Key result
Cardiac resynchronization therapy with a defibrillator (CRT-D) did not significantly alter the incidence of ventricular arrhythmias compared to ICD alone (35.0% vs. 38.1%, p=0.74) in patients with cardiomyopathy.
Why the study?
Does CRT-D increase the incidence of ventricular arrhythmias compared to ICD alone in patients with cardiomyopathy for primary prevention?
Observational (n=180)
No
Does CRT-D increase the incidence of ventricular arrhythmias compared to ICD alone in patients with cardiomyopathy for primary prevention?
Answers are grounded in this paper and cite their sources.
In patients with cardiomyopathy receiving devices for primary prophylaxis, CRT-D does not increase the burden of ventricular arrhythmias compared to ICD alone, alleviating concerns of pro-arrhythmic effects.
UNLABELLED: Aim and Hypothesis: Despite the proven symptomatic and mortality benefit of cardiac resynchronization therapy (CRT), there is anecdotal evidence it may be pro-arrhythmic in some patients. We aimed to identify if there were significant differences in the incidence of ventricular arrhythmias (VAs) in patients undergoing CRT-D and implantable cardioverter-defibrillators (ICD) implantation for primary prevention indication. We hypothesized that CRT is unlikely to be pro-arrhythmic based on the positive mortality and morbidity data from large randomized trials. METHODS AND RESULTS: A retrospective analysis of device therapies for VA in a primary prevention device cohort was performed. Patients with ischemic (IHD) and non-ischemic (DCM) cardiomyopathy and ICD or CRT+ICD devices (CRT-D) implanted between 2005 and 2007 without prior history of sustained VA were included for analysis. VA episodes were identified from stored electrograms and defined as sustained (VT/VF) if therapy [anti-tachycardia pacing (ATP) or shocks] was delivered or non-sustained (NSVT) if not. Of a total of 180 patients, 117 (68% male) were in the CRT-D group, 42% IHD, ejection fraction (EF) 24.5 ± 8.2% and mean follow-up 23.9 ± 9.8 months. 63 patients (84% male) were in the ICD group, 60% IHD, EF 27.7 ± 7.2% and mean follow-up 24.6 ± 10.8 months. Overall, there was no significant difference in the incidence of VA (35.0 vs. 38.1%, p = 0.74), sustained VT (21.3 vs. 28.5%, p = 0.36) or NSVT (12.8 vs. 9.5%, p = 0.63) and no significant difference in type of therapy received for VT/VF: ATP (68 vs. 66.6%, p = 0.73) and shocks (32 vs. 33.3%, p = 0.71) between the CRT-D and ICD groups, respectively. CONCLUSION: In patients with cardiomyopathy receiving CRT-D and ICDs for primary prophylaxis, there was no significant difference in the incidence of VA. From this single center retrospective analysis, there is no evidence to support cardiac resynchronization causing pro-arrhythmia.
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Gopalamurugan et al. (2014) conducted an observational in Cardiomyopathy with poor left ventricular function (n=180). CRT-D vs. ICD was evaluated on Incidence of ventricular arrhythmias (p=0.74). Cardiac resynchronization therapy with a defibrillator (CRT-D) did not significantly alter the incidence of ventricular arrhythmias compared to ICD alone (35.0% vs. 38.1%, p=0.74) in patients with cardiomyopathy.
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