Efficacy of cardiac resynchronization therapy in very old patients: the Insync/Insync ICD Italian Registry.
OBJECTIVE
To assess the effects of cardiac resynchronization therapy (CRT) in > or =80-year-old patients vs. patients <80 years, in terms of clinical, functional, and echocardiographic parameters after 12 month of CRT, survival, and incidence of arrhythmic events.


RESULTS
The study population consisted of 1181 CRT patients (85 were > or =80 years old). They were enrolled in a national observational registry and underwent baseline evaluation and periodical follow-up visits. In the overall population, New York Heart Association class and ejection fraction (EF) improved and ventricular diameters decreased. Similar changes were observed in the two groups. In the study population, 157 patients died, 144 (13%) in the <80 years group and 13 (15%) in the > or =80 years group. There was a higher all-cause mortality (log-rank test, P = 0.015) among > or =80 years patients, with a trend towards higher sudden cardiac death (SCD) (P = 0.057), but similar non-SCD (P = 0.293). Using the combined endpoint of SCD or appropriate shock from a defibrillator for ventricular fibrillation, no significant differences resulted between groups (P = 0.455). In both groups, lower EF was associated with higher mortality.


CONCLUSIONS
Cardiac resynchronization therapy demonstrated similar efficacy in patients aged > or =80 years and in those under 80, in terms of clinical and functional parameters and reverse remodelling. Similarly, CRT resulted in comparable effects on death for heart failure and on SCD.
Achilli
Augusto
A
Belcolle Hospital, Via Monfalcone 20/A, 01100, Viterbo, Italy. a_achilli@virgilio.it
Turreni
Federico
F
Gasparini
Maurizio
M
Lunati
Maurizio
M
Sassara
Massimo
M
Santini
Massimo
M
Landolina
Maurizio
M
Padeletti
Luigi
L
Puglisi
Andrea
A
Bocchiardo
Mario
M
Orazi
Serafino
S
Perego
Giovanni Battista
GB
Valsecchi
Sergio
S
Denaro
Alessandra
A
D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000517:prevention & control*