Outcome After Implantation of Cardiac Resynchronization/Defibrillation Systems in Patients With Congestive Heart Failure and Left Bundle-Branch Block

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 24; no. 1; pp. 30 - 36
• Main Authors: Pfau, Giselher, MD, Schilling, Thomas, MD, DEAA, Kozian, Alf, MD, Lux, Anke, MSc, Götte, A., MD, Huth, Christof, MD, Hachenberg, Thomas, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2010
• Subjects: Aged; Anesthesia & Perioperative Care; Anesthesia, General - methods; anesthetic management; Bundle-Branch Block - therapy; Cardiac Pacing, Artificial - methods; cardiac resynchronization/defibrillation devices; cardiac resynchronization/defibrillation therapy; congestive heart failure; Critical Care; Defibrillators, Implantable; Electric Countershock - instrumentation; Electric Countershock - methods; Female; Heart Failure - therapy; Humans; left bundle-branch block; Male; Middle Aged; mortality; Odds Ratio; Postoperative Care; Retrospective Studies; Risk Factors; Severity of Illness Index; Treatment Outcome; cardiac resynchronization/defibrillation devices; mortality; congestive heart failure; cardiac resynchronization/defibrillation therapy; anesthetic management; left bundle-branch block
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2009.07.009

Objective The implantation of cardiac resynchronization/defibrillation devices (CRT-Ds) increasingly is used in patients with congestive heart failure and left bundle-branch block. There are no data on the effects of anesthesia and surgery on outcome after implantation. Design A retrospective, observational study; postoperative survey. Setting University hospital. Participants Three hundred forty-one patients (258 men/83 women, 63 ± 9 years) with congestive heart failure and left bundle-branch block who underwent CRT-D implantation in 1996 to 2005. Measurements and Main Results Perioperative data were retrieved from the patients' records. Cardiologists caring for the patients were contacted to obtain information on current New York Heart Association (NYHA) status and mortality after CRT-D implantation. Preoperatively, 45 patients were classified as NYHA II, 246 as NYHA III, and 50 as NYHA IV. CRT was performed via thoracotomy in 100 and transvenously in 241 cases. General anesthesia (propofol or sevoflurane and remifentanil) was performed in 273 and local anesthesia (lidocaine) in 68 patients. Hypotension occurred mainly during general anesthesia (43% v 4%). The 30-day mortality was 0%. The postoperative survey started in 2006 and was completed by 215 patients. The mean survival time was 77 months; 151 patients survived the study period. Outcome was not influenced by local and general anesthesia. Presence of preoperative NYHA class >II (odds ratio [OR] = 1.6, confidence interval [CI] = 0.5-5.1), mitral regurgitation (OR = 2.5, CI = 1.2-5.5), and serum creatinine >1.1 mg/dL (OR = 3.0, CI = 1.5-6.2) resulted in an inferior prognosis. Conclusions In patients with severely impaired cardiac function, general anesthesia for the implantation of a biventricular pacing device can be used with justifiable risk. The method of anesthesia did not influence outcome.