Resynchronisation therapy 591 of patients implanted in our University Hospital for 16 years (January 1994 and June 2010). We collected data before implantation (age, PR duration, left ven- tricle ejection fraction), during follow-up (treatments) and incidence of complete AV blocks. We excluded patients with less than one year of follow-up, patients in atrial fibrillation, and previously implanted patients for hight degree AV blocks. Results: 789 patients received a CRT-P. Our study population included 349 pa- tients. The mean age at implantation was 67.3±9.5 years, 66.8±9.6 years in pa- tients who will present AV block, 67.3±9.5 years in patients without AV block. The mean follow-up was 39±22 months. 9 patients (2.5%, 0.77%/year) presented a complete AV block. Mean LVEF was 23.8±6.5% in the general population, 25.3±7.3% in AV block group, 23.8±6.5% in no-AV block group. PR length before implantation was 212±5.8 ms in the population, 270±82 ms in AV block group, and 211±57 in no-AV block group. No significant difference exists in the 2 groups, including medical treatments. Conclsusion: Contrary to all expectations, incidence of complete AV blocks in this specific population is very low, in spite of major underlying conduction trou- bles. No predictive factor has been identified, even if pre-implantation AV dura- tions seem greater in AV-block patients. These findings could make us suspect a positive effect of CRT, due to well established inverse remodelling. This could be due to a decrease in stretch effect on conductions pathways. P3203 | BEDSIDE Worldwide geographic differences of patients selected for cardiac resynchronization therapy V.A. Kuznetsov 1 , E. Pokushalov 2 , F. Al Kandary 3 , I. Ebrahim 4 , P. DeVusser 5 , A. Naik 6 , J. Escudero 7 , B. Gerritse 8 , M. Sepsi 9 . 1 Tyumen Cardiology Center, Tyumen, Russian Federation; 2 Scientific Research Institute of Circ. Pathology, Novosibirsk, Russian Federation; 3 Kuwait Cardiac Center, Kuwait City, Kuwait; 4 Medi-Clinic -Location Heart Hospital, Pretoria, South Africa; 5 Ziekenhuis Oost-Limburg locatie St.-Jan Genk, Genk, Belgium; 6 Care Insititute of Medical Sciences, CIMS hospital, Ahmedabad, India; 7 Hospital Dr. Carlos Arvelo, Caracas, Venezuela; 8 Medtronic Bakken Research Center, Maastricht, Netherlands; 9 University Hospital Brno, Brno, Czech Republic Background and objective: The guideline recommendations for Cardiac Resyn- chronization Therapy (CRT) are based on trials that were conducted predomi- nantly in North America and Western Europe. We investigate if patients currently implanted with CRT devices in other regions have comparable characteristics. Methods: Data were obtained from PANORAMA, a long term, prospective obser- vational study of 8522 patients from 34 countries across 6 geographical regions (Latin America, South Africa, India, Middle East, Eastern Europe, Western Eu- rope), implanted with a cardiac rhythm management device between 2005 and 2011. This analysis is based on the 1355 patients who were implanted with a CRT device. Results: All baseline characteristics showed significant differences between the regions. Conclusions: Populations of CRT patients differed significantly in different geo- graphic regions. The influence of such differences on the outcome of CRT pa- tients must be investigated in the future. P3204 | BEDSIDE CRT-P or CRT-D? Which parameters can help in selection? N. Nyolczas, B. Szabo, M. Dekany, T. Borsanyi, B. Ancsin, B. Muk, G.Y. Marton, M. Vamos, G. Duray, R.G. Kiss. Military Hospital - State Health Centre, Budapest, Hungary Background: According to current guidelines CRT-D (cardiac resynchronization therapy with implantable cardioverter defibrillator) is preferred over CRT-P (car- diac resynchronization therapy without implantable cardioverter defibrillator) in patients with chronic systolic heart failure (HF-REF) with NYHA II-III and LVEF (left ventricular ejection fraction) ≤ 35%. However, a certain proportion of patients becomes asymptomatic and/or their LVEF increases above 35% some months after biventricular pacemaker (BiV PM) implantation, and in such cases the indi- cation of ICD no longer exists. Aim: To quantify the proportion of patients with HF-REF whose LVEF increases Abstract P3203 – Table 1 Total Subjects Eastern Europe India Latin America Middle East South Africa Western Europe p-value n=1355 n=402 n=105 n=104 n=277 n=384 n=83 Women 27% 17% 46% 25% 28% 31% 30% <0.0001 Age, years; Mean ± SD 62±13 58±12 58±11 63±12 63±13 63±12 73±8 <0.0001 NYHA I–II 23% 11% 11% 27% 40% 26% 26% <0.0001 LVEF 28±11 28±8 23±8 23±8 25±9 34±16 30±7 <0.0001 QRS duration 136±37 152±33 158±27 151±38 138±24 111±37 150±28 <0.0001 LBBB 52% 66% 76% 43% 63% 25% 52% <0.0001 ICM 38% 41% 25% 25% 51% 25% 48% <0.0001 Atrial fibrillation 26% 35% 5% 14% 18% 31% 29% <0.0001 Hypertension 55% 58% 23% 53% 66% 53% 51% <0.0001 Diabetes 30% 18% 38% 23% 62% 19% 32% <0.0001 BMI 28±6 29±5 25±4 26±5 30±7 29±6 27±6 <0.0001 Smoking history 41% 52% 15% 35% 47% 33% 44% <0.0001 CRT-P 50% 48% 70% 21% 15% 85% 30% <0.0001 Replacement 18% 8% 13% 22% 27% 18% 34% <0.0001 above 35% six months after CRT, and to determine parameters, which can predict the lack of such improvement of LVEF. Patients and methods: 188 pts (82.4% men, mean age: 60.8±11.6 years, is- chemic etiology: 38.4%, mean LVEF: 27.8±6.3%, mean NYHA: 2.51±0.87) with CRT (99 pts – CRT-D, 89 pts – CRT-P) followed at our heart failure clinic were in- cluded in the study. Baseline (before CRT application) clinical, echocardiographic, ECG and laboratory parameters were analyzed by logistic regression method to assess their power to predict whether LVEF remains below 35%, 6 months after initiation of CRT. Results: At the time of implantation of BiV PM, according to the indication, every pt had LVEF lower than 35%. Six months after BiV PM implantation 36.8% of patients had LVEF higher than 35%, so they had no indication for ICD at that time. Among investigated parameters left ventricular end-systolic diameter above 55mm (OR: 8.13; CI: 2.19-30.10; p<0.01), systolic blood pressure lower than 110 mmHg (OR: 5.49; CI: 1.31-23.02; p<0.05), ischemic etiology (OR: 3.81; CI: 1.06- 13.70; p<0.05), and estimated pulmonary artery systolic pressure higher than 35 mmHg (OR: 3.58; CI: 1.03-12.41; p<0.05) proved to be independent predictors of the lack of an LVEF improvement above 35%. During 6 months after BiV PM implantation no patient died, and appropriate ICD shock was observed only in one patient with CRT-D. Conclusions: Six months after BiV PM implantation LVEF increases above 35% in more than one-third of patients, as a consequence of the beneficial effects of CRT. In these patients CRT-P implantation would have been enough instead of CRT-D application. Parameters which can predict the lack of LVEF improvement above 35% may play a role in the prediction of non-responderity to CRT as well as in the appropriate selection of CRT-P and CRT-D candidates. P3205 | BEDSIDE Implantation of cardiac resynchronisation therapy with defibrillation more cost effective than implantable cardioverter defibrillator therapy alone in patients with left ventricular dysfunction F. Umar, R.J. Taylor, A. Vakharia, H. Marshall, F. Leyva. University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom Purpose: Clinical outcomes studies suggest that cardiac resynchronisation ther- apy with defibrillation (CRT-D) is superior to implantable cardioverter defibrillator (ICD) therapy alone in patients with left ventricular dysfunction. Methods: A retrospective analysis of all ICD and CRT-D implants from April 2006 to July 2012 from a single tertiary referral centre was undertaken. Cost data was obtained on an individual patient basis, derived from records of transactions be- tween payers and providers. Results: A total of 921 patients (aged 63±14 yrs [mean ± SD]) underwent de- vice implantation: 486 (53%) de novo CRT-D; 381 (41%) single/dual chamber ICD; and 54 (6%) upgrade from ICD to CRT-D. Amongst the latter, the me- dian time to upgrade to CRT-D implantation was 3.2 yrs. From the time of as- sessment prior to ICD implantation to the assessment prior to CRT-D implanta- tion, the left ventricular ejection fraction decreased from 30±9.4% to 22±8.7% (p<0.001), the QRS duration increased from 133±34.9ms to 158±29.3ms (p = 0.0003) and all patients had progressed to NYHA class III. In this upgrade group, the initial ICD implantation cost 1,016,236 (34 electives: 614,284; 20 non- electives: 401,952) and the upgrade to CRT-D cost 1,596,736 (44 electives: 1,255,636; 10 non-electives: 341,100), totalling 2,612,972 in implantation costs alone over a median of 3.2 yrs. If these 54 patients had a CRT-D at the initial implant, it would have cost 1,652,464 (34 electives: 970,264; 20 non- electives: 682,200). Therefore, this approach would have saved 960,508 in implantation costs alone. Conclusion: This study indicates that upgrading from ICD to CRT-D is costly. Our findings suggest that implantation of CRT-D in patients with known left ventricular dysfunction may be more cost-effective. Downloaded from https://academic.oup.com/eurheartj/article-abstract/34/suppl_1/P3204/2861768 by guest on 11 June 2020