Cardiac Resynchronization Therapy for Heart Failure in National Hospital of Sri Lanka from Year 2005 to 2020 – A Retrospective Observational Study.

Background: Cardiac resynchronization therapy (CRT) has been a well-established treatment modality for moderate to severe left ventricular systolic dysfunction with dyssynchrony. This is the pioneering study which has been conducted in Sri Lankan context to analyze the cohort which has undergone CRT implantation in National Hospital of Sri Lanka (NHSL), Colombo from 2005–2020. Objectives This study was carried out to describe socio demographic factors, improvement in clinical outcome (symptoms, electrocardiographic and echocardiographic features) and post CRT complications in the study population and also to determine the efficacy of CRT in heart failure. Method A retrospective observational study was conducted on patients who have undergone CRT implantation from 2005 to 2020. The data was gathered from all the consented patients who visited device programming clinic using a physician-administered questionnaire and clinical records. Data was analyzed using software SPSS 25 and significant statistics were assessed with McNemer test, Student T test and Chi-Squared test. Results Study included 50 patients with a mean age of 52.82+/-11.66 years and female predominance (56%, n = 28). Idiopathic dilated cardiomyopathy (50%, n = 25) was the leading etiological factor followed by ischemic Cardiomyopathy (28%, n = 14). Clinical symptoms had been improved significantly with CRT implantation (p < 0.001). A significant improvement was found in NYHA functional class (p < 0.001, 95% CI = 0.072 to 0.284), QRS width (p < 0.001, 95% CI = 0.229 to 0.534), ejection fraction (p < 0.001, 95% CI = -16.437 to -8.504) and LV EDD (p < 0.001, 95% CI = 2.89 to 9.24). Post CRT complications included lead malfunction acute (6%, n = 3) and chronic (14%, n = 7), bleeding/ hematoma (2%, n = 1), pocket erosion/ infection (6%, n = 3), infective endocarditis (2%, n = 1). Conclusion The study has shown the efficacy of CRT in moderate to severe heart failure with significant clinical and functional improvement.