Original article

Cardiac Resynchronisation Therapy (CRT) Survey II: CRT implantation in Europe and in Switzerland

DOI: https://doi.org/10.4414/smw.2018.14643
Publication Date: 22.08.2018
Swiss Med Wkly. 2018;148:w14643

Ivan Zeljkovica, Haran Burrib, Alexander Breitensteinc, Peter Ammannd, Andreas Muellere, Angelo Auricchiof, Etienne Delacrétazg, Kenneth Dicksteinh, Cecilia Lindei, Camilla Normandh, Christian Sticherlinga

a University Hospital Basel, Switzerland

b University Hospital Geneva, Switzerland

c University Hospital Zurich, Switzerland

d Cantonal Hospital St Gallen, Switzerland

e Triemli Hospital, Zurich, Switzerland

f Cardiocentro Lugano, Switzerland

g Clinique Cecil, Lausanne, Switzerland

h Stavanger University Hospital, Stavanger, Norway

i Karolinska University Hospital, Stockholm, Sweden

Summary

AIM: Between October 2015 and December 2016, 11,088 patients from 42 countries having cardiac resynchronisation therapy (CRT) devices implanted were included in the CRT II Survey. We compared the characteristics of Swiss CRT recipients with the overall European population.

METHODS

Demographic and procedural data from seven Swiss centres recruiting all consecutive patients undergoing either de-novo CRT implantation or an upgrade to a CRT system were collected and compared with the European population.

RESULTS

A total of 320 Swiss patients (24.4% female, mean age 71.0 ± 10.2 years, 47% ischaemic cardiomyopathy) were enrolled, which amounts to 38% of all CRT implantations in Switzerland during this period. Of the patients enrolled, 38% had atrial fibrillation, 27% second- or third-degree atrioventricular block, and 68% complete left bundle-branch block. Swiss patients had significantly less often the classical indication of heart failure with a wide QRS complex (40 vs 61%; odds ratio [OR] 0.44, 95% confidence interval [CI] 0.35–0.55; p <0.001). Compared with the European population, Swiss patients were significantly older (71 vs 68.5 years, p <0.001), less symptomatic from heart failure and had more chronic kidney disease. Swiss patients significantly more often received a CRT-pacemaker (37 vs 30%; OR 1.37; 95% CI 1.09–1.73; p = 0.007) and quadripolar left ventricular leads (69 vs 57%; OR 1.67, 95% CI 1.32–2.13; p <0.001).

CONCLUSION: Compared with European CRT recipients, Swiss CRT patients are older, less symptomatic and suffer more often from comorbidities. Although two thirds of the implantations were CRT-defibrillator systems, Swiss patients more often received CRT-pacemaker systems than their European counterparts.

Keywords: cardiac resynchronisation therapy, pacemaker, defibrillator, survey, heart failure, implantation, sudden cardiac death

Introduction

The benefits of cardiac resynchronisation therapy (CRT) on long-term clinical outcomes in symptomatic heart failure patients (New York Heart Association [NYHA] class II–IV) with reduced left ventricular (LV) ejection fraction (EF) and electrical dyssynchrony have been repeatedly proven in randomised controlled trials (RCTs) [13]. Surveys and registries supplement RCTs by providing important data on daily clinical practice [1, 3]. These data complement results from RCTs, which tend to exclude high-risk patients [35]. The European Cardiac Resynchronisation Therapy (CRT) Survey was conducted in 2008, as a joint project by the Heart Failure Association (HFA) and the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC) [6]. This 6-month snapshot survey included data from 2438 CRT recipients in 13 ESC member countries. At the time, it showed underutilisation of resynchronisation therapy and indicated that large numbers of CRT-pacemaker (CRT-P) or -defibrillator (CRT-D) devices were implanted outside the guideline recommendations [6]. The design of the European CRT Survey II was based on the first CRT Survey [7]. The CRT II survey included 42 ESC member countries and its aim was to gather real-life clinical and demographic data on current patient selection, and implantation and follow-up practice [8]. Ultimately, it provides information relevant for assessing healthcare resource utilisation and the adherence to latest guidelines on CRT implantation [7, 8]. We compared the Swiss CRT utilisation with that in the overall European population.

Materials and methods

The rationale and design of the CRT Survey II have been published earlier [7]. All consecutive patients planned for CRT-P/CRT-D device implantation, de-novo or upgrade, in a 15-month period (October 2015 to December 2016), were included regardless of the success of the procedure. Data were collected prospectively using an online database. A central database was created and maintained at the data management centre at the Institut für Herzinfarktforschung in Ludwigshafen at the Heidelberg University, Germany. The data management centre also performed the analyses.

The European CRT Survey II included two internet-based questionnaires [7]. The first was a one-time questionnaire completed by participating centres and characterised the facility, its catchment area, invasive procedures and device implantations performed, cardiac facilities, types of imaging equipment employed, number and speciality of implanting physicians and the follow-up options provided, as well as the type and source of hospital reimbursement. The second questionnaire was an electronic case report form (eCRF) for each patient, which collected demographic, medical history and clinical data as well as procedural and postprocedural details. Importantly, data from unsuccessful CRT implantations were also included.

Ethics approval from the relevant Ethics Committee in Switzerland was obtained. The study protocol complied with the Declaration of Helsinki and Good Clinical Practice.

Statistical analysis

Continuous variables are presented as median with interquartile range or mean with standard deviation, as appropriate. Categorical variables are presented in absolute values and percentages. Continuous variables were compared with nonparametric Mann-Whitney U-tests and categorical variables were compared with Pearson χ2 tests. Descriptive statistics were calculated for the available cases. All p-values are the results of two-tailed tests and a value of <0.05 was considered significant. Statistical analysis was carried out using SAS statistical software, version 9.1 (Cary, North Carolina, USA).

Results

Participating centres

Seven out of 36 CRT-implanting centres in Switzerland participated in the CRT II survey (Universitätsspital Basel, Hôpitaux Universitaires de Genève, Universitätsspital Zurich, Cardiocentro Lugano, Kantonsspital St. Gallen, Stadtspital Triemli Zurich and Clinique Cecil Lausanne) [9]. During the 15-month enrolment period (October 2015 to December 2016), out of 11,088 patients recruited by 288 centres in 42 ESC member countries participating in the CRT II Survey, 320 patients (2.9%) were recruited in Switzerland (table 1). This was 38% of all CRT implantations in Switzerland during this period (n = 838), according to data from the national device registry [9].

Table 1

Analysis overview and participating centres in Switzerland.

 SwitzerlandAll other countries
Number of patients32010,768
Advanced analysis population99.7% (319/320)96.7% (10,411/10,768)
Number of centres7281
Swiss centres (no. of patients)  
Universitätsspital Basel76 
Hôpitaux universitaires de Genève71 
Universitätspital Zurich43 
Kantonspital St. Gallen41 
Triemli Zurich42 
Cardiocentro Lugano34 
Clinique Cecil Lausanne13 

Baseline characteristics and procedural

The patient demographics are shown in table 2, procedural data in table 3, and postprocedural data in table 4, together with comparisons between the Swiss and European populations. There were no procedural deaths or bleeding complications. One Swiss patient died during hospitalisation from progressive heart failure.

Table 2

Baseline characteristics and pre-procedural data of Swiss cardiac resynchronisation therapy (CRT) population and comparison with the European population.

 SwitzerlandEuropep-valueOR (95% CI)
Demographics    
Age (years)71 ± 1068 ± 11<0.001 
Men (%)75.675.70.98 
BMI (kg/m2)27 ± 528 ± 5<0.001 
Medical history    
Hypertension69 (221/320)64 (6741/10580)0.050.66 (0.51–0.86)
Diabetes mellitus23 (75/320)32 (3353/10601)0.002
Obstructive lung disease11 (35/320)12 (1280/10602)0.54 
Atrial fibrillation38 (121/320)41 (4338/10600)0.26 
Paroxysmal37 (45/121)35 (1503/4338)  
Persistent28 (34/121)22 (960/4338)  
Permanent35 (42/121)43 (1847/4338)  
Chronic kidney disease (<60 ml/min)41 (132/320)31 (3263/10587)<0.0011.58 (1.26–1.98)
Prior revascularisation (CABG or PCI)43 (138/320)39 (4107/10604)0.11 
HF hospitalisation during last year32 (103/320)47 (4975/10597)<0.0010.54 (0.42–0.68)
Prior device (PPM, ICD)33 (105/320)28 (2954/10672)0.0431.28 (1.01–1.62)
Primary HF aetiology  0.34 
Ischaemic47 (149/320)44 (4726/10633)  
Non-ischaemic49 (157/320)50 (5296/10633)  
Other4 (14/320)6 (611/10633)  
ECG    
Heart rate (beats/min)71 ± 1972 ± 160.23 
Sinus rhythm68 (218/319)69 (7278/10517)0.55 
Atrial fibrillation24 (77/319)26 (2701/10517)0.55 
PR interval (ms)193 ± 53189 ± 500.39 
AV block II or III27 (86/320)18.7 (1940/10380)<0.0011.60 (1.24–2.06)
QRS duration (ms)152 ± 29157 ± 27<0.001 
QRS duration <120 ms13 (37/285)7 (674/9250) 1.90 (1.33–2.71)
QRS duration 120–130 ms5 (15/285)5 (490/9250) 0.99 (0.59–1.68)
QRS duration 130–150 ms23 (66/285)18 (1713/9250) 1.33 (1.00–1.75)
QRS duration 150–180 ms40 (115/285)47 (4371/9250) 0.76 (0.59–0.96)
QRS duration >180 ms18 (52/285)22 (2002/9250) 0.81 (0.60–1.10)
QRS morphology    
LBBB68 (213/312)75 (7625/10105)0.0040.70 (0.55–0.89)
RBBB6 (20/312)7 (668/10105)0.890.97 (0.61–1.53)
Other25 (79/312)18 (1812/10105)<0.0011.55 (1.20–2.01)
CRT indication    
Heart failure with wide QRS40 (128/317)61 (6422/10606)<0.0010.44 (0.35–0.55)
HF or LV dysfunction and an indication for ICD43 (137/317)48 (5091/10606)0.09 
PPM indication + expected pacing dependency32 (103/317)22 (2391/10606)<0.0011.65 (1.30–2.10)
Evidence of medical dyssynchrony4 (13/317)12 (1247/10606)<0.0010.32 (0.18–0.56)
Clinical evaluation  0.70 
NYHA I6 (18/318)3 (352/10530)  
NYHA II34 (108/318)38 (3975/10530)  
NYHA III55 (174/318)54 (5735/10530)  
NYHA IV6 (18/318)4 (468/10530)  
Echocardiography    
Mean LV ejection fraction (%)30 ± 828 ± 80.005 
<35%71 (226/320)77 (8056/10485) 1.01 (0.80–1.27)
35–50%27 (86/320)21 (2242/10485) 1.44 (1.08–1.94)
>50%2 (8/320)2 (187/10485) 1.41 (0.69–2.89)
LV end-diastolic diameter (mm)60 ± 964 ± 9<0.001 
Mitral regurgitation (%)46 (136/297)46 (4508/9703)<0.001 
    Mild16 (49/297)27 (2597/9703) 0.97 (0.77–1.23)
    Moderate9 (26/297)7 (664/9703) 0.54 (0.40–0.74)
    Severe29 (86/297)20 (1934/9703) 1.31 (0.87–1.97)
Laboratory results    
BNP (pg/ml)1422 ± 20381104 ± 19730.012 
NT-pro-BNP (pg/ml)7163 ± 119935055 ± 80100.14 
Haemoglobin (g/l)132 ± 18133 ± 180.32 
Creatinine (μmol/l)121 ± 68113 ± 650.032

BMI = body mass index; BNP = brain-type natriuretic peptide; CABG = coronary artery bypass grafting; HF = heart failure; ICD = implantable cardioverter-defibrillator; LBBB = left bundle-branch block; LV = left ventricle; NT-pro-BNP = N-terminal prohormone of brain natriuretic peptide; PCI = percutaneous coronary intervention; PPM = permanent pacemaker; RBBB = right bundle-branch block Values are % (n) for categorical and mean ± standard deviation or median (interquartile range) for continuous variables.

Table 3

Procedural data of Swiss cardiac resynchronisation therapy (CRT) population and comparison with the European practice.

 SwitzerlandEuropep-valueOR (95% CI)
Elective procedure84 (268/320)77 (8190/10678)0.0031.56 (1.16–2.11)
Location of procedure  0.22 
EP/Catheterisation lab.83 (266/320)89 (9354/10439)  
Operating room5 (16/320)10 (1068/10439)  
Other12 (38/320)0.2 (17/10439)  
Operator  <0.001 
Electrophysiologist90 (288/319)77 (8014/10460) 2.84 (1.95–4.12)
Heart failure physician0 (0/319)5 (541/10460) /
Invasive cardiologist8 (26/319)12 (1304/10460) 0.62 (0.42–0.93)
Surgeon2 (5/319)4 (459/10460) 0.35 (0.14–0.84)
Duration of procedure (min)110 (82, 136)90 (65, 120)<0.001 
Fluoroscopy time (min)16 (10, 25)14 (8, 22)<0.001 
Successful attempt of implantation98.897.20.09 
RV lead position  0.019 
Apex67 (211/313)61 (6069/9940) 1.32 (1.04–1.68)
Septum31 (98/313)37 (3635/9940) 0.79 (0.62–1.01)
RVOT1 (4/313)2 (236/9940) 0.53 (0.20–1.44)
LV lead position  <0.001 
Anterior2 (8/317)4 (439/9983) 0.56 (0.28–1.14)
Lateral78 (249/317)84 (8416/9983) 0.68 (0.52–0.90)
Posterior19 (60/317)11 (1128/9983) 1.83 (1.37–2.44)
Epicardial14 (44/319)9 (923/10214) 1.61 (1.16–2.23)
LV lead type  <0.001 
Unipolar0 (0/319)0.7 (77/10282)  
Bipolar31 (100/319)43 (4378/10282) 0.62 (0.48–0.78)
Multipolar69 (219/319)57 (5827/10282) 1.67 (1.32–2.13)
Coronary venogram performed93 (298/319)91 (9338/10210)0.22 
Venogram performed with occlusion61 (183/298)47 (4303/9224)<0.0011.82 (1.44–2.31)
Periprocedural complications4 (13/320)6 (611/10768)0.21 
Bleeding0 (0/320)1 (108/10768)0.07 
Pocket haematoma0 (0/320)0.8 (85/10768)0.11 
Pneumothorax2 (7/320)1 (105/10768)0.0332.27 (1.05–4.92)
Pericardial tamponade0.3 (1/320)0.3 (27/10768)0.56 
Coronary sinus dissection0.3 (1/320)2.0 (213/10768)0.0230.16 (0.02–1.11)
Type of the device  0.007 
CRT-P37 (118/318)30 (3138/10451) 1.37 (1.09–1.73)
CRT-D63 (200/318)70 (7313/10451) 0.73 (0.58–0.92)

CRT-P = cardiac resynchronisation therapy pacemaker system; ; CRT-D = cardiac resynchronisation therapy cardioverter-defibrillator system; EP = electrophysiology; LV = left ventricle; RV = right ventricle, RVOT = RV outflow tract Values are % (n) for categorical and mean ± standard deviation or median (interquartile range) for continuous variables

Table 4

Postprocedural data of Swiss cardiac resynchronisation therapy (CRT) population and comparison with the European average.

 SwitzerlandEuropep-valueOR (95% CI)
Hospital mortality0.3 (1/320)0.4 (44/10525)0.79 
Device related complications4 (13/320)4.8 (515/10768)0.55 
Lead displacement2 (8/320)1.7 (180/10510)0.29 
RV37 (3/8)31 (52/169)0.68 
LV37 (3/8)53 (90/169)0.38 
Atrial37 (3/8)18 (31/169)0.18 
Lead malfunction0 (0/320)0.2 (23/10510)0.40 
Phrenic nerve stimulation0.6 (2/320)1.2 (121/10510)0.38 
Infection0.6 (2/320)0.6 (58/10496)0.86 
Stroke0 (0/320)0.6 (58/10496)0.67 
Worsening of HF0.6 (2/320)0.7 (76/10496)0.84 
Arrhythmias0.9 (3/320)1.2 (125/10496)0.68 
Total length of hospital stay2 (2, 5)3 (2, 7)<0.001 
Paced QRS duration (sec)138 ± 26138 ± 240.77 
Medical therapy at discharge    
Diuretic70 (223/318)81 (8398/10317)<0.0010.54 (0.42–0.69)
ACE inhibitor / ARB87 (277/319)86 (8886/10284)0.83 
Aldosterone antagonist48 (153/319)64 (6529/10254)<0.0010.53 (0.42–0.66)
Beta-blocker85 (272/319)89 (9200/10329)0.0320.71 (0.52–0.97)
Digoxin5 (17/319)11 (1083/10225)0.0020.48 (0.29–0.78)
Calcium channel blocker7 (23/317)9 (923/10214)0.27 
Amiodarone20 (62/317)17 (1763/10230)0.28 
Ivabradine0.6 (2/319)6 (591/10224)<0.0010.10 (0.03–0.41)
Other antiarrhythmic agent4 (12/318)2 (169/10213)  
Oral anticoagulation43 (136/319)47 (4792/10258)0.150.85 (0.68–1.06)
    Vitamin K antagonist59 (80/136)71 (3383/4792)0.0030.59 (0.42–0.84)
    Dabigatran3 (4/136)7 (323/4792)0.080.42 (0.15–1.14)
    Rivaroxaban29 (40/136)12 (571/4792)<0.0013.08 (2.11–4.50)
    Apixaban6 (8/136)10 (501/4792)0.080.54 (0.26–1.10)
    Edoxaban3 (4/136)0.3 (14/4792)<0.00110.34 (3.36–31.84)
Platelet inhibitor51 (162/320)43 (4684/10768)0.0111.33 (1.07–1.66)
    ASA48 (152/319)41 (4205/10228)0.0191.30 (1.04–1.63)
    Clopidogrel11 (35/319)12 (1269/10228)0.44 
    Ticagrelor3 (8/319)1 (128/10228)0.051 
Dual antiplatelet therapy11 (34/319)9 (947/10228)0.39 
OAC plus P2Y12 inhibitor3 (10/319)4 (430/10301)0.36 
Triple therapy1 (4/319)2 (214/10302)0.31 
Device follow-up planned    
At implanting centre68 (219/320)87 (9126/10498)<0.0010.33 (0.26–0.42)
Other hospital10 (33/320)8 (840/10498)0.14 
Private cardiologists22 (71/320)5 (498/10498)<0.0015.73 (4.33–7.57)

ACE = angiotensin converting-enzyme; ARB = angiotensin-receptor blocker; ASA = acetylsalicylic acid; LV = left ventricle; OAC = oral anticoagulation; RV = right ventricle Values are % (n) for categorical and mean ± standard deviation or median (interquartile range) for continuous variables.

Differences between Swiss and European CRT recipients

Compared with European CRT recipients, Swiss patients were older (71 vs 68.5 years, p <0.001), with a significantly higher proportion of patients older than 75 years (42 vs 32%, p <0.001). In both groups women were underrepresented (24 vs 24%, p = 0.975). Swiss patients significantly less often had the classical indication of heart failure with a wide QRS complex (40 vs 61%; odds ratio [OR] 0.44, 95% confidence interval [CI] 0.35–0.55; p <0.0001), less often presented with complete left bundle-branch block (68 vs 75%; OR 0.7, 95% CI 0.55–0.89) and consequently displayed a shorter mean duration of the QRS complex (152 ± 29 vs 157 ± 27 ms, p <0.01). Conversely, they significantly more often had underlying second or third degree atrioventricular block (27 vs 19%, OR 1.6, 95% CI 1.24–2.06) with CRT employed for expected dyssynchrony induced by a high amount of right ventricular pacing.

Although there was no overall difference in the NYHA status, more Swiss patients were in NYHA functional class I (6 vs 3%; OR 1.73, 95% CI 1.07–2.82) and they were significantly less often hospitalised for heart failure the year before implantation (32 vs 47%; OR 0.54, 95% CI 0.42–0.68), although they had significantly higher levels of preprocedural brain natriuretic peptide (BNP) (1422 vs 1104 pg/ml, p = 0.012). Swiss patients had a higher prevalence of chronic kidney disease (OR 1.58, 95% CI 1.26–1.98; p <0.001) and previously implanted devices (OR 1.28, 95% CI 1.01–1.62; p = 0.043).

In Switzerland, CRT-D systems were more often implanted than CRT-P systems (63 vs 37%). Compared with the European population, however, Swiss patients received fewer CRT-D devices (63 vs 70%, p = 0.007). This may be explained by the older age of the patients and the fact that the procedure was done significantly more often by an electrophysiologist (OR 2.84, 95% CI 1.95–4.12; p <0.001). In Switzerland, the quadripolar left ventricular lead was used more often (OR 1.67, 95% CI 1.32–2.13; p <0.001), reflecting unhindered access to modern technology.

The overall complication rate was 4% and not different from the European average. Postprocedural QRS duration was not different nor was the incidence of major adverse events. Total length of hospital stay was lower in Swiss hospitals (5.5 vs 6.3 days, p <0.001). There was a statistically significant difference between the groups regarding the discharge medication therapy, programming of the device and follow-up planning.

Discussion

The most important findings in this registry study comparing Swiss CRT recipients with their European counterparts is that Swiss patients were older, had fewer heart failure hospitalisations in the year before implantation and significantly less often had the “classical” CRT indication of symptomatic heart failure in the presence of a wide left bundle-branch block. Although the reimbursement system in Switzerland allows for easy access to all available technologies, significantly fewer Swiss patients received the more expensive CRT defibrillator (CRT-D) system than in the rest of Europe. Nonetheless, CRT-D systems still account for two thirds of all CRT implants in Switzerland.

The higher prevalence of CRT pacemaker (CRT-P) systems may in part be explained by the fact that Swiss patients were older and that more procedures were done by electrophysiologists with potentially more detailed knowledge of current risk stratification for sudden cardiac death [1013]. On the other hand, it may also reflect a different attitude of the patient population to the mode of death. Swiss patients were less often hospitalised for heart failure before CRT implantation, although they had higher levels of preprocedural BNP. Better access to ambulatory healthcare services than in other countries may be the reason for that.

After the type of CRT system was chosen, Swiss patients received the latest technology with a higher proportion of quadripolar left ventricular leads than the European population. Furthermore, although our population had the same overall incidence of comorbidities, they had a higher prevalence of chronic kidney disease, a risk factor repeatedly identified as hampering the effectiveness of implantable cardioverter-defibrillator (ICD) therapy and which is not improved by CRT [14, 15]. As in other CRT and ICD trials and registries, only 25% of the recipients were women, reflecting the fact that women are undertreated in the field of cardiovascular diseases [1, 8, 1618].

The “classical” class I indication of symptomatic heart failure and a wide left bundle-branch block was less often the indication for implantation in Switzerland. Relatively more patients received an upgrade or a de-novo CRT system because they had the indication for pacing with or without defibrillation therapy, with an expected or actual high percentage of ventricular pacing (e.g., in the presence of atrioventricular block II or III). Consequently, the Swiss group had a greater share of patients with preprocedural QRS duration <120 ms and NYHA class I. However, most patients had symptomatic heart failure as an indication for CRT implantation, displayed a left bundle-branch block morphology on the 12-lead ECG, had a LVEF <35% and very high mean NT-pro BNP, which also means high adherence to guideline recommendations by physicians [19].

Electrocardiographically, the average QRS duration decreased significantly with biventricular pacing, which is expected and a predictor of good clinical response [13]. The reported perioperative complication rates were low, which is in line with the fact that most of the participating Swiss centres are high-volume centres [9, 16, 17]. The Swiss group had no relevant bleeding complications, despite the fact that almost 80% of patients took either oral anticoagulation, antiplatelet therapy, or even both. This could be explained by high adherence to new recommendations on antithrombotic dual and triple therapy, as well as by the experience of the recruiting centres [1922].

In conclusion, when compared with other European countries, Swiss CRT recipients were older, less symptomatic, received more device upgrades, had a higher incidence of chronic kidney disease and more frequently received quadripolar left ventricular leads. At the same time, the percentage of CRT-D implantations was lower than in the overall European population. Our data indicate that, despite almost free access to modern technology, Swiss patients and physicians more often use the less expensive CRT-pacemaker system with the primary goal of symptomatic relieve from heart failure when compared with their European counterparts. The data from Swiss patients participating in the European CRT Survey II provide important information for physicians, patients and health economists and demonstrate significant differences between Swiss and European patients in some aspects of the application of CRT.

Acknowledgments

The authors wish to thank Beat Schaer, MD, Carine Stettler, RN, Rainer Zbinden, MD, for their continued support in enrolling patients.

Financial disclosure

The CRT II Survey was supported by both EHRA and the HFA as well as by grants from five device companies (Medtronic, Boston Scientific, St. Jude, Biotronik, Sorin). Several pharmaceutical and diagnostic companies also provided their financial support [8].

Potential competing interests

AA is consultant for Biosense Webster, Boston Scientific, Corúa, Daichii-Sankyo, EBR Systems, Medtronic and Microport CRM, and has received speaker fees from Boston Scientific, Medtronic and Microport CRM. No other potential conflict of interest relevant to this article was reported.

Correspondence

Christian Sticherling, MD, Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Christian.Sticherling[at]usb.ch

References

1 Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al.; Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539–49. doi:. http://dx.doi.org/10.1056/NEJMoa050496 PubMed

2 Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, et al.; Resynchronization-Defibrillation for Ambulatory Heart Failure Trial Investigators. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med. 2010;363(25):2385–95. doi:. http://dx.doi.org/10.1056/NEJMoa1009540 PubMed

3 Bogale N, Priori S, Cleland JG, Brugada J, Linde C, Auricchio A, et al.; Scientific Committee, National Coordinators, and Investigators. The European CRT Survey: 1 year (9-15 months) follow-up results. Eur J Heart Fail. 2012;14(1):61–73. doi:. http://dx.doi.org/10.1093/eurjhf/hfr158 PubMed

4 Gitt AK, Bueno H, Danchin N, Fox K, Hochadel M, Kearney P, et al.The role of cardiac registries in evidence-based medicine. Eur Heart J. 2010;31(5):525–9. doi:. http://dx.doi.org/10.1093/eurheartj/ehp596 PubMed

5 Masoudi FA, Havranek EP, Wolfe P, Gross CP, Rathore SS, Steiner JF, et al.Most hospitalized older persons do not meet the enrollment criteria for clinical trials in heart failure. Am Heart J. 2003;146(2):250–7. doi:. http://dx.doi.org/10.1016/S0002-8703(03)00189-3 PubMed

6 Dickstein K, Bogale N, Priori S, Auricchio A, Cleland JG, Gitt A, et al.; Scientific Committee; National Coordinators. The European cardiac resynchronization therapy survey. Eur Heart J. 2009;30(20):2450–60. doi:. http://dx.doi.org/10.1093/eurheartj/ehp359 PubMed

7 Dickstein K, Normand C, Anker SD, Auricchio A, Blomström CL, Bogale N, et al.European cardiac resynchronization therapy survey II: rationale and design. Europace. 2015;17(1):137–41. doi:. http://dx.doi.org/10.1093/europace/euu312 PubMed

8 Dickstein K, Normand C, Auricchio A, Bogale N, Cleland JG, Gitt AK, et al.; Scientific Committee, National Coordinators, and Investigators. CRT Survey II: a European Society of Cardiology survey of cardiac resynchronisation therapy in 11 088 patients-who is doing what to whom and how?Eur J Heart Fail. 2018;20(6):1039–51. doi:. http://dx.doi.org/10.1002/ejhf.1142 PubMed

9 www.pacemakerstiftung.ch/statistiken (last accessed 8 February 2018)

10 Køber L, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Korup E, et al.; DANISH Investigators. Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. N Engl J Med. 2016;375(13):1221–30. doi:. http://dx.doi.org/10.1056/NEJMoa1608029 PubMed

11 Schaer B, Frey S, Sticherling C, Osswald S, Reichlin T, Kühne M. Persistent improvement of ejection fraction in patients with a cardiac resynchronisation therapy defibrillator correlates with fewer appropriate ICD interventions and lower mortality. Swiss Med Wkly. 2016;146:w14300. doi:. http://dx.doi.org/10.4414/smw.2016.14300 PubMed

12 Bossard M, Sticherling C, Kühne M, Frey S, Osswald S, Schaer B. Outcome of patients with cardiac resynchronisation defibrillator therapy and a follow-up of at least five years after implant. Swiss Med Wkly. 2014;144:w13938. doi:. http://dx.doi.org/10.4414/smw.2014.13938 PubMed

13 Schaer B, Theuns DA, Sticherling C, Szili-Torok T, Osswald S, Jordaens L. Effect of implantable cardioverter-defibrillator on left ventricular ejection fraction in patients with idiopathic dilated cardiomyopathy. Am J Cardiol. 2010;106(11):1640–5. doi:. http://dx.doi.org/10.1016/j.amjcard.2010.07.024 PubMed

14 Bansal N, Szpiro A, Reynolds K, Smith DH, Magid DJ, Gurwitz JH, et al.Long-term Outcomes Associated With Implantable Cardioverter Defibrillator in Adults With Chronic Kidney Disease. JAMA Intern Med. 2018;178(3):390–8. doi:. http://dx.doi.org/10.1001/jamainternmed.2017.8462 PubMed

15 Schaer BA, Hitz L, Sticherling C, Kühne M, Dickenmann M, Jordaens L, et al.Changes in renal function over time in patients with cardiac resynchronisation therapy. Swiss Med Wkly. 2013;143:w13863. doi:. http://dx.doi.org/10.4414/smw.2013.13863 PubMed

16 Hindricks G, Camm AJ, Merkely B, Raatikainen P, Arnar DO. The EHRA White Book 2016. 2016; www.escardio.org/EHRA/Publications (last accessed February 2018).

17 Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C; REVERSE (REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction) Study Group. Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. J Am Coll Cardiol. 2008;52(23):1834–43. doi:. http://dx.doi.org/10.1016/j.jacc.2008.08.027 PubMed

18 Sticherling C, Arendacka B, Svendsen JH, Wijers S, Friede T, Stockinger J, et al.; EU-CERT-ICD Investigators. Sex differences in outcomes of primary prevention implantable cardioverter defibrillator therapy: combined registry data from eleven European countries. Europace. 2018;20(6):963–70. doi:. http://dx.doi.org/10.1093/europace/eux176 PubMed

19 Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al.; European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA). 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace. 2013;15(8):1070–118. doi:. http://dx.doi.org/10.1093/europace/eut206 PubMed

20 Bogale N, Priori S, Gitt A, Alings M, Linde C, Dickstein K, et al.; Scientific Committee, National coordinators, and investigators. The European cardiac resynchronization therapy survey: patient selection and implantation practice vary according to centre volume. Europace. 2011;13(10):1445–53. doi:. http://dx.doi.org/10.1093/europace/eur173 PubMed

21 Winnik S, Elsener C, Seifert B, Starck C, Straub A, Saguner AM, et al.“Real world” experience in Cardiac Resynchronization Therapy at a Swiss Tertiary Care Center. Swiss Med Wkly. 2017;147:w14425. doi:. http://dx.doi.org/10.4414/smw.2017.14425 PubMed

22 Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al.; ESC Scientific Document Group; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213–60. doi:. http://dx.doi.org/10.1093/eurheartj/ehx419 PubMed

Verpassen Sie keinen Artikel!

close