Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.
Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.
J Card Fail. 2015 Mar;21(3):226-32. doi: 10.1016/j.cardfail.2014.12.006. Epub 2014 Dec 17.
Implantable cardioverter-defibrillators (ICDs) can improve survival in left ventricular assist device (LVAD) recipients. However, the impact of cardiac resynchronization therapy (CRT-D) on outcomes in continuous-flow left ventricular assist device (CF-LVAD) patients is not known. We sought to determine if CRT-D improved clinical outcomes in CF-LVAD patients compared with ICDs alone.
Sixty-one consecutive CF-LVAD patients with an ICD or CRT-D were evaluated. Impacts of CRT-D on mortality, all-cause hospitalization, and incidence of atrial (AA) and ventricular (VA) arrhythmias after LVAD implantation was compared with patients with ICD alone. Of the 61 LVAD patients, 31 (age 59.8 ± 16 years, 84% male) had CRT-D and 30 (age 57.2 ± 13 years, 74% male) had ICD. Before LVAD implantation, no significant differences were noted between the groups in demographic and clinical characteristics, LVAD indications, and incidence of AA and VA. Over 682 ± 45 days of LVAD support, 8 patients (25.8%) died in the CRT-D arm versus 5 (16.7%) in the ICD arm (P = .35). No differences were noted between the CRT-D and ICD groups in all-cause (96.8 vs 93.3%; P = .63) and HF (19.4 vs 26.7%; P = .78) hospitalizations, left ventricular (LV) end-diastolic diameter (6.4 ± 1.5 vs 6.2 ± 1.1 cm, P = .47), and incidence of AA (35.4% vs 33.3%; P = .80), VA (29% vs 26.6%; P = .86), and ICD shocks (22.6% vs 16.7%; P = .93). Beta-blocker and antiarrhythmic drug use after LVAD implantation was similar in both groups.
In patients with refractory HF who received CF-LVADs, CRT-D, compared with ICD, did not significantly improve mortality, all-cause hospitalization, LV dimensions, and incidence of AA and VA.
植入式心脏复律除颤器（ICD）可改善左心室辅助装置（LVAD）受者的生存率。然而，心脏再同步治疗（CRT-D）对连续血流左心室辅助装置（CF-LVAD）患者的结局影响尚不清楚。我们旨在确定 CRT-D 是否能改善 CF-LVAD 患者的临床结局，与单独使用 ICD 相比。
评估了 61 例连续的 CF-LVAD 患者，这些患者均装有 ICD 或 CRT-D。比较了 CRT-D 对 LVAD 植入后死亡率、全因住院率以及房性（AA）和室性（VA）心律失常发生率的影响，与单独使用 ICD 的患者进行比较。在 61 例 LVAD 患者中，31 例（年龄 59.8 ± 16 岁，84%为男性）接受了 CRT-D，30 例（年龄 57.2 ± 13 岁，74%为男性）接受了 ICD。在 LVAD 植入前，两组在人口统计学和临床特征、LVAD 适应证以及 AA 和 VA 的发生率方面无显著差异。在 682 ± 45 天的 LVAD 支持下，CRT-D 组有 8 例（25.8%）患者死亡，而 ICD 组有 5 例（16.7%）患者死亡（P=0.35）。CRT-D 组和 ICD 组在全因（96.8%比 93.3%；P=0.63）和心力衰竭（HF）住院率（19.4%比 26.7%；P=0.78）、左心室（LV）舒张末期直径（6.4 ± 1.5 比 6.2 ± 1.1 cm，P=0.47）、AA 发生率（35.4%比 33.3%；P=0.80）、VA 发生率（29%比 26.6%；P=0.86）和 ICD 电击率（22.6%比 16.7%；P=0.93）方面无差异。两组患者在 LVAD 植入后β受体阻滞剂和抗心律失常药物的使用情况相似。
在接受 CF-LVAD 的难治性心力衰竭患者中，与 ICD 相比，CRT-D 并未显著改善死亡率、全因住院率、LV 尺寸以及 AA 和 VA 的发生率。
