Arrhythmic and mortality outcomes in patients with dilated cardiomyopathy receiving cardiac resynchronization therapy
Mohammed Samy1, Rehab M Hamdy2
1Cardiology Department, Faculty of Medicine (For Boys), Al-Azhar University, Cairo, 11765, Egypt.
Insights
Cardiac resynchronization therapy without defibrillators (CRT-P) improved outcomes in dilated cardiomyopathy patients who responded to the therapy. This approach may reduce costs and complications, enhancing survival and reducing ventricular arrhythmias.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- The routine implantation of cardiac resynchronization therapy with defibrillators (CRT-D) is under consideration for patients with dilated cardiomyopathy (DCM).
- Evaluating the necessity of defibrillator capabilities in CRT for DCM patients is crucial.
Purpose of the Study:
- To investigate arrhythmic and mortality outcomes after CRT implantation in DCM patients.
- To assess the need for defibrillator capabilities in this specific patient group.
Main Methods:
- A study included 67 patients with DCM, reduced ejection fraction (EF ≤ 35%), prolonged QRS duration (>130 msec), and NYHA class II-IV, or those with pacing indications.
- Patients received CRT with pacing (CRT-P) and were assessed for response based on clinical and echocardiographic improvements over 36 months.
- Outcomes included ventricular arrhythmias, all-cause mortality, and overall morbidity.
Main Results:
- CRT responders showed significant improvements in NYHA class, left ventricular ejection fraction (LVEF), and left ventricular end-systolic volume (LVESV) compared to non-responders.
- Responders experienced significantly lower rates of ventricular arrhythmia, mortality, and all-cause morbidity.
- A survival advantage was observed in responders, linked to clinical and echocardiographic CRT response over 36 months.
Conclusions:
- CRT-P implantation without defibrillation backup is a promising option for DCM patients, especially responders.
- This approach may lead to cost savings, fewer complications, and improved outcomes, including reduced ventricular arrhythmias and enhanced survival.
Introduction:
The routine implantation of cardiac resynchronization therapy with defibrillators in all patients who are candidates for this treatment is now being negotiated, mainly in patients with dilated cardiomyopathy.
Objective:
We investigated the arrhythmic and mortality outcomes following CRT implantation in DCM, as well as the necessity for defibrillator capabilities in that particular group of patients.
Methods:
we included 67- patients with DCM with EF ≤ 35%, QRS duration >130 msec and NYHA class II-IV, or those with EF ≤ 35% with indications of permanent pacing for implantation of CRT-P. Patients were followed to obtain good CRT response. Improved clinical outcomes were defined as improvement in at least one NYHA class, ≥5% increase in LVEF, and ≥15% reduction in left ventricular end-systolic volume versus baseline. Patients were classified into responder and non-responder. Patients were followed for 36 months regarding all-cause morbidity mainly ventricular tachycardia and all-cause mortality.
Results:
CRT responder patients had better clinical outcomes than CRT non-responder patients (post NYHA, 1.3 ± 0.5 vs. 2.5 ± 0.6, p < 0.0001; post LVEF 30.0 ± 1.6 vs. 20.3 ± 2.2%, p < 0.0001; LVESV, 151.7 ± 7.6 vs. 190.4 ± 9.0 ml, p < 0.0001), with lower ventricular arrhythmia (p < 0.0001), lower mortality (p = 0.015) and lower all-cause morbidity (p < 0.001). This survival advantage may be related to the response to CRT response determined by clinical and echocardiographic parameters over a 36-month period of follow-up.
Conclusions:
Our findings suggest that CRT-P implantation without defibrillation backup is an encouraging treatment option for patients with DCM, principally those who responded to it. It may result in cost savings, a decrease in complications, and an improvement in all-cause morbidity, particularly ventricular arrhythmia and survival.
Related Concept Videos
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:25Dysrhythmias VI: Management of Dysrhythmias
01:25Dysrhythmias VII: Nursing Management of Dysrhythmias
01:29Cardiomyopathy V: Interprofessional Care
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy
01:28Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...