21. Cardiac Resynchronization Therapy: Implanting & Clinical Aspects

Cardiac resynchronization therapy (CRT) has become one of the main therapeutic alternatives for advanced congestive heart failure (CHF), but the effects on morbidity and mortality are still unclear. Aim of the Study was to analyze hospitalization rate and mortality - total mortality (TM) and cardiac mortality (CM) - in a wide patient population implanted in our institution in the last six years. Methods since 1999, 187 pts (158 male) underwent CRT for severe CHF (EF 26.3% ± 6.9). In 82 pts a backup ICD was associated. The mean age was 71.1 ± 8.8 years (range 36 to 92); 103 pts (53%) had ischemic heart disease (IHD) while 84 were non ischemic (NIHD); 36 pts were in atrial fibrillation at the time of implant; 46 were previously paced via the right ventricular apex; 16 were candidates for heart transplantation. All the pts were evaluated in our clinic and the follow-up was scheduled every three month for the first year and then twice a year. Results the implant success rate was 98.9%. The mean follow-up was 29±16 months (range 1 – 74 months). Compared to the year before CRT, a significant decrease in hospitalization rate was observed during the first year of follow-up (2.38±1.6 vs. 0.56±0.7, p<.001). TM was 10.7%, CM was 8.0 %. The ICD group shows a reduction of TM compared to the group without: 7.3% vs. 13.3%: - 46 %. TM was also evaluated at implant, 6 months and steps of 1 year as follow: ![Graphic][1] In the group of IHD vs. NIHD, TM was 11.6% % vs. 9.5% and CM was 10.7% vs. 4.7% respectively. The main causes of death in IHD were heart failure (8 pts) and sudden death (3 pts). In NIHD 3 pts died from cancer and 1 due to acute abdomen. Conclusions 1) the benefit of CRT is similar in IHD and NIHD; 2) IHD seems to have a worse prognosis than NIHD in term of TM and CM; 3) CRT decreases the hospitalization rate and increases survival; 4) the association with a back-up ICD strongly reduces the mortality in this population. [1]: /embed/graphic-1.gif