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CLINICAL RESEARCH: HEART FAILURE

Long-term retention of cardiac resynchronization therapy

Bradley P. Knight, MD, FACC^*,*, Aseem Desai, MD^*, James Coman, MD, FACC, Mitchell Faddis, MD, FACC and Patrick Yong, MSEE

^* Division of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA
Division of Cardiology, Department of Internal Medicine, University of Oklahoma, Tulsa, Oklahoma, USA
Division of Cardiology, Department of Internal Medicine, Washington University, St. Louis, Missouri, USA
Divisions of Cardiology, Department of Internal Medicine, Guidant Corporation, St. Paul, Minnesota, USA

Manuscript received December 19, 2003; revised manuscript received February 18, 2004, accepted March 16, 2004.

^* Reprint requests and correspondence: Dr. Bradley P. Knight, University of Chicago Hospitals, Center for Advanced Medicine, MC 9024, 5758 South Maryland Avenue, Chicago, Illinois 60637, USA.
bknight{at}medicine.bsd.uchicago.edu

OBJECTIVES: The purpose of this study was to determine the frequency and causes of intermittent and permanent loss of cardiac resynchronization therapy (CRT) in patients who have undergone the successful implantation of a transvenous defibrillator that delivers CRT (CRT-D).

BACKGROUND: The causes of loss of CRT have not been described.

METHODS: The records of 512 patients who underwent an attempt at implantation of a transvenous CRT-D device as part of the VENTAK CHF/CONTAK CD Biventricular Pacing study were analyzed.

RESULTS: Device implantation was successful in 443 of 512 (87%) of patients. Among these 443 patients, CRT was interrupted in 161 (36%) patients during a mean follow-up of 2.5 ± 1.1 years. Reasons included the development of an atrial tachyarrhythmia (18%), loss of left ventricular capture (10%), diaphragmatic stimulation (2%), loss of right ventricular capture (2%), infection (1%), intentional discontinuation of CRT (1%), loss of right atrial sensing (1%), and ventricular oversensing (0.2%). Most patients underwent an intervention that permitted the reinstitution of CRT, such that only 20 of the 443 patients (5%) experienced the permanent loss of CRT. Using an intention-to-treat analysis, the long-term retention of CRT was 83% during the course of 2.5 years.

CONCLUSIONS: Cardiac resynchronization therapy is interrupted in more than one-third of patients after the successful implantation of a CRT-D device. However, CRT can be reinstituted in most patients and has a high long-term retention rate. Because patients with slower heart rates were more likely to develop atrial tachyarrhythmias, a dual-chamber rate-modulated pacing mode (DDDR) may reduce interruptions of CRT.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   AT = atrial tachyarrhythmia   AV = atrioventricular   CI = confidence interval   CRT = cardiac resynchronization therapy   CRT-D = cardiac resynchronization and defibrillation therapy   DDI = dual-chamber nonatrial tracking   DDDR = dual-chamber rate-modulated   HR = hazard ratio   LV = left ventricular   RV = right ventricular   VDD = atrial synchronous ventricular   VVI = ventricular demand   VVIR = ventricular rate-modulated

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