Why the study?
Response to CRT decreases ventricular arrhythmia risk in patients with LV dysfunction, but selecting a suitable CRT device remains challenging.
Does a novel VA risk score predict ventricular arrhythmia in patients with LV dysfunction receiving CRT compared to ICD?
Does a novel VA risk score predict ventricular arrhythmia in patients with LV dysfunction receiving CRT compared to ICD?
A novel clinical risk score effectively stratifies the risk of ventricular arrhythmias in patients receiving cardiac resynchronization therapy, but not in those receiving standard implantable cardioverter defibrillators.
VA risk score may stratify VA risk in CRT but not ICD patients; leaves open utility for device selection pending validation.
Background: Patients with left ventricular (LV) dysfunction have a higher risk of ventricular arrhythmia (VA) compared with those without, and are candidates for implantable cardioverter defibrillator (ICD). Response to cardiac resynchronization therapy (CRT) decreases the risk of VA; however, selection of a suitable CRT device remains challenging. Methods and Results: In 678 patients with a CRT/ICD device and LV dysfunction, we investigated 325 CRT and 142 ICD patients for primary prevention. VA was defined as lasting ≥30 s or being treated with an ICD. CRT non-responders were defined as patients without reduced LV end-systolic volume ≥15%. During the follow-up period, 98 (21%) patients had a VA event (CRT 71 [22%] vs. ICD 27 [19%]; P=0.49). The VA risk score was calculated by summing values for non-left bundle branch block, left atrial diameter >45 mm, persistent atrial fibrillation, male sex, LV ejection fraction <25%, and ischemic cardiomyopathy. Our results showed that the VA risk score stratified the risk of VA among CRT patients (P<0.01), but was not significant for ICD patients (P=0.24). Patients with a VA risk score ≥4 (divided by receiver operating characteristic analysis) had a higher risk of VA among CRT patients (log rank P<0.01); however, it was not significant for ICD patients (log rank P=0.71). Conclusions: The VA risk score could be a useful indicator for VA among CRT candidates.
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Ueda et al. (2025) studied this question.
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