Comparison of De Novo versus Upgrade Cardiac Resynchronization Therapy; Focused on the Upgrade for Pacing-Induced Cardiomyopathy.
10.3349/ymj.2017.58.4.703
- Author:
Hye Bin GWAG
1
;
Kwang Jin CHUN
;
Jin Kyung HWANG
;
Kyoung Min PARK
;
Young Keun ON
;
June Soo KIM
;
Seung Jung PARK
Author Information
1. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. orthovics@gmail.com
- Publication Type:Original Article
- Keywords:
Cardiac resynchronization therapy;
pacemaker;
cardiomyopathy;
ventricular remodeling
- MeSH:
Cardiac Resynchronization Therapy*;
Cardiomyopathies*;
Cardiomyopathy, Dilated;
Death;
Focus Groups;
Follow-Up Studies;
Heart;
Heart Transplantation;
Humans;
Multivariate Analysis;
Ventricular Remodeling
- From:Yonsei Medical Journal
2017;58(4):703-709
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: This study aimed to determine whether upgrade cardiac resynchronization therapy (CRT) shows better outcomes than de novo CRT. To do so, we compared the efficacy of CRT between de novo and upgrade groups, focusing particularly on the effect of upgrade CRT on patients with pacing-induced cardiomyopathy (PiCM). MATERIALS AND METHODS: PiCM was defined as new-onset dilated cardiomyopathy following pacemaker implantation in patients with baseline normal ejection fraction ≥50%. Electro-mechanical reverse remodeling and clinical outcomes were compared among the de novo (n=62), PiCM upgrade (n=7), and non-PiCM upgrade (n=8) CRT groups. RESULTS: The PiCM upgrade group showed significantly greater electro-mechanical reverse remodeling than the de novo CRT or non-PiCM upgrade groups at 6-month follow-up. The rate of super-responders was significantly higher in the PiCM upgrade group than the other CRT groups. The group factor of the PiCM upgrade was identified as an independent predictor of super-responder in multivariate analysis (odds ratio 10.4, 95% confidential interval 1.08–99.4, p=0.043). During the median follow-up of 15.8 months, the PiCM upgrade group showed the lowest rate of composite clinical outcomes, including cardiac death, heart transplantation, and heart failure-related rehospitalization (p=0.059). CONCLUSION: The upgrade CRT for PiCM patients showed better performance in terms of electro-mechanical reverse remodeling than de novo implantation or upgrade CRT in non-PiCM patients.
