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Clinical Characteristics, Mortality, Cardiac Hospitalization, and Ventricular Arrhythmias in Patients Undergoing CRT‐D Implantation: Results of the ACTION‐HF Study
Author(s) -
BOTTO GIOVANNI LUCA,
DICANDIA COSIMO DAMIANO,
MANTICA MASSIMO,
ROSA CONCETTO LA,
D’ONOFRIO ANTONIO,
BONGIORNI MARIA GRAZIA,
MOLON GIULIO,
VERLATO ROBERTO,
VILLANI GIOVANNI QUINTO,
SCACCIA ALBERTO,
RACITI GIOVANNI,
OCCHETTA ERALDO
Publication year - 2013
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12023
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , heart failure , incidence (geometry) , population , adverse effect , implantable cardioverter defibrillator , clinical trial , ejection fraction , physics , environmental health , optics
CRT Patient Characteristics and Outcomes . Introduction: The characteristics and outcomes of patients who undergo cardiac resynchronization therapy (CRT) device implantation in current clinical practice may differ from those of reference trial populations. Study objectives were to assess 2‐year outcomes in a population implanted with a CRT plus defibrillator device in accordance with the standard of care and to evaluate any independent association between clinical variables and outcome.Methods and Results:A total of 406 patients enrolled at 35 centers in Italy were followed up prospectively for 2 years. All patient management decisions were left to the treating physician's discretion, in accordance with clinical practice. ACTION‐HF patients had a better baseline clinical status than patients enrolled in the COMPANION study: shorter HF history (1 vs 3.5 years, P < 0.01), less advanced NYHA functional class (III–IV: 73% vs 100%, P < 0.01), higher LVEF (26% vs 21%, P < 0.01), higher SBP (122 vs 112 mmHg, P < 0.01), and less diabetes (27% vs 41%, P < 0.01). This status was reflected in lower mortality (11.5% vs 26%) and a lower incidence of appropriate ICD shocks (12.1% vs 19.3%). AF history was an independent predictor of the combination of all‐cause mortality and cardiac‐cause hospitalization (HR: 3.31; P < 0.001). Recurrent or new atrial arrhythmias were independently associated with the development of ventricular arrhythmias (HR: 3.4; P < 0.001).Conclusions: This population appears clinically less compromised and had a lower incidence of adverse clinical outcomes than those of reference trials. However, we recorded a substantial burden of atrial arrhythmias, which was independently associated with a higher incidence of ventricular arrhythmias. (J Cardiovasc Electrophysiol, Vol. 24, pp. 173‐181, February 2013)