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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

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

Role of cardiac resynchronization in end-stage heart failure patients requiring inotrope therapy

Sanjoy Bhattacharya1, Kaleab Abebe, Marc Simon

  • 1Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Journal of Cardiac Failure
|November 30, 2010
PubMed

Insights

Heart failure patients needing inotropes before cardiac resynchronization therapy (CRT) have worse survival. Weaning inotropes before CRT may improve outcomes for these advanced heart failure patients.

Area of Science:

  • Cardiology
  • Heart Failure Management
  • Medical Devices

Background:

  • Outcomes for heart failure (HF) patients on inotropes undergoing cardiac resynchronization therapy (CRT) are not well-defined.
  • Patients requiring intravenous inotropes at the time of CRT implantation present a specific challenge.

Purpose of the Study:

  • To characterize survival outcomes in HF patients receiving CRT based on their inotrope use.
  • To compare outcomes between CRT recipients and a standard defibrillator group.

Main Methods:

  • Analysis of 759 CRT-defibrillator recipients categorized by inotrope use: never on inotropes (NI), weaned before implant (PI), or on inotropes at implant (II).
  • Comparison with a standard defibrillator (SD) group (n=94).
  • Propensity score analysis to adjust for baseline differences and comparison of survival endpoints using the Social Security Death Index.

Main Results:

  • Inotrope-dependent patients (II) had more comorbidities and significantly shorter survival than inotrope-naïve (NI) patients.
  • After propensity score adjustment, overall survival differences persisted, with a significant pairwise difference between NI and II groups at 12 months.
  • Patients ever on inotropes (PI, II) and SD patients requiring inotropes had similar survival.

Conclusions:

  • Inotrope-dependent HF patients have worse survival despite CRT, partly due to comorbidities.
  • CRT may not offer a survival advantage over standard defibrillators for patients previously on inotropes.
  • Pre-CRT inotrope weaning and initiation of neurohormonal antagonists are crucial goals for inotrope-dependent HF patients.
Abstract

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