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Europace Advance Access originally published online on December 12, 2007
Europace 2008 10(1):48-52; doi:10.1093/europace/eum259
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org.

CARDIAC RESYNCHRONISATION THERAPY

Upgrading to biventricular pacing/defibrillation systems in right ventricular paced congestive heart failure patients: prospective assessment of procedural parameters and response rate

Gabor Z. Duray, Carsten W. Israel, Dimitrij Pajitnev and Stefan H. Hohnloser*

Section Clinical Electrophysiology, Division of Cardiology, Department of Medicine, J.W. Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt a. M., Germany

Aims: Cardiac resynchronization therapy (CRT) is indicated in patients with heart failure and bundle branch block. It is less clear whether this includes patients with pre-existing right ventricular pacemaker/defibrillator systems, particularly with respect to implantation success and clinical benefit.

Methods and results: In consecutive patients scheduled for CRT, we prospectively compared implantation success, procedural parameters, and clinical response in ‘de novo’ vs. upgrade procedures of previously implanted right ventricular systems. CRT implantation was attempted in 79 consecutive patients (64 ± 11 years, 63 male, 38 ischaemic, 41 non-ischaemic cardiomyopathy). De novo implantation was performed in 61 patients, upgrade procedures in 18 patients. Implant success (92 vs. 94%, P = 1.00), procedure duration (153 ± 43 vs. 164 ± 65 min, P = 0.51), fluoroscopy time (25 ± 18 vs. 32 ± 22 min, P = 0.18) or dose (40 ± 31 vs. 52 ± 49 Gy/cm2, P = 0.35), and response rate (66 vs. 59%, P = 0.5) were comparable for both groups.

Conclusion: Procedural aspects, implantation success, and clinical response to CRT were comparable for patients undergoing de-novo vs. upgrade procedures. Accordingly, patient selection for upgrading should be the same as for new CRT implantation.

Key Words: Cardiac resynchronization therapy, Biventricular pacing, Implantation, Complications, Response, Implantable cardioverter defibrillator

*Corresponding author. Tel.: +49 69 6301 7404; fax: +49 6173 950290. E-mail address: hohnloser{at}em.uni-frankfurt.de

Manuscript submitted 26 July 2007. Accepted after revision 5 November 2007.


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