Efficacy of cardiac resynchronisation therapy in the treatment of end-stage inotrope-dependent heart failure patients

Abstract

CRT can be an alternative for end-stage inotrope-dependent HF patients with wide QRS who are ineligible for urgent heart transplantation.

An urgent in-hospital upgrade to resynchronization therapy is associated with lower likelihood of survival as compared to planned procedures

“…However, few studies showed a beneficial effect of CRT de novo implantation in inotropy-dependent end-stage heart failure patients. Sokal et al [7] reported 100% success in weaning from inotropes in eleven individuals after a CRT implantation. In a meta-analysis by Hernandez et al [8], weaning from inotropes was successful in 93% of patients, and the 1-year survival rate was 69% after CRT de novo implantation.…”

“…Despite these guidelines, there are reports of successful off-label de novo CRT implantations in inotropy-dependent patients or on mechanical support [7,8]. However, there are only limited data on off-label CRT upgrades [9,10].…”

Cardiac Resynchronization Therapy Device Implantation in a Patient with Cardiogenic Shock under Percutaneous Mechanical Circulatory Support

“…There have been few selective studies and case reports investigating the usefulness of “rescue” CRT in patients with non-ambulatory New York Heart Association (NYHA) functional class IV HF or cardiogenic shock. 3) 4) 5) 6) 7) Most attempts, however, have been unsuccessful. For example, in a retrospective study by Mantziari et al 3) 24 patients underwent CRT implantation during hospitalization in the cardiac critical care unit.…”

“… 1) 2) However, uncertainty remains whether it is beneficial to implant CRT devices in patients with severe HF, especially those in cardiogenic shock or end-stage HF, since such patients have been excluded from most CRT trials. Few cases have been reported about CRT implantation in patients with acute decompensated HF being treated with vasopressors/inotropes, 3) 4) 5) 6) but patients in the intensive care unit requiring mechanical circulatory support were usually not considered as eligible for CRT or CRT-implantable cardioverter defibrillator (CRT-D) “salvage” therapy. In this report, we present a case of successful extracorporeal membrane oxygenation (ECMO) weaning in a cardiogenic shock patient after CRT-D implantation.…”

Cardiac resynchronization as rescue therapy for ventilator-dependent heart failure

“…However, current guidelines do not recommend CRT in non-ambulatory NYHA class IV HF patients [2,3] . Several small, retrospective studies of CRT implantation in inotrope-dependent HF patients have described high rates of successful implant, weaning from inotrope, clinical improvement, hospital discharge, and in some cases echocardiographic improvements following CRT [10][11][12][13][14][15][16][17] . To our knowledge, no previous studies or cases have specifically described CRT implant in ventilator-dependent HF patients.…”