Cardiac resynchronization therapy (CRT) improves outcomes in heart failure patients with wide QRS complex. However, CRT management following continuous flow Left Ventricular Assist Device (LVAD) implant vary: some centers continue CRT while others turn off the left ventricular (LV) lead at LVAD implant. We sought to study the effect of continued CRT versus turning off CRT pacing following continuous flow LVAD implantation. A comprehensive retrospective multicenter cohort of 295 patients with LVAD and pre-existing CRT was studied. CRT was programmed off after LVAD implant in 44 patients. We compared their outcomes to the rest of the cohort using univariate and multivariate models. Mean age was 60 ± 12 years, 83% were males, 52% had ischemic cardiomyopathy and 54% were destination therapy. Mean follow-up was 2.4 ± 2.0 years, and mean LVAD support time was 1.7 ± 1.4 years. Patients with CRT OFF had a higher Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) mean profile (3.9 vs 3.3, p = 0.01), more secondary prevention indication for a defibrillator (64.9% vs 44.5%, p = 0.023), and more pre-LVAD ventricular arrhythmias (VA) (77% vs 60%, p = 0.048). There were no differences between the CRT OFF and CRT ON groups in overall mortality (Log rank p = 0.32, adjusted HR = 1.14 [0.54–2.22], p = 0.71), heart transplantation, cardiac and noncardiac mortality, all cause hospitalizations, hospitalizations for ICD shocks, and number and frequency of ICD shocks or anti-tachycardia pacing therapy. There were no differences in post LVAD atrial arrhythmias (AA) (Adjusted OR = 0.45 [0.18–1.06], p = 0.31) and ventricular arrhythmias (OR = 0.65 [0.41–1.78], p = 0.41). There was no difference in change in LVEF, LV end diastolic and end systolic diameters between the 2 groups. Our study suggests that turning off CRT pacing after LVAD implantation in patients with previous CRT pacing did not affect mortality, heart transplantation, device therapies or arrhythmia burden. A prospective study is needed to confirm these findings.
Bibliographical noteFunding Information:
Dr. Roukoz has received consulting fees from Boston Scientific and speaking fees from Medtronic. Dr. Ravichandran has been a speaker for Abbott Medical. Dr. Gopinathannair is a consultant and/or speaker for Abbott Medical, Boston Scientific, Pfizer, Bristol Myers Squibb, and Zoll Medical. He also serves as a physician advisor for HealthTrust PG and Abiomed and has received research grant from Boston Scientific. Dr. Slaughter has received research grant funding from Heartware Inc. and serves on the advisory board for Oregon Heart (no compensation). Dr. Cowger is a paid speaker for Abbott and Medtronic and is on the Medtronic Advisory Board. Henry Ford receives clinical trial research funds from both Medtronic and Abbott. The remaining authors have no disclosures to report.
© 2020, The Author(s).
Copyright 2020 Elsevier B.V., All rights reserved.
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