Open AccessCardiac resynchronization therapy is associated with a reduction in ICD therapies as it improves ventricular function
Author(s) -
Galve Enrique,
Oristrell Gerard,
Acosta Gabriel,
RiberaSolé Aida,
MoyaMitjans Àngel,
FerreiraGonzález Ignacio,
PérezRodon Jordi,
GarcíaDorado David
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22958
Subject(s) - medicine , ejection fraction , cardiac resynchronization therapy , cardiology , hazard ratio , implantable cardioverter defibrillator , heart failure , cardiomyopathy , confidence interval , proportional hazards model , ischemic cardiomyopathy , retrospective cohort study , cardiac function curve
Background Repeated implantable cardioverter‐defibrillator (ICD) therapies cause myocardial damage and, thus, an increased risk of arrhythmias and mortality. Hypothesis Cardiac resynchronization therapy–defibrillator (CRT‐D) reduces the number of appropriate therapies in patients with left ventricular dysfunction (left ventricular ejection fraction [LVEF] <50%). Methods The retrospective study involved 175 consecutive patients (mean age, 64.6 ±10.4 years; 86.9% males) with reduced LVEF of 27.9% ±7.6% treated with an ICD (56.6%) or CRT‐D (43.4%), according to standard indications, between January 2009 and July 2014. Devices were placed for either primary (54.3%) or secondary prevention (45.7%). Mean follow‐up was 2.5 ±1.5 years. Predictors of first appropriate therapy were assessed using Cox regression analysis. Results Forty‐four (25.1%) patients received ≥1 appropriate therapy. Although patients treated with CRT‐D had lower LVEF and poorer New York Heart Association class, CRT‐D patients with LVEF improvement >35% at the end of follow‐up had a significantly lower risk of receiving a first appropriate therapy relative to those with an ICD (adjusted hazard ratio: 0.24, 95% confidence interval: 0.07–0.83, P = 0.025), independently of ischemic cardiomyopathy, baseline LVEF, and secondary prevention. There were no differences in mortality between the ICD and the CRT‐D groups. Conclusions Although patients receiving CRT‐D had a worse clinical profile, they received fewer device therapies in comparison with those receiving an ICD. This reduction is associated with a significant improvement in LVEF.