Cardiac resynchronization therapy pacemaker or cardiac resynchronization therapy defibrillator: what determines the choice?-findings from the ESC CRT Survey II
Camilla Normand1,2, Cecilia Linde3, Nigussie Bogale1
1Cardiology Division, Stavanger University Hospital, Stavanger, Norway.
Insights
Choosing between cardiac resynchronization therapy pacemakers (CRT-P) and defibrillators (CRT-D) is complex. Patients receiving CRT-P often have specific characteristics like advanced age, female gender, and more severe heart failure symptoms.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Research
Background:
- Deciding between CRT-P and CRT-D is challenging due to a lack of comparative randomized studies.
- No clear guidelines exist for selecting CRT-P versus CRT-D.
- The CRT Survey II investigated factors influencing this clinical decision.
Purpose of the Study:
- To identify patient and implantation center characteristics associated with CRT-P versus CRT-D selection.
- To understand the real-world practice patterns in CRT device implantation.
- To provide insights into the decision-making process for CRT device choice.
Main Methods:
- Analysis of clinical practice data from 10,692 patients undergoing CRT implantation.
- Data collected across 42 ESC countries between October 2015 and January 2017.
- Comparison of patient demographics and clinical factors between CRT-P and CRT-D recipients.
Main Results:
- 70% of patients received CRT-D, while 30% received CRT-P.
- Factors favoring CRT-P included age >75, female gender, non-ischemic HF, NYHA Class III/IV, LVEF >25%, atrial fibrillation, and AV block.
- Significant international variations in CRT-P versus CRT-D proportions were observed.
Conclusions:
- Patients receiving CRT-P often present with more symptomatic heart failure and comorbidities.
- Specific patient phenotypes are associated with CRT-P selection.
- Country-level differences highlight the need for further research into optimal CRT device selection criteria.
Aims:
The decision to implant a cardiac resynchronization therapy pacemaker (CRT-P) or a cardiac resynchronization therapy defibrillator (CRT-D) may be challenging. There are no clear guideline recommendations as no randomized study of cardiac resynchronization therapy (CRT) has been designed to compare the effects of CRT-P with those of CRT-D on patients' outcomes. In the CRT Survey II, we studied patient and implantation centre characteristics associated with the choice of CRT-P vs. CRT-D.
Methods And Results:
Clinical practice data from 10 692 patients undergoing CRT implantation of whom 7467 (70%) patients received a CRT-D and 3225 (30%) received a CRT-P across 42 ESC countries were collected and analysed between October 2015 and January 2017. Factors favouring the selection of CRT-P implantation included age >75 years, female gender, non-ischaemic heart failure (HF) aetiology, New York Heart Association functional Class III/IV symptoms, left ventricular ejection fraction >25%, atrial fibrillation, atrioventricular (AV) block II/III, and implantation in a university hospital.
Conclusion:
In a large cohort from the CRT Survey II, we found that patients allocated to receive CRT-P exhibited particular phenotypes with more symptomatic HF, more frequent comorbidities, advanced age, female gender, non-ischaemic HF aetiology, atrial fibrillation, and evidence of AV block. There were substantial differences in the proportion of patients allocated to receive CRT-P vs. CRT-D between countries.
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