Long-term outcome of cardiac resynchronization therapy in patients with severe congestive heart failure

Cardiac resynchronization therapy (CRT) has recently been shown to be an effective short-term therapy for patients with drug-refractory heart failure and intraventricular conduction delay. Little is known about the long-term effects of this therapy.

To determine the long-term outcome of all consecutive patients who underwent CRT at two Canadian centres, and to determine what baseline variables predict a response to CRT.

The present study comprised a total of 85 patients (mean age 66+/-9 years; 88% male) with New York Heart Association class II (4%), class III (84%) or class IV (12%) heart failure. All patients fulfilled the standard CRT indications with a QRS duration of 168+/-22 ms and a nuclear gated ejection fraction (EF) of 21+/-6%. Eighteen of the 85 patients were implanted with a combination automatic implantable cardioverter-defibrillator and CRT device. Within a mean clinical follow-up of 3.0+/-1.0 years, 26 of the 85 patients died, and eight patients underwent cardiac transplantation, with four transplant-related deaths (mean survival 3.53+/-0.26 years). Ten patients died of sudden cardiac death, eight patients died of progressive heart failure and eight patients died of noncardiac causes. None of the baseline factors (age, sex, EF, etiology, New York Heart Association class, QRS duration or implantable cardioverter-defibrillator) or indexes of CRT (change in EF or QRS duration) were predictive of a poor outcome. There was a clear trend for patients with a greater left ventricular EF gain to have a better outcome (P=0.1). The present observational data represent one of the longest follow-up databases of patients undergoing CRT. The significant morbidity and mortality found after CRT highlight the severity of the underlying cardiac pathology and concurrent illnesses.