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DOI: 10.1055/s-0034-1367421
Is an upgrade to a cardiac resynchronisation therapy-ICD safe? A single center experience
Objectives: Due to extended indication we see an increase in upgrades of existing pacemakers or ICDs. The clinical benefit of CRT has already been shown. Therefore this therapy is offered to a wide spectrum of patients because of its favorable results. However little is know about the surgical risk and perioperative outcome of upgrads.
Methods: Between 02/2008 and 12/2010 146 patients underwent CRT-implantation. Mean patient age was 64.5 ± 12 years, 125 (85.6%) were male. In our cohort 58 (39.7%) patients received an upgrade to a CRT-ICD. 40 (68.9%) patients had an upgrade of a pre-existing ICD-system, respectively 18 (31.0%) patients of a pre-existing pacemaker. We evaluated the perioprative risk in both groups defined as tamponade, diaphragmatic twitch, pneumothorax, lead dislocation and ventricle perforation by leads as well as frustrane CS-lead implantation.
Results: There were no significant differences in both groups regarding comorbidities, age or gender. In the upgrade group significantly more patients (p = 0.02) received an ICD due to secondary prevention. The overall rate of adverse events in both groups did not show a significant difference (p = 0.44). The rate of procedure related complications was 10.2% in the de-novo implantation group compared to 15.5% in the upgrade group. We registered as significant difference the unseccessful CS-lead implantation. In the de-novo implantion group no frustrane CS-lead implantation was seen compared to 6 (10.3%) in the upgrade group (p = 0.003). All six patients were provided with epicardial leads. In total 12 (20.6%) patients in the upgrade group had a cardiacthoracic intervention to receive epicardial leads.
Conclusion: CRT-implantation was performed safe and feasible without major complications. Both groups did not show a significant difference in procedure related adverse events. However, in the upgrade group a significant higher number of unseccessful CS-lead implantation with consecutive epicardial lead surgery was seen. Therefore an upgrade of a pre-existing ICD or pacemaker to a CRT-ICD should be discussed by the heart team to provide best care for the patients.