Patients with heart failure meeting criteria for cardiac resynchronization therapy(CRT) pacemaker(CRT-P)could also receive implantable cardioverter defibrillator therapy(CRT-D) according to current guidelines.The selection of CRT-P or CRT-D is affected by many factors in clinical practice.The present study aimed to analyze factors influencing the selection of CRT-P or CRT-D in Chinese patients with heart failure.

This was a prospective, multicenter, and open registry study.Data were from the database platform for interventional therapy of arrhythmia.All heart failure patients more than 18 years old were consecutively enrolled from 22 hospitals in 15 provinces if they received a CRT device with or without ICD between May 2013 and November 2015.We collected patients’ baseline clinical data, including demographic data, etiology, medical history, electrocardiogram(ECG)and echocardiography(UCG)data.Patients were excluded from this study if they had missing or invalid data or just requiring device replacement.All hospitals were divided into 3 groups(<2 trillion RMB, 2-4 trillion RMB and >4 trillion RMB)by the GDP levels of the province which the hospital is located for analyzing the impact of GDP level on the selection of CRT-D.Multivariable logistic regression analysis was used to identify determinants of CRT-D.

A total of 454 patients receiving new implant of CRT were included into this study, and 52.2% of them received CRT-D implantation.Compared with patients receiving CRT-P, patients receiving CRT-D had less proportion of elderly more than 70 years old(20.7% vs.30.0%, P=0.023), lower left ventricular ejection fractions(LVEF, 30.5% vs.35.0%, P<0.001), less atrioventricular block(8.9% vs.23.0%, P<0.001), larger left ventricular end-diastolic diameter(69 mm vs. 65 mm, P<0.001), more common taking antiarrhythmic drugs(25.4% vs.7.1%, P<0.001), and more common having ventricular arrhythmias(29.7% vs.4.1%, P<0.001)or syncope(16.0% vs.9.5%, P=0.046). The selection of CRT-D varied significantly among hospitals according to CRT implant volumes.The percentage of CRT-D use remained 54.9%-67.1% in hospitals with more than 40 CRT implant within 2 years, was pronounced lower in hospitals with 15-40 CRT implant volume(18.8%-35.3%), and was significantly higher in hospitals with less than 15 CRT implant volume(76.9%-81.8%). The proportional use of CRT-D differed significantly among GDP groups(55.6% vs.54.5% vs.28.9%, P=0.005). Multivariable logistic regression analysis showed that factors increasing the selection of CRT-D were history of ventricular arrhythmia(OR 6.00; 95%CI 2.67-13.47), use of digoxin(OR 1.95; 95%CI 1.17-3.26), and use of antiarrhythmic drugs (OR 2.46; 95%CI 1.10-5.33); while factors decreasing CRT-D selection included the presence of atrioventricular block(OR 0.32; 95%CI 0.15-0.69)and localizing in provinces with low-level GDP(OR 0.14; 95%CI 0.04-0.50).

Over half of patients receiving CRT therapy selected CRT-D device in this contemporary Chinese cohort of patients with heart failure.Factors influencing selection of CRT-D included the presence of arrhythmias, combination of medical treatment, and GDP levels in the patients’ province.

Cardiac resynchronization therapy; Implantable cardioverter defibrillator; Influencing factors; Heart failure; Rigistry