Multicenter prospective observational long-term follow-up study of endocardial cardiac resynchronization therapy
Benjamin Elencwajg1, Néstor López-Cabanillas1, Avi Fischer1
1Presidente Perón Hospital, Buenos Aires, Argentina; Seventh Day Adventist Clinic, Buenos Aires, Argentina; Santa Isabel Clinic, Buenos Aires, Argentina.
Insights
Endocardial cardiac resynchronization therapy (eCRT) using the Jurdham procedure shows long-term effectiveness and safety in patients with heart failure, particularly those on anticoagulation or who failed other CRT methods.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Endocardial cardiac resynchronization therapy (eCRT) offers an alternative to coronary sinus (CS) based CRT.
- Long-term outcome data for eCRT are limited, necessitating further investigation.
Purpose of the Study:
- To evaluate the long-term outcomes of eCRT performed with the Jurdham procedure in a real-world clinical setting.
- To assess the efficacy and safety of eCRT in patients with specific indications, including CRT failure and need for anticoagulation.
Main Methods:
- The Jurdham procedure for eCRT was performed in 88 patients across 15 centers from August 2009 to March 2018.
- Long-term follow-up assessed New York Heart Association functional class (NYHA FC), left ventricular ejection fraction (LVEF), and stimulation parameters.
Main Results:
- Significant improvement in NYHA FC from 2.9 to 1.3 was observed during follow-up.
- 82% of patients experienced an increase in LVEF of over 20 percentage points.
- All-cause mortality at 60 months was 30.5%; stroke incidence was 3.06 per 100 patient-years, with good recovery in most cases.
Conclusions:
- eCRT via the Jurdham procedure is effective and safe for anticoagulated patients.
- This technique is a viable option for patients with failed CS implants or CRT non-responders.
- eCRT may be considered a primary treatment for patients requiring lifelong oral anticoagulation.
Background:
Endocardial cardiac resynchronization therapy (eCRT) avoids the limitations and failures of coronary sinus (CS) resynchronization. However, data regarding long-term outcomes are lacking.
Objective:
The purpose of this study was to report the long-term outcome of eCRT performed using the Jurdham procedure in a real-world setting.
Methods:
eCRT was performed in patients who failed a CS implant or failed to respond to cardiac resynchronization therapy (CRT), or in selected patients requiring lifelong oral anticoagulation (OAC). Left ventricular ejection fraction (LVEF), New York Heart Association functional class (NYHA FC), and left ventricular stimulation parameters were assessed during long-term follow-up (FU).
Results:
From August 2009 to March 2018, the Jurdham procedure was performed in 88 patients at 15 centers in 8 countries, with FU of 32.88 ± 61.52 months (range 0-88 months; 196 patient-years). NYHA FC improved from 2.9 preimplant to 1.3 during FU. LVEF increased <10 percentage points from baseline in 7% of patients, between 10 and 20 percentage points in 11% of patients, and >20 percentage points in 82% of patients. All-cause mortality at 60 months was 30.5%. Three transient ischemic attacks (1.53 per 100 patient-years) and 6 strokes (3.06 per 100 patient-years) occurred. Of the 6 patients with stroke, 4 (66%) had almost complete recovery.
Conclusion:
eCRT using the Jurdham procedure is an effective and safe technique in anticoagulated patients. This approach may be an attractive option for patients with failed CS implants or nonresponders to CS CRT. In addition, it might be a reasonable approach as a first option for treatment of patients requiring lifelong OAC.
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