Association of cardiac resynchronization therapy with the incidence of appropriate implantable cardiac defibrillator therapies in ischaemic and non-ischaemic cardiomyopathy
Por:
Loughlin, G, Avila, P, Martinez-Ferrer, JB, Alzueta, J, Vinolas, X, Brugada, J, Arizon, JM, Fernandez-Lozano, I, Garcia-Campo, E, Basterra, N, De La Concha, JF, Arenal, A
Publicada:
1 nov 2017
Resumen:
Aims Cardiac resynchronization therapy (CRT) reduces the incidence of sudden cardiac death and the use of appropriate implantable cardioverter-defibrillator (ICD) therapies (AICDTs); however, this antiarrhythmic effect is only observed in certain groups of patients. To gain insight into the effects of CRT on ventricular arrhythmia (VA) burden, we compared the incidence of AICDT use in four groups of patients: patients with ischaemic cardiomyopathy vs. non-ischaemic dilated cardiomyopathy (NIDC) and patients implanted with an ICD vs. CRT-ICD.
Methods and results We analysed 689 consecutive patients (mean follow-up 37 +/- 16 months) included in the Umbrella registry, a multicentre prospective registry including patients implanted with ICD or CRT-ICD devices with remote monitoring capabilities in 48 Spanish Hospitals. The primary outcome was the time to first AICDT. Despite a worse clinical risk profile, NIDC patients receiving a CRT-ICD had a lower cumulative probability of first AICDT use at 2 years compared with patients implanted with an ICD [24.7 vs. 41.6%, hazard ratio (HR): 0.49, P = 0.003]; on the other hand, there were no significant differences in the incidence of first AICDT use at 2 years in ischaemic patients (22.6 vs. 21.9%, P = NS). Multivariate analysis confirmed the association of CRT with lower AICDT rates amongst NIDC patients (Adjusted HR: 0.55, CI 95% 0.35-0.87).
Conclusions These data suggest that CRT is associated with significantly lower rates of first AICDT use in NIDC patients, but not in ischaemic patients. This study suggests that ICD patients with NIDC and left bundle branch block experiencing VAs may benefit from an upgrade to CRT-ICD despite being in a good functional class.
Filiaciones:
Loughlin, G:
Hosp Gen Univ Gregorio Maranon, IiSGM, Calle Dr Esquerdo 46, Madrid 28007, Spain
Avila, P:
Hosp Gen Univ Gregorio Maranon, IiSGM, Calle Dr Esquerdo 46, Madrid 28007, Spain
Martinez-Ferrer, JB:
Hosp Univ Araba, Vitoria, Spain
Alzueta, J:
Hosp Virgen de la Victoria, Malaga, Spain
Vinolas, X:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Brugada, J:
Hosp Clin Barcelona, Barcelona, Spain
Arizon, JM:
Hosp Reina Sofia, Cordoba, Spain
Fernandez-Lozano, I:
Hosp Univ Puerta de Hierro, Majadahonda, Spain
Garcia-Campo, E:
Complejo Hosp Vigo, Vigo, Spain
Basterra, N:
Hosp Navarra, Pamplona, Spain
De La Concha, JF:
Hosp Infanta Cristina, Badajoz, Spain
Arenal, A:
Hosp Gen Univ Gregorio Maranon, IiSGM, Calle Dr Esquerdo 46, Madrid 28007, Spain
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