Cardiac resynchronization therapy: an option for inotrope-supported patients with end-stage heart failure?
BACKGROUND
Patients with refractory heart failure requiring inotropic support have a very poor prognosis. Cardiac resynchronization therapy (CRT) offers symptomatic and possibly a survival benefit for patients with stable chronic heart failure (CHF) and a prolonged QRS, but its role in the management of end-stage heart failure requiring inotropic support has not been evaluated.


METHODS
We performed a retrospective observational study of patients undergoing CRT at our institution.


RESULTS
We identified 10 patients who required inotropic support for refractory CHF and who underwent CRT while on intravenous inotropic agents. Patients had been in hospital for 30+/-29 days and had received inotropic support for 11+/-6 days prior to CRT. All patients were weaned from inotropic support (2+/-2 days post-CRT) and all patients survived to hospital discharge (12+/-13 days post-CRT). Furosemide dose fell from 160+/-38 mg on admission to 108+/-53 mg on discharge (p<0.01). Serum creatinine fell from 192+/-34 micromol/l prior to CRT to 160+/-37 micromol/l on discharge (p<0.05). Serum sodium was 131+/-4 mmol/l prior to CRT and remained low at 132+/-5 mmol/l on discharge. At short-term follow up (mean 47 days), all patients were alive; mean furosemide dose was 130+/-53 mg (p=0.056 versus pre-CRT). Serum creatinine was 157+/-36 micromol/l and serum sodium had increased to 138+/-6 mmol/l (p<0.05 and p<0.01, respectively, versus pre-CRT).


CONCLUSIONS
CRT may offer a new therapeutic option for inotrope-supported CHF patients with a prolonged QRS.
Cowburn
Peter J
PJ
Mount Sinai Hospital, 600 University Avenue, Suite 1609, Toronto, Ontario, Canada M5G 1X5.
Patel
Harshna
H
Jolliffe
Robynn E
RE
Wald
Robert W
RW
Parker
John D
JD
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004232:Diuretics / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D004232:Diuretics; D005665:Furosemide