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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Cardiac resynchronisation therapy in patients with end-stage heart failure--long-term follow-up
Anna Faran1, Ewa Lewicka-Nowak, Alicja Dabrowska-Kugacka
1Klinika Kardiologii i Elektroterapii Serca, Akademia Medyczna, ul. Debinki 7, 80-210 Gdańsk. anfar@wp.pl
Insights
Cardiac resynchronisation therapy (CRT) offers sustained benefits for end-stage heart failure patients, improving NYHA class and quality of life. This therapy also enhances long-term survival rates, demonstrating progressive clinical improvements over two years.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Devices
Background:
- Cardiac resynchronisation therapy (CRT) is established for end-stage heart failure (HF).
- Long-term efficacy of CRT requires further validation.
Purpose of the Study:
- To evaluate the sustained benefits of CRT in end-stage HF patients.
- To identify predictors of CRT response.
Main Methods:
- 28 end-stage HF patients received biventricular devices (BiV).
- Evaluated NYHA class, QoL, QRS duration, 6-minute walking distance, and hospitalisation rates.
- Compared outcomes with a control group of 29 patients over 2 years.
Main Results:
- Significant improvements in NYHA class and walking distance sustained up to 24 months.
- Quality of life improvements were maintained over 2 years.
- CRT group showed significantly better 1- and 2-year survival rates compared to controls.
Conclusions:
- Clinical improvements from CRT are progressive and sustained for at least 2 years.
- Baseline NYHA class was the sole predictor of clinical improvement.
Background:
Cardiac resynchronisation therapy (CRT) has been shown to be effective in the treatment of patients with end-stage heart failure (HF). However, long-term results of CRT have not yet been validated.
Aim:
To assess the sustained benefit of CRT in patients with end-stage HF at long-term follow-up. In addition, predictors of response to CRT were analysed.
Methods:
Twenty-eight patients with end-stage HF, NYHA class >or=III (>or=II in patients with indications for ICD and echocardiographic signs of ventricular mechanical systolic dyssynchrony), left ventricular ejection fraction <35%, QRS duration >120 ms and left bundle branch block morphology received a biventricular device (BiV). In 27 patients LV pacing was achieved via the coronary sinus tributaries and in 1 patient an endocardial LV lead was introduced transseptally. Ten patients received an ICD-CRT device. The control group consisted of 29 patients fulfilling the criteria for ICD-CRT implantation in whom the CRT system was not implanted for various reasons. At baseline, 3 months after implantation, and then every 6 months the following parameters were evaluated: NYHA class, quality of life (QoL) score, QRS duration on surface ECG, and 6-minute walking distance. The need for hospitalisation assessed one year before and one year after implantation was compared. Follow-up was obtained up to 2 years.
Results:
The NYHA class and 6-minute walking test were significantly improved in the CRT group after 3 months and continued to improve gradually until 24 months of follow-up. The QoL improvement at 6 months was sustained over 2 years. Hospitalisation rate due to worsening of HF decreased. One-year and two-year survival were significantly better in the CRT group than in the control group (94 and 87 vs. 80 and 73% respectively). The only predictor of clinical improvement after CRT implantation was baseline NYHA class.
Conclusion:
Clinical improvements with CRT are progressive and sustained over 2 years of follow-up.
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