Friedrich-Ebert Hospital, Medical Clinic, Friesenstr. 11, D 24531 Neumünster, Germany.
Europace. 2013 Jan;15(1):71-6. doi: 10.1093/europace/eus247. Epub 2012 Aug 26.
The decision to implant a cardiac resynchronization therapy (CRT) system with (defibrillator, CRT-D) or without (pacemaker, CRT-P) cardioverter defibrillator should weigh its benefits and risks. This study examined the (i) incidence of loss of capture and infectious complications and (ii) 1-year clinical outcomes of 402 CRT-D and CRT-P recipients enrolled in the MASCOT study.
The indications for CRT-D or CRT-P were posed by the implanting physicians. All (i) losses of atrial and right and left ventricular capture, (ii) system-related infections, and (iii) clinical outcomes, including hospitalizations for worsening heart failure (HF) and deaths from all causes, were recorded up to 1 year of follow-up. Cardiac resynchronization therapy-defibrillator was implanted in 228 (57%) and CRT-P in 174 (43%) patients. The incidence of loss of capture was greater in CRT-D with 21 patients (9.2%) than in CRT-P with 6 patient (3.5%) recipients (P = 0.01), while the infection rates were 1.3% (3 patients) and 1.2% (2 patients), respectively (ns). In the CRT-D group, 42 of 228 patients (18.4%) died or were hospitalized for HF, compared with 38 of 174 patients (21.8%) in the CRT-P group (ns). In the CRT-D group, 23 patients (10.1%) were hospitalized for worsening HF and 20 (8.8%) patients died, vs. 22 (12.6%) and 19 (10.9%) patients, respectively, in the CRT-P group (ns for both comparisons).
Cardiac resynchronization therapy-defibrillator was implanted in 57% of candidates for CRT. Within 1 year after device implant, the incidence of loss of capture at any lead was nearly three-fold greater among CRT-D than among CRT-P recipients. System-related infections were infrequent and clinical outcomes were similar in both groups.
决定植入心脏再同步治疗（CRT）系统（带除颤器，CRT-D）或不带除颤器（起搏器，CRT-P）应权衡其益处和风险。本研究检查了 MASCOT 研究中 402 例 CRT-D 和 CRT-P 受者的（i）丧失捕获和感染性并发症的发生率和（ii）1 年临床结局。
CRT-D 或 CRT-P 的适应证由植入医生提出。所有（i）心房和右、左心室捕获丧失，（ii）系统相关感染，和（iii）临床结局，包括因心力衰竭（HF）恶化而住院和因任何原因导致的死亡，均在 1 年随访时记录。228 例（57%）患者植入 CRT-D，174 例（43%）患者植入 CRT-P。CRT-D 组 21 例（9.2%）患者出现失夺获，而 CRT-P 组 6 例（3.5%）患者出现失夺获（P = 0.01），感染率分别为 1.3%（3 例）和 1.2%（2 例）（无统计学差异）。在 CRT-D 组中，228 例患者中有 42 例（18.4%）死亡或因 HF 住院，而在 CRT-P 组中，174 例患者中有 38 例（21.8%）（无统计学差异）。在 CRT-D 组中，23 例（10.1%）因 HF 恶化住院，20 例（8.8%）患者死亡，而在 CRT-P 组中，22 例（12.6%）和 19 例（10.9%）患者分别住院（两种比较均无统计学差异）。
57%的 CRT 候选者植入了 CRT-D。在装置植入后 1 年内，CRT-D 组丧失任何部位捕获的发生率几乎是 CRT-P 组的三倍。系统相关感染较少，两组临床结局相似。
