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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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07. Syncope and Bradycardia
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32. Cardiovascular Nursing
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Natural history of resynchronized patients: experience of a single centre
Session:
Painel 5- Arritmologia 4
Speaker:
Tamara Pereira
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.5 Device Complications and Lead Extraction
Session Type:
Posters
FP Number:
---
Authors:
Tamara Pereira; Bebiana Faria; Pedro Von Hafe Leite; Geraldo Dias; Ana Filipa Cardoso; Filipa Cordeiro; Francisco Castro Ferreira; Vítor Sanfins; António Lourenço
Abstract
<p><strong>Background: </strong>Cardiac resynchronization therapy (CRT) is associated with reduced mortality, morbidity and improved quality of life in patients with low ejection fraction and left bundle brunch block.</p> <p><strong>Methods</strong>: Retrospective, single- centre study of 143 patients undergoing CRT implantation according to the current guideline indications, between 2013 and 2017. We assessed clinical events and ‘lead related events’, in order to compare the outcomes of patients with CRT according to the type of left ventricular lead: transvenous and epicardial lead. The primary endpoint was the rehospitalization caused by heart failure (HF) and the composite endpoint was the rehospitalization and death for any cause. The mean follow-up was 43 ±18 months.</p> <p><strong>Results: </strong>From the 143 patients (mean age 67.5 ± 10.8 years, 69.9% males, 41% ischemic) undergoing CRT implantation, 95 received transvenous coronary sinus lead and 48 epicardial leads (EPL).</p> <p>Patients with EPL were more frequently male (82% vs 64%, p=0.032) and diabetics (63% vs 37%, p=0.006). There were no significant differences in age, QRS duration, left ventricular ejection fraction (LVEF) or telediastolic left ventricular volumes between the groups.</p> <p>The number of days of hospitalization was higher in epicardial lead group comparing with transvenous (9.9 days ± 6.2 vs 6.4 ± 7.9, p= 0.008). Regarding complications related to the lead implant, an early revision of the lead (<6 month) was nedded in 14.3% of transvenous group ( 42.9% right atrium, 14.3% right ventricle, 14.3% both, 25% left ventricle) and only 2.2% needed reintervention in EPL group (p=0.037).</p> <p>During follow-up, there were no significant differences in the mortality and HF decompensated hospitalization between transvenous and EPL patients (18.4% vs 26.7%; 31.6% vs 28.9%, respectively). However, patients in transvenous group died more often due to cardiovascular cause than EPL (77.8% vs 33.3%, p=0.015).</p> <p> </p> <p><strong>Conclusion: </strong>This study demonstrated a statistically significant difference in lead related complications between the two groups. There was a higher need of lead revisions in transvenous group. There were no significant differences in the mortality and hospitalization due to HF rate between the two groups.</p> <p>Our data shows that EPL is safe and has a very low complication rate. In our experience this approach is a good alternative when transvenous implantation fails.</p>
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