Cardiac resynchronisation as a rescue therapy in patients with catecholamine-dependent overt heart failure: results from a short and mid-term study.
BACKGROUND
Cardiac resynchronisation therapy (CRT) is a validated treatment for heart failure (HF) patients in NYHA class III-IV despite optimal medical therapy. We aimed to assess the beneficial effects of CRT in patients with catecholamine-dependent overt HF (CDOHF).


METHODS
We studied 20 CDOHF patients who had undergone CRT implantation. Patients had a mean baseline QRS duration of 174+/-25 ms and/or echocardiographic asynchrony, and LVEF of 18+/-3%. Mean follow-up was 18+/-12 months. Dependence on catecholamine agents was defined as the inability to stop or reduce drug infusion without re-occurrence of hypotension, low urine output and hypoxaemia.


RESULTS
After CRT implantation, catecholamine agents were mostly withdrawn within 2 days and blood pressure, urine output and BNP rapidly improved within 24 h. During follow-up, survival rates were 85% at 3 months, 80% at 6 months and 55% at 18 months. Among the 9 deaths, 5 were related to overt HF, 3 to sudden cardiac death and 1 to non-cardiac death. LVEF improved from 18+/-3% to 21+/-4% three months after CRT implantation.


CONCLUSIONS
"Rescue" CRT implantation in CDOHF patients allowed a rapid and successful catecholamine weaning in all studied patients. Furthermore, this immediate beneficial effect is sustained for more than one year in surviving patients.
Milliez
Paul
P
AP-HP, Department of Cardiology, Lariboisiere Hospital, Denis Diderot University, Paris, France. paulmilliez@hotmail.com
Thomas
Olivier
O
Haggui
Abdeddayem
A
Schurando
Patrick
P
Squara
Pierre
P
Cohen-Solal
Alain
A
Mebazaa
Alexandre
A
Leenhardt
Antoine
A
D000368:Aged; D002303:Cardiac Output, Low / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D002395:Catecholamines / Q000502:physiology; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
D002395:Catecholamines