Barra, S;
Boveda, S;
Providência, R;
Sadoul, N;
Duehmke, R;
Reitan, C;
Borgquist, R;
... French-UK-Sweden CRT Network, .; + view all
(2017)
Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate.
Journal of the American College of Cardiology
, 69
(13)
pp. 1669-1678.
10.1016/j.jacc.2017.01.042.
Preview |
Text
Barra_CRTp vs CRTd ARTICLE aetiology JACC revision.pdf - Accepted Version Download (386kB) | Preview |
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 (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.
| Type: | Article |
|---|---|
| Title: | Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.jacc.2017.01.042 |
| Publisher version: | https://doi.org/10.1016/j.jacc.2017.01.042 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Implantable cardioverter-defibrillator; cardiac resynchronization therapy; cause of death analysis; sudden cardiac death; all-cause mortality; ischemic cardiomyopathy; coronary artery disease; dilated cardiomyopathy; propensity score matching; propensity score weighting |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10052007 |
Archive Staff Only
 |
View Item |
