© 2008 European Society of Cardiology
Cardiac resynchronisation as a rescue therapy in patients with catecholamine-dependent overt heart failure: Results from a short and mid-term study
a AP-HP, Department of Cardiology, Lariboisiere Hospital, Denis Diderot University Paris, France
b Department of Cardiology, Ambroise Pare Clinic Neuilly sur Seine, France
c AP-HP, Department of Anesthesiology, Lariboisiere Hospital, Denis Diderot University Paris, France
* Corresponding author. Cardiology Department, Lariboisiere Hospital, 2, rue Ambroise Pare 75010 Paris, France. Tel.: +33 1 49958223; fax: +33 1 49958439. E-mail address: paulmilliez{at}hotmail.com (P. Milliez).
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Abstract |
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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Results: After CRT implantation, catecholamine agents were mostly withdrawn within 2days and blood pressure, urine output and BNP rapidly improved within 24h. During follow-up, survival rates were 85% at 3months, 80% at 6months 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.
Conclusion: "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.
Key Words: CRT • Rescue • Acute decompensated heart failure
Received August 7, 2007; Revised December 21, 2007; Accepted February 7, 2008
1 Paul Milliez and Olivier Thomas equally contributed to this work.
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