Importance of Implantable Cardioverter‐Defibrillator Back‐Up in Cardiac Resynchronization Therapy Recipients: A Systematic Review and Meta‐Analysis
Key result
CRT-defibrillator significantly reduced all-cause mortality compared with CRT-pacemaker (16.6% vs 27.1%; RR 0.69, 95% CI 0.62-0.76; P<0.00001), with a number needed to treat of 10.
Why the study?
Does CRT-D reduce all-cause mortality compared to CRT-P in patients receiving cardiac resynchronization therapy?
Study Design
Type
Meta-Analysis (n=12,378)
Structured PICO
Does CRT-D reduce all-cause mortality compared to CRT-P in patients receiving cardiac resynchronization therapy?
P
Population
12,378 patients receiving cardiac resynchronization therapy across 19 studies, with 29,799 patient-years of follow-up.
I
Intervention
Cardiac resynchronization therapy with defibrillator (CRT-D)
C
Comparator
Cardiac resynchronization therapy with pacemaker (CRT-P)
O
Outcome
All-cause mortalityhard clinical
Main Result
Relative Risk: 0.69 (95% CI 0.62–0.76)
Absolute Event Rate: 16.6% vs 27.1%
Number Needed to Treat: 10
p-value: p=<0.00001
The addition of an implantable cardioverter-defibrillator to cardiac resynchronization therapy is associated with a significant reduction in all-cause mortality, particularly in patients with ischemic cardiomyopathy.
Authors
Discussion
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Implication
CRT-D was associated with lower mortality than CRT-P in observational cohorts; leaves open whether randomized evidence supports routine defibrillator addition.
Cite This Study
Barra et al. (2015) conducted a meta-analysis in Cardiac resynchronization therapy (CRT) recipients (n=12,378). CRT-defibrillator (CRT-D) vs. CRT-pacemaker (CRT-P) was evaluated on All-cause mortality (RR 0.69, 95% CI 0.62-0.76, p=<0.00001). CRT-defibrillator significantly reduced all-cause mortality compared with CRT-pacemaker (16.6% vs 27.1%; RR 0.69, 95% CI 0.62-0.76; P<0.00001), with a number needed to treat of 10.