The outcomes of cardiac resychronization therapy in University Hospital Centre Split

    Authors

    Abstract

    **Introduction**: Cardiac resynchronization therapy (CRT) is standard for heart failure patients with low left ventricular ejection fraction (LVEF ≤35%) and QRS duration ≥130ms despite optimal medical treatment (1). **Patients and Methods**: This is a retrospective study that involved patients with implanted biventricular heart electrostimulators with (CRT-D) or without (CRT-P) defibrillator functions since 2011 to April 2018. The goal was to assess the CRT efficiency during check-ups after 6 months. **Results**: Including 40 patients, 23 men and 17 women of an average age of 66.3 years. There were 4 (10%) patients with ischemic cardiomyopathy (IDCM), while 36 (90%) of the non-ischemic cardiomyopathy (NIDCM) had equal gender distribution. The average width of the QRS was 160 ms, and 75% of patients presented with typical Strauss left bundle branch block (LBBB). At the time of implantation, 6 (15%) patients had atrial fibrillation. The average LVEF value was 28%, and their NYHA status was III. CRT-D was implanted in all patients with IDCM. CRT-P was implanted in 19 and CRT-D in 17 patients with NIDCM. In 36 (85%) patients, there was an improvement of LVEF of which 11 (all with NIDCM, sinus rhythm and typical LBBB) achieved almost normal heart function (LVEF ≥50%) with regression of LV volume. There was no improvement in NYHA status with 5 (12.5%) patients, and with 6 (15%) there was deterioration or there was no improvement in LVEF. Four (10%) patients were hospitalized for acute heart failure. The average LVEF was 45.4% and the NYHA status was I/II. Sudden deaths or syncope in CRT-P patients were absent, while appropriate and necessary treatment of tachyarrhythmia occurred in 3 patients with CRT-D. Lethal outcomes were with 3 patients (one non-cardiac and two non-sudden cardiac deaths). **Conclusion**: Targeted patient selection with proper left ventricular lead implantation and optimal device programming improves the response rate to resynchronization therapy.

    Keywords

    heart failure, cariomyopathy, cardiac resynchronization therapy

    DOI

    https://doi.org/10.15836/ccar2018.328

    Literature

    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129–200. https://doi.org/10.1093/eurheartj/ehw128
    Cardiologia Croatica
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    The outcomes of cardiac resychronization therapy in University Hospital Centre Split

    Extended Abstract
    Issue11-12
    Published
    Pages328
    PDF via DOIhttps://doi.org/10.15836/ccar2018.328
    heart failure
    cariomyopathy
    cardiac resynchronization therapy

    Authors

    Ivo BožićORCIDKlinički bolnički centar Split, Split, Hrvatska
    Zrinka Jurišić*ORCIDKlinički bolnički centar Split, Split, Hrvatska
    Josip KedžoORCIDKlinički bolnički centar Split, Split, Hrvatska
    Ante AnićORCIDKlinički bolnički centar Split, Split, Hrvatska
    Toni BreškovićORCIDKlinički bolnički centar Split, Split, Hrvatska
    Marina Jurić PaićORCIDKlinički bolnički centar Split, Split, Hrvatska
    Ivan PletikosićORCIDKlinički bolnički centar Split, Split, Hrvatska

    *Correspondence email: zrinkacn@gmail.com

    Abstract

    **Introduction**: Cardiac resynchronization therapy (CRT) is standard for heart failure patients with low left ventricular ejection fraction (LVEF ≤35%) and QRS duration ≥130ms despite optimal medical treatment (1). **Patients and Methods**: This is a retrospective study that involved patients with implanted biventricular heart electrostimulators with (CRT-D) or without (CRT-P) defibrillator functions since 2011 to April 2018. The goal was to assess the CRT efficiency during check-ups after 6 months. **Results**: Including 40 patients, 23 men and 17 women of an average age of 66.3 years. There were 4 (10%) patients with ischemic cardiomyopathy (IDCM), while 36 (90%) of the non-ischemic cardiomyopathy (NIDCM) had equal gender distribution. The average width of the QRS was 160 ms, and 75% of patients presented with typical Strauss left bundle branch block (LBBB). At the time of implantation, 6 (15%) patients had atrial fibrillation. The average LVEF value was 28%, and their NYHA status was III. CRT-D was implanted in all patients with IDCM. CRT-P was implanted in 19 and CRT-D in 17 patients with NIDCM. In 36 (85%) patients, there was an improvement of LVEF of which 11 (all with NIDCM, sinus rhythm and typical LBBB) achieved almost normal heart function (LVEF ≥50%) with regression of LV volume. There was no improvement in NYHA status with 5 (12.5%) patients, and with 6 (15%) there was deterioration or there was no improvement in LVEF. Four (10%) patients were hospitalized for acute heart failure. The average LVEF was 45.4% and the NYHA status was I/II. Sudden deaths or syncope in CRT-P patients were absent, while appropriate and necessary treatment of tachyarrhythmia occurred in 3 patients with CRT-D. Lethal outcomes were with 3 patients (one non-cardiac and two non-sudden cardiac deaths). **Conclusion**: Targeted patient selection with proper left ventricular lead implantation and optimal device programming improves the response rate to resynchronization therapy.

    Literature

    1. 1.
      Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129–200.DOI