Very long-term survival and late sudden cardiac death in cardiac resynchronization therapy patients

Sérgio Barra, Rudolf Duehmke, Rui Providência, Kumar Narayanan, Christian Reitan, Tomas Roubicek, Rostislav Polasek, Antony Chow, Pascal Defaye, Laurent Fauchier, Olivier Piot, Jean-Claude Deharo, Nicolas Sadoul, Didier Klug, Rodrigue Garcia, Seth Dockrill, Munmohan Virdee, Stephen Pettit, Sharad Agarwal, Rasmus BorgquistEloi Marijon, Serge Boveda

Research output: Contribution to journalArticlepeer-review

22 Citations (SciVal)

Abstract

AIMS: The very long-term outcome of patients who survive the first few years after receiving cardiac resynchronization therapy (CRT) has not been well described thus far. We aimed to provide long-term outcomes, especially with regard to the occurrence of sudden cardiac death (SCD), in CRT patients without (CRT-P) and with defibrillator (CRT-D).

METHODS AND RESULTS: A total of 1775 patients, with ischaemic or non-ischaemic dilated cardiomyopathy, who were alive 5 years after CRT implantation, were enrolled in this multicentre European observational cohort study. Overall long-term mortality rates and specific causes of death were assessed, with a focus on late SCD. Over a mean follow-up of 30 months (interquartile range 10-42 months) beyond the first 5 years, we observed 473 deaths. The annual age-standardized mortality rates of CRT-D and CRT-P patients were 40.4 [95% confidence interval (CI) 35.3-45.5] and 97.2 (95% CI 85.5-109.9) per 1000 patient-years, respectively. The adjusted hazard ratio (HR) for all-cause mortality was 0.99 (95% CI 0.79-1.22). Twenty-nine patients in total died of late SCD (14 with CRT-P, 15 with CRT-D), corresponding to 6.1% of all causes of death in both device groups. Specific annual SCD rates were 8.5 and 5.8 per 1000 patient-years in CRT-P and CRT-D patients, respectively, with no significant difference between groups (adjusted HR 1.0, 95% CI 0.45-2.44). Death due to progressive heart failure represented the principal cause of death (42.8% in CRT-P patients and 52.6% among CRT-D recipients), whereas approximately one-third of deaths in both device groups were due to non-cardiovascular death.

CONCLUSION: In this first description of very long-term outcomes among CRT recipients, progressive heart failure death still represented the most frequent cause of death in patients surviving the first 5 years after CRT implant. In contrast, SCD represents a very low proportion of late mortality irrespective of the presence of a defibrillator.

Original languageEnglish
Pages (from-to)2121-2127
JournalEuropean Heart Journal
Volume40
Issue number26
Early online date2019 May 2
DOIs
Publication statusPublished - 2019 Jul 7

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

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