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Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate

Barra, Sérgio; Boveda, Serge; Providência, Rui; Sadoul, Nicolas; Duehmke, Rudolf; Reitan, Christian LU ; Borgquist, Rasmus LU ; Narayanan, Kumar; Hidden-Lucet, Françoise and Klug, Didier, et al. (2017) In Journal of the American College of Cardiology 69(13). p.1669-1678
Abstract

BACKGROUND: Patients with nonischemic dilated cardiomyopathy (DCM) may be at lower risk for ventricular arrhythmias compared with those with ischemic cardiomyopathy (ICM). In addition, DCM has been identified as a predictor of positive response to cardiac resynchronization therapy (CRT).

OBJECTIVES: The aim of this study was to investigate the impact of an additional implantable cardioverter-defibrillator over CRT, according to underlying heart disease, in a large study group of primary prevention patients with heart failure.

METHODS: This was an observational, multicenter, European cohort study of 5,307 consecutive patients with DCM or ICM, no history of sustained ventricular arrhythmias, who underwent CRT implantation with... (More)

BACKGROUND: Patients with nonischemic dilated cardiomyopathy (DCM) may be at lower risk for ventricular arrhythmias compared with those with ischemic cardiomyopathy (ICM). In addition, DCM has been identified as a predictor of positive response to cardiac resynchronization therapy (CRT).

OBJECTIVES: The aim of this study was to investigate the impact of an additional implantable cardioverter-defibrillator over CRT, according to underlying heart disease, in a large study group of primary prevention patients with heart failure.

METHODS: This was an observational, multicenter, European cohort study of 5,307 consecutive patients with DCM or ICM, no history of sustained ventricular arrhythmias, who underwent CRT implantation with (n = 4,037) or without (n = 1,270) a defibrillator. Propensity-score and cause-of-death analyses were used to compare outcomes.

RESULTS: After a mean follow-up period of 41.4 ± 29.0 months, patients with ICM had better survival when receiving CRT with a defibrillator compared with those who received CRT without a defibrillator (hazard ratio for mortality adjusted on propensity score and all mortality predictors: 0.76; 95% confidence interval [CI]: 0.62 to 0.92; p = 0.005), whereas in patients with DCM, no such difference was observed (hazard ratio: 0.92; 95% CI: 0.73 to 1.16; p = 0.49). Compared with recipients of defibrillators, the excess mortality in patients who did not receive defibrillators was related to sudden cardiac death in 8.0% among those with ICM but in only 0.4% of those with DCM.

CONCLUSIONS: Among patients with heart failure with indications for CRT, those with DCM may not benefit from additional primary prevention implantable cardioverter-defibrillator therapy, as opposed to those with ICM.

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publication status
published
keywords
Journal Article
in
Journal of the American College of Cardiology
volume
69
issue
13
pages
10 pages
publisher
Elsevier USA
external identifiers
  • scopus:85016459493
ISSN
0735-1097
DOI
10.1016/j.jacc.2017.01.042
language
English
LU publication?
no
id
484eaabe-0963-4f99-9e65-6f9e50fa09a5
date added to LUP
2017-04-07 15:11:06
date last changed
2017-08-27 06:38:57
@article{484eaabe-0963-4f99-9e65-6f9e50fa09a5,
  abstract     = {<p>BACKGROUND: Patients with nonischemic dilated cardiomyopathy (DCM) may be at lower risk for ventricular arrhythmias compared with those with ischemic cardiomyopathy (ICM). In addition, DCM has been identified as a predictor of positive response to cardiac resynchronization therapy (CRT).</p><p>OBJECTIVES: The aim of this study was to investigate the impact of an additional implantable cardioverter-defibrillator over CRT, according to underlying heart disease, in a large study group of primary prevention patients with heart failure.</p><p>METHODS: This was an observational, multicenter, European cohort study of 5,307 consecutive patients with DCM or ICM, no history of sustained ventricular arrhythmias, who underwent CRT implantation with (n = 4,037) or without (n = 1,270) a defibrillator. Propensity-score and cause-of-death analyses were used to compare outcomes.</p><p>RESULTS: After a mean follow-up period of 41.4 ± 29.0 months, patients with ICM had better survival when receiving CRT with a defibrillator compared with those who received CRT without a defibrillator (hazard ratio for mortality adjusted on propensity score and all mortality predictors: 0.76; 95% confidence interval [CI]: 0.62 to 0.92; p = 0.005), whereas in patients with DCM, no such difference was observed (hazard ratio: 0.92; 95% CI: 0.73 to 1.16; p = 0.49). Compared with recipients of defibrillators, the excess mortality in patients who did not receive defibrillators was related to sudden cardiac death in 8.0% among those with ICM but in only 0.4% of those with DCM.</p><p>CONCLUSIONS: Among patients with heart failure with indications for CRT, those with DCM may not benefit from additional primary prevention implantable cardioverter-defibrillator therapy, as opposed to those with ICM.</p>},
  author       = {Barra, Sérgio and Boveda, Serge and Providência, Rui and Sadoul, Nicolas and Duehmke, Rudolf and Reitan, Christian and Borgquist, Rasmus and Narayanan, Kumar and Hidden-Lucet, Françoise and Klug, Didier and Defaye, Pascal and Gras, Daniel and Anselme, Frédéric and Leclercq, Christophe and Hermida, Jean-Sébastien and Deharo, Jean Claude and Looi, Khang Li and Chow, Anthony W. and Virdee, Munmohan and Fynn, Simon and Le Heuzey, Jean-Yves and Marijon, Eloi and Agarwal, Sharad and , },
  issn         = {0735-1097},
  keyword      = {Journal Article},
  language     = {eng},
  month        = {04},
  number       = {13},
  pages        = {1669--1678},
  publisher    = {Elsevier USA},
  series       = {Journal of the American College of Cardiology},
  title        = {Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate},
  url          = {http://dx.doi.org/10.1016/j.jacc.2017.01.042},
  volume       = {69},
  year         = {2017},
}