Cardiac resynchronisation therapy in patients with end-stage heart failure--long-term follow-up

Cardiac resynchronisation therapy (CRT) has been shown to be effective in the treatment of patients with end-stage heart failure (HF). However, long-term results of CRT have not yet been validated. To assess the sustained benefit of CRT in patients with end-stage HF at long-term follow-up. In addition, predictors of response to CRT were analysed. Twenty-eight patients with end-stage HF, NYHA class >or=III (>or=II in patients with indications for ICD and echocardiographic signs of ventricular mechanical systolic dyssynchrony), left ventricular ejection fraction 120 ms and left bundle branch block morphology received a biventricular device (BiV). In 27 patients LV pacing was achieved via the coronary sinus tributaries and in 1 patient an endocardial LV lead was introduced transseptally. Ten patients received an ICD-CRT device. The control group consisted of 29 patients fulfilling the criteria for ICD-CRT implantation in whom the CRT system was not implanted for various reasons. At baseline, 3 months after implantation, and then every 6 months the following parameters were evaluated: NYHA class, quality of life (QoL) score, QRS duration on surface ECG, and 6-minute walking distance. The need for hospitalisation assessed one year before and one year after implantation was compared. Follow-up was obtained up to 2 years. The NYHA class and 6-minute walking test were significantly improved in the CRT group after 3 months and continued to improve gradually until 24 months of follow-up. The QoL improvement at 6 months was sustained over 2 years. Hospitalisation rate due to worsening of HF decreased. One-year and two-year survival were significantly better in the CRT group than in the control group (94 and 87 vs. 80 and 73% respectively). The only predictor of clinical improvement after CRT implantation was baseline NYHA class. Clinical improvements with CRT are progressive and sustained over 2 years of follow-up.