Aims There are limited and contradictory data on the effects of CRT with implantable cardioverter defibrillator (CRT‐D) on mortality as compared with CRT with pacemaker (CRT‐P). Methods and results We evaluated the long‐term outcome of patients implanted with a CRT‐D or CRT‐P device in our high‐volume single‐centre experience. Data on all‐cause mortality were derived from clinic visits and the Hungarian National Healthcare Fund Death Registry. Kaplan–Meier survival analyses and multivariate Cox regression models were used to evaluate all‐cause mortality in patients with CRT‐D vs. CRT‐P, stratified by the aetiology of cardiomyopathy. From 2000 to 2011, 1122 CRT devices, 693 CRT‐P (LVEF 28.2 ± 7.4%) and 429 CRT‐D (LVEF 27.6 ± 6.4%), were implanted at our centre. During the median follow‐up of 28 months, 379 patients died from any cause, 250 patients (36%) with an implanted CRT‐P and 129 patients (30%) with an implanted CRT‐D. There was no evidence of mortality benefit in patients implanted with a CRT‐D compared with a CRT‐P in the total cohort [hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.73–1.32, P = 0.884]. In patients with ischaemic cardiomyopathy, CRT‐D treatment was associated with a significant 30% risk reduction in all‐cause mortality compared with an implanted CRT‐P (HR 0.70, 95% CI 0.51–0.97, P = 0.03). In non‐ischaemic patients, there was no mortality benefit of CRT‐D over CRT‐P (HR 0.98, 95% CI 0.73–1.32, P = 0.894, interaction P‐value = 0.15). Conclusions In heart failure patients with ischaemic cardiomyopathy, CRT‐D was associated with a mortality benefit compared with CRT‐P, but no benefit of CRT‐D over CRT‐P in mortality was observed in non‐ischaemic cardiomyopathy.

Remote monitoring is an established, guideline-recommended technology with unequivocal clinical benefits; however, its ability to improve survival is contradictory. The aim of our study was to investigate the effects of remote monitoring on mortality in an optimally treated heart failure patient population undergoing cardiac resynchronization defibrillator therapy (CRT-D) implantation in a large-volume tertiary referral center. The population of this single-center, retrospective, observational study included 231 consecutive patients receiving CRT-D devices in the Medical Centre of the Hungarian Defence Forces (Budapest, Hungary) from January 2011 to June 2016. Clinical outcomes were compared between patients on remote monitoring and conventional follow-up. The mean follow-up time was 28.4 (SD 18.1) months. Patients on remote monitoring were more likely to have atrial fibrillation, received heart failure management at our dedicated heart failure outpatient clinic more often, and have a slightly lower functional capacity. Crude all-cause mortality of remote-monitored patients was significantly lower compared with patients followed conventionally (hazard ratio [HR] 0.368, 95% CI 0.186-0.727, P=.004). The survival benefit remained statistically significant after adjustment for important baseline parameters (adjusted HR 0.361, 95% CI 0.181-0.722, P=.004). In this single-center, retrospective study of optimally treated heart failure patients undergoing CRT-D implantation, the use of remote monitoring systems was associated with a significantly better survival rate.

Background/Objectives: Pacemaker-induced cardiomyopathy (PICM) develops in up to 30% of patients with chronic right ventricular pacing. While biventricular (BIV) upgrade is the conventional strategy, conduction system pacing (CSP) offers a physiologic alternative recently endorsed by the 2025 ESC/EHRA Consensus Statement. However, comparative evidence in PICM is limited. Therefore, we aimed to compare outcomes of PICM patients undergoing CSP versus BIV upgrade. Methods: This retrospective analysis included consecutive PICM patients who were upgraded to CSP or BIV between 2022 and 2024 at a single, experienced center. Follow-up averaged >19 months. Clinical outcomes, lead performance, echocardiographic parameters, complications, and quality of life (QoL) were evaluated. Results: Sixty-three patients were included (CSP: 26; BIV: 37). Mean age and sex distribution were similar; both groups had wide paced QRS complexes and a high ventricular pacing burden. Baseline left ventricular ejection fraction (LVEF) was lower in BIV patients (29 ± 7% vs. 35 ± 6%, p = 0.01). Procedure duration was comparable, but fluoroscopy was shorter with CSP. QRS duration narrowed significantly in both groups (CSP: 163 ± 28→132 ± 12 ms; BIV: 171 ± 23→140 ± 18 ms; both p < 0.05). During follow-up, LVEF improved (CSP: 41 ± 8%; p = 0.008; BIV: 39 ± 8%, p = 0.0001), as did NYHA class, with no significant intergroup differences. The rates of heart failure hospitalization, all-cause mortality, and QoL were similar. Notably, 34.6% of CSP patients retained their existing generator, suggesting procedural and economic benefits. Conclusions: CSP is a feasible and potentially cost-efficient alternative to BIV upgrade in PICM, with comparable improvements in ventricular function, symptoms, and clinical outcomes. Larger prospective trials are warranted.

Background: Modern implantable cardioverter-defibrillators (ICDs) utilize single-chamber (SC) or dual-chamber (DC) discrimination algorithms to differentiate between tachyarrhythmias and minimize the risk of inappropriate therapies. While modern SC algorithms, especially those with morphology detection, are considered comparable to DC algorithms, the available data are limited. We aimed to compare the efficacy of SC and DC discrimination algorithms in malignant tachyarrhythmias. Methods: We retrospectively analyzed data from all patients with ICDs from a single manufacturer (Biotronik, Berlin, Germany) who were remotely monitored and followed up at two tertiary centers. Patients were divided into SC and DC groups, based on the programmed discrimination algorithm. The primary outcome was the risk of inappropriate therapies comparing SC vs. DC discriminators. A sensitivity analysis was also conducted, including only a subgroup of SC patients with active morphology discrimination. Results: A total of 557 patients were included. The distribution of the implanted ICDs was as follows: 76 VVI; 226 VDD; 76 DDD; and 179 CRT-D devices. A total of 124 ICDs were programmed utilizing SC and 433 were programmed into the DC discriminators group. Among the SC group, 47 (39%) ICDs used active morphology discrimination. The incidence of inappropriate ICD therapies did not differ among the SC and DC discrimination groups (Hazard Ratio [HR] 1.165; 95% Confidence Interval [CI] 0.393–3.448; p = 0.783). The predefined sensitivity analysis did not reveal any significant difference regarding this outcome (HR 1.809; 95% CI 0.241–13.577; p = 0.564). Conclusions: In this bicentric, remote monitoring-based study, the risk of inappropriate therapy in the SC group was similar to that of the DC group. Based on our results, SC discrimination is a suitable option, even for patients with dual-chamber devices.

BACKGROUND Remote monitoring is an established, guideline-recommended technology with unequivocal clinical benefits; however, its ability to improve survival is contradictory. OBJECTIVE The aim of our study was to investigate the effects of remote monitoring on mortality in an optimally treated heart failure patient population undergoing CRT-D implantation in a large-volume tertiary referral centre. METHODS The population of this single-centre, retrospective, observational study included 231 consecutive patients receiving CRT-D devices in the Medical Centre of the Hungarian Defence Forces (Budapest, Hungary) from January 2011 to June 2016. Clinical outcomes were compared between patients on remote monitoring and on conventional follow-up. RESULTS The average follow-up time was 28.4 ± 18.1 months. Patients on remote monitoring suffered more likely from atrial fibrillation, received heart failure management at our dedicated heart failure outpatient clinic more often, and had a slightly lower NYHA functional class. Crude all-cause mortality of remote-monitored patients was significantly lower compared to patients followed conventionally (HR: 0.368, 95% CI: 0.186-0.727, p=0.004). The survival benefit remained statistically significant after adjustment for important baseline parameters (adjusted HR: 0.361, 95% CI: 0.181-0.722, p=0.004) CONCLUSIONS In this current single-centre, retrospective study of optimally treated heart failure patients undergoing CRT-D implantation, the use of remote monitoring systems was associated with significantly better survival.