CRT Survey II: a European Society of Cardiology (ESC) survey of cardiac resynchronization therapy—an Irish subset analysis

Abstract

Cardiac resynchronization therapy (CRT) has been shown to reduce mortality and morbidity in symptomatic patients with reduced left ventricular systolic function < 35%, a left bundle branch block (LBBB) and a widened QRS complex. This paper compares Irish national CRT practices with the European data that was gathered in the same multi-centre CRT Survey II. Each recruiting centre completed an internet-based facilitating collection of information relating to health care resource utilization by each centre. A second form was completed for consecutive patients undergoing CRT implantation, to provide information on patient demographics, pre-implantation clinical evaluation and investigations, indication for implantation and the procedure as well as short-term complications and adverse events. A total of 85 patients from 2 centres were representative of the current Irish practice and compared with data obtained. This was 26.6% of all CRT implantations in Ireland during this period (total number 319, 88 CRT-P, 231 CRT-D). Of those receiving CRT device, mean age was 73years, 74.1% were male, with predominantly NYHA class III symptoms, and left ventricular ejection fraction < 35%. NT-pro-BNP level was substantially elevated in most patients. 56% were in sinus rhythm, 31% in atrial fibrillation with overall mean QRS duration of 166ms. Within Ireland, the majority of CRT implantation are adherent with ESC guidelines. It has also highlighted problems that are noted in other ESC member countries such as the underutilization of device therapy in women, lack of referrals from peripheral centres and further need for optimization of medical therapy before device implantation.