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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Rates of upgrade of ICD recipients to CRT in clinical practice and the potential impact of the more liberal use of CRT at initial implant
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Rates of upgrade of ICD recipients to CRT in clinical practice and the potential impact of the more liberal use of CRT at initial implant

机译：ICD接受者在临床实践中升级为CRT的比率以及在初始植入时更自由地使用CRT的潜在影响

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Background: Many implantable cardioverter defibrillator (ICD) recipients may develop indications for cardiac resynchronization therapy (CRT) during follow-up. However, the actual upgrade rate during follow-up in clinical practice is not known. Methods: We performed a single center retrospective observational study of all new ICD implants over 5 years (2003-2007). The rate of CRT upgrade of patients initially implanted with a single-/dual-chamber ICD during follow-up was assessed. The impact of using alternative criteria on the need for CRT in ICD recipients at initial implant was also evaluated. Results: During the study period, there were 549 new ICD implants. The initial implant was a single/dual-chamber ICD in 73% (n = 399) and a CRT-D in 27% (n = 150). During follow-up (48±20 months) of the 399 ICD recipients, 70 (17.5%) died and 15 (3.8%) were upgraded to CRT, including eight cases where left ventricular lead implant had been initially unsuccessful. Upgrade rates at 1, 3, and 5 years were 0.03%, 2.4%, and 5.1%, respectively. Using alternative CRT criteria (left ventricular ejection fraction [LVEF]≤30%, QRS a 130 ms, New York Heart Association I-IV) 42.6% (n = 234) of ICD recipients met criteria for CRT at initial implant. Conclusion: In this retrospective single center study, rates of CRT upgrade in ICD recipients over the medium term were low, which may reflect underuse in otherwise appropriate candidates. The more liberal use of CRT at initial implant in patients with a reduced LVEF, a broad QRS, but only mild heart failure symptoms would require approximately 50% increase in CRT use in ICD recipients at initial implant, and may help address some of the suggested underutilization.
机译：背景：许多植入式心脏复律除颤器（ICD）接受者在随访期间可能会出现心脏再同步治疗（CRT）的适应症。但是，在临床实践中随访期间的实际升级率尚不清楚。方法：我们对所有新的ICD植入物进行了为期5年（2003-2007年）的单中心回顾性观察研究。评估随访期间最初植入单腔/双腔ICD的患者的CRT升级率。还评估了在初次植入时在ICD接受者中使用替代标准对CRT需求的影响。结果：在研究期间，有549种新的ICD植入物。最初的植入是73％（n = 399）的单腔/双腔ICD和27％（n = 150）的CRT-D。在399名ICD接受者的随访中（48±20个月），有70例（17.5％）死亡，15例（3.8％）升级为CRT，其中包括8例最初未成功植入左心室铅的病例。在1年，3年和5年的升级率分别为0.03％，2.4％和5.1％。使用其他CRT标准（左心室射血分数[LVEF]≤30％，QRS a 130 ms，纽约心脏协会I-IV），有42.6％（n = 234）的ICD接受者在初次植入时符合CRT标准。结论：在这项回顾性单中心研究中，ICD接受者的CRT中期升级率很低，这可能反映出在其他合适的候选人中使用率不足。对于左室射血分数降低，QRS广泛，但只有轻度心力衰竭症状的患者，在初始植入时更广泛地使用CRT才需要在初始植入时在ICD接受者中使用CRT约增加50％，这可能有助于解决一些建议利用不足。

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