When Is Cardiac Resynchronization Therapy with a Defibrillator Indicated in Patients with Heart Failure, Especially Elderly Patients?

Hiroaki Mano, Toshiko Nakai, Yukitoshi Ikeya, Rikitake Kogawa, Yuki Saito, Sayaka Kurokawa, Koichi Nagashima, Yasuo Okumura

Research output: Contribution to journalArticlepeer-review

Abstract

One benefit of an implantable cardioverter-defibrillator is the prevention of sudden cardiac death (SCD). It is recommended for patients with a low left ventricular ejection fraction (LVEF). However, the choice of cardiac resynchronization therapy (CRT) with or without a defibrillator (CRT-D and CRT-P) in elderly patients is controversial. To understand the current situation for proper device selection, we investigated the impact of de-fibrillators on mortality in elderly patients with heart failure. Consecutive patients who underwent CRT implantation were retrospectively recruited. Baseline characteristics, all-cause mortality, cardiac death, and defibrillator implantation rates were investigated in patients aged >75or≤75 years. A total of 285 patients (79 patients aged > 75 years) were analyzed. Elderly patients had more comorbidities, but a lower proportion had ventricular arrhythmia. During the mean follow-up of 47 months, 109 patients died (67 due to cardiac death). Kaplan-Meier analysis showed higher mortality in elderly patients (P = 0.0428) but no significant difference in cardiac death by age group (P = 0.7472). There were no significant differences in mortality between patients with CRT-D versus CRT-P (P = 0.3386). SCD was rare. A defibrillator had no significant impact on mortality. In elderly patients, comorbidities are common and related to mortality. The selection of CRT-D versus CRT-P should take those factors into account.

Original languageEnglish
Pages (from-to)358-364
Number of pages7
JournalInternational Heart Journal
Volume64
Issue number3
DOIs
Publication statusPublished - 2023

Keywords

  • Cause of death
  • Device complication
  • Mortality
  • Sudden cardiac death
  • Ventricular arrhythmia

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