Hottigoudar RU


            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
              &lt;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.
            
          </jats:sec

Rakesh Gopinathannair

Henri Roukoz

Adarsh Bhan

Ashwin Ravichandran

Mustafa M. Ahmed

Dmitry Familtsev

Geetha Bhat

Jennifer Cowger

Munazzah Abdullah

Chirag Sandesara

Rahul Dhawan

Emma J. Birks

Jaimin R. Trivedi

Mark S. Slaughter

Crossref

Journal of the American Heart Association

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Abstract

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