Pacemaker Versus Defibrillator Therapy in Patients Eligible for Cardiac Resynchronisation Therapy: Evidence from the...

Area of Science:

• Cardiology
• Medical Devices
• Clinical Research

Background:

• Cardiac resynchronization therapy (CRT) is guideline-recommended for heart failure patients with reduced ejection fraction and left bundle branch block.
• The choice between CRT with a pacemaker (CRT-P) and CRT with a defibrillator (CRT-D) is debated, with registry data suggesting higher mortality with CRT-P.
• This study investigates the clinical factors influencing CRT-P vs. CRT-D selection and their comparative outcomes in a real-world setting.

Purpose of the Study:

• To identify clinical determinants for selecting CRT-P versus CRT-D in patients eligible for CRT.
• To compare the one-year clinical outcomes of CRT-P and CRT-D therapies using large, multi-center registry data.

Main Methods:

• Analysis of the German Device Registry (DEVICE), a prospective, nationwide registry of 5451 patients with device implantations.
• Focus on 1603 patients who received cardiac resynchronization therapy, comparing CRT-P (n=67) and CRT-D (n=1536) groups.
• One-year follow-up data were used to assess mortality and clinical characteristics.

Main Results:

• The majority of CRT patients (95.8%) received CRT-D. CRT-P patients had better baseline left ventricular systolic function and less history of myocardial infarction.
• Preexisting pacemakers and history of stroke/peripheral embolism were key determinants for CRT-P selection.
• Overall one-year mortality was 8.0%. In ischemic cardiomyopathy, CRT-P was associated with significantly higher mortality (21.2%) than CRT-D (8.9%). No significant difference was observed in non-ischemic cardiomyopathy.

Conclusions:

• Most patients undergoing CRT receive a CRT-D system.
• CRT-P is more frequently selected for patients with non-ischemic cardiomyopathy and those with a prior pacemaker.
• Treatment outcomes differ significantly between CRT-P and CRT-D, particularly in patients with ischemic cardiomyopathy, where CRT-D appears superior.