Key result
CRT-D shows no significant difference in ventricular arrhythmias compared with CRT-P.
Why the study?
It is uncertain whether CRT-D provides better survival benefits than CRT-P in patients with HFrEF (LVEF ≦35%) treated with contemporary HF therapy.
Does CRT-D compared to CRT-P alter the incidence of ventricular arrhythmias or mortality in HFrEF patients receiving primary prevention?
Observational (n=79)
No
Does CRT-D compared to CRT-P alter the incidence of ventricular arrhythmias or mortality in HFrEF patients receiving primary prevention?
Absolute Event Rate: 18% vs 3%
p-value: p=0.08
In HFrEF patients receiving primary prevention CRT, females and those without prior NSVT have a notably low risk of ventricular arrhythmias, suggesting they may derive less benefit from a defibrillator.
Low VA rates in females without prior NSVT should not yet change CRT-D selection; leaves open randomized confirmation in primary-prevention HFrEF.
Background It is uncertain whether cardiac resynchronization therapy with a defibrillator (CRT‐D) provides better survival benefits than a CRT‐pacemaker (CRT‐P) in heart failure patients with a reduced ejection fraction (≦35%, HFrEF) treated with contemporary HF therapy. Methods We retrospectively analyzed the ventricular arrhythmia (VAs; sustained ventricular tachycardia/fibrillation) events in HFrEF patients who underwent CRT without a prior history of VAs or aborted sudden cardiac death before the CRT implantation. Between January/2010 and December/2020, a CRT device was implanted in 79 HFrEF patients (mean age: 69 ± 12 years, male: 57, ischemic cardiomyopathy: 16). CRT‐D and CRT‐P devices were implanted in 50 and 29 patients, respectively, at each physician's discretion. CRT‐Ds were indicated in younger patients than were CRT‐Ps (66 ± 12 vs. 73 ± 12 years, p = 0.03), but the gender distribution did not differ (female, 24% [12 of 50] vs. 35% [10 of 29], p = 0.44). The VA events during a median follow‐up of 3.5‐years (interquartile range [IQR]:1.6–5.5) and their predictors were analyzed. Results VA events occurred in 9 patients with CRT‐Ds (18%) and one with a CRT‐P (3%, p = 0.08). The VA event rate was significantly lower in patients without a prior non‐sustained ventricular tachycardia (NSVT: ≥3 beats; rate, ≥120 bpm; lasting <30 s, HR 0.05; 95% CI 0.01–0.30; p < 0.01) and females (HR 0.11; 95% CI 0.01–0.93; p = 0.04). Of note, no female patients without a prior history of NSVT experienced VA events. Conclusion HFrEF CRT candidates without a prior history of NSVT and females may obtain less benefit from a primary preventive defibrillator indication.
No takes yet. Share an insight, caveat, or question.
Nakamura et al. (2022) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) ≤35% (n=79). Cardiac resynchronization therapy with a defibrillator (CRT-D) vs. Cardiac resynchronization therapy with a pacemaker (CRT-P) was evaluated on Ventricular arrhythmia events (sustained ventricular tachycardia/fibrillation) (p=0.08). Ventricular arrhythmias occurred in 18% of CRT-D and 3% of CRT-P patients (p=0.08); female gender and lack of prior NSVT independently predicted significantly fewer events.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: