Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate

Sérgio Barra; Serge Boveda; Rui Providência; Nicolas Sadoul; Rudolf Duehmke; Christian Reitan; Rasmus Borgquist; Kumar Narayanan; Françoise Hidden-Lucet; Didier Klug; Pascal Defaye; Daniel Gras; Frédéric Anselme; Christophe Leclercq; Jean-Sébastien Hermida; Jean Claude Deharo; Khang Li Looi; Anthony W. Chow; Munmohan Virdee; Simon Fynn; Jean-Yves Le Heuzey; Eloi Marijon; Sharad Agarwal; French-UK-Sweden CRT Network

doi:10.1016/j.jacc.2017.01.042

Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate

Sérgio Barra, Serge Boveda, Rui Providência, Nicolas Sadoul, Rudolf Duehmke, Christian Reitan, Rasmus Borgquist, Kumar Narayanan, Françoise Hidden-Lucet, Didier Klug, Pascal Defaye, Daniel Gras, Frédéric Anselme, Christophe Leclercq, Jean-Sébastien Hermida, Jean Claude Deharo, Khang Li Looi, Anthony W. Chow, Munmohan Virdee, Simon FynnJean-Yves Le Heuzey, Eloi Marijon, Sharad Agarwal, French-UK-Sweden CRT Network

Skåne University Hospital

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	1669-1678
Number of pages	10
Journal	Journal of the American College of Cardiology
Volume	69
Issue number	13
DOIs	https://doi.org/10.1016/j.jacc.2017.01.042
Publication status	Published - 2017 Apr 4
Externally published	Yes

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Barra, S., Boveda, S., Providência, R., Sadoul, N., Duehmke, R., Reitan, C., Borgquist, R., Narayanan, K., Hidden-Lucet, F., Klug, D., Defaye, P., Gras, D., Anselme, F., Leclercq, C., Hermida, J.-S., Deharo, J. C., Looi, K. L., Chow, A. W., Virdee, M., ... French-UK-Sweden CRT Network (2017). Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate. Journal of the American College of Cardiology, 69(13), 1669-1678. https://doi.org/10.1016/j.jacc.2017.01.042

@article{484eaabe09634f999e656f9e50fa09a5,

title = "Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate",

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.",

keywords = "Journal Article",

author = "S{\'e}rgio Barra and Serge Boveda and Rui Provid{\^e}ncia and Nicolas Sadoul and Rudolf Duehmke and Christian Reitan and Rasmus Borgquist and Kumar Narayanan and Fran{\c c}oise Hidden-Lucet and Didier Klug and Pascal Defaye and Daniel Gras and Fr{\'e}d{\'e}ric Anselme and Christophe Leclercq and Jean-S{\'e}bastien Hermida and Deharo, {Jean Claude} and Looi, {Khang Li} and Chow, {Anthony W.} and Munmohan Virdee and Simon Fynn and {Le Heuzey}, Jean-Yves and Eloi Marijon and Sharad Agarwal and {French-UK-Sweden CRT Network}",

year = "2017",

month = apr,

day = "4",

doi = "10.1016/j.jacc.2017.01.042",

language = "English",

volume = "69",

pages = "1669--1678",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

number = "13",

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Barra, S, Boveda, S, Providência, R, Sadoul, N, Duehmke, R, Reitan, C, Borgquist, R, Narayanan, K, Hidden-Lucet, F, Klug, D, Defaye, P, Gras, D, Anselme, F, Leclercq, C, Hermida, J-S, Deharo, JC, Looi, KL, Chow, AW, Virdee, M, Fynn, S, Le Heuzey, J-Y, Marijon, E, Agarwal, S & French-UK-Sweden CRT Network 2017, 'Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate', Journal of the American College of Cardiology, vol. 69, no. 13, pp. 1669-1678. https://doi.org/10.1016/j.jacc.2017.01.042

TY - JOUR

T1 - Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate

AU - Barra, Sérgio

AU - Boveda, Serge

AU - Providência, Rui

AU - Sadoul, Nicolas

AU - Duehmke, Rudolf

AU - Reitan, Christian

AU - Borgquist, Rasmus

AU - Narayanan, Kumar

AU - Hidden-Lucet, Françoise

AU - Klug, Didier

AU - Defaye, Pascal

AU - Gras, Daniel

AU - Anselme, Frédéric

AU - Leclercq, Christophe

AU - Hermida, Jean-Sébastien

AU - Deharo, Jean Claude

AU - Looi, Khang Li

AU - Chow, Anthony W.

AU - Virdee, Munmohan

AU - Fynn, Simon

AU - Le Heuzey, Jean-Yves

AU - Marijon, Eloi

AU - Agarwal, Sharad

AU - French-UK-Sweden CRT Network

PY - 2017/4/4

Y1 - 2017/4/4

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1016/j.jacc.2017.01.042

DO - 10.1016/j.jacc.2017.01.042

M3 - Article

C2 - 28359511

SN - 0735-1097

VL - 69

SP - 1669

EP - 1678

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 13

ER -

Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate

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