Comparison of de novo implantation vs. upgrade cardiac resynchronisation therapy: a multicentre experience
Zahra Zandi1, Masoud Eslami2, Farzad Kamali1
1Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Insights
Upgrading patients with heart failure to cardiac resynchronisation therapy (CRT) is safe and effective. This procedure improves functional class and left ventricular function, similar to new CRT implants.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Clinical outcomes of cardiac resynchronisation therapy (CRT) upgrades versus de novo implantations are not well-defined.
- Heart failure management strategies require evaluation of different therapeutic approaches.
Purpose of the Study:
- To compare the clinical and procedural consequences of CRT upgrade versus de novo implantation in heart failure patients.
- To assess the safety and efficacy of upgrading existing implantable cardioverter-defibrillator (ICD) systems to CRT.
Main Methods:
- Prospective cohort study comparing two groups: de novo CRT implantation and upgrade from ICD to CRT.
- Inclusion criteria: NYHA class II-IV, LVEF ≤35%, QRS >130ms.
- Outcomes assessed included procedural success, clinical outcomes, echocardiography parameters, and complications.
Main Results:
- Procedural success rates were 95.9% for CRT upgrade and 100% for de novo implantation.
- Both groups showed significant improvements in LVEF, mitral regurgitation, and NYHA class, with no significant difference between groups.
- No significant differences in procedural complications or cardiac death rates were observed between the upgrade and de novo groups.
Conclusions:
- Upgrading to CRT is a safe and effective procedure for heart failure patients.
- The procedure leads to significant improvements in functional class and left ventricular function.
- Post-procedural outcomes are comparable between CRT upgrades and de novo implantations.
Background:
The clinical safety and consequences of upgrade procedures compared with de novo cardiac resynchronisation therapy (CRT) implantation in heart failure remain unclear. The present study aimed to assess clinical and procedural consequences of patients undergoing CRT upgrade as compared to de novo CRT implantations.
Methods:
In this prospective cohort study, two subgroups were considered as the study population as (1) de novo group that CRT was considered on optimised medical treatment with heart failure of NYHA functional class from II to IV, left ventricular ejection fraction (LVEF) of ≤35%, and QRS width of >130 ms and (2) upgrade group including the patients with previously implantable cardioverter defibrillator (ICD) with the indications for upgrading to CRT. The two groups were compared regarding the changes in clinical outcome and echocardiography parameters.
Results:
The procedure was successful in 95.9% of patients who underwent CRT upgrade and 100% of those who underwent de novo CRT implantation. It showed a significant improvement in LVEF, severity of mitral regurgitation and NYHA functional classification, without any difference between the two study groups. Overall procedural related complications were reported in 10.8% and 3.8% (p = .093) and cardiac death in 5.4% and 2.5% (p = .360), respectively, with no overall difference in postoperative outcome between the two groups.
Conclusions:
Upgrading to CRT is a safe and effective procedure regarding improvement of functional class, left ventricular function status and post-procedural outcome.
