Cardiac resynchronisation therapy: results from daily practice in Rijnstate Hospital, Arnhem.

BACKGROUND: Cardiac resynchronisation therapy (CRT) is an effective treatment to improve the clinical outcome of selected patients with heart failure. Clinical trials have studied clinical outcome and reported clinical improvements, but clinical consequences and results in daily practice are less well known. We evaluated clinical outcome in all patients with CRT implantation in our centre. METHODS: Data of 119 consecutive patients who met the criteria for CRT implantation in Rijnstate Hospital, Arnhem in the period 28 November 2000 until 1 January 2006 were collected. We analysed implantation procedure, hospitalisation for heart failure or other causes, mortality and device-related events. RESULTS: In total 119 patients (83 men, 36 women; mean age 69 years) were eligible for CRT. Before implantation they had received optimal pharmacological therapy. Implantation was successful in 97% of patients. Procedural-related complications were seen in eight patients. During follow-up, 22 patients (18.5%: 14 men, 8 women) died. Causes of death were heart failure (11 patients), sudden cardiac death (4 patients) and noncardiac death (7 patients). Hospitalisation occurred 81 times, of which 77 for cardiac reasons. In follow-up the estimated five-year cumulative survival was 70%. CONCLUSION: This retrospective study from a single centre showed a high procedural success rate, low prevalence of complications and low mortality in comparison to other studies. Despite better functional capacity, the hospitalisation rate due to heart failure was high. (Neth Heart J 2009;17:6-8.).

[Diagnostic image (355). A man with special valvular vegetations without fever]. / Diagnose in beeld (355). Een man met bijzondere klepvegetaties zonder koorts.

A 63-year-old man suffered from a cardiogenic shock. Upon echocardiography vegetations on the tricuspid valve were seen. As fever was absent, marantic endocarditis was diagnosed.

[Diagnostic image (151). A woman with malaise and changed liver enzyme levels]. / Diagnose in beeld (151). Een vrouw met malaise en afwijkende leverenzymwaarden. Adenomatosis hepatis.

In a 41-year-old woman with general malaise and changed liver enzyme levels ultrasonography and MRI revealed hepatic adenomatosis.