ABSTRACT
BACKGROUND: The role of cardiac resynchronization therapy (CRT) in patients aged ≥75 years is not well established. METHODS: We identified 607 patients aged ≥75 years with left ventricular ejection fraction (LVEF) of ≤35 %, of whom 78 met the guidelines for indication of CRT. Based on the decision of the patients or attending cardiologists, 34 patients received a CRT defibrillator (CRT-D). RESULTS: The age of patients with a CRT indication was 80 ± 4 years, and 73 % were males. As compared with patients on medical therapy, CRT-D patients were younger (79 ± 3 vs. 83 ± 4, P < 0.001), had lower LVEF (23 ± 7 vs. 27 ± 7 %, P = 0.008) and higher rate of decompensated heart failure episodes (77 vs. 55 %, P = 0.04), were more frequently New York Heart Association (NYHA) class III-IV (53 vs. 25 %, P = 0.01), and were more likely to be on beta-blockers (88 vs. 66 %, P = 0.023), anticoagulants (61 vs. 32 % P = 0.02), and anti-aldosterone drugs (82 vs. 50 %, P = 0.003). After a median follow-up of 26 months, seven patients in the CRT-D group (21 %) and 20 non-CRT patients (46 %) died (hazard ratio (HR) 0.16 [95 % confidence interval (CI) 0.06-0.46]). The end point of mortality or hospitalization was not reduced because of a similar rate of hospitalizations for heart failure of CRT-D patients. Four CRT-D patients (12 %) had received appropriate device therapy, and one had been inappropriately discharged. During follow-up, 44 % of CRT-D patients improved their LVEF by >40 %. CONCLUSION: CRT-D is potentially of benefit in terms of mortality in our population; this effect persists after correction for use of beta-blockers. In patients ≥75 years, CRT indications should be similar to those accepted for younger subjects.
Subject(s)
Cardiac Resynchronization Therapy/mortality , Cardiac Resynchronization Therapy/statistics & numerical data , Cardiotonic Agents/therapeutic use , Heart Failure/mortality , Heart Failure/prevention & control , Length of Stay/statistics & numerical data , Aged , Aged, 80 and over , Combined Modality Therapy/mortality , Combined Modality Therapy/statistics & numerical data , Female , Hospital Mortality , Humans , Male , Prevalence , Retrospective Studies , Spain/epidemiology , Survival Rate , Treatment OutcomeABSTRACT
Rapidly growing mycobacteria are a rare cause of pacemaker infection. A low index of suspicion and conventional diagnostic methods may delay diagnosis. We present a review of the literature and report a case of pacemaker infection due to Mycobacterium fortuitum rapidly detected by universal 16S rRNA gene polymerase chain reaction and sequencing.
