Key result
Continued CRT in CF-LVAD recipients lacks survival benefit over ICD alone but increases generator changes.
Why the study?
Many patients with heart failure continue cardiac resynchronization therapy after continuous flow left ventricular assist device implantation, but its impact on clinical outcomes was unknown.
Does continued CRT-D improve survival, hospitalizations, or ventricular arrhythmia incidence compared to ICD alone in patients with a CF-LVAD?
Cohort (n=488)
Yes
Does continued CRT-D improve survival, hospitalizations, or ventricular arrhythmia incidence compared to ICD alone in patients with a CF-LVAD?
p-value: p=0.16
Continued CRT after CF-LVAD implantation does not improve clinical outcomes but increases the need for pulse generator replacements compared to ICD alone.
Does not support routine CRT continuation in CF-LVAD recipients; hypothesis-generating and warrants prospective RCTs before practice change.
Background Many patients with heart failure continue cardiac resynchronization therapy ( CRT ) after continuous flow left ventricular assist device ( CF ‐ LVAD ) implant. We report the first multicenter study to assess the impact of CRT on clinical outcomes in CF ‐ LVAD patients. Methods and Results Analysis was performed on 488 patients (58±13 years, 81% male) with an implantable cardioverter defibrillator ( ICD ) (n=223) or CRT ‐D (n=265) who underwent CF ‐ LVAD implantation at 5 centers from 2007 to 2015. Effects of CRT on mortality, hospitalizations, and ventricular arrhythmia incidence were compared against CF ‐ LVAD patients with an ICD alone. Baseline differences were noted between the 2 groups in age (60±12 versus 55±14, P <0.001) and QRS duration (159±29 versus 126±34, P =0.001). Median biventricular pacing in the CRT group was 96%. During a median follow‐up of 478 days, Kaplan–Meier analysis showed no difference in survival between groups (log rank P =0.28). Multivariate Cox regression demonstrated no survival benefit with type of device ( ICD versus CRT ‐D; P =0.16), whereas use of amiodarone was associated with increased mortality (hazard ratio 1.77, 95% confidence interval 1.1–2.8, P =0.01). No differences were noted between CRT and ICD groups in all‐cause ( P =0.06) and heart failure ( P =0.9) hospitalizations, ventricular arrhythmia incidence (43% versus 39%, P =0.3), or ICD shocks (35% versus 29%, P =0.2). During follow‐up, 69 (26%) patients underwent pulse generator replacement in the CRT ‐D group compared with 36 (15.5%) in the ICD group ( P =0.003). Conclusions In this large, multicenter CF ‐ LVAD cohort, continued CRT was not associated with improved survival, hospitalizations, incidence of ventricular arrhythmia and ICD therapies, and was related to a significantly higher number of pulse generator changes.
No takes yet. Share an insight, caveat, or question.
Gopinathannair et al. (2018) conducted a cohort in Heart failure with continuous flow left ventricular assist device (CF-LVAD) (n=488). Cardiac resynchronization therapy (CRT-D) vs. ICD alone was evaluated on Survival (p=0.16). Continued cardiac resynchronization therapy in CF-LVAD recipients was not associated with improved survival compared to ICD alone (P=0.16), but led to significantly more pulse generator changes.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: