PhD Scientific Days 2021

Budapest, 7-8 July 2021

CL_I_P: Clinical Medicine I. Posters

Pacemaker Upgrade to Cardiac Resynchronization Therapy-Defibrillator or Cardiac Resynchronization Therapy-Pacemaker Without Prior Ventricular Arrhythmias: a Long-term Single-centre Retrospective Analysis

1 Walter Richard Schwertner MD, Heart and Vascular Centre, Semmelweis University, Budapest
2 Márton Tokodi MD, Heart and Vascular Centre, Semmelweis University, Budapest
3 Anett Behon MD, Heart and Vascular Centre, Semmelweis University, Budapest
4 Eperke Dóra Merkel MD, Heart and Vascular Centre, Semmelweis University, Budapest
5 Boglárka Veres MD, Heart and Vascular Centre, Semmelweis University, Budapest
6 Luca Kuthi MD, Heart and Vascular Centre, Semmelweis University, Budapest
7 István Osztheimer MD, PhD, Heart and Vascular Centre, Semmelweis University, Budapest
8 Attila Kovács MD, PhD, Heart and Vascular Centre, Semmelweis University, Budapest
9 Endre Zima MD, PhD, Heart and Vascular Centre, Semmelweis University, Budapest
10 László Gellér MD, PhD, DSc, Heart and Vascular Centre, Semmelweis University, Budapest
11 Roland Papp MD, Heart and Vascular Centre, Semmelweis University, Budapest
12 Annamária Kosztin MD, PhD, Heart and Vascular Centre, Semmelweis University, Budapest
13 Béla Merkely MD, PhD, DSc, Heart and Vascular Centre, Semmelweis University, Budapest

Text of the abstract

Introducion: Cardiac Resynchronization Therapy (CRT) can reverse the harmful effects of right ventricular pacing (RVP). Data are sparse on comparing survival among patients undergone CRT-defibrillator (CRT-D) or CRT-pacemaker (CRT-P) upgrade from pacemakers (PM) without prior ventricular arrhythmias.
Aims: We compared the differences in long-term all-cause mortality among patients receiving CRT-D or CRT-P upgrade.
Methods: Patients with conventional PMs developing heart failure (HF) despite optimal medical treatment and high rates of RVP were included. Altogether 326 patients were investigated, 117 (35.9%) upgraded to CRT-D, 209 (64.1%) to CRT-P in our retrospective registry. The primary endpoint was all-cause mortality. We performed subgroup analysis based on comorbidities and CRT device types. Using topological data analysis, we identified risk groups based on the primary endpoint.
Results: CRT-D upgrade patients were more likely to be males, have a favourable renal function and lower left ventricular ejection fraction (LVEF). During the median follow-up time of 3.6 years, 33 (28.2%) of CRT-D and 145 (69.4%) of CRT-P upgrade patients reached the primary endpoint. The CRT-D upgrade group showed a lower risk of all-cause mortality in the total cohort (HR:0.55; 95% CI:0.40-0.76; p=0.001) and in the ischaemic subgroup compared to CRT-P. After adjustment, CRT-D and male gender have been confirmed as independent predictors of all-cause mortality. Patients upgraded with CRT-D demonstrated favourable survival in the intermediate- and high-risk groups over the CRT-P group.
Conclusions: Patients benefited more from the CRT-D upgrade, especially with ischaemic HF aetiology. However, no difference was observed between the two patient groups among low-risk patients.
Funding: This work was supported by the ÚNKP-20-3-I-SE-43 New National Excellence Program if the Ministry for Innovation and Technology in Hungary. Project no. NVKP_16-1–2016-0017 has been implemented with the support provided by the National Research, Development and Innovation Fund of Hungary, funded under the NVKP_16 funding scheme. The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University.

University and Doctoral School

Semmelweis University, Doctoral School of Theoretical and Translational Medicine