Comparison of de novo implantation vs. upgrade cardiac resynchronisation therapy: a multicentre experience

Abstract

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.

Keywords:

• CRT upgrade
• cardiac resynchronisation therapy
• de novo CRT
• heart failure

Author contributions

Study concept and design: Emkanjoo, Eslami. Analysis and interpretation of data: Teimouri-jervekani. Drafting of the manuscript: Zandi. Critical revision of the manuscript for important intellectual content: Emkanjoo, Kamali. Data collection: Zandi, Alizadeh, Kamali, Eslami, Taherpour, Mollazadeh, Haghjoo, Fazelifar, Madadi, Emkanjoo. Approval of the final draft: Zandi, Alizadeh, Kamali, Eslami, Taherpour, Mollazadeh, Haghjoo, Fazelifar, Madadi, Hosseini Selki Sar, Emkanjoo.

Disclosure statement

The authors declare that there is no conflict of interest.