Clinical outcomes after upgrading from pacemakers to cardiac resynchronization therapy

Francisco Leyva, Abbasin Zegard, Kiran Patel, Jonathan Panting, Howard Marshall, Tian Qiu

Research output: Contribution to journalArticle

Abstract

Background and Aims: Right ventricular pacing may lead to heart failure (HF). Upgrades from pacemakers to cardiac resynchronization therapy (CRT) were excluded from most randomized, controlled trials. We sought to determine the long-term outcomes of upgrading from pacemakers to CRT with (CRT-D) or without (CRT-P) defibrillation in patients with no history of sustained ventricular arrhythmias.

Methods and Results: In this observational study, clinical events were quantified in relation to the type of implant (de novo or upgrade) and device type at upgrade (CRT-P or CRT-D). Patients underwent CRT implantation (n = 1,545; 1,314 [85%] de novo implants and 231 [15%] upgrades) over a median of 4.6 years [interquartile range: 2.4 - 7.0]). In analyses of crude event rates, upgrades had a higher total mortality (adjusted hazard ratio [aHR]: 1.33; 95% confidence interval [CI] 0.10-1.61), a higher total mortality or HF hospitalization (aHR: 1.26; 95% CI 1.05-1.51), but similar mortality or hospitalization for major adverse cardiac events (MACEs, aHR: 1.15; 95% CI 0.96-1.38). No group differences emerged in any of these endpoints after propensity score matching. After inverse probability weighting in upgrades, total mortality (HR: 0.55; 95% CI 0.36-0.73), total mortality or HF hospitalization (HR: 0.56; 95% CI 0.34-0.79) and total mortality or hospitalization for MACEs (HR: 0.61; 95% CI 0.40-0.82) were lower after CRT-D than after CRT-P.

Conclusion: Upgrading from pacemakers to CRT was associated with a similar long-term risk of mortality and morbidity to de novo CRT. After upgrade, CRT-D was CRT-D was associated with lower mortality than CRT-P
Original languageEnglish
Pages (from-to)290-298
JournalPacing and Clinical Electrophysiology
Volume41
Issue number3
Early online date25 Jan 2018
DOIs
Publication statusPublished - 8 Mar 2018

Fingerprint

Cardiac Resynchronization Therapy
Mortality
Confidence Intervals
Hospitalization
Heart Failure
Propensity Score
Observational Studies

Bibliographical note

Copyright: 2018 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Funding: Boston Scientific

Keywords

  • cardiac resynchronization therapy
  • pacemakers
  • implantable cardioverter defibrillators
  • device upgrade

Cite this

Leyva, F., Zegard, A., Patel, K., Panting, J., Marshall, H., & Qiu, T. (2018). Clinical outcomes after upgrading from pacemakers to cardiac resynchronization therapy. Pacing and Clinical Electrophysiology, 41(3), 290-298. https://doi.org/10.1111/pace.13287
Leyva, Francisco ; Zegard, Abbasin ; Patel, Kiran ; Panting, Jonathan ; Marshall, Howard ; Qiu, Tian. / Clinical outcomes after upgrading from pacemakers to cardiac resynchronization therapy. In: Pacing and Clinical Electrophysiology. 2018 ; Vol. 41, No. 3. pp. 290-298.
@article{5af32d284ef24a6d889d018428662bcc,
title = "Clinical outcomes after upgrading from pacemakers to cardiac resynchronization therapy",
abstract = "Background and Aims: Right ventricular pacing may lead to heart failure (HF). Upgrades from pacemakers to cardiac resynchronization therapy (CRT) were excluded from most randomized, controlled trials. We sought to determine the long-term outcomes of upgrading from pacemakers to CRT with (CRT-D) or without (CRT-P) defibrillation in patients with no history of sustained ventricular arrhythmias. Methods and Results: In this observational study, clinical events were quantified in relation to the type of implant (de novo or upgrade) and device type at upgrade (CRT-P or CRT-D). Patients underwent CRT implantation (n = 1,545; 1,314 [85{\%}] de novo implants and 231 [15{\%}] upgrades) over a median of 4.6 years [interquartile range: 2.4 - 7.0]). In analyses of crude event rates, upgrades had a higher total mortality (adjusted hazard ratio [aHR]: 1.33; 95{\%} confidence interval [CI] 0.10-1.61), a higher total mortality or HF hospitalization (aHR: 1.26; 95{\%} CI 1.05-1.51), but similar mortality or hospitalization for major adverse cardiac events (MACEs, aHR: 1.15; 95{\%} CI 0.96-1.38). No group differences emerged in any of these endpoints after propensity score matching. After inverse probability weighting in upgrades, total mortality (HR: 0.55; 95{\%} CI 0.36-0.73), total mortality or HF hospitalization (HR: 0.56; 95{\%} CI 0.34-0.79) and total mortality or hospitalization for MACEs (HR: 0.61; 95{\%} CI 0.40-0.82) were lower after CRT-D than after CRT-P. Conclusion: Upgrading from pacemakers to CRT was associated with a similar long-term risk of mortality and morbidity to de novo CRT. After upgrade, CRT-D was CRT-D was associated with lower mortality than CRT-P",
keywords = "cardiac resynchronization therapy, pacemakers, implantable cardioverter defibrillators, device upgrade",
author = "Francisco Leyva and Abbasin Zegard and Kiran Patel and Jonathan Panting and Howard Marshall and Tian Qiu",
note = "Copyright: 2018 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Funding: Boston Scientific",
year = "2018",
month = "3",
day = "8",
doi = "10.1111/pace.13287",
language = "English",
volume = "41",
pages = "290--298",
number = "3",

}

Leyva, F, Zegard, A, Patel, K, Panting, J, Marshall, H & Qiu, T 2018, 'Clinical outcomes after upgrading from pacemakers to cardiac resynchronization therapy', Pacing and Clinical Electrophysiology, vol. 41, no. 3, pp. 290-298. https://doi.org/10.1111/pace.13287

Clinical outcomes after upgrading from pacemakers to cardiac resynchronization therapy. / Leyva, Francisco; Zegard, Abbasin; Patel, Kiran; Panting, Jonathan; Marshall, Howard; Qiu, Tian.

In: Pacing and Clinical Electrophysiology, Vol. 41, No. 3, 08.03.2018, p. 290-298.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical outcomes after upgrading from pacemakers to cardiac resynchronization therapy

AU - Leyva, Francisco

AU - Zegard, Abbasin

AU - Patel, Kiran

AU - Panting, Jonathan

AU - Marshall, Howard

AU - Qiu, Tian

N1 - Copyright: 2018 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Funding: Boston Scientific

PY - 2018/3/8

Y1 - 2018/3/8

N2 - Background and Aims: Right ventricular pacing may lead to heart failure (HF). Upgrades from pacemakers to cardiac resynchronization therapy (CRT) were excluded from most randomized, controlled trials. We sought to determine the long-term outcomes of upgrading from pacemakers to CRT with (CRT-D) or without (CRT-P) defibrillation in patients with no history of sustained ventricular arrhythmias. Methods and Results: In this observational study, clinical events were quantified in relation to the type of implant (de novo or upgrade) and device type at upgrade (CRT-P or CRT-D). Patients underwent CRT implantation (n = 1,545; 1,314 [85%] de novo implants and 231 [15%] upgrades) over a median of 4.6 years [interquartile range: 2.4 - 7.0]). In analyses of crude event rates, upgrades had a higher total mortality (adjusted hazard ratio [aHR]: 1.33; 95% confidence interval [CI] 0.10-1.61), a higher total mortality or HF hospitalization (aHR: 1.26; 95% CI 1.05-1.51), but similar mortality or hospitalization for major adverse cardiac events (MACEs, aHR: 1.15; 95% CI 0.96-1.38). No group differences emerged in any of these endpoints after propensity score matching. After inverse probability weighting in upgrades, total mortality (HR: 0.55; 95% CI 0.36-0.73), total mortality or HF hospitalization (HR: 0.56; 95% CI 0.34-0.79) and total mortality or hospitalization for MACEs (HR: 0.61; 95% CI 0.40-0.82) were lower after CRT-D than after CRT-P. Conclusion: Upgrading from pacemakers to CRT was associated with a similar long-term risk of mortality and morbidity to de novo CRT. After upgrade, CRT-D was CRT-D was associated with lower mortality than CRT-P

AB - Background and Aims: Right ventricular pacing may lead to heart failure (HF). Upgrades from pacemakers to cardiac resynchronization therapy (CRT) were excluded from most randomized, controlled trials. We sought to determine the long-term outcomes of upgrading from pacemakers to CRT with (CRT-D) or without (CRT-P) defibrillation in patients with no history of sustained ventricular arrhythmias. Methods and Results: In this observational study, clinical events were quantified in relation to the type of implant (de novo or upgrade) and device type at upgrade (CRT-P or CRT-D). Patients underwent CRT implantation (n = 1,545; 1,314 [85%] de novo implants and 231 [15%] upgrades) over a median of 4.6 years [interquartile range: 2.4 - 7.0]). In analyses of crude event rates, upgrades had a higher total mortality (adjusted hazard ratio [aHR]: 1.33; 95% confidence interval [CI] 0.10-1.61), a higher total mortality or HF hospitalization (aHR: 1.26; 95% CI 1.05-1.51), but similar mortality or hospitalization for major adverse cardiac events (MACEs, aHR: 1.15; 95% CI 0.96-1.38). No group differences emerged in any of these endpoints after propensity score matching. After inverse probability weighting in upgrades, total mortality (HR: 0.55; 95% CI 0.36-0.73), total mortality or HF hospitalization (HR: 0.56; 95% CI 0.34-0.79) and total mortality or hospitalization for MACEs (HR: 0.61; 95% CI 0.40-0.82) were lower after CRT-D than after CRT-P. Conclusion: Upgrading from pacemakers to CRT was associated with a similar long-term risk of mortality and morbidity to de novo CRT. After upgrade, CRT-D was CRT-D was associated with lower mortality than CRT-P

KW - cardiac resynchronization therapy

KW - pacemakers

KW - implantable cardioverter defibrillators

KW - device upgrade

UR - http://onlinelibrary.wiley.com/doi/10.1111/pace.13287/abstract

U2 - 10.1111/pace.13287

DO - 10.1111/pace.13287

M3 - Article

VL - 41

SP - 290

EP - 298

IS - 3

ER -

Leyva F, Zegard A, Patel K, Panting J, Marshall H, Qiu T. Clinical outcomes after upgrading from pacemakers to cardiac resynchronization therapy. Pacing and Clinical Electrophysiology. 2018 Mar 8;41(3):290-298. https://doi.org/10.1111/pace.13287