title: Impact of cardiac resynchronization therapy on clinical outcomes in patients with continuous-flow left ventricular assist devices.
abstract: BACKGROUND
  Implantable cardioverter-defibrillators (ICDs) can improve survival in left ventricular assist device (LVAD) recipients. However, the impact of cardiac resynchronization therapy (CRT-D) on outcomes in continuous-flow left ventricular assist device (CF-LVAD) patients is not known. We sought to determine if CRT-D improved clinical outcomes in CF-LVAD patients compared with ICDs alone.
  
  
  RESULTS
  Sixty-one consecutive CF-LVAD patients with an ICD or CRT-D were evaluated. Impacts of CRT-D on mortality, all-cause hospitalization, and incidence of atrial (AA) and ventricular (VA) arrhythmias after LVAD implantation was compared with patients with ICD alone. Of the 61 LVAD patients, 31 (age 59.8 ± 16 years, 84% male) had CRT-D and 30 (age 57.2 ± 13 years, 74% male) had ICD. Before LVAD implantation, no significant differences were noted between the groups in demographic and clinical characteristics, LVAD indications, and incidence of AA and VA. Over 682 ± 45 days of LVAD support, 8 patients (25.8%) died in the CRT-D arm versus 5 (16.7%) in the ICD arm (P = .35). No differences were noted between the CRT-D and ICD groups in all-cause (96.8 vs 93.3%; P = .63) and HF (19.4 vs 26.7%; P = .78) hospitalizations, left ventricular (LV) end-diastolic diameter (6.4 ± 1.5 vs 6.2 ± 1.1 cm, P = .47), and incidence of AA (35.4% vs 33.3%; P = .80), VA (29% vs 26.6%; P = .86), and ICD shocks (22.6% vs 16.7%; P = .93). Beta-blocker and antiarrhythmic drug use after LVAD implantation was similar in both groups.
  
  
  CONCLUSIONS
  In patients with refractory HF who received CF-LVADs, CRT-D, compared with ICD, did not significantly improve mortality, all-cause hospitalization, LV dimensions, and incidence of AA and VA.
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky. Electronic address: rakesh.gopinathannair@louisville.edu.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gopinathannair
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Birks
authors.affiliation: Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Jaimin R
authors.initials: JR
authors.lastname: Trivedi
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.
authors.forename: Kelly C
authors.initials: KC
authors.lastname: McCants
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.
authors.forename: Brad S
authors.initials: BS
authors.lastname: Sutton
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.
authors.forename: Allen G
authors.initials: AG
authors.lastname: Deam
authors.affiliation: Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Slaughter
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.
authors.forename: Rashmi U
authors.initials: RU
authors.lastname: Hottigoudar
mesh_terms: D000328:Adult; D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000401:mortality* / Q000639:trends; D017147:Defibrillators, Implantable / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D016027:Heart Transplantation / Q000401:mortality / Q000639:trends; D006353:Heart-Assist Devices / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D016896:Treatment Outcome
keywords: ICD; Left ventricular assist device; cardiac resynchronization therapy; heart failure; ventricular arrhythmias