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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/26310

Title: Incremental benefit of cardiac resynchronisation therapy with versus without a defibrillator
Authors: Martens, Pieter
Verbrugge, Frederik H.
Nijst, Petra
Dupont, Matthias
Nuyens, Dieter
Van Herendael, Hugo
Rivero-Ayerza, Maximo
Tang, Wilson H.
Mullens, Wilfried
Issue Date: 2017
Publisher: BMJ PUBLISHING GROUP
Citation: HEART, 103(24), p. 1977-1984
Abstract: Objective To determine the incremental value of implantable cardioverter defibrillators (ICD) in contemporary optimally treated patients with heart failure (HF) undergoing cardiac resynchronisation therapy (CRT). Methods Consecutive patients with HF undergoing CRT-pacemaker (CRT-P) or CRT-defibrillator (CRT-D) implantation in a single tertiary care centre between October 2008 and August 2015 were retrospectively evaluated. For patients with a primary prevention indication of the CRT-D, no benefit of the ICD was defined as absence of appropriate therapy (device analysis) or lethal ventricular tachyarrhythmias (mode of death analysis) during follow-up. Results 687 patients (CRT-P/CRT-D; n=361/326) were followed for 38 +/- 22 months. CRT-P recipients were older (75.7 +/- 9.1 vs 71.8 +/- 9.3 years; p<0.001) and had a higher comorbidity burden. Five patients with CRT-P (1%) experienced episodes of sustained ventricular-tachycardia vs 64 (20%) patients with CRT-D (p<0.001). Remote tele-monitoring detected the episodes of sustained ventricular tachycardia in four patients with CRT-P, allowing for elective upgrade to CRT-D. All-cause mortality was higher in patients with CRT-P versus CRT-D (21% vs 12%, p=0.003), even after adjusting for baseline characteristics (HR 2.5; 95% CI 1.36 to 4.60; p=0.003). However, mode of death analysis revealed a predominant non-cardiac mode of death in CRT-P recipients (n=47 (71%) vs n=13 (38%) in CRT-D, p=0.002). Multivariate analysis revealed that age >80 years, New York Heart Association class IV, intolerance to beta-blockers and underlying non-ischaemic cardiomyopathy were independently associated with little incremental value of a primary prevention ICD on top of CRT. Conclusions The majority of patients with contemporary HF as currently selected for CRT-P exhibit mainly non-cardiac-driven mortality. Weighing risk of ventricular-tachyarrhythmic death versus risk of all-cause mortality helps to address the incremental value of an ICD to CRT-P.
Notes: [Martens, Pieter; Verbrugge, Frederik H.; Nijst, Petra; Dupont, Matthias; Nuyens, Dieter; Van Herendael, Hugo; Rivero-Ayerza, Maximo; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium. [Martens, Pieter; Nijst, Petra] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Tang, Wilson H.] Cleveland Clin, Dept Cardiovasc Med, Heart & Vasc Inst, Cleveland, OH 44106 USA. [Mullens, Wilfried] Hasselt Univ, Biomed Res Inst, Fac Med & Life Sci, Diepenbeek, Belgium.
URI: http://hdl.handle.net/1942/26310
DOI: 10.1136/heartjnl-2017-311423
ISI #: 000416271200011
ISSN: 1355-6037
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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