Abstract 2506: Long-Term Effect of Robotic-Assisted Left Ventricular Epicardial Leads for Cardiac Resynchronization Therapy on Mortality
INTRODUCTION: In cardiac resynchronization therapy (CRT), our group has previously reported on positive clinical response and reverse remodeling using a novel robotically assisted left ventricular (LV) epicardial lead placement approach for pts with primary lead implant failure. In addition, CRT via transvenous approach is associated with an approximate 20% mortality rate at 18 mos. Long term mortality via robotic placement is unknown.
METHODS: We evaluated 71 pts (70 ± 11 yrs, 48 [68%] male) who underwent robotic LV lead placement after failed transvenous LV lead placement. Leads were placed based on Tissue Doppler Imaging to localize the site of latest mechanical activation. The Social Security Death Index was queried to identify mortality.
RESULTS: All pts had successful lead placement and were discharged in stable condition. During a follow-up (f/u) of 27 ± 16 mos, there were 18 deaths (25%) after 17.3 ± 14.5 mos (range 1.3 – 50.2 mos) (Figure⇓). These pts were older (77 ± 6 v. 68 ± 11 yrs; p < 0.001), with a lower EF (13 ± 7% v. 18 ± 9%; p < 0.05) and carried a greater symptom burden by NYHA class (3.6 ± 0.5 v. 3.1 ± 0.5; p = 0.02) when compared to those alive. There was no difference in pts with respect to HF duration, cardiomyopathy etiology or atrial fibrillation prevalence. A significant improvement in symptoms by NYHA class (3.1 ± 0.5 to 2.3 ± 0.7; p < 0.001) was seen at 8 ± 3 mos.
CONCLUSION: Pts undergoing robotic LV lead implant show symptomatic improvement, and have a similar mortality rate to transvenous placement during f/u. Those at greatest risk for death include older pts with a very low EF; risk/benefit for these pts should be carefully considered before undergoing implant.