Key result
Primary CRT-D prophylaxis linked to ~41% greater absolute event-free survival from appropriate ICD therapy vs secondary.
Why the study?
Does primary versus secondary prophylactic ICD indication affect event-free survival from arrhythmias in patients with CRT-D?
Cohort (n=86)
No
Does primary versus secondary prophylactic ICD indication affect event-free survival from arrhythmias in patients with CRT-D?
Patients with CRT-D for secondary prophylaxis experience a significantly higher rate of appropriate ICD therapy compared to those with primary prophylaxis, despite primary prophylaxis patients having worse heart failure class.
Secondary prophylaxis CRT-D patients warrant heightened arrhythmia surveillance; observational data leaves open whether indication should guide device selection or programming.
BACKGROUND: The incidence of ventricular tachyarrhythmias in ICD patients with cardiac resynchronisation therapy (CRT-D) is not well studied. AIM: To analyse event free survival in CRT-D patients with a primary or a secondary prophylactic ICD indication. METHODS: Prospective, single centre. Eighty-six patients, 44% with a primary prophylactic indication. Actuarial event-free rates for mortality and arrhythmias were calculated. RESULTS: Baseline clinical characteristics were not significantly different between primary and secondary prophylaxis. Primary prophylaxis patients were more likely to be in NYHA class III. Over 21 months, 724 ventricular events with therapy occurred in 36 patients (42%). The actuarial event-free rates, at 1 and 3 years, from appropriate ICD therapy were higher (P<0.001) for primary (79.0% and 67.8%) than for secondary prophylaxis (45.6% and 27.0%). Appropriate ICD therapy occurred more in NYHA class II compared to class III (P=0.016). Underlying disease (ischemic versus non-ischemic) and functional class did not play a role in multivariate analysis. CONCLUSION: Important arrhythmic events in patients with heart failure, and CRT-D occur at a very high rate when the indication is secondary prophylaxis. Patients with primary prophylaxis have an annual event rate of 10%, even though they tend to have a worse heart failure class.
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Theuns et al. (2005) conducted a cohort in Heart failure with CRT-D (n=86). Primary prophylactic ICD indication vs. Secondary prophylactic ICD indication was evaluated on Event-free survival from appropriate ICD therapy at 3 years (p=<0.001). Primary prophylactic CRT-D indication was associated with higher event-free survival from appropriate ICD therapy at 3 years (67.8%) compared to secondary prophylaxis (27.0%; P<0.001).
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