Clinical Impact of Off‐Label Cardiac Resynchronization Therapy in End‐Stage Heart Failure Patients on Continuous Intravenous Inotrope

Abstract

Potential benefits of off-label cardiac resynchronization therapy (CRT) in end-stage heart failure (EHF) patients have not been fully investigated. Some EHF patients who are dependent on intravenous inotropes can benefit from CRT. We retrospectively enrolled 14 EHF patients who were dependent on intravenous inotropes at the time of CRT implantation. Mean duration of inotropic support was 51 ± 47 days before CRT device implantation. To identify the efficacy of CRT, we assessed the successful withdrawal rate from inotropic support and survival estimates after device implantation. We also tried to identify possible predictors for withdrawal by comparing patient demographics between successful withdrawal (SW) and nonwithdrawal (NW) groups. Successful withdrawal was achieved in 9 (64%) of 14 patients 46 ± 33 days after CRT device implantation. Event-free survival was longer in the SW group than in the NW group (810 ± 169 days vs 114 ± 34 days; P = 0.007). In addition, patients in the SW group showed a higher previous surgery rate (89% vs 20%; P = 0.010) and a lower grade of mitral regurgitation (median, 0 vs 2; P = 0.010) than those in the NW group. Our retrospective data showed potential benefits of CRT among EHFpatients. Treatment of mitral regurgitation might be an essential qualification for managing EHF patients with CRT.