Cardiac resynchronisation therapy: an option for inotrope-supported patients with end-stage heart failure?

Background: Patients with refractory heart failure requiring inotropic support have a very poor prognosis. Cardiac resynchronisation therapy (CRT) offers symptomatic and possibly a survival benefit for patients with stable chronic heart failure (CHF) and a prolonged QRS, but its role in the management of end-stage heart failure requiring inotropic support has not been evaluated. Methods: We performed a retrospective observational study of patients undergoing CRT at our institution. Results: We identified 10 patients who required inotropic support for refractory CHF and who underwent CRT while on intravenous inotropic agents. Patients had been in hospital for 30+/-29 days and had received inotropic support for 11+/-6 days prior to CRT. All patients were weaned from inotropic support (2+/-2 days post-CRT) and all patients survived to hospital discharge (12+/-13 days post-CRT). Furosemide dose fell from 160+/-38 mg on admission to 108+/-53 mg on discharge (p<0.01). Serum creatinine fell from 192+/-34 mumol/l prior to CRT to 160+/-37 mumol/l on discharge (p<0.05). Serum sodium was 131+/-4 mmol/l prior to CRT and remained low at 132+/-5 mmol/l on discharge. At short-term follow up (mean 47 days), all patients were alive; mean furosemide dose was 130+/-53 mg (p=0.056 versus pre-CRT). Serum creatinine was 157+/-36 mumol/l and serum sodium had increased to 138+/-6 mmol/l (p<0.05 and p<0.01, respectively, versus pre-CRT). Conclusion: CRT may offer a new therapeutic option for inotrope-supported CHF patients with a prolonged QRS. (C) 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.