Biventricular pacemaker and defibrillator implantation in patients with chronic heart failure in China

Area of Science:

• Cardiology
• Medical Devices
• Public Health

Background:

• Chronic heart failure (CHF) poses a significant risk for sudden cardiac death (SCD).
• Biventricular pacing, including cardiac resynchronization therapy (CRT), is a key intervention for eligible CHF patients.
• Understanding the real-world outcomes of CRT devices in China is crucial for clinical practice.

Purpose of the Study:

• To assess the current implantation status of biventricular pacemakers and defibrillators in Chinese CHF patients.
• To evaluate the impact of CRT-pacemaker (CRT-P) and CRT-defibrillator (CRT-D) on the clinical prognosis of CHF patients.
• To compare the rates of all-cause death and SCD between CRT-P and CRT-D recipients.

Main Methods:

• A multicentric prospective cohort study (POSCD-China) enrolled 798 patients receiving implantable cardioverter defibrillators, CRT-D, or CRT-P.
• Patients were followed for a mean of 27.7 months.
• Primary endpoint was all-cause death; secondary endpoint was SCD.

Main Results:

• Non-ischaemic CHF was the predominant aetiology (71.3%).
• Heart failure was the leading cause of death (68.4%), followed by SCD (22.2%).
• The SCD rate was significantly higher in the CRT-P group (8.0%) compared to CRT-D (3.3%) and implantable cardioverter defibrillator (2.0%) groups. No significant difference in all-cause mortality was found between CRT-D and CRT-P groups.

Conclusions:

• In China, CRT-D implantation is associated with a lower SCD rate than CRT-P in CHF patients indicated for primary SCD prevention.
• Heart failure remains the primary cause of mortality in these patients.
• While CRT-D offers an advantage in SCD reduction, overall mortality does not differ significantly between CRT-D and CRT-P.