Key result
Achieving super-responder status (post-CRT ejection fraction ≥50%) was highly protective against appropriate ICD therapy compared with non-super responders (HR 0.13; 95% CI 0.02-0.91).
Why the study?
Does super-response to cardiac resynchronization therapy reduce the frequency of appropriate implantable cardioverter defibrillator therapy in patients receiving CRT-D?
Cohort (n=629)
Yes
Does super-response to cardiac resynchronization therapy reduce the frequency of appropriate implantable cardioverter defibrillator therapy in patients receiving CRT-D?
Hazard Ratio: 0.13 (95% CI 0.02–0.91)
Patients who achieve an ejection fraction ≥50% after CRT-D implantation have significantly lower rates of appropriate ICD therapy, suggesting a markedly reduced risk of life-threatening ventricular arrhythmias.
Super-response to CRT associated with reduced appropriate ICD therapy; leaves open whether ICD can be safely avoided in this subgroup.
Aims: To determine the frequency of implantable cardioverter defibrillator (ICD) therapy following cardiac resynchronization therapy (CRT-D) implantation in super and non-super responders and whether greater improvement in left ventricular (LV) function after CRT is associated with a reduced burden in ICD therapy. Methods and results: This is a two-centre, retrospective study between January 2002 and September 2011. Patients were classified as non-super responders and super-responders based on the post-CRT ejection fraction (EF) of < 50% and ≥50%, respectively. Of 629 recipients of CRT-D, 37 (5.9%) were super-responders. Implantable cardioverter defibrillator follow-up was available for a mean duration of 6.2 ± 2.7 years. The 5-year rate of antitachycardia pacing (ATP) in super-responders was significantly lower than in non-super responders (2.7% vs. 22.1%, P = 0.004). Super-responders also had a lower 5-year rate of appropriate ICD shock compared with non-super responders (2.7% vs. 14.3%, P = 0.03). On multivariable analysis, factors associated with appropriate ICD therapy (ICD shock/ATP) include male gender (hazard ratio, HR 1.97, 95% confidence interval, 95% CI 1.15-3.35), secondary prevention indication (HR 2.09, 95% CI 1.13-3.85), increased baseline LV end-systolic diameter (HR 1.03 per mm, 95% CI 1.01-1.06) and higher baseline EF (HR 1.03 per %, 95% CI 1.00-1.06) while super-responder status was highly protective (HR 0.13, 95% CI 0.02-0.91). Conclusion: Recipients of CRT-D that normalize their EF have very low rates of ventricular arrhythmias requiring appropriate ICD therapy compared with those that do not.
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Killu et al. (2017) conducted a cohort in Heart failure requiring CRT-D (n=629). Super-responder status (post-CRT EF ≥50%) vs. Non-super responders (post-CRT EF <50%) was evaluated on Appropriate ICD therapy (ICD shock/ATP) (HR 0.13, 95% CI 0.02-0.91). Achieving super-responder status (post-CRT ejection fraction ≥50%) was highly protective against appropriate ICD therapy compared with non-super responders (HR 0.13; 95% CI 0.02-0.91).
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