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CRT implantation in patients with borderline criteria – is it worth it?
Session:
Painel 5 - Arritmologia 6
Speaker:
Alexandra Briosa
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:
Alexandra Briosa; Ana Rita F. Pereira; João Grade Santos; Daniel Sebaiti; Ana I. Marques; Sofia Alegria; Rita Miranda; Sofia Almeida; Luis Brandão; Helder Pereira
Abstract
<p><strong><em>Introduction:</em></strong> The ESC guidelines support the implantation of Cardiac Ressynchronization Therapy (CRT) in symptomatic patients (pts) with heart failure (HF) with reduced left ventricle ejection fraction (LVEF), left bundle branch block (LBBB) and wide QRS. However, the implantation of CRT in certain pts with only borderline criteria is a reality.</p> <p><strong><em>Aim:</em></strong> To characterize patients (pts) who underwent CRT implantation, identify those who did not meet implantation criteria and analyze their performance over time. </p> <p><strong><em>Methods:</em></strong> A retrospective single center study was performed in order to analyze pts submitted to CRT implantation in the last 7 years (2012-2019). Clinical and imaging data were collected, as well as long term outcomes (hospitalization, mortality and response. Pts who did not meet guidelines criteria were considered as having only borderline criteria (LVEF>35% and QRS<130). Responders were defined as pts who improved >=1 NYHA class or/and > 10%LVEF</p> <p><strong><em>Results:</em></strong></p> <p>We analyzed a total of 130 pts, 65% males with a mean age of 71±11 years, with optimized medical treatment. </p> <p>Non-ischemic cardiomyopathy was present in 77% of pts. 70% pts had QRS >150 and 79% pts had complete LBBB. The mean LVEF was 28±7,5%, mean left ventricular end-diastolic volume index (LVEDVI) was 125±116 ml/m2 and mean VTI LVOT was 14±5cm. Most of pts were NYHA class 3.</p> <p>By the time of CRT implantation, 23% pts did not meet the full implantation criteria defined by guidelines. Those had mean LVEF of 38±4,2%, mean QRS of 129±2.8 and NYHA class 2.9 ± 0.6. Despite not meeting those criteria, they were considered for CRT implantation as they were highly symptomatic despite optimized medical therapy.</p> <p>After implantation, 68,8% were considered responders, subsequent hospitalizations occurred in 25,4%, and 20 pts died. </p> <p>When analyzing the subpopulation of pts with only borderline criteria we found no differences in what concerns gender, previous medical history or HF etiology. Before implantation, they had higher NYHA class (2,70±0,6 vs 2,45±0,6 p=0,004) and but higher VTI LVOT (17,3±4,4 cm vs 3,6±4,9 cm p=0,018). Mostly CRT-P were implanted (72,4% vs 45% p=0,009), requiring shorter time of fluoroscopy (11± 7 min vs 17±12 min, p=0,009).</p> <p>In what concerns overall outcomes, they had a higher rate of failure of the target pacing site (10,3% vs 1.1% p=,014), had more hospital admissions (44,8% vs 20% p=0.007), specially HF admissions (37.9% vs 13.1% p=0.003), and were considered less responders (46,4% vs 75% p=0.004). No differences were found in what concerns mortality due to HF and overall survival (log rank: 0,791, p=0.37).</p> <p><strong><em>Conclusion:</em></strong> CRT therapy has proven to be very effective in improving morbimortality in pts with severe congestive HF. Specific criteria were determined to identify the best candidates. Implantation of CRT in pts with borderline criteria is not harmless, being associated with worse response and more hospital admissions. </p>
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