Real world" experience in cardiac resynchroni-sation therapy at a Swiss tertiary care centre: Update 2016

Abstract

BACKGROUND: Based on a reduction in morbidity and mortality, car-diac resynchronisation therapy (CRT) has evolved as a standard ther-apy for patients with advanced heart failure. OBJECTIVE: To provide insight into patient demographics, safety, echo-cardiographic remodelling and long-term follow-up of patients treated with CRT in a "real-world" setting at a Swiss tertiary care centre. METHODS: Patients implanted with a CRT device at the University Heart Centre Zurich between 2000 and 2015 were consecutively en-rolled. Initial clinical and echocardiographic therapy response as well as long-term follow-up for mortality (defined as all-cause death, heart transplantation or ventricular assist device implantation) and hospital-isation for heart failure were assessed. RESULTS: A total of 418 patients with a median age of 66 years at the time of CRT implantation (78% male) were enrolled. Serious peri-inter-ventional complications (from the time of implantation up to 14 days thereafter) were rare and included systemic infections in 2.4%, pneu-mothorax in 3.3% and haematoma requiring revision in 2.2% of cases. Overall, the Kaplan-Meier estimate for 5-year freedom from the com-posite endpoint (hospitalisation for heart failure or mortality) was 55.8%; the Kaplan-Meier estimate for 5-year freedom from mortality was 64.1%. CRT was associated with a significant symptomatic im-provement and left ventricular reverse remodelling. Overall, 3.9% of patients did not respond to cardiac resynchronisation therapy (decline in left ventricular ejection fraction [LVEF] >5%), whereas 35.1% experienced neither a continued decline nor a relevant improvement of LVEF (±5%). In the remaining 61% of patients we ob-served an improvement in LVEF of more than 5%. Forty percent and 31% of patients were super responders, defined as an absolute LVEF improvement of ≥10% and by a relative reduction of left ventricular end-diastolic volume index by 20% or more. Super-response to CRT was associated with a significant benefit in terms of survival and re-hospitalisation rates. CONCLUSION: Our data are consistent with large multicentre trials and indicate that CRT is similarly effective in a real-world setting in Swit-zerland.