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

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Left ventricular reverse remodeling, device-related adverse events, and long-term outcome after cardiac

Ulas Höke1, Hein Putter1, Enno T Van Der Velde1

  • 1From the Departments of Cardiology (U.H., E.T.V.D.V., M.J.S., V.D., J.J.B., N.A.M.) and Medical Statistics and Bioinformatics (H.P.), Leiden University Medical Center, Leiden, The Netherlands; and Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands (U.H.).

Circulation. Cardiovascular Quality and Outcomes
|May 15, 2014
PubMed

Insights

Cardiac resynchronization therapy (CRT) shows similar efficacy and safety in elderly patients compared to younger ones. However, elderly individuals face higher long-term mortality, primarily from noncardiac causes, after four years.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Medical Devices

Background:

  • Limited data exist on cardiac resynchronization therapy (CRT) efficacy, safety, and long-term outcomes in elderly populations.
  • This study addresses the need for comprehensive evaluation of CRT in patients aged 75 years and older.

Purpose of the Study:

  • To evaluate the efficacy, safety, and long-term prognosis of CRT in elderly patients (≥75 years).
  • To compare outcomes between elderly and nonelderly CRT recipients.

Main Methods:

  • A cohort of 798 CRT recipients was analyzed, including 208 elderly and 590 nonelderly patients.
  • Clinical and echocardiographic data were collected at baseline and 6-month follow-up.
  • Long-term adverse events and all-cause mortality were assessed over a median follow-up of 38.6 months.

Main Results:

  • Elderly patients demonstrated comparable improvements in clinical symptoms, left ventricular function, and reverse remodeling to nonelderly patients.
  • Rates of device-related adverse events (in-hospital, early, and long-term) were similar between the groups.
  • While long-term survival was lower in the elderly, significant differences in mortality emerged after 4 years, with noncardiac causes predominating.

Conclusions:

  • CRT is effective and safe for elderly patients, with outcomes comparable to younger individuals in the short to medium term.
  • Long-term survival in elderly CRT recipients is reduced, mainly due to noncardiac conditions.
  • Diabetes mellitus, impaired renal function, and reduced 6-minute walk distance are independent predictors of mortality in elderly patients post-CRT.
Abstract

Keywords:
agedcardiac resynchronization therapyheart failureprognosis

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