Mid-term feasibility and safety of downgrade procedure from defibrillator to pacemaker with cardiac resynchronization therapy

Backgrounds Some patients who undergo implantation of cardiac resynchronization therapy with defibrillator (CRT-D) survive long enough, thus requiring CRT-D battery replacement. Defibrillator therapy might become unnecessary in patients who have had significant clinical improvement and recovery of left ventricular ejection fraction (LVEF) after CRT-D implantation. Methods Forty-nine patients who needed replacement of a CRT-D battery were considered for exchange of CRT-D for cardiac resynchronization therapy with pacemaker (CRT-P) if they met the following criteria: LVEF >45%; the indication for an implantable cardioverter defibrillator was primary prevention at initial implantation and no appropriate implantable cardioverter defibrillator therapy was documented after initial implantation of the CRT-D. Results Seven patients (14.2%) were undergone a downgrade from CRT-D to CRT-P without any complications. No ventricular tachyarrhythmic events were observed during a mean follow-up of 39.7 ± 21.1 months and there was no significant change in LVEF between before and 1 year after device replacement (53.5% ± 6.2% vs. 56.4% ± 7.3%, P = 0.197). Conclusions This study confirmed mid-term feasibility and safety of downgrade from CRT-D to CRT-P alternative to conventional replacement with CRT-D.
Highlights • Downgrade from CRT-D to CRT-P is feasible for patients with improved LVEF of >45%. • Patients without VT/VF after initial CRT-D implantation are suitable for downgrade. • Patients had no ventricular arrhythmias or HF hospitalization after the downgrade.