Predictors for early mortality and arrhythmic events in patients with cardiac resynchronization therapy with defibrillator: A two center cohort study

Abstract

Background: Guidelines of heart failure therapy include cardiac resynchronization as standard of care in patients with severely depressed left ventricular function and wide QRS complex. It has been shown that patients benefit regarding mortality and morbidity. However, early mortality precludes longterm benefits from the device. The aim of the study was to identify predictors for early occurrence of both death and first-ever implantable cardioverter-defibrillator (ICD) therapy using a large combined database of patients with cardiac resynchronization therapy with defibrillator (CRT-D). Methods: From two registries (tertiary care centers) 904 patients were identified, no single patient was excluded. Early death was defined as death occurring within the 3 years after implantation whereas early ICD therapy as such occurring within the first year. 33 baseline parameters were compared using uni-and multivariate analysis with the Cox model and binary logistic regression. Results: The population was predominantly male (77%), with mean age of 63 ± 11 years and primary prevention indication in 80%. Mean follow-up was 55 ± 38 months. 256 (28%) patients had ICD therapies whereof the first-ever event occurred early in 52%. 270 (30%) patients died after 41 ± ± 31 months, mostly from advancing heart failure (41%), 141 (52%) patients of them early. Independent predictors for early ICD therapy were secondary prevention and renal failure. Independent predictors for early mortality were a history of percutaneous coronary intervention and of peripheral vascular disease. Conclusions: Predictors for early mortality after CRT-D implantation were a history of percutaneous coronary intervention and peripheral vascular disease, present in only a minority of patients, thus limiting their use in clinical practice.

Heart failure treatment in patients with cardiac implantable electronic devices: Opportunity for improvement

“…Baseline medical therapy in major registries and cohort studies of CRT and ICD (n 5 19) is presented in Figure 3. [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] CRT studies reported ACEI/ARB and betablocker baseline use in 78% (52%-100%) and 80% (70%-87%). Uptake was similar in ICD studies, 78% (59%-99%) and 85% (53%-97%), respectively.…”