Impact of Cardiac Resynchronization Therapy on Clinical Outcomes in Patients With Continuous-Flow Left Ventricular Assist Devices

Gopinathannair, Rakesh; Birks, Emma J.; Trivedi, Jaimin R.; McCants, Kelly C.; Sutton, Brad; Deam, A. Gregory; Slaughter, Mark S.; Hottigoudar, Rashmi U.

doi:10.1016/j.cardfail.2014.12.006

Cited by 39 publications

(25 citation statements)

References 26 publications

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“…In contrast, our study results are strengthened significantly by our large sample size and multicenter experience, allowing robust Cox regression analyses exploring the independent association of CRT with survival. Our study results concur with the prior studies13, 14 in that concomitant CRT following CF‐LVAD did not offer any significant survival advantage. In fact, we noted a trend towards reduced survival in the CRT‐D group at 1‐year follow‐up compared with the ICD group, suggesting early harm.…”

Section: Discussionsupporting

confidence: 92%

“…Over a mean follow‐up of 682±45 days of LVAD support, 8 (26%) patients died in the CRT group and 5 (17%) died in the ICD group ( P =0.53). No significant differences were seen in all‐cause and HF hospitalizations as well in incidence of VA and ICD therapies 13. Schleifer et al compared the arrhythmic outcomes between CF‐LVAD patients with continued CRT (CRT‐on, n=39) and those who had CRT turned off (CRT‐off, n=27) before discharge.…”

Section: Discussionmentioning

confidence: 99%

“…ECGs and stored‐device electrograms were analyzed for incidence of AA, VA, and ICD shocks. VA was defined as sustained ventricular tachyarrhythmias lasting >30 s or requiring ICD therapy (antitachycardia pacing or shocks) 13. AA was defined as atrial tachycardia, atrial flutter, or atrial fibrillation lasting either >6 hours or ≥1% burden on device interrogation or requiring pharmacological or electrical therapy for termination.…”

Section: Methodsmentioning

confidence: 99%

“…AA was defined as atrial tachycardia, atrial flutter, or atrial fibrillation lasting either >6 hours or ≥1% burden on device interrogation or requiring pharmacological or electrical therapy for termination. HF hospitalization was defined as any hospitalization secondary to clinical signs and symptoms of congestive HF (dyspnea, fatigue, volume overload, as well as use of intravenous diuretics and/or inotropes for volume) and included device malfunction (LVAD thrombosis) and aortic insufficiency–related HF 13. All‐cause and HF hospitalizations are reported as number of hospitalizations per 100 days of LVAD support.…”

Section: Methodsmentioning

confidence: 99%

“…However, the benefit of CRT on clinical outcomes following CF‐LVAD implantation remains unclear. Available data, from 2 observational studies evaluating this question show possible arrhythmic benefits but no overall survival benefit for CRT in a CF‐LVAD population 13, 14. These single‐center studies, however, were limited by very small sample size.…”

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confidence: 99%

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Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Gopinathannair

Roukoz

Bhan

et al. 2018

JAHA

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BackgroundMany patients with heart failure continue cardiac resynchronization therapy (CRT) after continuous flow left ventricular assist device (CF‐LVAD) implant. We report the first multicenter study to assess the impact of CRT on clinical outcomes in CF‐LVAD patients.Methods and ResultsAnalysis was performed on 488 patients (58±13 years, 81% male) with an implantable cardioverter defibrillator (ICD) (n=223) or CRT‐D (n=265) who underwent CF‐LVAD implantation at 5 centers from 2007 to 2015. Effects of CRT on mortality, hospitalizations, and ventricular arrhythmia incidence were compared against CF‐LVAD patients with an ICD alone. Baseline differences were noted between the 2 groups in age (60±12 versus 55±14, P<0.001) and QRS duration (159±29 versus 126±34, P=0.001). Median biventricular pacing in the CRT group was 96%. During a median follow‐up of 478 days, Kaplan–Meier analysis showed no difference in survival between groups (log rank P=0.28). Multivariate Cox regression demonstrated no survival benefit with type of device (ICD versus CRT‐D; P=0.16), whereas use of amiodarone was associated with increased mortality (hazard ratio 1.77, 95% confidence interval 1.1–2.8, P=0.01). No differences were noted between CRT and ICD groups in all‐cause (P=0.06) and heart failure (P=0.9) hospitalizations, ventricular arrhythmia incidence (43% versus 39%, P=0.3), or ICD shocks (35% versus 29%, P=0.2). During follow‐up, 69 (26%) patients underwent pulse generator replacement in the CRT‐D group compared with 36 (15.5%) in the ICD group (P=0.003).ConclusionsIn this large, multicenter CF‐LVAD cohort, continued CRT was not associated with improved survival, hospitalizations, incidence of ventricular arrhythmia and ICD therapies, and was related to a significantly higher number of pulse generator changes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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