Yonsei Med J.  2017 Jul;58(4):703-709. 10.3349/ymj.2017.58.4.703.

Comparison of De Novo versus Upgrade Cardiac Resynchronization Therapy; Focused on the Upgrade for Pacing-Induced Cardiomyopathy

• Gwag HB
• Chun KJ
• Hwang JK
• Park KM
• On YK
• Kim JS
• Park SJ

• KMID: 2419074
• DOI: http://doi.org/10.3349/ymj.2017.58.4.703

Abstract

PURPOSE
This study aimed to determine whether upgrade cardiac resynchronization therapy (CRT) shows better outcomes than de novo CRT. To do so, we compared the efficacy of CRT between de novo and upgrade groups, focusing particularly on the effect of upgrade CRT on patients with pacing-induced cardiomyopathy (PiCM).
MATERIALS AND METHODS
PiCM was defined as new-onset dilated cardiomyopathy following pacemaker implantation in patients with baseline normal ejection fraction ≥50%. Electro-mechanical reverse remodeling and clinical outcomes were compared among the de novo (n=62), PiCM upgrade (n=7), and non-PiCM upgrade (n=8) CRT groups.
RESULTS
The PiCM upgrade group showed significantly greater electro-mechanical reverse remodeling than the de novo CRT or non-PiCM upgrade groups at 6-month follow-up. The rate of super-responders was significantly higher in the PiCM upgrade group than the other CRT groups. The group factor of the PiCM upgrade was identified as an independent predictor of super-responder in multivariate analysis (odds ratio 10.4, 95% confidential interval 1.08-99.4, p=0.043). During the median follow-up of 15.8 months, the PiCM upgrade group showed the lowest rate of composite clinical outcomes, including cardiac death, heart transplantation, and heart failure-related rehospitalization (p=0.059).
CONCLUSION
The upgrade CRT for PiCM patients showed better performance in terms of electro-mechanical reverse remodeling than de novo implantation or upgrade CRT in non-PiCM patients.

Keyword

Cardiac resynchronization therapy; pacemaker; cardiomyopathy; ventricular remodeling

MeSH Terms

Aged
Cardiac Pacing, Artificial/*adverse effects
Cardiac Resynchronization Therapy/*methods
Cardiomyopathies/diagnostic imaging/*etiology/physiopathology/*therapy
Female
Heart Failure/etiology/physiopathology/therapy
Humans
Male
Middle Aged
Stroke Volume
Survival Analysis
Treatment Outcome

Figure

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  Fig. 1 Study population. CHF, chronic heart failure; CRT, cardiac resynchronization therapy; PiCM, pacing-induced cardiomyopathy.

• 

  Fig. 2 Percent narrowing of QRS duration (A) and percent reduction in left ventricular end-systolic volume (B) 6 months after cardiac resynchronization therapy. *p value refers to the difference among the three groups by Kruskal-Wallis test. LVESV, left ventricular end-systolic volume; PiCM, pacing-induced cardiomyopathy.

• 

  Fig. 3 Echocardiographic responder and super-responder rates according to various echocardiographic criteria at 6 months after cardiac resynchronization therapy. LVEF, left ventricular ejection fraction; LVESV, left ventricular end-systolic volume; PiCM, pacing-induced cardiomyopathy.

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  Fig. 4 Comparison of survival curves for MACEs. MACEs, major adverse cardiovascular events; PiCM, pacing-induced cardiomyopathy.

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