Cardiac resynchronization therapy in the ageing population – With or without an implantable defibrillator?

Abstract

BackgroundCardiac resynchronization therapy (CRT) is an effective treatment option for systolic heart failure, but the benefit of an additional implantable cardioverter-defibrillator (ICD) in elderly patients is not well established. The aim of our study was to evaluate the impact of an additional ICD on survival in elderly CRT recipients. MethodsPatients aged ≥75 years with an indication for CRT and primary preventive ICD therapy, which underwent implantation of either a CRT-pacemaker (CRT-P) or CRT-defibrillator (CRT-D) were included in the study. Patient characteristics, procedural and follow-up data, and subsequent all-cause mortality were analyzed. ResultsA total of 775 consecutive patients underwent CRT implantation, whereof 177 patients fulfilled the inclusion criteria. Of these, 80 patients with CRT-P and 97 with CRT-D formed the two study groups. Patients in the CRT-P group were significantly older (82.6 ± 4.5 vs. 77.8 ± 1.9 years, p < 0.001) and more often female (44 vs. 25%; p < 0.001), had a better left ventricular ejection fraction (29.5 ± 5.7 vs. 27.4 ± 6.0%; p = 0.019) and narrower QRS-complex (150 ± 19 vs. 158 ± 18 ms; p = 0.025). During a mean follow-up of 26 ± 19 months, 62 (35%) study patients died, 28 (35%) in the CRT-P and 34 (35%) in the CRT-D group (p = 0.994). The Kaplan-Meier analysis of survival probability showed no significant difference between the two groups (p = 0.562). ConclusionIn our study, an additional ICD had no impact on survival in elderly patients undergoing implantation of a CRT device. Randomized controlled trials have to confirm this finding.