Cardiac resynchronization in Poland - comparable procedural routines? Insights from CRT Survey II.

INTRODUCTION: CRT Survey II was initiated by the European Heart Rhythm Association and the Heart Failure Association, to explore everyday implantation practice of cardiac resynchronization therapy (CRT) devices in a broad spectrum of hospitals in European Society of Cardiology (ESC) member countries. AIM: To compare Polish and European procedural practice. MATERIAL AND METHODS: Procedural details of Polish patients collected in 37 Polish centres (n = 1241 - Poland group) were compared to the patients enrolled throughout Europe (n = 9847 - CRT II Survey group). RESULTS: There were significant differences in: successful implantation (96.1% vs. 97.4%), type of device implanted (for CRT-D: 87% vs. 67.6%), implanting physician subspecialty (for electrophysiologist: 69.2% vs. 79.8%), type of location of procedure (for operating room: 19.4% vs. 8.9%), duration of procedure (117.8 ±44 vs. 97.5 ±46.1 min), left ventricle lead type (for multipolar lead: 50% vs. 57.9%), coronary sinus venogram with occlusion rate (41.4% vs. 47.9%) and peri-procedural complication rate (7.5% vs. 5.3%) between Poland and CRT II Survey groups, respectively. CONCLUSIONS: This study provides important information describing current differences in Polish procedural routines in relation to ESC member countries. Heterogeneous CRT implantation practices across European countries still exist. However, it may be related to different clinical profile of patients qualified for CRT implantation in Poland as well as organization of care.

Clinical characteristics, treatment, and prognosis of patients with ischemic and nonischemic acute severe heart failure. Analysis of data from the COMMIT­AHF registry.

INTRODUCTION There are limited data on the impact of ischemic etiology on the clinical status and long­term prognosis of patients with acute severe heart failure (HF) not associated with acute coronary syndrome (ACS). OBJECTIVES The aim of this study was to assess the clinical characteristics, treatment, and 12­month mortality of patients with acute severe HF not associated with ACS, according to the etiology of HF.  PATIENTS AND METHODS Data from 112 patients with acute severe HF not associated with ACS were analyzed: 61 patients with ischemic HF and 51 patients with nonischemic HF. Acute severe HF was defined as acute HF on admission with at least one of the following characteristics: pulmonary congestion, cardiogenic shock, catecholamine or intraaortic balloon pump support, ultrafiltration, mechanical ventilation, prolonged use of intravenous diuretics, fluid in the body cavities requiring decompression, or multiorgan failure. RESULTS Patients with ischemic HF were older (62 vs 54 years, P = 0.001), predominately male (84% vs 65%, P = 0.02), had more comorbidities, and had lower left ventricular ejection fraction (21% vs 27%, P = 0.02). There were no significant differences in treatment modalities (ie, mechanical ventilation, hemodiafiltration, intraaortic balloon pump, left ventricular assist device, heart transplantation), except for 14 percutaneous coronary interventions in the ischemic group. In­hospital adverse events were similar between the groups. Among 83 discharged patients with available follow­up, death was reported for 15 patients with ischemic and 11 patients with nonischemic HF (34% vs 28%, P = 0.42).  CONCLUSIONS Ischemic HF, accounting for approximately half of the cases of acute severe HF not related to ACS, was not associated with a significantly worse prognosis than nonischemic HF.

Complications in recipients of cardioverter-defibrillator or cardiac resynchronization therapy: Insights from Silesian Center Defibrillator registry.

BACKGROUND: Current real-life information from all-comers registries from middle and east Europe about the incidence and type of complications during long-term follow-up of patients with cardioverters-defibrillators (ICD) and cardiac resynchronization devices-defibrillators (CRT-D) is still insufficient. The aim of the study was to assess the incidence and determinants of short- and long-term complications related to implantable ICD and CRT-D. METHODS: We studied 1,105 recipients hospitalized in our center in 2009-2013, followed for a mean of 2.4 years (total of 2,652 patient-years). The independent association between ICD and CRT-D recipients' and implantation-procedures' characteristics with the incidence of complications was analyzed using multivariable Cox regression analysis. RESULTS: In 2-month post-procedural period, 124 (11.2%) patients developed complications. Independent predictors of short-term complications (within 2 months) were: atrial fibrillation, dual chamber ICD implantation, and use of antiplatelet therapy or coumarin. Twenty-seven (2.44%) patients experienced complications, mostly lead-related (n = 21). Independent predictors of long-term complications (2-12 months after implantation) were atrial fibrillation and dual chamber ICD implantation. CONCLUSIONS: Despite significant technological progress and operators' experience, the occurrence of complications in ICD and CRT-D recipients is still substantial. Majority of complications are recorded in the early post-implantation phase. Analysis of independent predictors of complications seem to be essential in helping to reduce adverse events in the future and strongly supports the need for routine follow-up.