How to choose between a pacemaker or defibrillator for resynchronization therapy?

Gillebert, Carl; Marynissen, Thomas; Janssen, Roel; Droogné, Walter; Vörös, Gábor; Garweg, Christophe; Willems, Rik

doi:10.1080/ac.69.5.3044874

Cited by 5 publications

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“…The number needed to treat (NNT) was 10. Ten studies showed significantly lower mortality rates with the CRT‐D device, while the remaining 9 were neutral . The observed I 2 values showed moderate heterogeneity within this analysis (I 2 =48%).…”

Section: Resultsmentioning

confidence: 76%

“…An adequately powered randomized controlled trial on CRT‐D versus CRT‐P is very unlikely to be performed in the near future and therefore a meta‐analysis is the most adequate method to address this subject. The meta‐analysis by Jiang et al provided valuable insight, but several studies comparing CRT‐D with CRT‐P have been published since its publication …”

Section: Introductionmentioning

confidence: 99%

“…The meta-analysis by Jiang et al 20 provided valuable insight, but several studies comparing CRT-D with CRT-P have been published since its publication. 3,[12][13][14]16,18,19,[21][22][23] We aim to perform a systematic review with meta-analysis of the current literature regarding the potential applicability and effectiveness of the ICD in patients receiving CRT.…”

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confidence: 99%

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Importance of Implantable Cardioverter‐Defibrillator Back‐Up in Cardiac Resynchronization Therapy Recipients: A Systematic Review and Meta‐Analysis

Barra

Providência

Tang

et al. 2015

JAHA

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BackgroundIt remains to be determined whether patients receiving cardiac resynchronization therapy (CRT) benefit from the addition of an implantable cardioverter‐defibrillator (ICD).Methods and ResultsWe performed a literature search looking for studies of patients implanted with CRTs. Comparisons were performed between patients receiving CRT‐defibrillator (CRT‐D) versus CRT‐pacemaker (CRT‐P). The primary outcome was all‐cause mortality. Data were pooled using a random‐effects model. The relative risk (RR) and hazard ratio (HR, when available) were used as measurements of treatment effect. Nineteen entries were entitled for inclusion, comprising 12 378 patients (7030 receiving CRT‐D and 5348 receiving CRT‐P) and 29 799 patient‐years of follow‐up. Those receiving CRT‐D were younger, were more often males, had lower NYHA class, lower prevalence of atrial fibrillation, higher prevalence of ischemic heart disease, and were more often on beta‐blockers. Ten studies showed significantly lower mortality rates with the CRT‐D device, while the remaining 9 were neutral. The pooled data of studies revealed that CRT‐D patients had significantly lower mortality rates compared with CRT‐P patients (mortality rates: CRT‐D 16.6% versus CRT‐P 27.1%; RR=0.69, 95% CI 0.62–0.76; P<0.00001). The number needed to treat to prevent one death was 10. The observed I2 values showed moderate heterogeneity among studies (I2=48%). The benefit of CRT‐D was more pronounced in ischemic cardiomyopathy (HR=0.70, 95% CI 0.59–0.83, P<0.001, I2=0%), but a trend for benefit, albeit of lower magnitude, could also be seen in non‐ischemic dilated cardiomyopathy (HR=0.79, 95% CI 0.61–1.02, P=0.07, I2=36%).ConclusionsThe addition of the ICD associates with a reduction in the risk of all‐cause mortality in CRT patients. This seems to be more pronounced in patients with ischemic cardiomyopathy.

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Section: Resultsmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Importance of Implantable Cardioverter‐Defibrillator Back‐Up in Cardiac Resynchronization Therapy Recipients: A Systematic Review and Meta‐Analysis

Barra

Providência

Tang

et al. 2015

JAHA

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“…Of those included studies, 17 of them reported aHR of all‐cause mortality, 6,8–10,12–14,16,17,19–27 and four studies reported HRs after PSM 8,14,17,19 . Adjusted covariates of each study are listed in Table S2.…”

Section: Resultsmentioning

confidence: 99%

The benefits of defibrillator in heart failure patients with cardiac resynchronization therapy: A meta‐analysis

Long

Cui

et al. 2021

Pacing Clinical Electrophis

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Background Current guidelines did not provide recommendations on indications of an additional implantable cardioverter‐defibrillator (ICD) to patients receiving cardiac resynchronization therapy (CRT), and it still remains controversial due to lack of evidence from randomized controlled trials. Method PubMed, Embase, and Cochrane CENTRAL from the inception to May 2020 were systematically screened for studies reporting on the comparison of cardiac resynchronization therapy with defibrillator (CRT‐D) and cardiac resynchronization therapy with pacemaker (CRT‐P), focusing on the adjusted hazard ratio (aHR) of all‐cause mortality. We pooled the effects using a random‐effect model. Results Twenty‐one studies encompassing 69,919 patients were included in this meta‐analysis. With no restriction to characteristics of including population, CRT‐D was associated with a lower all‐cause mortality compared with CRT‐P significantly (aHR: 0.80, 95% confidence interval [CI]: 0.74‐0.87, I2 = 36.8%, p < .001). This mortality benefit was also observed in patients with ischemic cardiomyopathy (aHR: 0.74, 95% CI: 0.64‐0.86, I2 = 0%, p < .001). However, there is no significant difference in patients with nonischemic cardiomyopathy (NICM) (aHR: 0.91, 95% CI: 0.82‐1.01, I2 = 0%, p = .087), older age (age ≥75 years, aHR: 0.96, 95% CI: 0.83‐1.12, I2 = 0%, p = .610). Subgroup analysis was performed and indicated the survival benefit of CRT‐D for primary prevention compared with CRT‐P (aHR: 0.87, 95% CI: 0.79‐0.95, I2 = 0%, p = .003). Conclusion After adjusted the differences in clinical characteristics, additional ICD therapy was associated with a reduced all‐cause mortality in patients receiving CRT. However, our work suggested that additional ICD may not be applied to elderly (≥75 years) or patients with NICM.

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“…Of those included studies, 17 of them reported adjusted HR of all-cause mortality [6,[8][9][10][12][13][14]16,17,[19][20][21][22][23][24][25][26][27], and 4 studies reported HRs after propensity score matching [8,14,17,19]. Adjusted covariates of each studies are listed in Supplementary Table 2.…”

Section: Results Description Of Included Studiesmentioning

confidence: 99%

the Benefits of Additional Defibrillator in Heart Failure Patients with Cardiac Resynchronization Therapy: A Meta-analysis of Observational Studies

Long¹,

Cui²,

Liu³

2020

Preprint

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Background: Current guidelines did not provide recommendations on indications of an additional implantable cardioverterdefibrillator (ICD) to patients receiving cardiac resynchronization therapy (CRT), and it still remains controversial due to lack of evidence from randomized controlled trials (RCTs). Method: PubMed, Embase and Cochrane CENTRAL from the inception to May 2020 were systematically screened for studies reporting on the comparison of CRT-defibrillator (CRT-D) and CRT-pacemaker (CRT-P), focusing on the adjusted hazard ratio (aHR) of all-cause mortality. We pooled the effects using a random-effect model. Results: Twenty-one studies encompassing 69919 patients were included in this meta-analysis. With no restriction to characteristics of including population, CRT-D was associated with a lower all-cause mortality compared with CRT-

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How to choose between a pacemaker or defibrillator for resynchronization therapy?

Abstract: The choice of a CRT-D seemed a predictor of improved survival in simple but not in more complex multivariable analyses. The fact that the survival benefit strongly depended on the number of co-variables suggests that it is at most marginal.

Cited by 5 publications

References 0 publications

Importance of Implantable Cardioverter‐Defibrillator Back‐Up in Cardiac Resynchronization Therapy Recipients: A Systematic Review and Meta‐Analysis

Importance of Implantable Cardioverter‐Defibrillator Back‐Up in Cardiac Resynchronization Therapy Recipients: A Systematic Review and Meta‐Analysis

The benefits of defibrillator in heart failure patients with cardiac resynchronization therapy: A meta‐analysis

the Benefits of Additional Defibrillator in Heart Failure Patients with Cardiac Resynchronization Therapy: A Meta-analysis of Observational Studies

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