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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
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Cardiac resynchronization therapy: in responders, do defibrillation matters?
Session:
Posters 1 - Écran 3 - Arritmologia
Speaker:
Fernando Montenegro Sá
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Fernando Montenegro Sá; João Gonçalves Almeida; Paulo Fonseca; Marco André Oliveira; Helena Gonçalves; Filipa Rosas; José Ribeiro; Elisabeth Santos; João Primo; Pedro Braga
Abstract
<p><strong>Introduction: </strong>Regarding device therapy for primary prevention heart failure (HF) patients (and particularly in non-ischemic cardiomyopathy - NICM), there is no consensus if cardiac resynchronization therapy-defibrillation (CRT-D) is superior to CRT-pacing (CRT-P). After successful resynchronization, responders often improve cardiac function to levels in which defibrillation would no longer be recommended.</p> <p><strong>Aim: </strong>We aim to determine the impact of device choice on survival of CRT responders, in primary prevention NICM patients.</p> <p><strong>Methods: </strong>We retrospectively analyzed 127 consecutive NICM patients referred for primary prevention CRT implantation between 2007 and 2016, selecting those who were classified as responders to CRT: both 1 year improvement in ≥ 1 NYHA functional class and left ventricle ejection fraction (LVEF) improvement by 25% from baseline to an absolute value ≥35%. Device indication was governed by current European Society of Cardiology guidelines and decision between CRT-P and CRT-D was based on clinical judgment. All included patients (n=96) were evaluated with device interrogation and transthoracic echo every 6 months during a mean follow-up time of 54.6±32.2 months. Patients were stratified according to the device implanted, and to compare survival a Kaplan-Meier curve with log rank test was performed. In order to determine if CRT-D increased survival, we used a Cox-regression survival analysis to determine all independent mortality predictors, including device type and all baseline clinical, echo and electrocardiographic data.</p> <p><strong>Results: </strong>The included population presented a mean age at implant of 66.1±9.7 years and 86.1% (n=83) males. A CRT-D was implanted in 60 (62.5%) patients. Device therapies occurred in 21.7% (n=13): 10 patients had only antitachycardia pacing therapies and 3 had also defibrillation therapies, with all events first occurring during the first cycle of device battery life. Mean baseline LVEF was 26.3±5.8%. Regarding baseline differences between groups, CRT-P patients were older (73.6±6.2 vs. 61.6±8.6 years, p<0.01), had more hypertension (86.1% vs. 52.5%, p=0.001), chronic pulmonary (30.6% vs. 13.3%, p=0.04) and renal disease (36.1% vs. 16.7%, p=0.04). Death occurred in 9 patients (10.2%), with 4 in the CRT-P and 5 in the CRT-D group. Kaplan-Meier analysis showed no differences in mortality between CRT type (figure). On multivariate analysis (table), CRT-D (p=0.82) was not a survival independent predictor.</p> <p><strong>Conclusion: </strong>Our study shows that CRT responders have no long-term survival benefit with the addition of defibrillation therapies. This may raise cost-management questions regarding which CRT type should be chosen when replacing devices in primary prevention NICM responders.</p>
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