Abstract 13521: Cardiac Resynchronization Therapy After Prophylactic Epicardial Leads Implantation During Concomitant Cardiac Surgery: Impact on Left Ventricular Remodeling and Clinical Outcomes
Introduction: Concomitant prophylactic epicardial leads implantation can be performed in patients with heart failure (HF) and dyssynchrony undergoing cardiac surgery, but the indication and timing of cardiac resynchronization therapy (CRT) remain controversial.
Hypothesis: In surgical HF patients with criteria for CRT, most remain eligible for activation at distance from surgery. CRT activation can positively impact left ventricular (LV) remodeling and event-free survival.
Methods: Forty-three patients with QRS≥120ms and EF<35% had LV epicardial leads implanted during cardiac surgery (index operation). Twenty-five of them eventually underwent CRT activation (CRT+) while 18 patients did not (CRT-). Echocardiographic data were reviewed at baseline, discharge, prior to CRT activation, and last follow-up. Re-hospitalizations for HF and cardiovascular (CV) deaths were recorded.
Results: Clinical characteristics were similar at baseline and prior to CRT activation. At distance from the index operation (9.3±11.9 months) the majority of patients (77%) still had QRS≥120ms and EF<35%. The proportion of resynchronized patients was 25%, 50% and 75% at 1, 6 and 18 months postoperatively. CRT was associated with marked reverse LV remodeling with more pronounced reduction in LVEDV (-74±70ml vs. -14±38ml, p=0.007) and LVESV (-79±66ml vs. -25±34ml, p=0.009) and prominent increase in LVEF (+17±11% vs. +7±8%, p=0.006) at last follow-up (mean 3.5±2.1 years) compared with CRT- patients (mean 1.5±1.3 year). Including the period between index operation and CRT activation, rates per 100-patients-years of re-hospitalization for HF (16.6 vs. 1.5, p<0.0001) and the composite of re-hospitalization and death (31.5 vs. 1.5 p<0.0001) were higher in the CRT- compared to CRT+ group. Freedom from CV death was 100% at 3 years for resynchronized patients, higher than for CRT- patients (89%, 80% and 60% at 1, 2 and 3 years, respectively, p=0.002).
Conclusions: The majority of HF patients with QRS≥120ms who undergo prophylactic implantation of epicardial leads during cardiac surgery remain eligible for CRT at distance from surgery. Delaying CRT denies them of reverse LV remodeling and results in significant increases in CV death and re-hospitalizations for HF.
Author Disclosures: M. Senechal: None. A. Marceau: None. F. Philippon: None. J. Sarrazin: None. E. Charbonneau: None. F. Jacques: None. A. Cinq-Mars: None. F. Dagenais: None. E. Leroux: None. P. Voisine: None.
- © 2016 by American Heart Association, Inc.