https://doi.org/10.55788/e2e00341
“It has not been established whether an upgrade from a pacemaker or an ICD to a CRT offers benefits for patients with HFrEF,” said Dr Béla Merkely (Semmelweis University, Hungary) [1]. According to Dr Merkely, the lack of data on hard outcomes from large trials led to several modifications of CRT guidelines in the last decade. “This demonstrates the need for more robust evidence,” he argued. “Furthermore,” Dr Merkely claimed, “in 60% of the patients, an indicated upgrade is not performed or postponed to a later, often undetermined date.”
The multicentre, randomised-controlled BUDAPEST CRT Upgrade trial (NCT02270840) evaluated the efficacy and safety of a CRT-D upgrade in patients with HFrEF and intermittent or permanent RV pacing who already had an ICD [1,2]. Participants had HFrEF, a prior pacemaker or ICD, RV pacing of 20–100%, and a paced QRS complex ≥150 ms (n=360) and were randomised 3:2 to a CRT-D upgrade or no upgrade. The composite primary endpoint was the first occurrence of HF hospitalisation, all-cause mortality, or <15% reduction in left ventricular end-systolic volume (LVESV) at month 12.
After 12 months, 78.9% of participants in the no-intervention arm had experienced a primary endpoint event, whereas only 32.4% of the participants in the CRT-D arm had one of the primary outcome events (adjusted OR 0.11; 95% CI 0.06–0.19; P<0.001). The secondary outcome of all-cause mortality or HF hospitalisation favoured the CRT-D arm over the no-intervention arm as well (adjusted HR 0.27; 95% CI 0.16–0.47; P<0.001). For mortality alone the adjusted HR was 0.52 (95% CI 0.23–1.19).
“These results show that patients with HFrEF with a pacemaker or ICD and intermittent or permanent RV pacing should receive a CRT upgrade without delay to reduce the risk for serious adverse events,” according to Prof. Merkely. Even though the results of this open-label trial were impressive, larger studies are needed to confirm whether the investigated intervention really reduces mortality in this population.
- Merkely B, et al. Cardiac resynchronisation therapy upgrade in heart failure with right ventricular pacing: a multicentre, randomised, controlled trial. Hot Line Session 2, ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.
- Merkely B, et al. Eur Heart J. 2023; Aug 26. DOI: 1093/eurheartj/ehad591.
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Table of Contents: ESC 2023
Featured articles
How to manage arterial thrombosis and thromboembolism in COVID-19?
2023 ESC Guidelines & Updates
Heart failure: the 2023 update
Guidelines for Acute Coronary Syndrome
Guidelines for the management of cardiomyopathies
Cardiovascular disease and diabetes: new guidelines
Guidelines for the management of endocarditis
Trial Updates in Heart Failure
Traditional Chinese medicine successful in HFrEF
CRT upgrade benefits patients with HFrEF and an ICD
Catheter ablation saves lives in end-stage HF with AF
Meta-analysis: Does FCM improve clinical outcomes in HF?
HEART-FID: Is intravenous ferric carboxymaltose helpful in HFrEF with iron deficiency?
Natriuresis-guided diuretic therapy to facilitate decongestion in acute HF
DICTATE-AHF: Early dapagliflozin to manage acute HF
STEP-HFpEF: Semaglutide safe and efficacious in HFpEF plus obesity
Key Research on Prevention
Does colchicine prevent perioperative AF and MINS?
Diagnostic tool doubles cardiovascular diagnoses in patients with COPD or diabetes
Inorganic nitrate strongly reduces CIN in high-risk patients undergoing angiography
Finetuning Antiplatelet and Anticoagulation Therapy
Should we use anticoagulation in AHRE to prevent stroke?
Results of FRAIL-AF trial suggest increased bleeding risk with DOACs
The optimal duration of anticoagulation therapy in cancer patients with DVT
DAPT or clopidogrel monotherapy after stenting in high-risk East-Asian patients?
Assets for ACS and PCI Optimisation
Immediate or staged revascularisation in STEMI plus multivessel disease?
Lp(a) and cardiovascular events: which test is the best?
No benefit of extracorporeal life support in MI plus cardiogenic shock
Functional revascularisation outperforms culprit-only strategy in older MI patients
Can aspirin be omitted after PCI in patients with high bleeding risk?
Angiography vs OCT vs IVUS guidance for PCI: a network meta-analysis
OCTOBER trial: OCT-guided PCI improves clinical outcomes in bifurcation lesions
Other
Minimising atrial pacing does not reduce the risk for AF in sinus node disease
ARAMIS: Can anakinra alleviate acute myocarditis?
Expedited transfer to a specialised centre does not improve cardiac arrest outcomes
Acoramidis improves survival and functional status in ATTR-CM
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