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Usefulness and Consequences of Cardiac Resynchronization Therapy in Dialysis-Dependent Patients With Heart Failure
Study Questions:
What is the role of cardiac resynchronization therapy (CRT) in patients with end-stage renal disease (ESRD) on dialysis?
Methods:
Authors from a single center studied their experience with a cohort of patients from May 24, 2002 to February 9, 2012, with ESRD and CRT. The primary endpoint was all-cause mortality and echocardiographic response. Echocardiographic evidence was defined as ≥5% absolute increase in ejection fraction (EF). Secondary endpoints included time until heart failure (HF) hospitalization, time until all-cause hospitalization, and the combined endpoint of HF hospitalization or death.
Results:
Fifteen dialysis-dependent patients with HF were implanted with CRT. Twenty percent of the subjects were women. The mean EF was 21 ± 7%, 53% had a left bundle branch block, and 67% had an ischemic cardiomyopathy. Eighty-seven percent of the patients had CRT with defibrillator. By 6-month follow-up, one third of the patients had died. At 3 years, Kaplan-Meier modeling predicted a 31% incidence of HF hospitalization, 100% incidence of hospitalization for any cause, 73% mortality, and 82% incidence of HF hospitalization or death. Patients on dialysis did not demonstrate a significant improvement in EF or LV diameters.
Conclusions:
The authors concluded that CRT implantation in patients with ESRD and HF appears safe, with no major complications. There was variable evidence of improvement in echocardiographic parameters.
Perspective:
Further studies with a larger cohort of patients are needed to determine the role of CRT in ESRD patients.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Acute Heart Failure
Keywords: Myocardial Ischemia, Defibrillators, Kidney Failure, Chronic, Intracellular Signaling Peptides and Proteins, Cardiac Resynchronization Therapy, Heart Diseases, Renal Dialysis, Cardiac Pacing, Artificial, Heart Failure, Bundle-Branch Block, Parkinson Disease, Hospitalization, Renal Insufficiency, Chronic
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