Europace Advance Access originally published online on July 18, 2007
Europace 2007 9(9):732-738; doi:10.1093/europace/eum143
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CARDIAC RESYNCHRONISATION THERAPY
Efficacy of cardiac resynchronization therapy in very old patients: the Insync/Insync ICD Italian Registry
1 Belcolle Hospital, Via Monfalcone 20/A, 01100 Viterbo, Italy; 2 IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy; 3 Niguarda Hospital, Milan, Italy; 4 S. Filippo, Neri Hospital, Rome, Italy; 5 Policlinico S. Matteo IRCCS, Pavia, Italy; 6 Careggi Hospital, Firenze, Italy; 7 Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy; 8 Civile Hospital, Asti, Italy; 9 S. Camillo, Hospital, Rieti, Italy; 10 Istituto Auxologico S., Luca Hospital, Milano, Italy; 11 Medtronic Italia, Rome, Italy
Aims To assess the effects of cardiac resynchronization therapy (CRT) in 
80-year-old patients vs. patients <80 years, in terms of clinical, functional, and echocardiographic parameters after 12 month of CRT, survival, and incidence of arrhythmic events.
Methods and results The study population consisted of 1181 CRT patients (85 were 80 years old). They were enrolled in a national observational registry and underwent baseline evaluation and periodical follow-up visits. In the overall population, New York Heart Association class and ejection fraction (EF) improved and ventricular diameters decreased. Similar changes were observed in the two groups. In the study population, 157 patients died, 144 (13%) in the <80 years group and 13 (15%) in the 80 years group. There was a higher all-cause mortality (log-rank test, P = 0.015) among 80 years patients, with a trend towards higher sudden cardiac death (SCD) (P = 0.057), but similar non-SCD (P = 0.293). Using the combined endpoint of SCD or appropriate shock from a defibrillator for ventricular fibrillation, no significant differences resulted between groups (P = 0.455). In both groups, lower EF was associated with higher mortality.
Conclusion Cardiac resynchronization therapy demonstrated similar efficacy in patients aged 80 years and in those under 80, in terms of clinical and functional parameters and reverse remodelling. Similarly, CRT resulted in comparable effects on death for heart failure and on SCD.
Key Words: Cardiac resynchronization therapy, Heart failure, Elderly
* Corresponding author. Tel: +39 0761 339451; fax: +39 0761 339278. E-mail address: a_achilli{at}virgilio.it
Manuscript submitted 1 March 2007. Accepted after revision 21 June 2007.