Key result
Pacemaker upgrades to CRT link to greater EF and NYHA improvements than ICD upgrades.
Why the study?
International guidelines recommend CRT upgrade for patients with pacemakers or ICDs using identical criteria, raising the question of whether one population benefits more than the other.
Does upgrade to CRT from a pacemaker improve ejection fraction and NYHA class more than upgrade from an ICD in patients with chronic right ventricle pacing-induced cardiomyopathy?
Cohort (n=151)
Yes
Does upgrade to CRT from a pacemaker improve ejection fraction and NYHA class more than upgrade from an ICD in patients with chronic right ventricle pacing-induced cardiomyopathy?
Patients upgraded to CRT from a pacemaker show a significantly greater improvement in ejection fraction compared to those upgraded from an ICD.
May support preferring pacemaker-origin CRT upgrades for EF/NYHA gains; hypothesis-generating and should not yet change practice.
Background: This is a comparative analysis of upgrade to cardiac resynchronisation therapy (CRT) of an existing pacemaker implanted for bradyarrhythmia or an implantable cardioverter defibrillator (ICD). International guidelines recommend an upgrade to CRT for both groups based on the same criteria; this may lead to a hypothesis of whether we are under-treating a population that would otherwise benefit more from a CRT than the other. Methods: So far, this is the largest multicentre retrospective study that includes in total, 151 (93 upgrades to CRT-P and 58 upgrades to CRT-D) participants who had an upgrade to a CRT device between January 2010 and January 2020. Clinical and echocardiographic parameters were analysed both, before and after an upgrade to CRT. Results: EF was greater in patients with PPM, both before and after upgrade. Moreover, the post upgrade increase in EF was significantly greater in patients with PPM. Patients with ICD have, on average, an NYHA class ranking greater than PPM patients, both before and after upgrade. Conclusions: These data show that the PPM group patients have a greater response to upgrade to CRT compared to those from the ICD group. It also demonstrates that patients with non-ischaemic cardiomyopathy are better responders compared to those with ischaemic aetiology.
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Farhangee et al. (2023) conducted a cohort in Chronic right ventricle pacing-induced cardiomyopathy (n=151). Upgrade to CRT from pacemaker (PPM) vs. Upgrade to CRT from ICD was evaluated on Change in ejection fraction (EF) and NYHA class. Patients upgraded to CRT from a pacemaker had a significantly greater increase in ejection fraction and better NYHA class response compared to those upgraded from an ICD.
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