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Original article

Vol. 147 No. 1516 (2017)

“Real world” experience in cardiac resynchronisation therapy at a Swiss tertiary care centre: update 2016

DOI
https://doi.org/10.4414/smw.2017.14425
Cite this as:
Swiss Med Wkly. 2017;147:w14425
Published
18.04.2017

Summary

BACKGROUND

Based on a reduction in morbidity and mortality, cardiac resynchronisation therapy (CRT) has evolved as a standard therapy for patients with advanced heart failure.

OBJECTIVE

To provide insight into patient demographics, safety, echocardiographic remodelling and long-term follow-up of patients treated with CRT in a “real-world” setting at a Swiss tertiary care centre.

METHODS

Patients implanted with a CRT device at the University Heart Centre Zurich between 2000 and 2015 were consecutively enrolled. Initial clinical and echocardiographic therapy response as well as long-term follow-up for mortality (defined as all-cause death, heart transplantation or ventricular assist device implantation) and hospitalisation for heart failure were assessed.

RESULTS

A total of 418 patients with a median age of 66 years at the time of CRT implantation (78% male) were enrolled. Serious peri-interventional complications (from the time of implantation up to 14 days thereafter) were rare and included systemic infections in 2.4%, pneumothorax in 3.3% and haematoma requiring revision in 2.2% of cases. Overall, the Kaplan-Meier estimate for 5-year freedom from the composite endpoint (hospitalisation for heart failure or mortality) was 55.8%; the Kaplan-Meier estimate for 5-year freedom from mortality was 64.1%. CRT was associated with a significant symptomatic improvement and left ventricular reverse remodelling.

​

Overall, 3.9% of patients did not respond to cardiac resynchronisation therapy (decline in left ventricular ejection fraction [LVEF] >5%), whereas 35.1% experienced neither a continued decline nor a relevant improvement of LVEF (±5%). In the remaining 61% of patients we observed an improvement in LVEF of more than 5%. Forty percent and 31% of patients were super responders, defined as an absolute LVEF improvement of ≥10% and by a relative reduction of left ventricular end-diastolic volume index by 20% or more. Super-response to CRT was associated with a significant benefit in terms of survival and rehospitalisation rates.

CONCLUSION

Our data are consistent with large multicentre trials and indicate that CRT is similarly effective in a real-world setting in Switzerland.

References

  1. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al.; MIRACLE Study Group. Multicenter InSync Randomized Clinical Evaluation. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346(24):1845–53. https://doi.org/10.1056/NEJMoa013168
  2. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al.; Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140–50. https://doi.org/10.1056/NEJMoa032423
  3. 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. https://doi.org/10.1056/NEJMoa050496
  4. Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A, et al. Survival with cardiac-resynchronization therapy in mild heart failure. N Engl J Med. 2014;370(18):1694–701. https://doi.org/10.1056/NEJMoa1401426
  5. Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M, et al.; MADIT-CRT Investigators. Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). Circulation. 2011;123(10):1061–72. https://doi.org/10.1161/CIRCULATIONAHA.110.960898
  6. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al.; Authors/Task Force Members. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. https://doi.org/10.1093/eurheartj/ehw128
  7. Ruschitzka F, Abraham WT, Singh JP, Bax JJ, Borer JS, Brugada J, et al.; EchoCRT Study Group. Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med. 2013;369(15):1395–405. https://doi.org/10.1056/NEJMoa1306687
  8. Steffel J, Robertson M, Singh JP, Abraham WT, Bax JJ, Borer JS, et al. The effect of QRS duration on cardiac resynchronization therapy in patients with a narrow QRS complex: a subgroup analysis of the EchoCRT trial. Eur Heart J. 2015;36(30):1983–9. https://doi.org/10.1093/eurheartj/ehv242
  9. Steffel J, Hürlimann D. Current practice of cardiac resynchronization therapy (CRT) in the real world: insights from the European CRT survey. Eur Heart J. 2009;30(20):2433–5. https://doi.org/10.1093/eurheartj/ehp366
  10. Kashani A, Barold SS. Significance of QRS complex duration in patients with heart failure. J Am Coll Cardiol. 2005;46(12):2183–92. https://doi.org/10.1016/j.jacc.2005.01.071
  11. 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. https://doi.org/10.1093/europace/eur173
  12. 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. https://doi.org/10.1093/eurheartj/ehp359
  13. Steffel J, Milosevic G, Hürlimann A, Krasniqi N, Namdar M, Ruschitzka F, et al. Characteristics and long-term outcome of echocardiographic super-responders to cardiac resynchronisation therapy: ‘real world’ experience from a single tertiary care centre. Heart. 2011;97(20):1668–74. https://doi.org/10.1136/heartjnl-2011-300222
  14. Auricchio A. Cardiac resynchronization therapy: does varying the pacing site or combination of sites improve cardiac function? Nat Clin Pract Cardiovasc Med. 2005;2(6):288–9. https://doi.org/10.1038/ncpcardio0222
  15. Butter C, Auricchio A, Stellbrink C, Fleck E, Ding J, Yu Y, et al.; Pacing Therapy for Chronic Heart Failure II Study Group. Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation. 2001;104(25):3026–9. https://doi.org/10.1161/hc5001.102229
  16. Hürlimann DSJ, Milosevic G, Krasniqi N, Gruner C, Oswlad F, Rahn M, et al. Cardiac resynchronization therapiy - “real world” experience from a swiss tertiary center. Cardiovasc Med. 2010;13:334–41.10.4414/cvm.2010.01543
  17. Achilli A, Sassara M, Ficili S, Pontillo D, Achilli P, Alessi C, et al. Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and “narrow” QRS. J Am Coll Cardiol. 2003;42(12):2117–24. https://doi.org/10.1016/j.jacc.2003.08.024
  18. Bleeker GB, Holman ER, Steendijk P, Boersma E, van der Wall EE, Schalij MJ, et al. Cardiac resynchronization therapy in patients with a narrow QRS complex. J Am Coll Cardiol. 2006;48(11):2243–50. https://doi.org/10.1016/j.jacc.2006.07.067
  19. Holzmeister J, Hürlimann D, Steffel J, Ruschitzka F. Cardiac resynchronization therapy in patients with a narrow QRS. Curr Heart Fail Rep. 2009;6(1):49–56. https://doi.org/10.1007/s11897-009-0009-5
  20. Yu CM, Chan YS, Zhang Q, Yip GW, Chan CK, Kum LC, et al. Benefits of cardiac resynchronization therapy for heart failure patients with narrow QRS complexes and coexisting systolic asynchrony by echocardiography. J Am Coll Cardiol. 2006;48(11):2251–7. https://doi.org/10.1016/j.jacc.2006.07.054
  21. Curtis AB, Worley SJ, Adamson PB, Chung ES, Niazi I, Sherfesee L, et al., Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK HF) Trial Investigators. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med. 2013;368(17):1585–93. https://doi.org/10.1056/NEJMoa1210356
  22. Fröhlich G, Steffel J, Hürlimann D, Enseleit F, Lüscher TF, Ruschitzka F, et al. Upgrading to resynchronization therapy after chronic right ventricular pacing improves left ventricular remodelling. Eur Heart J. 2010;31(12):1477–85. https://doi.org/10.1093/eurheartj/ehq065
  23. Steffel J, Ruschitzka F. Superresponse to cardiac resynchronization therapy. Circulation. 2014;130(1):87–90. https://doi.org/10.1161/CIRCULATIONAHA.113.006124
  24. Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al.; MADIT-CRT Trial Investigators. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361(14):1329–38. https://doi.org/10.1056/NEJMoa0906431
  25. 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. https://doi.org/10.1056/NEJMoa1009540
  26. Hernández Madrid A, Matía Francés R, Moro C, Zamorano J. Cardiac resynchronization therapy: do patient selection and implant practice vary depending on the volume a center handles? Pacing Clin Electrophysiol. 2013;36(7):863–71. https://doi.org/10.1111/pace.12135

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