Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy

Beca, Bogdan M.; Sapp, John L.; Gardner, Martin J.; Gray, Christopher; AbdelWahab, Amir; MacIntyre, Ciorsti; Doucette, Steve; Parkash, Ratika

doi:10.1016/j.cjco.2019.02.002

Cited by 5 publications

(2 citation statements)

References 36 publications

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“…5 Similarly, the cohort of Beca B et al, found a long-term mortality rate 2.86-fold increased. 11 On the other hand, this data differs from previously mentioned meta-analysis, and the European CRT survey, that demonstrated that CRT upgrade is associated with similar risk for all-cause mortality compared to De novo resynchronization therapy. 9 Some factors may justify these findings, firstly, it has been suggested that CRT upgrade procedures are associated with increased peri-procedural complications.…”

Section: Resultscontrasting

confidence: 87%

Upgrade is independently associated with short-term mortality after cardiac resynchronization therapy.

Viana¹,

Santana²,

Carvalho³

et al. 2023

Preprint

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Background: Cardiac resynchronization therapy (CRT) improves outcomes in heart failure (HF) patients with left bundle branch block (LBBB). However, the benefits of CRT in patients with previous pacing are still uncertain. The aim is to compare the short-term mortality between upgrade and De novo-CRT implantation.Methods: Prospective cohort study that included HF patients indicated for CRT with left ventricular ejection fraction (LVEF) of less than 35%. Data were collected to investigate mortality predictors after 1 year. The overall survival was calculated by the Kaplan-Meier method and multivariate analysis using Cox's regression model was performed. A value of p<0.05 was considered as significant.Results: 93 patients were evaluated with a mean follow-up of 1.0±0.6year. Of these, 22 (23.7%) were upgraded from right ventricular pacing. Chagas Disease (CD) was the most prevalent cause of HF with 29 (31.2%) individuals. LVEF at 6 months increased after CRT: 24,0%±7.8 to 30.3%±11.5, p=0.007, and there was no difference between upgraded patients and De novo CRT, p=0.26. Overall mortality at 1-year was 30.1% (28 patients). In univariate analysis, CD and upgraded therapy were associated with high mortality,

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Section: Resultscontrasting

confidence: 87%

Upgrade is independently associated with short-term mortality after cardiac resynchronization therapy.

Viana¹,

Santana²,

Carvalho³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…On the other hand, this data differs from previously mentioned meta-analysis, and the European CRT survey, that demonstrated that CRT upgrade is associated with similar risk for all-cause mortality compared to de novoresynchronization therapy. 5,[11][12][13] Some factors may justify these findings, firstly, it has been suggested that CRT upgrade procedures are associated with increased peri-procedural complications. In fact, all in-hospital deaths occurred in the upgraded-CRT group, and directly related to the procedure.…”

Section: Discussionmentioning

confidence: 99%

Heart failure patients with prior right ventricular pacing upgraded to resynchronization therapy had a worse prognosis compared to de novo cardiac resynchronization therapy at 1-year follow-up. Results from a Chagas disease cohort

Melo¹,

Carvalho²,

Viana³

et al. 2020

Preprint

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Introduction: Cardiac resynchronization therapy (CRT) improves outcomes in heart failure (HF) patients with left bundle branch block (LBBB). However, the benefits of CRT in patients with previous pacing are uncertain, specially in a population witch Chagas disease is a prevalent cause of HF. Methods and Results: Prospective cohort study that included HF patients indicated for CRT with left ventricular ejection fraction (LVEF) of less than 35%. Clinical and demographic data were collected to investigate mortality predictors after 1 year. The overall survival was calculated by the Kaplan-Meier method and multivariate analysis using Cox's regression model was performed. Between May 2017 and September 2019, 93 patients were evaluated with a mean follow-up of 1,0 (0.6) year. Of these, 22 (23,7%) were upgraded from right ventricular pacing. Chagas Disease was the most prevalent cause of HF 29 (31,2%). In overall patients, LVEF at 6 months increased after CRT: 24,0% (7,8) to 30,3% (11,5), p=0.007, and there was no significant difference between upgraded patients and de Novo CRT, p=0.26. Overall mortality at 1-year was 28 (30,1%). In the univariate analysis, Chagas disease and upgraded therapy were associated with mortality at follow-up, HR: 3.9, CI: 1.8-8,4, p = 0.001 and HR: 4.7, CI: 2.2-9.9, p < 0.001, respectively. In the multivariate model, only upgraded therapy remained independently associated with the outcome, adjusted HR: 2.9, CI: 1.2-7,2, p = 0.02. Conclusion: In this specific HF population, with a high prevalence of Chagas disease cardiomyopathy, upgraded therapy was independently associated with worsened 1-year survival after CRT.

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Upgrading right ventricular pacemakers to biventricular pacing or conduction system pacing: a systematic review and meta-analysis

et al. 2022

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Guidelines recommend patients undergoing a first pacemaker implant who have even mild left ventricular (LV) impairment should receive biventricular or conduction system pacing (CSP). There is no corresponding recommendation for patients who already have a pacemaker. We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies assessing device upgrades. The primary outcome was the echocardiographic change in LV ejection fraction (LVEF). Six RCTs (randomizing 161 patients) and 47 observational studies (2644 patients) assessing the efficacy of upgrade to biventricular pacing were eligible for analysis. Eight observational studies recruiting 217 patients of CSP upgrade were also eligible. Fourteen additional studies contributed data on complications (25 412 patients). Randomized controlled trials of biventricular pacing upgrade showed LVEF improvement of +8.4% from 35.5% and observational studies: +8.4% from 25.7%. Observational studies of left bundle branch area pacing upgrade showed +11.1% improvement from 39.0% and observational studies of His bundle pacing upgrade showed +12.7% improvement from 36.0%. New York Heart Association class decreased by −0.4, −0.8, −1.0, and −1.2, respectively. Randomized controlled trials of biventricular upgrade found improvement in Minnesota Heart Failure Score (−6.9 points) and peak oxygen uptake (+1.1 mL/kg/min). This was also seen in observational studies of biventricular upgrades (−19.67 points and +2.63 mL/kg/min, respectively). In studies of the biventricular upgrade, complication rates averaged 2% for pneumothorax, 1.4% for tamponade, and 3.7% for infection over 24 months of mean follow-up. Lead-related complications occurred in 3.3% of biventricular upgrades and 1.8% of CSP upgrades. Randomized controlled trials show significant physiological and symptomatic benefits of upgrading pacemakers to biventricular pacing. Observational studies show similar effects between biventricular pacing upgrade and CSP upgrade.

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Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy

Cited by 5 publications

References 36 publications

Upgrade is independently associated with short-term mortality after cardiac resynchronization therapy.

Upgrade is independently associated with short-term mortality after cardiac resynchronization therapy.

Heart failure patients with prior right ventricular pacing upgraded to resynchronization therapy had a worse prognosis compared to de novo cardiac resynchronization therapy at 1-year follow-up. Results from a Chagas disease cohort

Upgrading right ventricular pacemakers to biventricular pacing or conduction system pacing: a systematic review and meta-analysis

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