Key result
Selection of CRT-P (30%) over CRT-D (70%) was favored by age >75 years, female gender, non-ischaemic heart failure, NYHA class III/IV, LVEF >25%, atrial fibrillation, and AV block.
Why the study?
The decision to implant a CRT-P vs. CRT-D is challenging, and guidelines lack clear recommendations because no randomized trial has compared their effects on patient outcomes.
What patient and center characteristics determine the choice between CRT-P and CRT-D in patients undergoing CRT implantation?
Observational (n=10,692)
Yes
What patient and center characteristics determine the choice between CRT-P and CRT-D in patients undergoing CRT implantation?
Absolute Event Rate: 30% vs 70%
The choice of CRT-P over CRT-D in clinical practice is driven by specific patient phenotypes including advanced age, female gender, non-ischaemic aetiology, and more symptomatic HF, with significant regional variation.
Patient phenotypes shape real-world CRT-P vs CRT-D selection; leaves open effects on outcomes in prospective data.
AIMS: The decision to implant a cardiac resynchronization therapy pacemaker (CRT-P) or a cardiac resynchronization therapy defibrillator (CRT-D) may be challenging. There are no clear guideline recommendations as no randomized study of cardiac resynchronization therapy (CRT) has been designed to compare the effects of CRT-P with those of CRT-D on patients' outcomes. In the CRT Survey II, we studied patient and implantation centre characteristics associated with the choice of CRT-P vs. CRT-D. METHODS AND RESULTS: Clinical practice data from 10 692 patients undergoing CRT implantation of whom 7467 (70%) patients received a CRT-D and 3225 (30%) received a CRT-P across 42 ESC countries were collected and analysed between October 2015 and January 2017. Factors favouring the selection of CRT-P implantation included age >75 years, female gender, non-ischaemic heart failure (HF) aetiology, New York Heart Association functional Class III/IV symptoms, left ventricular ejection fraction >25%, atrial fibrillation, atrioventricular (AV) block II/III, and implantation in a university hospital. CONCLUSION: In a large cohort from the CRT Survey II, we found that patients allocated to receive CRT-P exhibited particular phenotypes with more symptomatic HF, more frequent comorbidities, advanced age, female gender, non-ischaemic HF aetiology, atrial fibrillation, and evidence of AV block. There were substantial differences in the proportion of patients allocated to receive CRT-P vs. CRT-D between countries.
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Normand et al. (2019) conducted an observational in Heart failure requiring cardiac resynchronization therapy (n=10,692). Cardiac resynchronization therapy pacemaker (CRT-P) vs. Cardiac resynchronization therapy defibrillator (CRT-D) was evaluated on Choice of CRT-P vs. CRT-D. Selection of CRT-P (30%) over CRT-D (70%) was favored by age >75 years, female gender, non-ischaemic heart failure, NYHA class III/IV, LVEF >25%, atrial fibrillation, and AV block.