Abstract 5928: Long Term Outcomes After Cardiac Resynchronization Therapy: Comparison of Robotic Epicardial Versus Endovascular Procedures
Cardiac resynchronization therapy (CRT) has been shown to improve functional class and cause reverse remodeling in patients with advanced heart failure (HF). Surgically implanted epicardial lead placement using a robotic technique (Robotic CRT) is a rescue therapy in patients with failed endovascular implants (Endo CRT). Long term efficacy of Robotic vs. Endo CRT is not well defined. 93 patients (Endo CRT, n = 60; Robotic CRT, n = 33) with advanced HF (NYHA Class=3.3 ± 0.3, EF =18 ± 6%) and optimized medical therapy undergoing CRT formed the study cohort. Reverse remodeling was assessed by left ventricular ejection fraction (LVEF) and LV end systolic volume index (LVESVI) during a follow up of 28 ± 10 months. The primary endpoint of this analysis was composite of heart failure hospitalization or all-cause mortality. Patients in each group were comparably matched in all clinical characteristics. Compared to patients treated with Endo CRT, patients treated with Robotic CRT demonstrated significantly increased LVEF (18 ± 7 % to 30 ± 11% vs 19 ± 6% to 24 ± 10%; p=0.04 for ΔLVEF), and decreased LVESVI (93 ± 22 ml/m2 to 74 ± 26 ml/m2 vs 88 ± 24 ml/m2 to 81 ± 27 ml/m2; p= 0.03 for ΔLVESVI). During follow-up, the group treated with Robotic CRT was less likely to meet the primary endpoint (Figure 1⇓) (p < 0.001) than the Endo CRT group. Robotic CRT is superior to Endo CRT in promoting reverse remodeling and decreasing the combined endpoint of heart failure hospitalization and mortality. The ability to place LV leads at all epicardial locations not constrained by venous anatomy likely underlies this benefit and warrants formal comparison in a randomized clinical trial.