Key result
CRT response is linked to ~53% lower risk of ventricular arrhythmia vs non-response.
Why the study?
The impact of cardiac resynchronization therapy super-response on ventricular arrhythmia risk remains unclear.
Does CRT super-response or response reduce the risk of ventricular arrhythmia and all-cause mortality compared to non-response in patients receiving cardiac resynchronization therapy?
Meta-Analysis (n=7,605)
Does CRT super-response or response reduce the risk of ventricular arrhythmia and all-cause mortality compared to non-response in patients receiving cardiac resynchronization therapy?
Relative Risk: 0.47 (95% CI 0.39–0.56)
Absolute Event Rate: 13% vs 29%
p-value: p=< 0.0001
CRT super-responders have a very low absolute risk of ventricular arrhythmia and all-cause mortality, whereas CRT responders retain a non-trivial residual risk, suggesting continued benefit of defibrillators in the latter group.
May aid ventricular arrhythmia risk stratification in CRT patients; hypothesis-generating pending prospective validation.
AIMS: Response to cardiac resynchronization therapy (CRT) is associated with improved survival, and reduction in heart failure hospitalization, and ventricular arrhythmia (VA) risk. However, the impact of CRT super-response [CRT-SR, increase in left ventricular ejection fraction (LVEF) to ≥ 50%] on VA remains unclear. METHODS AND RESULTS: We undertook a meta-analysis aimed at determining the impact of CRT response and CRT-SR on risk of VA and all-cause mortality. Systematic search of PubMed, EMBASE, and Cochrane databases, identifying all relevant English articles published until 31 December 2019. A total of 34 studies (7605 patients for VA and 5874 patients for all-cause mortality) were retained for the meta-analysis. The pooled cumulative incidence of appropriate implantable cardioverter-defibrillator therapy for VA was significantly lower at 13.0% (4.5% per annum) in CRT-responders, vs. 29.0% (annualized rate of 10.0%) in CRT non-responders, relative risk (RR) 0.47 [95% confidence interval (CI) 0.39-0.56, P < 0.0001]; all-cause mortality 3.5% vs. 9.1% per annum, RR of 0.38 (95% CI 0.30-0.49, P < 0.0001). The pooled incidence of VA was significantly lower in CRT-SR compared with CRT non-super-responders (non-responders + responders) at 0.9% vs. 3.8% per annum, respectively, RR 0.22 (95% CI 0.12-0.40, P < 0.0001); as well as all-cause mortality at 2.0% vs. 4.3%, respectively, RR 0.47 (95% CI 0.33-0.66, P < 0.0001). CONCLUSIONS: Cardiac resynchronization therapy super-responders have low absolute risk of VA and all-cause mortality. However, there remains a non-trivial residual absolute risk of these adverse outcomes in CRT responders. These findings suggest that among CRT responders, there may be a continued clinical benefit of defibrillators.
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Yuyun et al. (2020) conducted a meta-analysis in Heart failure with cardiac resynchronization therapy (n=7,605). Cardiac resynchronization therapy response vs. Cardiac resynchronization therapy non-response was evaluated on Appropriate implantable cardioverter-defibrillator therapy for ventricular arrhythmia (RR 0.47, 95% CI 0.39-0.56, p=< 0.0001). Cardiac resynchronization therapy response was associated with a significantly lower risk of ventricular arrhythmia compared to non-response (13.0% vs 29.0%; RR 0.47; 95% CI 0.39-0.56; P<0.0001).
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