Heart failure patients with previous right ventricular pacing upgraded to CRT had a lower risk of death or HF hospitalization than those without previous RVp (HR 0.67; 95% CI 0.51-0.89; P=0.005).
Observational (n=655)
Does cardiac resynchronization therapy yield different echocardiographic and clinical outcomes in heart failure patients with previous right ventricular pacing compared to those without?
Heart failure patients with previous right ventricular pacing upgraded to CRT show greater echocardiographic improvement and a lower risk of death or HF hospitalization compared to CRT patients without previous RV pacing.
Effect estimate: HR 0.67 (95% CI 0.51-0.89)
p-value: p=0.005
AIMS: Right ventricular pacing (RVp) results in an electrocardiographic left bundle branch block pattern and can lead to heart failure. This study aimed to evaluate echocardiographic and clinical outcomes of heart failure patients with RVp upgraded to cardiac resynchronization therapy (CRT), as they are frequently excluded from multicentre studies. METHODS AND RESULTS: This observational study assessed 655 consecutive patients with QRS ≥120 ms and left ventricular ejection fraction ≤35%. There were 465 patients without significant previous RVp and 190 with RVp >40%. Echocardiograms were analysed pre-CRT and ∼ 1 year post-CRT. Death and heart failure hospitalizations were analysed using Cox regression, adjusted for baseline characteristics. The RVp patients had smaller end-systolic volume (P = 0.002), were older (P < 0.001), and had more atrial fibrillation (P < 0.001) pre-CRT. Ejection fraction and proportion of ischaemic aetiology were similar. One year following CRT implantation the ejection fraction response was greater in the RVp group (8.3 ± 9 vs. 5.8 ± 9 units, P = 0.005). The RVp patients had an adjusted 33% lower risk of death or heart failure hospitalization hazard ratio (HR) 0.67 95% confidence interval (CI) 0.51-0.89, P = 0.005, while tending to have an adjusted lower risk of death (HR 0.73 95% CI 0.53-1.01, P = 0.055). CONCLUSION: Despite similar ejection fraction pre-CRT, patients upgraded to CRT with previous RVp have smaller end-systolic volume and respond to CRT at least as well as, if not better than, other wide QRS heart failure patients. A greater improvement in ejection fraction and a lower risk of death or heart failure hospitalization when adjusted for baseline characteristics were seen in those with previous RVp.
Gage et al. (Thu,) conducted a observational in Heart failure (n=655). Cardiac resynchronization therapy (CRT) upgrade with previous RVp >40% vs. CRT without significant previous RVp was evaluated on Death or heart failure hospitalization (HR 0.67, 95% CI 0.51-0.89, p=0.005). Heart failure patients with previous right ventricular pacing upgraded to CRT had a lower risk of death or HF hospitalization than those without previous RVp (HR 0.67; 95% CI 0.51-0.89; P=0.005).