Аңдатпа
Introduction: Cardiac resynchronisation therapy via biventricular pacing (CRT-P) is of established benefit in patients with congestive heart failure (CHF) that are on optimised pharmacotherapy and fulfil specific criteria relating to NYHA class and QRS duration. However, there is a paucity of data relating to procedural tolerability and complication rates in octogenarians undergoing CRT-P implantation. Methods: A single-centre, prospective analysis was performed of all patients admitted for elective CRT-P between 1st January 2014 and 31st December 2016. Octogenarians were deemed to be those aged ≥ 80 years. Medication regimes were reviewed, with optimisation determined by administration of beta-blocker, ACE-inhibitor (or ARB) and an aldosterone antagonist at time of procedure, irrespective of dose. Chronic kidney disease (CKD) was defined by eGFR<90ml/min. All procedures were performed using an axillary approach. Both immediate and long-term procedural complications were documented. Statistical comparisons were performed using two-tailed Fisher’s exact test, with significance defined by p-value< 0.05. Results: In total, 63 patients were included with a mean follow-up of 17 months. 65% (41/63) were male and 46% (29/63) were octogenarians. Prevalence of CKD (18% [6/34] vs 28% [8/29]; p = 0.38) was similar. Octogenarians had higher prevalence of AF (38% [11/29] vs 26% [9/34]; p = 0.42) but reduced burden of IHD (31% [9/29] vs 44% [15/34]; p = 0.31). Comparable proportions had QRS duration ≥ 150ms (48% [14/29] vs 45% [13/34]; p = 0.45). Optimised pharmacological regimes were present in 35% (12/34) aged < 80 and 28% (8/29) aged ≥ 80 [p = 0.59]. Median follow-up was 16.6 months (IQR 8-26). Only 1 complication occurred, in a female aged < 80 that required lead repositioning on the same day as implantation. All-cause mortality was 16% (10/63), with 21% (7/34) aged < 80 and 10% (3/29) aged ≥ 80 [p = 0.32]. Conclusions: Results from this study suggest that CRT-P implantation in octogenarians is safe, tolerable and associated with a relatively good prognosis.