Cardiac resynchronization therapy pacemaker or cardiac resynchronization therapy defibrillator: what determines the choice?—findings from the ESC CRT Survey II

• Published in: Europace (London, England) England), 2019-06, Vol.21 (6), p.918-927
• Main Authors: Normand, Camilla, Linde, Cecilia, Bogale, Nigussie, Blomström-Lundqvist, Carina, Auricchio, Angelo, Stellbrink, Christoph, Witte, Klaus K, Mullens, Wilfried, Sticherling, Christian, Marinskis, Germanas, Sciaraffia, Elena, Papiashvili, Giorgi, Iovev, Svetoslav, Dickstein, Kenneth
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Cardiac resynchronization therapy; Cardiac Resynchronization Therapy - methods; Cardiac resynchronization therapy defibrillator; Cardiac resynchronization therapy pacemaker; Cardiology; Comorbidity; Decision Making; Defibrillators, Implantable; Europe; Female; Heart failure; Heart Failure - etiology; Heart Failure - therapy; Humans; Implantable cardioverter-defibrillator; Kardiologi; Klinisk medicin; Male; Medicin och hälsovetenskap; Medicinsk material och protesteknik; Medicinteknik; Middle Aged; Pacemaker, Artificial; Phenotype; Sex Factors; Surveys and Questionnaires; Teknik
• ISSN: 1099-5129; 1532-2092; 1532-2092
• DOI: 10.1093/europace/euz002

Abstract Aims The decision to implant a cardiac resynchronization therapy pacemaker (CRT-P) or a cardiac resynchronization therapy defibrillator (CRT-D) may be challenging. There are no clear guideline recommendations as no randomized study of cardiac resynchronization therapy (CRT) has been designed to compare the effects of CRT-P with those of CRT-D on patients’ outcomes. In the CRT Survey II, we studied patient and implantation centre characteristics associated with the choice of CRT-P vs. CRT-D. Methods and results Clinical practice data from 10 692 patients undergoing CRT implantation of whom 7467 (70%) patients received a CRT-D and 3225 (30%) received a CRT-P across 42 ESC countries were collected and analysed between October 2015 and January 2017. Factors favouring the selection of CRT-P implantation included age >75 years, female gender, non-ischaemic heart failure (HF) aetiology, New York Heart Association functional Class III/IV symptoms, left ventricular ejection fraction >25%, atrial fibrillation, atrioventricular (AV) block II/III, and implantation in a university hospital. Conclusion In a large cohort from the CRT Survey II, we found that patients allocated to receive CRT-P exhibited particular phenotypes with more symptomatic HF, more frequent comorbidities, advanced age, female gender, non-ischaemic HF aetiology, atrial fibrillation, and evidence of AV block. There were substantial differences in the proportion of patients allocated to receive CRT-P vs. CRT-D between countries.