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Updated: Jun 25, 2026
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
Long-term outcomes of CRT-PM versus CRT-D recipients
Giuseppe Stabile1, Francesco Solimene, Emanuele Bertaglia
1Clinica Mediterranea, Napoli, Italy. gmrstabile@tin.it
Insights
Cardiac resynchronization therapy with a defibrillator (CRT-D) or pacemaker (CRT-PM) showed no difference in overall mortality. However, CRT-D devices were more effective in reducing sudden cardiac death rates.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure.
- CRT devices include pacemakers (CRT-PM) and defibrillators (CRT-D).
Purpose of the Study:
- To compare all-cause mortality rates between CRT-PM and CRT-D recipients.
- To identify predictors of mortality in patients receiving CRT.
Main Methods:
- A cohort study of 233 patients implanted with CRT-PM or CRT-D between 1999 and 2004.
- Cox regression analysis was used to determine predictors of death.
- Patients had advanced heart failure (NYHA class II-IV) and reduced ejection fraction.
Main Results:
- No significant difference in overall mortality was observed between CRT-PM and CRT-D groups over a mean follow-up of 58 months.
- CRT-D devices were associated with a lower rate of sudden cardiac death.
- Male sex, NYHA functional class IV, and atrial fibrillation were significant predictors of mortality.
Conclusions:
- Long-term survival rates are similar for patients receiving CRT-D versus CRT-PM.
- CRT-D may offer a survival benefit by reducing sudden cardiac death.
- Identifying high-risk patients (male, NYHA IV, atrial fibrillation) is crucial for prognosis.
Objective:
To compare the rates of all-cause mortality in recipients of cardiac resynchronization therapy devices without (CRT-PM) versus with defibrillator (CRT-D).
Methods:
Between February 1999 and July 2004, 233 patients (mean age = 69 +/- 8 years, 180 men) underwent implantation of CRT-PM or CRT-D devices. New York Heart Association (NYHA) heart failure functional class II was present in 11%, class III in 69%, and class IV in 20% of patients; mean left ventricle ejection fraction (LVEF) was 26.5 +/- 6.5 %, 48% presented with idiopathic dilated cardiomyopathy and 49% with ischemic heart disease. Cox multiple variable regression analysis was performed in search of predictors of death.
Results:
The clinical characteristics of the 117 CRT-PM and 116 CRT-D recipients were similar, except for LVEF (28.2 +/- 6.2% vs 25.0 +/- 6.5%, respectively; P < 0.001), and ischemic versus nonischemic etiology of heart failure (41% vs 56%, respectively P = 0.02). Over a mean follow-up of 58 +/- 15 months, no significance difference in overall mortality rate was observed between the two study groups. Male sex, NYHA functional class IV, and atrial fibrillation at implant were significant predictors of death.
Conclusions:
There was no difference in long-term survival rate among patients with CRT-D versus CRT-PM, although CRT-D more effectively lowered the sudden death rate. Male sex, NYHA functional class IV, and atrial fibrillation predicted the worst prognosis.
