Key result
CRT upgrade shows similar echocardiographic gains and complication rates compared to de novo implantation.
Why the study?
The clinical safety and consequences of upgrade procedures compared with de novo CRT implantation in heart failure remain unclear.
Does cardiac resynchronisation therapy (CRT) upgrade from a previous ICD have comparable clinical and procedural outcomes to de novo CRT implantation in patients with heart failure?
Cohort
Yes
Does cardiac resynchronisation therapy (CRT) upgrade from a previous ICD have comparable clinical and procedural outcomes to de novo CRT implantation in patients with heart failure?
Absolute Event Rate: 10.8% vs 3.8%
p-value: p=.093
Upgrading to CRT from an existing ICD is as safe and effective as de novo CRT implantation, providing comparable improvements in left ventricular function and functional status without a significant increase in complications.
CRT upgrades show comparable safety and efficacy to de novo; supports observational use but leaves open need for RCTs.
Background The clinical safety and consequences of upgrade procedures compared with de novo cardiac resynchronisation therapy (CRT) implantation in heart failure remain unclear. The present study aimed to assess clinical and procedural consequences of patients undergoing CRT upgrade as compared to de novo CRT implantations.Methods In this prospective cohort study, two subgroups were considered as the study population as (1) de novo group that CRT was considered on optimised medical treatment with heart failure of NYHA functional class from II to IV, left ventricular ejection fraction (LVEF) of ≤35%, and QRS width of >130 ms and (2) upgrade group including the patients with previously implantable cardioverter defibrillator (ICD) with the indications for upgrading to CRT. The two groups were compared regarding the changes in clinical outcome and echocardiography parameters.Results The procedure was successful in 95.9% of patients who underwent CRT upgrade and 100% of those who underwent de novo CRT implantation. It showed a significant improvement in LVEF, severity of mitral regurgitation and NYHA functional classification, without any difference between the two study groups. Overall procedural related complications were reported in 10.8% and 3.8% (p = .093) and cardiac death in 5.4% and 2.5% (p = .360), respectively, with no overall difference in postoperative outcome between the two groups.Conclusions Upgrading to CRT is a safe and effective procedure regarding improvement of functional class, left ventricular function status and post-procedural outcome.
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Zandi et al. (2023) conducted a cohort in Heart failure. CRT upgrade vs. De novo CRT implantation was evaluated on Overall procedural related complications (p=.093). Upgrading to CRT was associated with a 10.8% procedural complication rate compared with 3.8% for de novo CRT implantation (p=0.093), and resulted in similar functional and echocardiographic improvements.
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