Upgrade to cardiac resynchronization therapy with a defibrillator (CRT-D) reduces morbidity and mortality and improves left ventricular (LV) reverse remodeling compared to an implantable cardioverter-defibrillator (ICD) in select patients with heart failure and reduced ejection fraction (HFrEF) and intermittent or permanent right ventricular (RV) pacing, according to late breaking research presented in a Hot Line session today at ESC Congress 2023.
Approximately one million conventional pacemakers or ICDs are implanted each year worldwide. Nearly 30% of these patients experience LV systolic dysfunction due to intraventricular dyssynchrony induced by RV pacing, leading to a relatively high incidence of heart failure hospitalization and associated adverse clinical outcomes.
Participants were randomly assigned to receive a CRT-D upgrade or ICD in a 3:2 ratio. For patients with an ICD at baseline who were assigned to the ICD arm, there were two options at the physician's discretion: 1) no procedure; or 2) CRT-D upgrade with the CRT function turned off. The primary outcome was the composite of heart failure hospitalisation, all-cause mortality, or <15% reduction of LV end-systolic volume.
Regarding secondary endpoints, the composite of heart failure hospitalization and all-cause mortality favored CRT-D compared to ICD, with an adjusted hazard ratio of 0.28 and a difference at 12 months in LV ejection fraction of 9.76% .
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