Safety of transvenous cardiac resynchronization system implantation in patients with chronic heart failure: combined results of over 2,000 patients from a multicenter study program.

Published

Journal Article

OBJECTIVES: The purpose of this study was to evaluate the safety of implanting a cardiac resynchronization therapy (CRT) system. BACKGROUND: Clinicians and patients require data on the safety of the CRT implant procedure to estimate procedural risk. METHODS: We evaluated outcomes of transvenous CRT system implantation in 2,078 patients from the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) study, the MIRACLE Implantable Cardioverter-Defibrillator (ICD) study, and the InSync III study. We compared the MIRACLE study to the InSync III study and the MIRACLE ICD study randomized phase to its general phase to evaluate the effect of new technologies. RESULTS: The implant attempt succeeded in 1,903 of 2,078 (91.6%) patients. Implant time decreased from 2.7 h in the MIRACLE study to 2.3 h in the InSync III study (p < 0.001), and from 2.8 h in the MIRACLE ICD study randomized phase to 2.4 h in the general phase (p < 0.001). The implant procedure produced 62 perioperative complications in 53 (9.3%) MIRACLE trial patients; 159 in 135 (21.1%) MIRACLE ICD study randomized phase patients and 71 in 62 (13.9%) general phase patients (p < 0.05 vs. randomized); and 41 in 37 (8.8%) InSync III study patients (p = NS vs. the MIRACLE study). We observed 73 postoperative complications in 62 (11.7%) MIRACLE trial patients, 77 in 68 (11.9%) MIRACLE ICD study randomized phase patients and 56 in 45 (11.0%) general phase patients (p = NS), and 37 in 34 (8.6%) InSync III study patients (p = NS). A total of 8% of patients required reoperation to treat lead dislodgement, extracardiac stimulation, or infection during follow-up. CONCLUSIONS: Transvenous CRT system implantation appears safe, well-tolerated, has a high success rate, and improves with operator experience and the addition of new technologies.

Full Text

Duke Authors

Cited Authors

  • León, AR; Abraham, WT; Curtis, AB; Daubert, JP; Fisher, WG; Gurley, J; Hayes, DL; Lieberman, R; Petersen-Stejskal, S; Wheelan, K; MIRACLE Study Program,

Published Date

  • December 20, 2005

Published In

Volume / Issue

  • 46 / 12

Start / End Page

  • 2348 - 2356

PubMed ID

  • 16360070

Pubmed Central ID

  • 16360070

Electronic International Standard Serial Number (EISSN)

  • 1558-3597

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2005.08.031

Language

  • eng

Conference Location

  • United States