Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 144 No. 0910 (2014)

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

  • Matthias Bossard
  • Christian Sticherling
  • Michael Kühne
  • Simon Frey
  • Stefan Osswald
  • Beat Schaer
DOI
https://doi.org/10.4414/smw.2014.13938
Cite this as:
Swiss Med Wkly. 2014;144:w13938
Published
23.02.2014

Summary

QUESTIONS UNDER STUDY: 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.

METHODS: 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.

RESULTS: 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 <0.0001) at last follow-up. 14 patients (29%) had appropriate ICD therapy, mainly for ventricular tachycardia. No first-ever arrhythmic event occurred beyond year 4.5. Device longevity was 54±13 months. Twenty-three technical problems occurred in 20 patients (40%), 14 of whom (61%) required surgery (7 lead defects, 4 dislodgments, 3 others). Dislodgements occurred early (after 2±2 months); defects were scattered (2–59 months) during follow-up.

CONCLUSION: Selected patients who survive for at least 5 years experience sustained improvement in LVEF and NYHA- class and only few arrhythmic episodes. Technical problems occur in 40% of patients (60% requiring surgery), mainly shortly after implant and again after 4 to 5 years.

References

  1. Meyer K, Murner N, Laederach-Hofmann K, Simmet A, Hess OM. Heart failure events, and case fatalities in Switzerland based on hospital statistics and cause of death statistics. Swiss Med Wkly. 2008;138(35–36):p.506–11.
  2. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012;14(8):p.803–69.
  3. Sticherling C, Schaer B, Coenen M, Kuhne M, Ammann P, Osswald S. Cardiac resynchronization therapy in chronic heart failure. Swiss Med Wkly. 2006;136(39–40):p.611–7.
  4. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):p.2140–50.
  5. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):p.1539–49.
  6. Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 2009;361(14):p.1329–38.
  7. Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, et al. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med. 2010;363(25):p.2385–95.
  8. Linde C, Abraham WT, Gold MR, John Sutton M St, Ghio S, Daubert C, et al. 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):p.1834–43.
  9. Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M, et al. Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). Circulation. 2011;123(10):p.1061–72.
  10. Krahn AD, Lee DS, Birnie D, Healey JS, Crystal E, Dorian P, et al. Predictors of short-term complications after implantable cardioverter-defibrillator replacement: results from the Ontario ICD Database. Circ Arrhythm Electrophysiol. 2011;4(2):p.136–42.
  11. Stevenson WG, Hernandez AF, Carson PE, Fang JC, Katz SD, Spertus JA, et al. Indications for cardiac resynchronization therapy: 2011 update from the Heart Failure Society of America Guideline Committee. J Card Fail. 2012;18(2):p.94–106.
  12. Abraham WT, Young JB, Leon AR, Adler S, Bank AJ, Hall SA, et al. Effects of cardiac resynchronization on disease progression in patients with left ventricular systolic dysfunction, an indication for an implantable cardioverter-defibrillator, and mildly symptomatic chronic heart failure. Circulation. 2004;110(18):p.2864–8.
  13. Babotai I. Arbeitsgruppe Herzschrittmacher und Elektrophysiologie der Schweizerischen Gesellschaft für Kardiologie (SGK), Schweizerische Statistik für Herzschrittmacher, ICD und Ablationen 2012. 2013 April 30; Available from: http://www.pacemaker.ch/de/statistik/statistik_2012
  14. Stabile G, Solimene F, Bertaglia E, La Rocca V, Accogli M, Scaccia A, et al. Long-term outcomes of CRT-PM versus CRT-D recipients. Pacing Clin Electrophysiol, 2009;32(Suppl1):p.S141–5.
  15. Cleland JG, Freemantle N, Erdmann E, Gras D, Kappenberger L, Tavazzi L, et al. Long-term mortality with cardiac resynchronization therapy in the Cardiac Resynchronization-Heart Failure (CARE-HF) trial. Eur J Heart Fail. 2012;14(6):p.628–34.
  16. Kreuz J, Horlbeck F, Linhart M, Mellert F, Fimmers R, Schrickel J, et al. Independent predictors of mortality in patients with advanced heart failure treated by cardiac resynchronization therapy. Europace. 2012.
  17. Bogale N, Priori S, Cleland JG, Brugada J, Linde C, Auricchio A, et al. The European CRT Survey: 1 year (9–15 months) follow-up results. Eur J Heart Fail. 2012;14(1):p.61–73.
  18. Lee DS, Krahn AD, Healey JS, Birnie D, Crystal E, Dorian P, et al. Evaluation of early complications related to De Novo cardioverter defibrillator implantation insights from the Ontario ICD database. J Am Coll Cardiol. 2010.55(8):p.774–82.
  19. Reynolds MR, Cohen DJ, Kugelmass AD, Brown PP, Becker ER, Culler SD, et al. The frequency and incremental cost of major complications among medicare beneficiaries receiving implantable cardioverter-defibrillators. J Am Coll Cardiol. 2006.47(12):p.2493–7.
  20. Brignole M. Are complications of implantable defibrillators under-estimated and benefits over-estimated? Europace. 2009.11(9):p.1129–33.
  21. Duray GZ, Schmitt J, Cicek-Hartvig S, Hohnloser SH, Israel CW, Complications leading to surgical revision in implantable cardioverter defibrillator patients: comparison of patients with single-chamber, dual-chamber, and biventricular devices. Europace. 2009;11(3):p.297–302.
  22. Landolina M, Gasparini M, Lunati M, Lacopino S, Boriani G, Bonanno C, et al. Long-term complications related to biventricular defibrillator implantation: rate of surgical revisions and impact on survival: insights from the Italian Clinical Service Database. Circulation. 2011;123(22):p.2526–35.
  23. Moss AJ, Greenberg H, Case RB, Zareba W, Hall WJ, Brown MW, et al. Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation. 2004;110(25):p.3760–5.
  24. Kirkfeldt RE, Johansen JB, Nohr EA, Moller M, Arnsbo P, Nielsen JC. Risk factors for lead complications in cardiac pacing: a population-based cohort study of 28,860 Danish patients. Heart Rhythm. 2011;8(10):p.1622–8.
  25. Biffi M, Moschini C, Bertini M, Saporito D, Ziacchi M, Diemberger I, et al. Phrenic stimulation: a challenge for cardiac resynchronization therapy. Circ Arrhythm Electrophysiol. 2009;2(4):p.402–10.
  26. Horlbeck FW, Mellert F, Kreuz J, Nickenig G, Schwab JO. Real-World Data on the Lifespan of Implantable Cardioverter-Defibrillators Depending on Manufacturers and the Amount of Ventricular Pacing. J Cardiovasc Electrophysiol. 2012.
  27. Thijssen J, Borleffs CJ, van Rees JB, Man S, de Bie MK, Venlet J, et al. Implantable cardioverter-defibrillator longevity under clinical circumstances: an analysis according to device type, generation, and manufacturer. Heart Rhythm. 2012.9(4):p.513–9.
  28. Knops P, Theuns DA, Res JC, Jordaens L. Analysis of implantable defibrillator longevity under clinical circumstances: implications for device selection. Pacing Clin Electrophysiol. 2009;32(10):p.1276–85.
  29. Theuns DA, Thornton AS, Klootwijk AP, Scholten MF, Vantrimpont PJ, Balk AH, et al. Outcome in patients with an ICD incorporating cardiac resynchronisation therapy: differences between primary and secondary prophylaxis. Eur J Heart Fail 2005;7(6):p.1027–32.
  30. Schaer B, Kuhne M, Koller MT, Sticherling C, Osswald S. Therapy with an implantable cardioverter defibrillator (ICD) in patients with coronary artery disease and dilated cardiomyopathy: benefits and disadvantages. Swiss Med Wkly. 2009;139(45–46):p.647–53.
  31. Schaer BA, Osswald S, Di Valentino M, Soliman OI, Sticherling C, ten Cate FJ, et al. Close connection between improvement in left ventricular function by cardiac resynchronization therapy and the incidence of arrhythmias in cardiac resynchronization therapy-defibrillator patients. Eur J Heart Fail. 2010;12(12):p.1325–32.
  32. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346(24):p.1845–53.
  33. St John Sutton MG, Plappert T, Abraham WT, Smith AL, DeLurgio DB, Leon AR, et al. Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation. 2003;107(15):p.1985–90.
  34. Auricchio A, Metra M, Gasparini M, Lamp B, Klersy C, Curnis A, et al. Long-term survival of patients with heart failure and ventricular conduction delay treated with cardiac resynchronization therapy. Am J Cardiol. 2007;99(2):p.232–8.
  35. Johansen JB, Jorgensen OD, Moller M, Arnsbo P, Mortensen PT, Nielsen JC, Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients. Eur Heart J. 2011;32(8):p.991–8.
  36. Fornwalt BK, Sprague WW, BeDell P, Suever JD, Gerritse B, Merlino JD, et al. Agreement is poor among current criteria used to define response to cardiac resynchronization therapy. Circulation. 2010;121(18):p.1985–91.
  37. Marsan NA, Bleeker GB, van Bommel RJ, Ypenburg C, Delgado V, Borleffs CJ, et al. Comparison of time course of response to cardiac resynchronization therapy in patients with ischemic versus nonischemic cardiomyopathy. Am J Cardiol. 2009;103(5):p.690–4.

Most read articles by the same author(s)

1 2 3 > >>