Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate
(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.
(Less)
- author
- author collaboration
- publishing date
- 2017-04-04
- type
- Contribution to journal
- publication status
- published
- keywords
- Journal Article
- in
- Journal of the American College of Cardiology
- volume
- 69
- issue
- 13
- pages
- 10 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85016459493
- pmid:28359511
- 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
- 2024-09-15 23:13:01
@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}}, issn = {{0735-1097}}, keywords = {{Journal Article}}, language = {{eng}}, month = {{04}}, number = {{13}}, pages = {{1669--1678}}, publisher = {{Elsevier}}, 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}}, doi = {{10.1016/j.jacc.2017.01.042}}, volume = {{69}}, year = {{2017}}, }