Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients

Abstract

Background Many patients with heart failure continue cardiac resynchronization therapy ( CRT ) after continuous flow left ventricular assist device ( CF ‐ LVAD ) implant. We report the first multicenter study to assess the impact of CRT on clinical outcomes in CF ‐ LVAD patients. Methods and Results Analysis was performed on 488 patients (58±13 years, 81% male) with an implantable cardioverter defibrillator ( ICD ) (n=223) or CRT ‐D (n=265) who underwent CF ‐ LVAD implantation at 5 centers from 2007 to 2015. Effects of CRT on mortality, hospitalizations, and ventricular arrhythmia incidence were compared against CF ‐ LVAD patients with an ICD alone. Baseline differences were noted between the 2 groups in age (60±12 versus 55±14, P <0.001) and QRS duration (159±29 versus 126±34, P =0.001). Median biventricular pacing in the CRT group was 96%. During a median follow‐up of 478 days, Kaplan–Meier analysis showed no difference in survival between groups (log rank P =0.28). Multivariate Cox regression demonstrated no survival benefit with type of device ( ICD versus CRT ‐D; P =0.16), whereas use of amiodarone was associated with increased mortality (hazard ratio 1.77, 95% confidence interval 1.1–2.8, P =0.01). No differences were noted between CRT and ICD groups in all‐cause ( P =0.06) and heart failure ( P =0.9) hospitalizations, ventricular arrhythmia incidence (43% versus 39%, P =0.3), or ICD shocks (35% versus 29%, P =0.2). During follow‐up, 69 (26%) patients underwent pulse generator replacement in the CRT ‐D group compared with 36 (15.5%) in the ICD group ( P =0.003). Conclusions In this large, multicenter CF ‐ LVAD cohort, continued CRT was not associated with improved survival, hospitalizations, incidence of ventricular arrhythmia and ICD therapies, and was related to a significantly higher number of pulse generator changes.