PMID- 24573612
OWN - NLM
STAT- MEDLINE
DCOM- 20140918
LR  - 20140227
IS  - 1424-3997 (Electronic)
IS  - 0036-7672 (Linking)
VI  - 144
DP  - 2014 Feb 26
TI  - Outcome of patients with cardiac resynchronisation defibrillator therapy and a 
      follow-up of at least five years after implant.
PG  - w13938
LID - 10.4414/smw.2014.13938 [doi]
AB  - QUESTIONS UNDER STUDY: Cardiac resynchronisation therapy with defibrillator 
      backup (CRT-D) is an established therapeutic option in selected heart failure 
      patients. Data on its pronounced long-term outcome are scarce. We evaluated the 
      long-term outcome (>5 years) of patients with the main focus on device-associated 
      events. METHODS: Out of a prospective CRT-D registry with 219 patients, all 49 
      patients (22%) who survived for at least 5 years were analysed. Baseline 
      characteristics, device associated issues (battery longevity, lead problems, 
      phrenic nerve stimulation, infections and pacing threshold levels), implantable 
      cardioverter-defibrillator (ICD) therapies, mortality, changes in left 
      ventricular ejection fraction (LVEF) and improvement in New York Heart 
      Association (NYHA) class were considered. RESULTS: The mean +/- standard deviation 
      age of the patients was 63+/-10 years and follow-up was 84+/-18 months. Seventy-eight 
      percent were male, 73% had nonischaemic cardiomyopathy and 80% a primary 
      prevention indication. After initially surviving 5 years, 8 patients (16%) died 
      during further follow-up. LVEF improved from 23%+/-7% to 35%+/-13% (p-value <0.0001) 
      at last follow-up. 14 patients (29%) had appropriate ICD therapy, mainly for 
      ventricular tachycardia. No first-ever arrhythmic event occurred beyond year 4.5. 
      Device longevity was 54+/-13 months. Twenty-three technical problems occurred in 20 
      patients (40%), 14 of whom (61%) required surgery (7 lead defects, 4 
      dislodgments, 3 others). Dislodgements occurred early (after 2+/-2 months); defects 
      were scattered (2-59 months) during follow-up. CONCLUSION: Selected patients who 
      survive for at least 5 years experience sustained improvement in LVEF and NYHA- 
      class and only few arrhythmic episodes. Technical problems occur in 40% of 
      patients (60% requiring surgery), mainly shortly after implant and again after 4 
      to 5 years.
FAU - Bossard, Matthias
AU  - Bossard M
AD  - University Hospital, Petersgraben 4, 4031, Basel, SWITZERLAND; 
      matthias.bossard@usb.ch.
FAU - Sticherling, Christian
AU  - Sticherling C
FAU - Kuhne, Michael
AU  - Kuhne M
FAU - Frey, Simon
AU  - Frey S
FAU - Osswald, Stefan
AU  - Osswald S
FAU - Schaer, Beat
AU  - Schaer B
LA  - eng
PT  - Journal Article
DEP - 20140226
PL  - Switzerland
TA  - Swiss Med Wkly
JT  - Swiss medical weekly
JID - 100970884
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiac Pacing, Artificial
MH  - Coronary Artery Disease/complications
MH  - Death, Sudden, Cardiac/etiology/*prevention & control
MH  - *Defibrillators, Implantable
MH  - Equipment Failure
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/complications
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Tachycardia, Ventricular/etiology/physiopathology/*prevention & control
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/physiopathology
EDAT- 2014/02/28 06:00
MHDA- 2014/09/19 06:00
CRDT- 2014/02/28 06:00
PHST- 2014/02/28 06:00 [entrez]
PHST- 2014/02/28 06:00 [pubmed]
PHST- 2014/09/19 06:00 [medline]
AID - smw-13938 [pii]
AID - 10.4414/smw.2014.13938 [doi]
PST - epublish
SO  - Swiss Med Wkly. 2014 Feb 26;144:w13938. doi: 10.4414/smw.2014.13938.