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Cardiovascular disease (CVD) continues to be the primary cause of mortality and morbidity globally with middle-aged women presenting with additional and possibly, overlooked risk factors.1 Despite several awareness programmes, there remain several gaps in the political education and representation needs of this group, which includes those from low socioeconomic status (SES) and culturally diverse backgrounds. These […]

46/Predictors and clinical outcomes in patients undergoing cardiac resynchronization therapy (CRT) versus CRT upgrade in a real-world tertiary centre

C Sohrabi (Presenting Author) - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; N Papageorgiou - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; JSC Del Mundo - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; N Aziminia - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; M Finlay - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; A Creta - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; PD Lambiase - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; S Ahsan - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; P Moore - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; M Dhinoja - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; S Sporton - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; MJ Earley - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; RJ Schilling - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; C Hayward - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; R Providência - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; R Hunter - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; AW Chow - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London; A Muthumala - Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London
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Published Online: Oct 3rd 2011 European Journal of Arrhythmia & Electrophysiology. 2021;7(Suppl. 1):abstr46
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Article

Introduction: The role of pre-implant and intra-procedural parameters on mortality and hospitalisation for heart failure (HHF) in patients undergoing implantation with cardiac resynchronization therapy pacemaker (CRT-P) or defibrillator (CRT-D) versus CRT upgrade is poorly defined. In the present study we aimed to evaluate mortality predictors and clinical outcomes in patients undergoing CRT-P/D versus CRT upgrade.

Methods: This was a single-centre retrospective study of nine-hundred and thirty-three (933) patients receiving de novo implantation of CRT-P/D or CRT upgrade between 2016-2020: CRT-P (n=264), CRT-D (n=448), and CRT upgrade (n=221). The mean left ventricular ejection fraction was 34.9 ± 12.8 and median follow-up was 29.0 (17-41) months.

Results: We found that recipients of CRT-D were significantly younger (68.0 ± 11.9) than CRT-P (76.2 ± 10.8) and upgrade (71.8 ± 14.0; p<0.001) and had a higher uptake of oral anticoagulants (p=0.001) and aldosterone antagonists (p<0.001). CRT-P recipients were more likely to have baseline atrial fibrillation (AF; p<0.001). Overall mortality was significantly higher in upgrade (14.1%) and CRT-P (12.9%) patients versus those receiving CRT-D (8.7%) (p=0.039). On multivariate analysis, chronic kidney disease (CKD) and anaemia predicted both mortality (OR: 3.5 [2.1-5.9; 95% CI] p<0.001, and OR: 1.8 [1.1-3.2; 95% CI] p=0.024, respectively) and HHF (OR: 3.8 [1.6-9.2; 95% CI] p=0.003, and OR: 2.9 [1.3-6.6, 95% CI] p=0.012, respectively). In addition, the presence of diabetes mellitus predicted HHF (OR: 2.2 [1.0-4.7; 95% CI] p=0.047), while AF was associated with a higher likelihood of mortality as compared to patients in sinus rhythm (13.6% vs. 10.1%; p=0.045). In patients with CRT-D, use of a bipolar lead was associated with a significantly higher rate of mortality (16.7% vs. 10.7%; p=0.024) and HHF (8.0% vs. 4.0%; p=0.011) compared with use of a multipolar lead.

Conclusion: Our results showed that mortality is higher in patients receiving CRT upgrade or CRT-P as compared to CRT-D recipients. In addition, CKD, anaemia, diabetes mellitus, and presence of AF are associated with either higher mortality or HHF or both. The use of bipolar leads in patients with CRT-D was associated with poorer clinical outcomes compared to use of multipolar leads.

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