title: Cardiac resynchronization therapy with or without defibrillator: experience from a high-volume Belgian implantation centre.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) is an important treatment modality for heart failure with reduced ejection fraction and ventricular conduction delay. Considering limited health care budgets in an aging population, adding a defibrillator function to CRT remains a matter of debate. Our aim was to describe the experience of a high-volume Belgian implantation centre with CRT with/without defibrillator (CRT-D/P).
  
  
  RESULTS
  Consecutive CRT patients (n = 221), implanted between October 2008 and April 2011 in Ziekenhuis Oost-Limburg (Genk), were reviewed. From 209 primo-implantations, 74 CRT-D and 98 CRT-P patients with complete follow-up inside the centre, were analysed. Despite differences in baseline characteristics, both groups demonstrated similar reverse left ventricular remodelling, improvement in New York Heart Association functional class and maximal aerobic capacity. During mean follow-up of 18 +/- 9 months, 21 patients died and 83 spent a total of 1200 days in hospital. Annual mortality was 8% and equal among the groups. The mode of death differed between CRT-D (predominantly pump failure) and CRT-P patients (pump failure, comorbidity and sudden death). The yearly population attributable risk of malignant ventricular arrhythmia was 8.16% in CRT-D and 1.38% in CRT-P patients.
  
  
  CONCLUSIONS
  With current guidelines applied to the Belgian reimbursement criteria and at physicians'discretion, patient selection for CRT-D/ CRT-P was appropriate, with similar reverse remodelling, functional capacity improvement and good clinical outcome in both groups. High-risk patients for malignant ventricular arrhythmia were more likely to receive CRT-D, although the yearly attributable risk remained 1.38% in CRT-P patients.
authors: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors: Frederik H
authors: FH
authors: Verbrugge
authors: Philippe
authors: P
authors: De Vusser
authors: Maximo
authors: M
authors: Rivero-Ayerza
authors: Hugo
authors: H
authors: Van Herendael
authors: Koen
authors: K
authors: Rondelez
authors: Matthias
authors: M
authors: Dupont
authors: Mathias
authors: M
authors: Vrolix
authors: Christiaan
authors: C
authors: Van Kerrebroeck
authors: David
authors: D
authors: Verhaert
authors: Pieter
authors: P
authors: Vandervoort
authors: Wilfried
authors: W
authors: Mullens
mesh_terms: D000369:Aged, 80 and over; D001530:Belgium; D058406:Cardiac Resynchronization Therapy; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male