Implantable Cardiac Device Procedures in Older Patients

Swindle, Jason; Rich, Michael W.; McCann, Patrick J.; Burroughs, Thomas E.; Hauptman, Paul J.

doi:10.1001/archinternmed.2010.30

Cited by 87 publications

(64 citation statements)

References 35 publications

(22 reference statements)

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“…12,13,25 However, a recent study including 26 887 recipients of ICD or CRT devices has shown a significant higher frequency of acute device-related adverse event among elderly patients, women, and black race/ethnicity. 26 Similar to the results of the InSync, MADIT-CRT, MIR-ACLE, and MIRACLE-ICD studies, the present evaluation showed that the rates of early adverse events were not different between young and elderly patients. About the long-term CRT-related complications, the data are scarce.…”

supporting

confidence: 88%

Left Ventricular Reverse Remodeling, Device-Related Adverse Events, and Long-Term Outcome After Cardiac Resynchronization Therapy in the Elderly

Höke

Putter

Velde

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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T he incidence and prevalence of heart failure increase significantly with aging, and older patients often present with more advanced heart failure when compared with younger patients.1,2 Patients aged ≥75 to 80 years are often under-represented in heart failure therapy trials, including the ones involving cardiac resynchronization therapy (CRT). The mean age of patients in the large CRT trials was ranged between 62 and 67 years, whereas the mean age of patients included in large registries was higher with nearly one third of patients being ≥75 years old. [3][4][5][6][7] Device-related adverse events, efficacy, and long-term outcome after CRT implantation in the elderly are, therefore, unknown. 8 The present study aimed at evaluating (1) the effect of CRT on clinical and echocardiographic parameters in the elderly, (2) the effect of age on left ventricular (LV) reverse remodeling after CRT, (3) device-related adverse events after CRT and finally, and (4) the long-term prognosis of elderly CRT recipients. Methods Patient PopulationPatients included between June 2000 and July 2010 in an ongoing CRT registry from the Department of Cardiology of the Leiden University Medical Center (Leiden, The Netherlands) were evaluated in the present analysis. 9 Patients underwent CRT device implantation according to the presence of LV ejection fraction (EF) ≤35%, a QRS duration ≥120 ms, and New York Heart Association (NYHA) functional class II to IV heart failure symptoms, despite optimal medical therapy. 10 The cause of heart failure was considered ischemic in the presence of significant coronary artery disease (>50% stenosis in ≥1 major epicardial coronary artery) on coronary angiography and a history of myocardial infarction or revascularization. Patients with decompensated heart failure before the implantation or recent myocardial infarction (<3 months) were excluded.All patients underwent extensive clinical evaluation and transthoracic 2-dimensional (2D) echocardiography before and 6 months after CRT implantation. All patients were scheduled for regular visits to the outpatient clinic at 6 months of follow-up. To evaluate the association between age and CRT outcomes, patients were dichotomized Background-Limited data are available on efficacy, safety, and long-term prognosis after cardiac resynchronization therapy (CRT) in elderly patients. We aimed at evaluating the effect of CRT, device-related adverse events, and long-term outcome after CRT among elderly patients. Patient data were prospectively collected in the departmental Cardiology Information System (EPD-Vision; Leiden University Medical Center, Leiden, The Netherlands) and were subsequently analyzed. For this retrospective analysis of clinically acquired data, the institutional review board waived the need of patient written informed consent. Clinical and Echocardiographic EvaluationClinical evaluation included quality-of-life score according to Minnesota living with Heart failure questionnaire (higher scores indicate worse quality of life), 6-minute walk-test, fra...

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supporting

confidence: 88%

Left Ventricular Reverse Remodeling, Device-Related Adverse Events, and Long-Term Outcome After Cardiac Resynchronization Therapy in the Elderly

Höke

Putter

Velde

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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“…A potential explanation is that concomitant comorbid conditions often seen in elderly patients may also affect survival. Swindle et al pointed out that advanced age and elevated comorbidity score were independent predictors of in-hospital mortality after CRT or implantable cardioverter-defibrillator placement (27). Older patients may also have higher risk of noncardiac death; however, we did not differentiate the cause of death after CRT.…”

Section: Discussionmentioning

confidence: 73%

Impact of Myocardial Scarring on Outcomes of Cardiac Resynchronization Therapy: Extent or Location?

Mei²,

Feng³

et al. 2011

J Nucl Med

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Refining the criteria for patient selection for cardiac resynchronization therapy (CRT) may improve its outcomes. The study objective was to determine the effect of scar location, scar burden, and left ventricular (LV) lead position on CRT outcomes. Methods: The study included 213 consecutive CRT recipients with radionuclide myocardial perfusion imaging before CRT between January 2002 and December 2008. Scar localization and myocardial viability were analyzed using a 17-segment model and a 5-point semiquantitative scale. New York Heart Association (NYHA) class and echocardiography were assessed before and after CRT. The anatomic LV lead location in the 17-segment model was assessed by review of fluoroscopic cinegrams in right and left anterior oblique views. As in published studies, clinical response was defined as an absolute improvement in LV ejection fraction of $5 percentage points after CRT. Results: A total of 651 scar segments was identified in 213 patients. Eighty-three percent of scar segments were located in the LV anterior, posterior, septal, and apical regions, whereas 84% of LV leads were in the lateral wall. Only 11% of LV leads were positioned in scar segments. The extent of scarring was significantly higher in nonresponders than in responders (18.0% vs. 6%, P 5 0.001). Compared with patients with scarring .22%, patients #70 y with scarring #22% of the left ventricle had a greater increase in LV ejection fraction (10.1% 6 10.5% vs. 0.8% 6 6.1%; P , 0.001) and improvement in NYHA class (-0.9 6 0.7 vs. -0.5 6 0.8; P 5 0.02). Conclusion: LV leads were often located in viable myocardial regions. Less scar burden was associated with a greater improvement in heart failure but only in relatively younger CRT recipients.Key Words: cardiac resynchronization therapy; heart failure; myocardial scarring; viability; imaging Heart failure (HF) prevalence is estimated to be 1%-2% in Western countries, with an incidence of approximately 5-10 per 1,000 persons per year. HF negatively affects quality of life and survival and accounts for 1%-2% of all health-care expenditure in developed countries. Left ventricular (LV) systolic function underlies the traditional HF paradigm and, despite significant advances in treatment, 5-y mortality still approaches 50% (1). Cardiac resynchronization therapy (CRT) is a treatment option for advanced HF despite optimal medical therapy, reduced LV ejection fraction (EF), and wide QRS complex. Randomized studies have demonstrated that CRT can improve cardiac function, clinical symptoms, quality of life, and even survival for patients with advanced HF (2-5). However, about one third of HF patients with reduced LVEF and wide QRS do not clinically respond after CRT. The reasons are multifactorial, and predicting who will respond to CRT remains a challenge (2,6). The suboptimal selection of CRT candidates has been considered an important contributor to the less optimal response rate. Diverse strategies to identify cardiac mechanical dyssynchrony and other predictors of benefit from CRT ha...

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“…29 There is, however, no consistent evidence supporting a similar benefit of ICD treatment among younger and elderly patients. [30][31][32][33] This seems intuitive because older age is usually combined with more comorbid conditions that may dilute the salutary effects of ICD therapy. Advanced age was also found to constitute an independent predictor of in-hospital mortality following device implantation.…”

Section: Elderly Patientsmentioning

confidence: 99%