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When to implant CRT-P or CRT-D in the elderly?
Session:
Painel 5 - Arritmologia 8
Speaker:
Inês Ricardo
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Inês Aguiar Ricardo; Afonso Nunes Ferreira; Tiago Graça Rodrigues; Pedro Silvério António; Joana Rigueira; Rafael Santos; Nelson P. Cunha; Pedro Morais; Sara Couto Pereira; Igor Santos; Ana Bernardes; Andreia Magalhães; Helena Neves; Fausto José Pinto; João Rodrigues De Sousa; Pedro Nuno Carlos Marques
Abstract
<p><u>Introduction</u>:</p> <p>Cardiac resynchronization therapy (CRT) in elder patients is increasingly common. However, the decision to implant a device with defibrillator in these patients is often complex and it can be limited not only by the shorter life expectancy but also by a lower relative risk of arrhythmic compare to non-arrhythmic death due to other comorbidities. Thus, wether CRT is effective in an elderly population (≥75 years old), or if a defibrillator (CRT-D versus CRT-P) influences outcomes is a pivotal concern needing additional data.</p> <p> </p> <p><u>Purpose</u>:<br /> To compare the prognostic impact of CRT-P vs CRT-D in old patients (≥ 75 years old) and its impact in the response rate to CRT.</p> <p> </p> <p><u>Methods</u>:</p> <p>A prospective single-center study was conducted of patients indicated for <s>a</s> CRT implant since 2015. Demographic and clinical criteria were evaluated. Transthoracic echocardiography was performed before CRT implant and between 6-12 months post-implant. Patients with an ejection fraction (EF) elevation ≥ 10% or a LV end-systolic volume (ESV) reduction ≥ 15% were classified as responders. Patients with EF elevation ≥ 20% or LV ESV reduction ≥ 30% were classified as super-responders. Time to surgical revision and mortality were evaluated using the Cox regression and Kaplan-Meier methods. The decision to implant a CRT-P or CRT-D device was made according to clinical decision. Prognostic impact of CRT-P vs CRT-D was evaluated by comparing total mortality using the Cox regression and Kaplan-Meier methods.</p> <p> </p> <p><u>Results</u>:</p> <p>From 2015-2019, 566 CRTs were implanted (26.1% female, follow-up duration 18.9±15.8 months). Among these patients, 53.5% had < 75 years old and 46.5% ≥ 75 years. Baseline clinical characteristics were similar, except for a higher prevalence of chronic kidney disease and atrial fibrillation in the elderly population. The proportion of CRT-D/CRT-P was different between these groups (p<0.001): in the elderly group, more CRT-P were implanted (67.6% vs 32.4 CRT-D) and in the younger group more CRT-D were implanted (77.9% vs 22.1% CRT-P). </p> <p>The prevalence of complications due to CRT implant was similar in the two groups (4.7% vs 4.2%, p=NS) but the need for surgical revision was less frequent in the elderly group (11.0% vs 5.7%, p=0.03). The CRT response rate was equivalent in both groups (40.1% vs 59.9%, p=NS), as was the super-response rate (33% in young vs 26.5% in old patients, p=NS).</p> <p>In the elderly population, the 4-year survival rate was similar between CRT-P and CRT-D patients (75.4% vs 79.8%).</p> <p> </p> <p><u>Conclusion</u>:</p> <p>Patients older than 75 years old have similar benefits from the CRT as patients < 75 years, with equivalent response rates to CRT. However, judging from the similar prognostic impact of CRT-P vs CRT-D in this elder population, the implant of a defibrillator should be personalized.</p>
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