touchCARDIO touchCARDIO
Electrophysiology
Read Time: 2 mins

46/Predictors and clinical outcomes in patients undergoing cardiac resynchronization therapy (CRT) versus CRT upgrade in a real-world tertiary centre

Copy Link
Published Online: Oct 3rd 2011 European Journal of Arrhythmia & Electrophysiology. 2021;7(Suppl. 1):abstr46
Authors: C Sohrabi (Presenting Author) - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; N Papageorgiou - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; JSC Del Mundo - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; N Aziminia - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; M Finlay - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; A Creta - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; PD Lambiase - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; S Ahsan - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; P Moore - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; M Dhinoja - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; S Sporton - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; MJ Earley - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; RJ Schilling - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; C Hayward - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; R Providência - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; R Hunter - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; AW Chow - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; A Muthumala - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London
Quick Links:
Article
Article Information
Article:

Introduction: The role of pre-implant and intra-procedural parameters on mortality and hospitalisation for heart failure (HHF) in patients undergoing implantation with cardiac resynchronization therapy pacemaker (CRT-P) or defibrillator (CRT-D) versus CRT upgrade is poorly defined. In the present study we aimed to evaluate mortality predictors and clinical outcomes in patients undergoing CRT-P/D versus CRT upgrade.

Methods: This was a single-centre retrospective study of nine-hundred and thirty-three (933) patients receiving de novo implantation of CRT-P/D or CRT upgrade between 2016-2020: CRT-P (n=264), CRT-D (n=448), and CRT upgrade (n=221). The mean left ventricular ejection fraction was 34.9 ± 12.8 and median follow-up was 29.0 (17-41) months.

Results: We found that recipients of CRT-D were significantly younger (68.0 ± 11.9) than CRT-P (76.2 ± 10.8) and upgrade (71.8 ± 14.0; p<0.001) and had a higher uptake of oral anticoagulants (p=0.001) and aldosterone antagonists (p<0.001). CRT-P recipients were more likely to have baseline atrial fibrillation (AF; p<0.001). Overall mortality was significantly higher in upgrade (14.1%) and CRT-P (12.9%) patients versus those receiving CRT-D (8.7%) (p=0.039). On multivariate analysis, chronic kidney disease (CKD) and anaemia predicted both mortality (OR: 3.5 [2.1-5.9; 95% CI] p<0.001, and OR: 1.8 [1.1-3.2; 95% CI] p=0.024, respectively) and HHF (OR: 3.8 [1.6-9.2; 95% CI] p=0.003, and OR: 2.9 [1.3-6.6, 95% CI] p=0.012, respectively). In addition, the presence of diabetes mellitus predicted HHF (OR: 2.2 [1.0-4.7; 95% CI] p=0.047), while AF was associated with a higher likelihood of mortality as compared to patients in sinus rhythm (13.6% vs. 10.1%; p=0.045). In patients with CRT-D, use of a bipolar lead was associated with a significantly higher rate of mortality (16.7% vs. 10.7%; p=0.024) and HHF (8.0% vs. 4.0%; p=0.011) compared with use of a multipolar lead.

Conclusion: Our results showed that mortality is higher in patients receiving CRT upgrade or CRT-P as compared to CRT-D recipients. In addition, CKD, anaemia, diabetes mellitus, and presence of AF are associated with either higher mortality or HHF or both. The use of bipolar leads in patients with CRT-D was associated with poorer clinical outcomes compared to use of multipolar leads.

Further Resources

Share this Article
Related Content In Electrophysiology
  • Copied to clipboard!
    accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72