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

• Published in: International Heart Journal Vol. 64; no. 3; pp. 358 - 364
• Main Authors: Saito, Yuki, Ikeya, Yukitoshi, Kogawa, Rikitake, Kurokawa, Sayaka, Mano, Hiroaki, Okumura, Yasuo, Nakai, Toshiko, Nagashima, Koichi
• Format: Journal Article
• Language: English
• Published: Japan International Heart Journal Association 31.05.2023; Japan Science and Technology Agency
• Subjects: Arrhythmia; Cardiovascular diseases; Cause of death; Comorbidity; Congestive heart failure; Death; Defibrillators; Device complication; Heart failure; Mortality; Sudden cardiac death; Ventricle; Ventricular arrhythmia; Device complication; Ventricular arrhythmia; Sudden cardiac death; Cause of death; Mortality
• ISSN: 1349-2365; 1349-3299
• DOI: 10.1536/ihj.22-418

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 defibrillators 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 > 75 or ≤ 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.