Introduction: We have tested the hypothesis whether epicardial cardiac resynchronization therapy (CRT) concomitantly with surgical revascularization is superior to CRT and medical therapy in patients with ischemic heart failure, LVEF<35% and LV dyssynchrony, who were eligible to coronary artery bypass grafting or medical therapy.
Methods: Ninety seven consecutive patients with severe ischemic heart failure were randomly assigned to endocardial CRT implantation plus medical therapy (n=48) or epicardial CRT implantation plus CABG (n=49). The primary end point was reduction in left ventricle systolic volume (LVESV) by 15% mesured by echocardiography. The major secondary endpoint included the all cause death. The patients were followed up during 24 months.
Results: At 24 months, the mean LVESV was significantly lower in epicardial CRT plus CABG group compared with CRT plus medical therapy group (115.4±22.4.% vs. 137.8±19.7%, P=0.002). In epicardial CRT plus CABG group 6 patients (12.2%) died at 2-year follow compared with 11 (22.9%) in CRT plus medical therapy group (Log-Rank test, p=0.02). Totally, the number of patients with LVESV reduction by 15% were 37 (86%) in epicardial CRT plus CABG group and 25 (67.6%) in CRT plus medical therapy group (p=0.034).
Conclusions: In ischemic heart failure patients with LV dyssynchrony, who are eligible to surgical revascularization or medical therapy, epicardial implantation of a CRT system concomitantly with CABG is superior to CRT plus medical therapy in terms of cardiac reverse remodeling and is associated with low mortality in long-term follow up.