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Title: Association of cardiac resynchronization therapy with the incidence of appropriate implantable cardiac defibrillator therapies in ischaemic and non-ischaemic cardiomyopathy.
Authors: Loughlin, Gerard
Avila, Pablo
Martinez-Ferrer, Jose B
Alzueta, Javier
Vinolas, Xavier
Brugada, Josep
Arizon, Jose M
Fernandez-Lozano, Ignacio
García-Campo, Enrique
Basterra, Nuria
Fernandez De La Concha, Joaquin
Arenal, Angel
Keywords: Cardiac resynchronization therapy;Implantable cardioverter-defibrillator;Remodelling;Ventricular arrhythmia
metadata.dc.subject.mesh: Adult
Bundle-Branch Block
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy Devices
Death, Sudden, Cardiac
Defibrillators, Implantable
Disease-Free Survival
Electric Countershock
Kaplan-Meier Estimate
Middle Aged
Myocardial Ischemia
Proportional Hazards Models
Prospective Studies
Prosthesis Design
Prosthesis Failure
Risk Factors
Time Factors
Treatment Outcome
Issue Date: 2017
Abstract: Cardiac resynchronization therapy (CRT) reduces the incidence of sudden cardiac death and the use of appropriate implantable cardioverter-defibrillator (ICD) therapies (AICDTs); however, this antiarrhythmic effect is only observed in certain groups of patients. To gain insight into the effects of CRT on ventricular arrhythmia (VA) burden, we compared the incidence of AICDT use in four groups of patients: patients with ischaemic cardiomyopathy vs. non-ischaemic dilated cardiomyopathy (NIDC) and patients implanted with an ICD vs. CRT-ICD. We analysed 689 consecutive patients (mean follow-up 37 ± 16 months) included in the Umbrella registry, a multicentre prospective registry including patients implanted with ICD or CRT-ICD devices with remote monitoring capabilities in 48 Spanish Hospitals. The primary outcome was the time to first AICDT. Despite a worse clinical risk profile, NIDC patients receiving a CRT-ICD had a lower cumulative probability of first AICDT use at 2 years compared with patients implanted with an ICD [24.7 vs. 41.6%, hazard ratio (HR): 0.49, P = 0.003]; on the other hand, there were no significant differences in the incidence of first AICDT use at 2 years in ischaemic patients (22.6 vs. 21.9%, P = NS). Multivariate analysis confirmed the association of CRT with lower AICDT rates amongst NIDC patients (Adjusted HR: 0.55, CI 95% 0.35-0.87). These data suggest that CRT is associated with significantly lower rates of first AICDT use in NIDC patients, but not in ischaemic patients. This study suggests that ICD patients with NIDC and left bundle branch block experiencing VAs may benefit from an upgrade to CRT-ICD despite being in a good functional class.
metadata.dc.identifier.doi: 10.1093/europace/euw303
Appears in Collections:Producción 2020

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