Utilization of Subcutaneous Cardioverter-Defibrillator in Poland and Europe-Comparison of the Results of Multi-Center Registries.

The implantation of a subcutaneous cardioverter-defibrillator (S-ICD) may be used instead of a traditional transvenous system to prevent sudden cardiac death. Our aim was to compare the characteristics of S-ICD patients from the multi-center registry of S-ICD implantations in Poland with the published results of the European Snapshot Survey on S-ICD Implantation (ESSS-SICDI). We compared data of 137 Polish S-ICD patients with 68 patients from the ESSS-SICDI registry. The groups did not differ significantly in terms of sex, prevalence of ischemic cardiomyopathy, concomitant diseases, and the rate of primary prevention indication. Polish patients had more advanced heart failure (New York Heart Association (NYHA) class III: 11.7% vs. 2.9%, NYHA II: 48.9% vs. 29.4%, NYHA I: 39.4% vs. 67.7%, p < 0.05 each). Young age (75.9% vs. 50%, p < 0.05) and no vascular access (7.3% vs. 0%, p < 0.05) were more often indications for S-ICD. The percentage of patients after transvenous system removal due to infections was significantly higher in the Polish group (11% vs. 1.5%, p < 0.05). In the European population, S-ICD was more frequently chosen because of patients' active lifestyle and patients' preference (both 10.3% vs. 0%, p < 0.05). Our analysis shows that in Poland, compared to other European countries, subcutaneous cardioverters-defibrillators are being implanted in patients at a more advanced stage of chronic heart failure. The most frequent reason for choosing a subcutaneous system instead of a transvenous ICD is the young age of a patient.

Venous stenosis and occlusion in the presence of endocardial leads in patients referred for transvenous lead extraction.

Objective The aim of this study was to evaluate the incidence of venous stenosis and occlusion (VSO) in patients referred for transvenous lead extraction (TLE) with regard to the indications for this treatment and to analyse the influence of VSO on efficacy, complications and technical challenges of TLE procedures. Methods The material consists of 133 consecutive TLE procedure records. The contrast venography examination of the ipsilateral access vein was performed prior to the operation. The whole study population was divided into two subgroups, based on the presence (subgroup I) or absence (subgroup II) of VSO. Results Phlebography was performed in 133 patients with age ranging from 25.7 to 86.1 years, 44 female (33.1%). The VSO was confirmed in 48 (36.1%) patients - subgroup I. Most of the patients were referred to TLE due to non-infectious reasons (100 pts-75.2%). The absence of VSO was observed substantially more frequently in patients with diabetes (P = 0.02). Procedural success rate reached 93.3% in subgroup I and 98.8% in subgroup II (P = 0.1). There was no significant difference in the use of advanced tools and alternative access sites. Conclusion The presence of VSO can be expected in one third of patients referred for lead extraction. There is no association between indication for TLE (infected or noninfected lead extraction) and the incidence of VSO. Diabetes proved to have a protective effect on venous patency in the previously mentioned group. VSO does not influence the effectiveness, safety, and the use of additional tools during TLE procedures.

[Predictive parameters of occurrence of adequate interventions in patients with implanted cardioverter-defibrillators with or without resynchronisation therapy in primary prevention of sudden cardiac death in dilated cardiomyopathy]. / Parametry predykcyjne wystepowania adekwatnych interwencji u pacjentów z implantowanymi kardiowerterterami-defibrylatorami z lub bez funkcji resynchronizacji w prewencji pierwotnej naglego zgonu sercowego w kardiomiopatii rozstrzeniowej.

The task of the ICD is to detect ventricular arrhythmias and treatment of its adequate intervention. The task of the CRTD in addition to the above tasks is the treatment of heart failure. AIM: The aim of the study was to assess the predictive parameters of adequate interventions in patients with an ICD and CRTD. MATERIALS AND METHODS: The study consisted of 273 patients (230 M, mean age 65±11 years) with ICD and/or CRTD. The inclusion criteria were: left ventricle ejection fraction (LVEF) ≤ 35%, NYHA class ≥ II, implantation in primary SCD prevention and in case of CRTD additionally LBBB with wide QRS ≥ 120ms. The following data were assessed: age, gender, presence of dilated cardiomyopathy, diabetes, chronic kidney failure, atrial fibrillation (AF), LVEF, NYHA class, device interventions, number of arrhythmias, changes in pharmacotherapy, device parameters and mortality. RESULTS: During observation, which lasted the mean of 770±490 days, 102 patients had adequate device interventions. In the ICD group, adequate interventions appear mainly in the initial observation period (HR 2,01), in patients with left ventricular hypertrophy (HR 2,98) and ventricular arrhythmias (HR 6,78) and not treated with amiodarone (HR 4,31). In the CRTD group, adequate interventions appear mainly in younger patients (HR 1,06), in diabetes (HR 1,68), in NYHA class II, in paroxysmal atrial fibrillation (HR 1,09) and ventricular arrhythmias (HR 2,54) and not treated with amiodarone (HR 1,09). CONCLUSIONS: In the ICD group, left ventricular hypertrophy, ventricular arrhythmias is not treated with amiodarone in a significant influence on the risk of adequate intervention. In the Group of CRTD younger age, diabetes, NYHA class II, paroxysmal atrial fibrillation, ventricular arrhythmias is not treated with amiodarone in a significant influence on the risk of adequate intervention. In the ICD group, adequate interventions particularly often in the first year of follow-up. Patients with CRTD require special medical care.

[The evaluation of the ventricular arrhythmias and interventions of cardiac implantable electronic devices in patients with dilated cardiomyopathy for primary prevention of sudden cardiac death in ambulatory and telemetric follow-up]. / Ocena wystapienia arytmii komorowych i interwencji wszczepialnych urzadzen do elektroterapii serca u chorych na kardiomiopatie rozstrzeniowa w zapobieganiu pierwotnej naglego zgonu sercowego w obserwacji ambulatoryjnej i w kontroli metoda telemonitoringu.

Telemetric follow-up (RM) after cardiac devices implantation is not inferior to classic follow-up and enables earlier clinical complications detection. AIM: The aim of the study was to evaluation of the ventricular arrhythmias and interventions of ICD/CRTD in ambulatory and telemetric follow-up in patients with dilated cardiomyopathy. MATERIALS AND METHODS: Group A (CRT-D+ICD) - retrospective, patients followed-up in outpatient clinic - was consisted with 273 patients (mean age 65±11 years, 230M). In group A 128 patients after CRT-D implantation and 145 patients with ICD were selected. Group B (RM group) - prospective, RM Medtronic Carelink followup - was consisted with 177 patients (mean age 61±13 years, 141M). 35 patients had CRT-D and 142 had ICD implanted. Follow-up of patients from group A was performed in outpatient clinic. Follow-up of patients from group B was monitored daily follow-up using RM system (Medtronic Carelink). Frequency/type of ventricular arrhythmias, device interventions, patient's clinical status, medications, were assessed in both groups. To assess presence of ventricular arrhythmias, device interventions, ICD and CRT-D programming changes, pharmacotherapy changes, patients were randomly chosen from group A, according to age, gender, LVEF value, NYHA class, comorbidities, time of follow-up as a control group to group B (RM group). RESULTS: In multivariate analysis, it was found that a low ejection fraction <25% (HR 0,929; p<0,001), and diabetes mellitus (HR 7,038; p<0,009) predispose to ventricular arrhythmias. In the RM group, compared to control group, there were significantly less programming changes (5,9 vs 47,1%, p<0,001), time to first events (ventricular arrhythmias - 258 vs 487 d, p<0,001; interventions - 295 vs 775 d, p<0,01) was shorter, while time to first necessary programming (364 vs 304 d, p<0,001) or pharmacotherapy (330 vs 244 days, p<0,001) change was longer. General mortality did not differ significantly between the groups (p=0,130). CONCLUSIONS: Low ejection fraction <25%, and diabetes mellitus predispose to ventricular arrhythmias. Telemetric follow-up of cardiac implantable devices enables quick information transmission in cases of clinical complications (arrhythmias, interventions) and reduces number of ambulatory visits to only necessary ones. Telemetric followup of cardiac implantable devices is a safe. Key words: ventricular arrhythmias, interventions.

[The assessment of factors influencing occurrence of adequate interventions of cardiac resynchronization therapy with cardioverter-defibrillator implanted in primary prevention of sudden cardiac death in dilative cardiomyopathy and percentage of biventricular pacing].

The assessment of factors influencing occurrence of adequate interventions of cardiac resynchronization therapy with cardioverter-defibrillator implanted in primary prevention of sudden cardiac death in dilative cardiomyopathy and percentage of biventricular pacing. Introduction: The function of cardiac resynchronization therapy with cardioverter-defibrillator (CRT-D) is to treat heart failure (HF) and to treat ventricular arrhythmia, if it occurs, with adequate intervention. Aim: The aim of the study was to find predictors of adequate interventions and in how many patients biventricular pacing percentage decreases during the follow-up. Material and methods: The study comprised of 228 patients (178 M, mean age 66±10, 31-89 years) with implanted CRTD. The following data were analyzed: age, sex, presence of dilative cardiomyopathy, diabetes mellitus, lowered creatinine clearance, atrial fibrillation (AF), LVEF, NYHA class, adequate interventions, number of arrhythmias, pharmacotherapy modifications, device parameters and mortality. Results: Mean ejection fraction of the left ventricle was 20.9±6.4, (10.0- 35%). During the mean follow up of 770±490 days in 84 (37%) patients adequate interventions of the device occurred. The adequate interventions concerned mainly patients with diabetes mellitus (HR 2.95), in NYHA class II, with paroxysmal atrial fibrillation (HR 2.15). In 39 patients (17%) the mean percentage of biventricular pacing was below 90%, and in 18 (8%) below 85%. Conclusions: Diabetes mellitus, NYHA class II, paroxysmal atrial fibrillation have significantly increased the risk of adequate intervention. The most common causes of loss of biventricular pacing were: inappropriate AV delay, supraventricular arrhythmias and premature ventricular complexes. A significant correlation between low biventricular pacing percentage and the occurrence of supraventricular arrhythmias and adequate interventions was observed.

The utility of a CHA2DS2-VASc score in predicting the presence of significant stenosis and occlusion of veins with indwelling endocardial leads.

BACKGROUND: Currently, there are no studies in which a CHA2DS2-VASc score has been used to predict the risk of venous stenosis and occlusion (VSO) in patients after the implantation of a cardiac implantable electronic device (CIED). METHODS: The material consists of the records of 223 consecutive patients qualified for transvenous lead extraction, generator change and system revisions or upgrades in whom we assessed the utility of a CHA2DS2-VASc score in the prediction of VSO. The CHA2DS2-VASc score was calculated retrospectively based on the clinical data. The whole study population was divided into two groups, based on the presence (group I) or absence (group II) of VSO. Using the receiver operating characteristic (ROC) curve, we identified the optimal cut-off point for the CHA2DS2-VASc score that allowed the prediction of the absence of VSO. RESULTS: The venography was performed in 223 consecutive patients aged on average 68.2years (25.7-95.3), 77 females (34.5%). The presence of VSO was detected in 79 (35.4%) patients aged 68.3±14.1years, 30 female (40%) patients-group I. The level of the cut-off point for the CHA2DS2-VASc score that allowed the prediction of the absence of VSO was 3.0. CONCLUSION: In the whole population the incidence of VSO amounted to 35.4%. The result of the CHA2DS2-VASc score was a destimulant of VSO occurrence and was characterized by moderate sensitivity (73.4%) and specificity (42.4%) in predicting the absence of VSO. The most significant factor, which prevented VSO development was diabetes.

[Arrhythmia, device interventions and mortality analysis in patients with implanted cardioverter-defibrillator with/without resynchronisation therapy in dilative cardiomyopathy in primary prevention of sudden cardiac death]. / Analiza arytmii, interwencji urzadzenia oraz umieralnosci w populacji chorych z implantowanym kardiowerterem-defibrylatorem i/lub z funkcja resynchronizacji z powodu kardiomiopatii rozstrzeniowej w prewencji pierwotnej naglego zgonu sercowego.

UNLABELLED: Ambulatory follow-up of patients with implanted cardioverter-defibrillator (ICD) with/without resynchronisation therapy (CRTD) requires regular visits to assess arrhythmias, device interventions and mortality. AIM: The aim of the study was to examine arrhythmia prevalence, device interventions and mortality in patients with dilative cardiomyopathy with ICD/CRTD implanted in primary sudden cardiac death (SCD) prevention. MATERIALS AND METHODS: The study consisted of patients with ICD and/or CRTD implanted between 2010-2011. The inclusion criteria were: left ventricle ejection fraction (LVEF) ≤ 35%, NYHA class ≥ II, implantation in primary SCD prevention and in case of CRTD additionally LBBB with wide QRS ≥ 120ms. All of patients' visits in outpatient clinic were analysed. The following data were assessed: age, gender, presence of coronary artery disease (CAD), diabetes, thyroid gland diseases, chronic kidney failure, atrial fibrillation (AF), LVEF, NYHA class, device interventions, number of arrhythmias, changes in pharmacotherapy, device parameters and mortality. RESULTS: The study analysed 360 patients (302 M, mean age 64±12 years) with cardiac implantable devices (127 with CRTD, 233 with ICD). During observation, which lasted the mean of 768±491 days, 258 patients had ventricular arrhythmias and 118 patients had adequate device interventions. 10 patients died because of the progression of heart failure. Ventricular arrhythmia was more frequent in patients with CRTD, who died, with low cholesterol level, high NYHA class, low LVEF, diabetes and kidney failure. Device interventions occurred in the above described groups and additionally in patients with AF. After step exclusion of characteristics with highest p value in Wald test, it was confirmed that the factors influencing ventricular arrhythmia and death were low LVEF (HR=0,944, p<0,002 and HR=0,813, p<0,013) and diabetes (HR=7,043, p<0,009 and HR=29,931, p<0,002). CONCLUSIONS: Ventricular arrhythmia is more often in patients with CRTD, who died, with low cholesterol level, high NYHA class, low LVEF, diabetes and kidney failure. Adequate interventions are more often in patients who died, with low cholesterol level, high NYHA class, low LVEF, diabetes, kidney failure and AF. Patients who died, compared to those who survived, had significantly more often lipid level anomalies, high NYHA class, low LVEF, advanced age, diabetes, kidney failure, atrial fibrillation, arterial hypertension, device interventions and pharmacotherapy changes. Diabetes and low LVEF are predictors of ventricular arrhythmias and death.

[Safety and efficacy of classic ambulatory implantable cardioverter-defibrillator and resynchronisation systems follow-up compared to telemetric follow-up]. / Porównanie bezpieczenstwa i skutecznosci tradycyjnej kontroli ambulatoryjnej z kontrola metoda telemonitoringu wszczepialnych kardiowerterów-defibrylatorów oraz urzadzen resynchronizujacych serca.

UNLABELLED: Telemetric follow-up (RM) after cardiac devices implantation is not only not inferior to classic follow-up, but also enables earlier clinical complications detection and stricter patient monitoring. THE AIM: of the study was to confirm safety and efficacy of RM in patients with implantable cardioverter-defibrillator (ICD) or cardioverterdefibrillator with resynchronisation therapy (CRT-D), compared to traditional follow-up in outpatient clinic. MATERIALS AND METHODS: Group A (CRT-D+ICD) (retrospective, patients followed-up in outpatient clinic) was consisted with 273 patients (mean age 65±11 years, 230M). Group A included 128 patients after CRT-D implantation and 145 patients with ICD. Group B (RM group) (prospective, RM Medtronic CareLink follow-up) involved 89 patients (mean age 61±14 years, 73M). 11 patients had CRT-D and 78 had ICD implanted. Only patients with Medtronic equipment were included to group B. Follow-up of patients from group A - ambulatory visit in outpatient clinic: 1-3 months after implantation, then every 6 months. Follow-up of patients from group B - daily follow-up using RM system (Medtronic CareLink). Patient's clinical status, medications, frequency/ type of arrhythmias, device interventions were assessed in both groups. RESULTS: To assess presence of ventricular arrhythmia, device interventions, ICD and CRT-D programming changes, pharmacotherapy changes, a number of patients were randomly chosen from group A. They were similar in age, gender, LVEF value, NYHA class, comorbidities, time of follow-up (control group) to Group B (RM group). In the RM group, compared to control group, there were significantly less programming changes (3,4 vs 28,6%, p<0,001), time to first event was shorter (ventricular arrhythmia - 39 days, p<0,001; intervention - 102 days, p<0,001), time to first necessary programming change was longer (201 days, p<0,001). RM system proved to be save, more accurate (22% visits were performed personally by the physician operating Medtronic CareLink system, 71,4% consultations were performed via internet, phone), and general mortality did not differ significantly between the groups (p=0,147). CONCLUSIONS: Telemetric follow-up of cardiac implantable devices is a safe and more accurate method in comparison to classic ambulatory follow-up. Telemetric follow-up of cardiac implantable devices enables quick information transmission in case of clinical complications (arrhythmia, intervention). Telemetric follow-up allows to reduce number of ambulatory visits to only necessary ones.

Venous Stenosis and Occlusion in the Presence of Endocardial Leads.

BACKGROUND: Venous stenosis and occlusion in the presence of endocardial leads constitute one of the complications of permanent cardiac pacing either by pacemaker, implantable cardioverter-defibrillator or cardiac resynchronization therapy. OBJECTIVES: The aim of this study was to assess the incidence of stenosis and occlusions and determine the risk factors in patients with endocardial leads in a prospective single-center study. MATERIAL AND METHODS: Two hundred eighty consecutive patients aged 25-95 years (male 68.8%) were included. A contrast venography examination of the ipsilateral access vein was performed. The whole study population was divided into 2 groups, based on the presence (group I) or absence (group II) of endocardial leads. RESULTS: Venous stenosis/occlusion was identified in 51 patients (37.5%) in group I and in 3 patients (3.6%) in group II; p < 0.0001. The lead presence most highly correlated with venous complications (OR = 4.172; p < 0.001). In patients with endocardial leads divided into I A and I B according to venous patency diabetes mellitus was proved in multivariate analysis to be the only protective factor against the development of venous stenosis/occlusion (OR = 0.473; p = 0.010). CONCLUSIONS: The presence of endocardial leads is a predisposing factor for venous stenosis/occlusion and increases the risk 4-fold. The venous lesions in the presence of endocardial leads are less frequent among patients with diabetes mellitus.

[Reasons of recurrence and subjective arrhythmia feelings after successful RF AVNRT ablation].

Aim of the study was analysis of electrophysiological and clinical parameters related to increasement of recurrence risk of AVNRT and subjective heart feelings after successful RF ablation. Materials and methods: Retrospective analysis was made among patients after successful RF AVNRT ablation. Study group was 93 patients (F=63), mean age 46.7+15.9 (from 18 to 80y). Electrophysiological and physical parameters achieved during electrophysiological study was analysed. Using telephone monitoring and question survey patients were divided into 3 subgroups A ­ without symptoms, B ­ with subjective arrhythmia feelings and C with documented arrhythmia recurrence. Results: 6.4% patients (n=6) had documented arrhythmia recurrence AVNRT (subgroup C); women 100% (n=6), mean age 43.5±14 years. 43% of patients (n=40) after successful RF ablation had subjective feelings of heart palpitations of a different kind (subgroup B); women 68% (n=32), mean age 42.8±14 years. 51% (n=47) of patients didn't feel any arrhythmia (subgroup A); women 64% (n=36), mean age 50.7±17 years. Conclusions: Factors related to increased risk of arrhythmia recurrence was: atypical forms of tachycardia, shorter tachycardia cycle, slow pathway modification, low mean power during RF ablation. Among patients without documented arrhythmia recurrence: lower age, higher time from the beginning arrhythmia until ablation procedure and Wenckebach Point cycle length shorter predispose to inadequate subjective arrhythmia feelings after successful RF ablation.

[Ventricular arrhythmia and device intervention analysis in patients with implanted cardioverter-defibrillator with/without resynchronisation therapy in dilative cardiomyopathy in primary prevention of sudden cardiac death in telemetric follow-up].

Introduction: Remote monitoring of ICD/CRTD is safe, during which evaluates the type of arrhythmia, intervention. Aim: The aim of the study was the assessment of ventricular arrhythmia and ICD/CRTD intervention. Material and methods: The study included 177 patients (mean age 61,1±13; 23-88 y; Men 141) with an ICD/CRTD implanted. Patients were controlled telemonitoring system, Medtronic Carelink. The following variables were analyzed: age, gender, comorbidities, LVEF value, NYHA class, type of ventricular arrhythmias, device interventions, reprogramming and pharmacotherapy changes. Results: In multivariate analysis, it was found that, diabetes mellitus (HR 3,49), a low ejection fraction <25% (HR 2,51) predispose to ventricular arrhythmias; and a low ejection fraction <25% (HR 1,88), ischemic DCM (HR 1,92), II NYHA class, the lack of Amiodarone (HR 5,01) predispose to device intervention. Conclusions: 1. A low ejection fraction, ischemic dilative cardiomyopathy, II NYHA class, the lack treatment of Amiodarone predispose to ventricular arrhythmias. 2. A low ejection fraction, diabetes mellitus predispose to device intervention. 3. A significant correlation between interventions and ventricular arrhythmias, renal failure, diabetes mellitus, abnormal lipidogram were observed. 4. Telemetric follow-up of cardiac implantable devices is a safe and enables quick information transmission in cases of clinical complications (arrhythmias, interventions).

Effectiveness of atrial versus atrioventricular pacing for sick sinus syndrome during long-term follow-up.

BACKGROUND: According to the current guidelines, atrioventricular (DDD) pacing is superior to atrial pacing (AAI) in the treatment of sick sinus syndrome (SSS). AIM: To compare outcomes of AAI and DDD pacing in patients with SSS during long-term follow-up. METHODS: We studied 809 patients, including 86 patients in the AAI group (57 women, mean age 65 ± 15 years) and 723 patients in the DDD group (406 women, mean age 71.5 ± 10 years). Evaluation of outcomes of AAI and DDD pacing in SSS was based on the analysis of medical records of patients who underwent pacemaker implantation. RESULTS: Average duration of follow-up was 52 ± 25 months. In the AAI group, 63 of 86 patients remained without intervention. In the DDD group, 661 of 723 patients did not require surgical intervention. Overall, 105 patients died, including 13 in the AAI group and 92 in the DDD group (p = 0.4516). In the AAI group, a high degree atrioventricular block occurred on average after 46.3 ± 8.8 months and its incidence was estimated at 0.85% per year. Atrial fibrillation (AF) developed in 8 patients in the AAI group and 81 patients in the DDD group (p = 0.23). Among aetiological factors of an increased risk of developing AF, only the presence of tachycardia-bradycardia syndrome (hazard ratio [HR] 11.31) and the absence of antiarrhythmic therapy (HR 4.23) significantly increased the risk of AF. Urgent reoperation was needed in 23 patients in the AAI group and 62 patients in the DDD group (p < 0.01). Log-rank test analysis showed a significant effect of the development of AF on the risk of reoperation in this group (p = 0.0420). Lead-related complications were noted in 6 patients in the AAI group and 49 patients in the DDD group (p = 0.94). After 45 months, the risk of reoperation in the AAI group increased significantly due to a need for ventricular lead implantation. CONCLUSIONS: 1. Atrial stimulation is safe in SSS but it may be associated with an increased risk of ventricular lead implantation if atrioventricular block or persistent AF with slow ventricular rate develops. 2. DDD and AAI groups did not differ significantly in terms of survival, development of persistent AF, and lead-related complications. 3. Tachycardia-bradycardia syndrome and the lack of antiarrhythmic treatment with beta-blocker and amiodarone increased the risk of persistent AF during long-term follow-up. 4. A higher rate of reoperations in patients with AAI systems, related mainly to development of persistent AF, especially after the fourth year of follow-up, may justify DDD system implantation in SSS.

Pacemaker pocket displacement as a symptom of lead dependent infective endocarditis.

We here present a case of lead dependent infective endocarditis which manifested with pacemaker pocket displacement to the left infra mammary region. The patient underwent pacemaker removal without its reimplantation.

[Quality of life in patients after anti-arrhythmic devices implantation]. / Jakosc zycia chorych po implantacji wszczepialnych urzadzén antyarytmicznych.

THE AIM OF STUDY: To assess changes in quality of life in patients with advanced heart failure before ICD or CRTD implantation and after 6 months follow-up period. MATERIAL AND METHODS: The quality of life study was performed in group consisting of 98 patients (69 male, mean age 70.4 +/- 8.60 years), who underwent CRTD implantation (48 patients, 33 male, mean age 70.6 +/- 9.12 years) or ICD implantation (50 patients, 36 male, mean age 70.3 +/- 8.16 years) before the procedure and after 6 months of follow-up. Inclusion criteria were as follows: patients with indications to ICD or CRTD implantation, complete quality of life questionnaires before the procedure and after 6 months follow-up, lack of diagnosed dementia. The quality of life assessment was performed using patient's self-assessment with SF-36 and DASI questionnaires. Patients' self-assessment, NYHA class and ejection fraction was compared before the implantation and after 6 months. Additionally, co-morbidities and experiencing of high voltage therapy were analyzed. RESULTS: In the whole group after 6 months NYHA class improved from mean 2.9 +/- 0.5 to 2.3 +/- 0.84, p < 0.001; in CRTD group from mean 3.0 +/- 0.62 to 2.3 +/- 0.95, p < 0.001; in ICD group from mean 2.9 +/- 0.35 to 2.2 +/- 0.74, p < 0.001. In the whole group after 6 months ejection fraction improved from mean 27.7 +/- 6.92 to 31.0 +/- 7.23%, p < 0.001; in CRTD group from mean 25.3 +/- 7.85 to 32.4 +/- 8.98%, p < 0.001; in ICD group there was no significant improvement of ejection fraction. After CRTD implantation improvement of quality of life was achieved in SF36 and DASI questionnaires. There was no significant improvement in ICD group. DASI index is deteriorated by device's interventions (cardioversions) (regression index=3.45, odds ratio OR = 31.5, 95% confidence interval OR = 8.2-121, p < 0.001) and presence of permanent atrial fibrillation (regression index = 1,243, odds ratio OR = 3.45, 95% confidence interval OR = 1.03-11.7, p < 0.042). SF36 index is deteriorated by presence of kidney failure (regression index = 1.91, odds ratio OR = 6.74, 95% confidence interval OR = 1.75-26, p < 0.005) and permanent atrial fibrillation (regression index = 2.27, odds ratio OR = 9.7, 95% confidence interval OR = 3.1-29.6, p < 0.001). CONCLUSIONS: Cardiac resynchronization therapy (CRTD) improves quality of life, NYHA class and left ventricle ejection fraction. Implantable cardioverter-defibrillator (ICD) does not significantly improve quality of life, NYHA class or left ventricle ejection fraction. Only in the CRTD group a significant positive correlation between changes in DASI and SF36 indexes and left ventricle ejection fraction was achieved. Experiencing cardioversion/defibrillation from implantable device and co morbidities (diabetes mellitus, arterial hypertension, kidney failure, permanent atrial fibrillation) significantly deteriorate patients' self assessment of quality of life.