Influence of Cardiac Resynchronization Therapy in Patients With Left Ventricular Assist Device

A significant number of patients with left ventricular assist devices (LVAD) are also treated with cardiac resynchronization therapy (CRT). However, the effects of CRT on LVAD-recipient survival and ventricular arrhythmias (VAs) remain uncertain. To address this issue, we analyzed patients from the multicenter ASSIST-ICD registry using a 1:1 propensity score-matched cohort to evaluate the association between CRT and all-cause mortality. Secondary outcomes included cardiovascular/noncardiovascular mortality, and early (≤30 days postimplant) or late VAs. Among 652 LVAD recipients, 198 patients (30.4%) had CRT before LVAD implantation, followed for a median duration of 9.1 months (2.5-22.1). Cardiac resynchronization therapy patients were older with higher rates of atrial fibrillation, history of VAs, ischemic cardiomyopathy, and longer heart failure duration. After propensity matching, CRT use was not associated with improved survival (hazard ratio [HR]: 1.31 [0.94-1.82]), cardiovascular mortality (HR: 1.14 [0.68-1.90]), noncardiovascular mortality (HR: 0.88 [0.56-1.40]), or incidence of early (odds ratio [OR]: 0.71 [0.43-1.16]) or late (OR: 1.24 [0.73-2.11]) VAs. However, 27 CRT patients (13.6%) experienced device-related complications. These findings suggest that concomitant CRT with LVAD is not associated with survival benefit, despite notable device-related complications, warranting future randomized trials to clarify the clinical impact of pre-existing CRT in LVAD patients.