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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
[Quality of life in patients after anti-arrhythmic devices implantation]
Maria Lełakowska-Piela1, Joanna Pudło2, Anna Rydlewska2
1Jagiellonian University of Cracow, School of Medicine, Department of Electrocardiology, Institute of Cardiology, Poland.
Insights
Cardiac resynchronization therapy (CRTD) significantly improves quality of life and heart function in advanced heart failure patients. Implantable cardioverter-defibrillators (ICD) showed no significant improvements. Co-morbidities negatively impact outcomes.
Area of Science:
- Cardiology
- Medical Devices
- Quality of Life Research
Background:
- Advanced heart failure significantly impacts patient quality of life.
- Implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy devices (CRTD) are used to manage heart failure.
- Assessing the impact of these devices on quality of life is crucial for patient management.
Purpose of the Study:
- To evaluate changes in quality of life for advanced heart failure patients post-ICD or CRTD implantation.
- To compare the effectiveness of CRTD versus ICD in improving quality of life and cardiac function.
- To identify factors influencing quality of life outcomes after device implantation.
Main Methods:
- A prospective study involving 98 advanced heart failure patients undergoing ICD or CRTD implantation.
- Quality of life was assessed using SF-36 and DASI questionnaires before and 6 months after implantation.
- NYHA class, ejection fraction, and co-morbidities were analyzed.
Main Results:
- CRTD implantation led to significant improvements in quality of life, NYHA class, and ejection fraction.
- ICD implantation did not result in significant improvements in these parameters.
- Device interventions (cardioversions) and co-morbidities like permanent atrial fibrillation and kidney failure negatively impacted quality of life scores.
Conclusions:
- CRTD is effective in improving quality of life and cardiac function in advanced heart failure.
- ICD implantation alone does not significantly enhance quality of life or ejection fraction.
- Patient co-morbidities and device-related adverse events are significant predictors of poorer quality of life outcomes.
The Aim Of Study:
To assess changes in quality of life in patients with advanced heart failure before ICD or CRTD implantation and after 6 months follow-up period.
Material And Methods:
The quality of life study was performed in group consisting of 98 patients (69 male, mean age 70.4 +/- 8.60 years), who underwent CRTD implantation (48 patients, 33 male, mean age 70.6 +/- 9.12 years) or ICD implantation (50 patients, 36 male, mean age 70.3 +/- 8.16 years) before the procedure and after 6 months of follow-up. Inclusion criteria were as follows: patients with indications to ICD or CRTD implantation, complete quality of life questionnaires before the procedure and after 6 months follow-up, lack of diagnosed dementia. The quality of life assessment was performed using patient's self-assessment with SF-36 and DASI questionnaires. Patients' self-assessment, NYHA class and ejection fraction was compared before the implantation and after 6 months. Additionally, co-morbidities and experiencing of high voltage therapy were analyzed.
Results:
In the whole group after 6 months NYHA class improved from mean 2.9 +/- 0.5 to 2.3 +/- 0.84, p < 0.001; in CRTD group from mean 3.0 +/- 0.62 to 2.3 +/- 0.95, p < 0.001; in ICD group from mean 2.9 +/- 0.35 to 2.2 +/- 0.74, p < 0.001. In the whole group after 6 months ejection fraction improved from mean 27.7 +/- 6.92 to 31.0 +/- 7.23%, p < 0.001; in CRTD group from mean 25.3 +/- 7.85 to 32.4 +/- 8.98%, p < 0.001; in ICD group there was no significant improvement of ejection fraction. After CRTD implantation improvement of quality of life was achieved in SF36 and DASI questionnaires. There was no significant improvement in ICD group. DASI index is deteriorated by device's interventions (cardioversions) (regression index=3.45, odds ratio OR = 31.5, 95% confidence interval OR = 8.2-121, p < 0.001) and presence of permanent atrial fibrillation (regression index = 1,243, odds ratio OR = 3.45, 95% confidence interval OR = 1.03-11.7, p < 0.042). SF36 index is deteriorated by presence of kidney failure (regression index = 1.91, odds ratio OR = 6.74, 95% confidence interval OR = 1.75-26, p < 0.005) and permanent atrial fibrillation (regression index = 2.27, odds ratio OR = 9.7, 95% confidence interval OR = 3.1-29.6, p < 0.001).
Conclusions:
Cardiac resynchronization therapy (CRTD) improves quality of life, NYHA class and left ventricle ejection fraction. Implantable cardioverter-defibrillator (ICD) does not significantly improve quality of life, NYHA class or left ventricle ejection fraction. Only in the CRTD group a significant positive correlation between changes in DASI and SF36 indexes and left ventricle ejection fraction was achieved. Experiencing cardioversion/defibrillation from implantable device and co morbidities (diabetes mellitus, arterial hypertension, kidney failure, permanent atrial fibrillation) significantly deteriorate patients' self assessment of quality of life.
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