Coronary artery bypass grafting with concomitant cardiac resynchronisation therapy in patients with ischaemic heart failure and left ventricular dyssynchrony.

OBJECTIVE

We have tested the hypothesis that epicardial implantation of cardiac resynchronisation therapy (CRT) system during coronary artery bypass grafting (CABG) may be an additional treatment method, which can decrease the mortality and improve left ventricle (LV) systolic function in patients with ischaemic heart failure (HF) and LV dyssynchrony.

METHODS

One hundred and seventy-eight consecutive patients with severe ischaemic HF and LV dyssynchrony were enrolled in two groups: CABG alone (n=87) and epicardial CRT implantation during CABG (n=91). The primary end point of the study was the comparison of mortality between two groups at 18 months of follow-up.

RESULTS

Twenty-three patients (26.1%) in the CABG group died at 18 months of follow-up compared with nine (10%) in CABG+CRT group (log-rank test, p=0.006). The Cox regression analysis revealed that LV dyssynchrony (hazard ratio (HR) 2.634 (1.206-5.751), p=0.015) was the independent predictor of all-cause death and HF hospitalisation. LV systolic function, dyssynchrony signs and quality of life did not change significantly post-CABG compared to pre-CABG data in CABG group patients. On the contrary, echocardiography revealed an improved LV ejection fraction (42±1.9 vs 28±2.7; p<0.001), smaller LV end-systolic volume (120±57.5 vs 164±61.4; p=0.04) and improved LV synchrony in the CABG+CRT group compared with the CABG group. In the CABG+CRT group, more patients improved by two NYHA classes (NYHA, New York Heart Association; 49 vs 0; p=0.028), had a longer 6-min-walk test distance (452±65 vs 289±72; p<0.001) and a better quality of life (22.9±5 vs 46.4±11; p<0.001) compared with the CABG group.

CONCLUSION

For majority of the patients with ischaemic HF and evidence of LV dyssynchrony, CABG neither eliminates dyssynchrony nor improves systolic function. Epicardial implantation of a CRT system concomitant with CABG facilitates patient management in the early postoperative period, improves LV systolic function and quality of life and is associated with low mortality at 18 months of follow-up.