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Comparison of De Novo Implantation Vs. Upgrade Cardiac Resynchronisation Therapy: A Multicentre Experience Publisher



Zandi Z1 ; Eslami M2 ; Kamali F1 ; Teimourijervekani Z3 ; Taherpour M4 ; Mollazadeh R2 ; Haghjoo M1 ; Fazelifar AF1 ; Alizadeh A1 ; Madadi S1 ; Hosseini Selki Sar S2 ; Emkanjoo Z1
Authors
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Authors Affiliations
  1. 1. Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
  2. 2. Cardiology Department, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  4. 4. Department of Cardiac Electrophysiology, Razavi Hospital, Imam Reza International University, Mashhad, Iran

Source: Acta Cardiologica Published:2023


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. © 2023 Belgian Society of Cardiology.