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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 orcid ; 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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publishing date
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
  • pmid:28359511
  • 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
2024-06-23 14:52:18
@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}},
}