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

Research output: Contribution to journalArticle

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.

Details

Authors
  • Sérgio Barra
  • Rudolf Duehmke
  • Rui Providência
  • Kumar Narayanan
  • 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
  • Eloi Marijon
  • Serge Boveda
Organisations
External organisations
  • Grenoble University Hospital
  • University Hospital of Nancy
  • Poitiers University Hospital
  • Paris Descartes University
  • Clinique Pasteur, Toulouse
  • Lille University Hospital
  • University of Lille
  • Papworth Hospital NHS Foundation Trust
  • West Suffolk Hospital
  • Barts Health NHS Trust
  • Paris Cardiovascular Research Center (PARCC)
  • Skåne University Hospital
  • Regional Hospital Liberec
  • François Rabelais University
  • Centre Cardiologique du Nord, Saint Denis
  • La Timone University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
Original languageEnglish
Pages (from-to)2121-2127
JournalEuropean Heart Journal
Volume40
Issue number26
Early online date2019 May 2
Publication statusPublished - 2019 Jul 7
Publication categoryResearch
Peer-reviewedYes