Abstract
Background
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.
Methods
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.
Results
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 73 years, 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 166 ms.
Conclusions
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Change history
06 February 2020
In the original version of this article, the author list contained a number of errors, namely a missing author name, and author names that had been merged incorrectly.
References
Bristol MR, Saxon LA, Boehmer J, Krueger S, Kass D, De Marco T, Carson P, DiCarlo L, DeMets D, White BG et al (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350:2140–2150. https://doi.org/10.1056/NEJMoa032423
Cleland GF, Daubert JC, Erdman E, Freemantle N, Gras D, Kappenberger L, Tavazzi L (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352:1539–1549. https://doi.org/10.1056/NEJMoa050496
Ponokswi P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA et al (2016) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur Heart J 37(27):2129–2200
Bogale N, Prior S, Gitt A, Alings M, Linde C, Dickstein K (2011) Scientific committee. The European cardiac resynchronization therapy survey: patient selection and implantation practice vary according to centre volume. Europace. 13(10):1445–1453. https://doi.org/10.1093/europace/eur173
Woods B, Hawkins N, Mealing S, Sutton A, Abraham WT, Beshai JF, Klein H, Sculpher M, Plummer CJ, Cowie MR (2015) Individual patient data network meta-analysis of mortality effects of implantable cardiac devices. Heart 101:1800–1806
Zusterzeel R, Selzman KA, Sanders WE, Caños DA, O’Callaghan KM, Carpenter JL, Piña IL, Strauss DG (2014) Cardiac resynchronization therapy in women: US Food and Drug Administration meta-analysis of patient-level data. JAMA Intern Med 174:1340–1348
Linde C, Stahlberg M, Benson L, Braunschweig F, Edner M, Dahlstrom U, Alehagen U, Lund LH (2015) Gender, underutilization of cardiac resynchronization therapy, and prognostic impact of QRS prolongation and left bundle branch block in heart failure. Europace 17:424–431
Fonarow GC, Albert NM, Curtis AB, Stough WG, Gheorghiade M, Heywood JT, McBride ML, Inge PJ, Mehra MR, O’Connor CM, Reynolds D, Walsh MN, Yancy CW (2010) Improving evidence-based care for heart failure in outpatient cardiology practices: primary results of the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF). Circulation. 122:585–596
Hsich EM, Piña IL (2009) Heart failure in women: a need for prospective data. J Am Coll Cardiol 54:491–498
Scott PA, Turner NG, Chungh A, Morgan JM, Roberts PR (2009) Varying implantable cardioverter defibrillator referral patterns from implanting and non-implanting hospitals. Europace 11:1048–1051. https://doi.org/10.1093/europace/eup145
Shah B, Hernandez A, Liang L, Al-Khatib SM, Yancy CW, Fonarow GC, Peterson ED (2009) Get with the guidelines steering committee. Hospital variation and characteristics of implantable cardioverter-defibrillator use in patients with heart failure: data from the GWTG-HF (Get With The Guidelines–Heart Failure) registry. J Am Coll Cardiol 53(5):422
Frewen J, Finucane C, Cronin H, Rice C, Kearney PM, Harbison J, Kenny RA (2013) Factors that influence awareness and treatment of atrial fibrillation in older adults. Age Ageing 42:ii4
Cardiac resynchronization therapy in patients with atrial fibrillation: the CERTIFY study (Cardiac Resynchronization Therapy in Atrial Fibrillation Patients Multinational Registry). JACC Heart Fail. 2013;1(6):500–7. https://doi.org/10.1016/j.jchf.2013.06.003
Wood MA, Brown-Mahoney C, Kay GN, Ellenbogen KA (2000) Clinical outcomes after ablation and pacing therapy for atrial fibrillation : a meta-analysis. Circulation. 101(10):1138–1144
Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA, Investigators MOST (2003) Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 107(23):2932–2937
Sharma AD, Rizo-Patron C, Hallstrom AP, O’Neill GP, Rothbart S, Martins JB, Roelke M, Steinberg JS, Greene HL, Investigators D (2005) Percent right ventricular pacing predicts outcomes in the DAVID trial. Heart Rhythm 2(8):830–834
Curtis AB et al (2013) Biventricular versus right ventricular pacing in heart failure patients with atrioventricular block. N Engl J Med 368(17):1585–1593
Yu CM, Chan JY, Zhang Q, Omar R, Yip GW, Hussin A, Fang F, Lam KH, Chan HC, Fung JW (2009) Biventricular pacing in patients with bradycardia and normal ejection fraction. N Engl J Med 361(22):2123–2134
Doshi RN, Daoud EG, Fellows C, Turk K, Duran A, Hamdan MH, Pires LA, Group PS (2005) Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study). J Cardiovasc Electrophysiol 16(11):1160–1165
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The original version of this article was revised: In the original version of this article, the author list contained a number of errors, namely a missing author name, and author names that had been merged incorrectly.
Ricky Sheahan is a National Coordinator of CRT Survey II
Rights and permissions
About this article
Cite this article
Ranganathan, D., Sharif, Z., Murphy, T. et al. CRT Survey II: a European Society of Cardiology (ESC) survey of cardiac resynchronization therapy—an Irish subset analysis. Ir J Med Sci 189, 895–905 (2020). https://doi.org/10.1007/s11845-020-02173-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-020-02173-y