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Arrhythmias and sudden death
Original research
Cardiac resynchronisation therapy in anthracycline-induced cardiomyopathy
  1. Divyang Patel,
  2. Anirudh Kumar,
  3. Laurie Ann Moennich,
  4. Kevin Trulock,
  5. David M Nemer,
  6. Eoin Donnellan,
  7. Zachary J Il'Giovine,
  8. Trejeeve Martyn,
  9. Thomas D Callahan,
  10. Ayman A Hussein,
  11. Khaldoun G Tarakji,
  12. Mohamed Kanj,
  13. Daniel J Cantillon,
  14. Bryan Baranowski,
  15. Randall C Starling,
  16. W H Wilson Tang,
  17. Oussama M Wazni,
  18. Niraj Varma,
  19. Bruce L Wilkoff,
  20. John Rickard
  1. Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  1. Correspondence to Dr Divyang Patel, Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; pateld2{at}ccf.org

Abstract

Introduction Chemotherapy-induced cardiomyopathy has been increasingly recognised as patients are living longer with more effective treatments for their malignancies. Anthracyclines are known to cause left ventricular (LV) dysfunction. While heart failure medications are frequently used, some patients may need consideration for device-based therapies such as cardiac resynchronisation therapy (CRT). However, the role of CRT in anthracycline-induced cardiomyopathy (AIC) is not well understood.

Methods We performed a retrospective review of all patients undergoing CRT implantation at our centre from 2003 to 2019 with a diagnosis of AIC. The LV remodelling and survival outcomes of this population were obtained and then compared with consecutive patients with other aetiologies of non-ischaemic cardiomyopathy (NICM).

Results A total of 34 patients underwent CRT implantation with a diagnosis of AIC with a mean age of 60.5±12.7 years, left ventricular ejection fraction (LVEF) of 21.7%±7.4%, and 11.3±7.5 years and 10.2±7.4 years from cancer diagnosis and last anthracycline exposure, respectively. At 9.6±8.1 months after CRT implantation, there was an increase of LVEF from 21.8%±7.6% to 30.4%±13.0% (p<0.001). Patients whose LVEF increased by at least 10% post-CRT implant (42.5% of cohort) survived significantly longer than patients who failed to improve their LVEF by that amount (p=0.01). A propensity matched analysis between patients with AIC and 369 consecutive patients with other aetiologies of NICM who underwent CRT implantation during the same period revealed no significant differences in improvement in LVEF or long-term survival.

Conclusions Patients with AIC undergo LV remodelling with CRT at rates similar to other aetiologies of NICM. Furthermore, AIC post-CRT responders have a favourable long-term mortality compared with non-responders.

  • cardiomyopathy
  • dilated
  • defibrillators
  • implantable
  • heart failure

Data availability statement

Data are available upon reasonable request from the institution and the senior author.

https://doi.org/10.1136/heartjnl-2020-318333

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    Data availability statement

    Data are available upon reasonable request from the institution and the senior author.

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    Footnotes

    • Twitter @divyangrpatel

    • Contributors DP and JR participated in study concept and design. DP, AK, LAM, KT and JR were involved in data collection and participated in the data analysis. DP, AK, LAM, KT, DN, ED, ZIG, TM, TC, AAH, KGT, MK, DC, BB, RS, WHWT, OW, NV, BLW and JR participated in critical review. DP and JR were the responsible contributors for the overall content. DP contributed to the conception and design of the study, data collection, data analysis, data interpretation, manuscript drafting and the critical revision of the manuscript. AK contributed to the data collection, data interpretation and critical revision of the manuscript. LAM contributed to the data collection, data interpretation and critical revision of the manuscript. KT contributed to the data collection, data interpretation and critical revision of the manuscript. DN, ED, ZIG, TM, TC, AAH, KT, MK, DC, BB, RS, WHWT, OW, NV and BLW contributed to the data interpretation and critical revision of the manuscript. JR contributed to the conception and design of the study, supervision, data analysis, data interpretation, manuscript drafting and critical revision of the manuscript. JR is the corresponding author.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests TC: consultant, Biotronik. KGT: consulting and honoraria from Medtronic and Spectranetics Corporation; advisory board, Medtronic and AliveCor. DC: consultant, Abbott and Boston Scientific. OW: Honoraria Spectranetics. NV: consultant/honoraria from St. Jude Medical, Boston Scientific, Biotronik and Medtronic. BLW: honoraria/consultant fees from Abbott, Medtronic and Philipps. JR: honoraria/consultant fees from Abbott and Medtronic. All other authors have no disclosures to report.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.