least 5 years were analysed. Baseline characteristics, device associated issues (battery longevity, lead problems, phrenic nerve stimulation, infections and pacing threshold levels), implantable cardioverter-defibrillator (ICD) therapies, mortality, changes in left ventricular ejection fraction (LVEF) and improvement in New York Heart Association (NYHA) class were considered. The mean ± standard deviation age of the patients was 63±10 years and follow-up was 84±18 months. Seventy-eight percent were male, 73% had nonischaemic cardiomyopathy and 80% a primary prevention indication. After initially surviving 5 years, 8 patients (16%) died during further follow-up. LVEF improved from 23%±7% to 35%±13% (p-value