Key result
Upgrade cardiac resynchronization therapy in patients with pacing-induced cardiomyopathy resulted in significantly greater reduction in left ventricular end-systolic volume (46.2%) compared to de novo (18.1%) or non-PiCM upgrade CRT (9.4%).
Why the study?
Does upgrade CRT improve electro-mechanical reverse remodeling compared to de novo CRT or non-PiCM upgrade CRT in patients with pacing-induced cardiomyopathy?
Observational (n=77)
No
Does upgrade CRT improve electro-mechanical reverse remodeling compared to de novo CRT or non-PiCM upgrade CRT in patients with pacing-induced cardiomyopathy?
Absolute Event Rate: 46.2% vs 18.1%
p-value: p=0.022
Upgrade CRT for pacing-induced cardiomyopathy yields significantly greater electro-mechanical reverse remodeling and higher super-responder rates compared to de novo CRT or upgrade CRT for non-pacing-induced cardiomyopathy.
Supports upgrade CRT preference in pacing-induced cardiomyopathy; extends observational data but leaves open randomized confirmation.
PURPOSE: This study aimed to determine whether upgrade cardiac resynchronization therapy (CRT) shows better outcomes than de novo CRT. To do so, we compared the efficacy of CRT between de novo and upgrade groups, focusing particularly on the effect of upgrade CRT on patients with pacing-induced cardiomyopathy (PiCM). MATERIALS AND METHODS: PiCM was defined as new-onset dilated cardiomyopathy following pacemaker implantation in patients with baseline normal ejection fraction ≥50%. Electro-mechanical reverse remodeling and clinical outcomes were compared among the de novo (n=62), PiCM upgrade (n=7), and non-PiCM upgrade (n=8) CRT groups. RESULTS: The PiCM upgrade group showed significantly greater electro-mechanical reverse remodeling than the de novo CRT or non-PiCM upgrade groups at 6-month follow-up. The rate of super-responders was significantly higher in the PiCM upgrade group than the other CRT groups. The group factor of the PiCM upgrade was identified as an independent predictor of super-responder in multivariate analysis (odds ratio 10.4, 95% confidential interval 1.08-99.4, p=0.043). During the median follow-up of 15.8 months, the PiCM upgrade group showed the lowest rate of composite clinical outcomes, including cardiac death, heart transplantation, and heart failure-related rehospitalization (p=0.059). CONCLUSION: The upgrade CRT for PiCM patients showed better performance in terms of electro-mechanical reverse remodeling than de novo implantation or upgrade CRT in non-PiCM patients.
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Gwag et al. (2017) conducted an observational in Advanced heart failure with pacing-induced cardiomyopathy (n=77). Upgrade cardiac resynchronization therapy for pacing-induced cardiomyopathy vs. De novo CRT or non-PiCM upgrade CRT was evaluated on Percent reduction in left ventricular end-systolic volume (LVESV) at 6 months (p=0.022). Upgrade cardiac resynchronization therapy in patients with pacing-induced cardiomyopathy resulted in significantly greater reduction in left ventricular end-systolic volume (46.2%) compared to de novo (18.1%) or non-PiCM upgrade CRT (9.4%).
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