Abstract
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 language | English |
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Pages (from-to) | 290-298 |
Journal | Pacing and Clinical Electrophysiology |
Volume | 41 |
Issue number | 3 |
Early online date | 25 Jan 2018 |
DOIs | |
Publication status | Published - 8 Mar 2018 |
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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
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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 journal › Article
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 -