Analysis Of Response To Cardiac Resynchronization Therapy In Elderly Chronic Heart Failure Patients (≥75Years) Comparing With Non-elderly Patients

Purpose:Cardiac resynchronization therapy (CRT) has been demonstrated to be beneficial for patients with chronic heart failure, but elderly patients (≥75) are under-represented in major CRT trials, therefore, implantation of CRT in elderly patients remains controversial. The purpose of this study was to compare the effects of cardiac resynchronization therapy in elderly patients (>75years) with younger patients.Methods:A retrospective analysis was conducted in325consecutive patients with heart failure and who successfully underwent CRT device implantation (CRT-P/D) from January2006to August2014. Patients were divided into2groups according to the age, the elderly group (≥75years) and non-elderly group (<75years). Clinical parameters, electrocardiography and echocardiography (left ventricular ejection fraction and left ventricular end-diastolic diameter), procedural and long-term complication and were analyzed at baseline and at1,3,6, and12months, the evaluated the CRT response.Results:There were89patients in the elderly group, mean age was79±3.4years, compared with236patients in the non-elderly group, mean age was60.3±9.6years. Clinical baseline characteristics between the2groups were comparable. During follow-up, there was a comparable and sustained improvement at6months after implantation in both groups. There were60responders (67.4%) in elderly group and162responders (68.6%) in non-elderly group. After CRT, elder and non-elderly patients had similar improvements in NHYA class (0.82±0.78) vs (0.79±0.85), p=0.63,6-minites walking distance (48.7±30.2) m vs (50.1±29.3) m, p=0.53, QRS duration (4.1±45.7) ms vs (4.6±44.3) ms, p=0.12, left ventricular (LV) ejection fraction (7.9±11.0)%vs (8.1%±11.6)%, p=0.34, left ventricular end-diastolic diameter (6.1±9.1)mm vs(6.5±7.2)mm, p=0.44. The elderly group (≥75years) and non-elderly group (<75years) had similar outcome of procedural and long-term complication, the incidence of coronary sinus dissection was1.1%vs0.4%, p=0.16,, diaphragmatic stimulation was3.4%vs3.0%, p=0.62, lead dislocation was2.2%vs2.5%, p=0.66, pocket infection was2.2%vs1.7%, p=0.21, and there was no pneumothorax or myocardium perforation happened. In addition, Kaplan-Meier survival analysis revealed a non-significant difference (P=0.34) between elderly group and younger group.Conclusion:This study’s results showed patients with chronic heart failure who met the clinical CRT guideline could benefit from cardiac resynchronization therapy; elderly patients’ CRT response had no significant difference compared with nonelderly patients.