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Int J Cardiol. 2018 Jul 15;263:48-53. doi: 10.1016/j.ijcard.2018.03.087.

Cardiac resynchronization therapy in the ageing population - With or without an implantable defibrillator?

Author information

1
Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany. Electronic address: michael.doering@medizin.uni-leipzig.de.
2
Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
3
Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.

Abstract

BACKGROUND:

Cardiac resynchronization therapy (CRT) is an effective treatment option for systolic heart failure, but the benefit of an additional implantable cardioverter-defibrillator (ICD) in elderly patients is not well established. The aim of our study was to evaluate the impact of an additional ICD on survival in elderly CRT recipients.

METHODS:

Patients aged ≥75 years with an indication for CRT and primary preventive ICD therapy, which underwent implantation of either a CRT-pacemaker (CRT-P) or CRT-defibrillator (CRT-D) were included in the study. Patient characteristics, procedural and follow-up data, and subsequent all-cause mortality were analyzed.

RESULTS:

A total of 775 consecutive patients underwent CRT implantation, whereof 177 patients fulfilled the inclusion criteria. Of these, 80 patients with CRT-P and 97 with CRT-D formed the two study groups. Patients in the CRT-P group were significantly older (82.6 ± 4.5 vs. 77.8 ± 1.9 years, p < 0.001) and more often female (44 vs. 25%; p < 0.001), had a better left ventricular ejection fraction (29.5 ± 5.7 vs. 27.4 ± 6.0%; p = 0.019) and narrower QRS-complex (150 ± 19 vs. 158 ± 18 ms; p = 0.025). During a mean follow-up of 26 ± 19 months, 62 (35%) study patients died, 28 (35%) in the CRT-P and 34 (35%) in the CRT-D group (p = 0.994). The Kaplan-Meier analysis of survival probability showed no significant difference between the two groups (p = 0.562).

CONCLUSION:

In our study, an additional ICD had no impact on survival in elderly patients undergoing implantation of a CRT device. Randomized controlled trials have to confirm this finding.

KEYWORDS:

All-cause mortality; Cardiac resynchronization therapy; Heart failure; Implantable cardioverter defibrillator; Sudden cardiac death

PMID:
29754922
DOI:
10.1016/j.ijcard.2018.03.087
[Indexed for MEDLINE]

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